LINKs and CQC briefing 3 safeguarding - Care Quality Commission

LINks and
CQC
working
together
Introduction
3
Working together where we have
concerns for people’s safety
September 2012
This is one of a series of new briefings for local involvement networks (LINks) about
how to work with the Care Quality Commission (CQC). It builds on the Guide for
LINks: How LINks can work with the Care Quality Commission (June 2011) which is
available free at www.cqc.org.uk/public/sharing-your-experience/involving-peoplewho-use-services.
This briefing looks at safeguarding adults and children – and how
LINks and CQC can work together to prevent abuse and harm. It also includes
learning for Healthwatch which we hope will be of interest to local authority
Healthwatch commissioners and shadow Healthwatch organisations.
The briefings have drawn from CQC’s work with LINks over the last three years and,
in particular, from work with 26 LINks who took part in a national CQC development
project during 2011/12. CQC would like to thank all the LINks for their contributions.
CQC is the independent regulator for health and social care services in England. We
value any information from people who use services and their representatives to help
us check on the quality and safety of care, and we have a statutory duty to ‘have
regard’ to the views of LINks.
CQC’s local relationships with LINks will remain in place until 31 March 2013 and
transfer to local Healthwatch from 1 April 2013. The learning from our work with
LINks will be used to develop a guide for local Healthwatch about working together
with CQC from April 2013. CQC will work closely with Healthwatch England from
October 2012 to best coordinate our work with emerging Healthwatch.
LINKs and CQC working together – 3: Working together where we have concerns for people’s safety 1

LINks and CQC – principles of working
together
CQC works with all LINks across the country to exchange information that can help
us both to tackle poor care and improve services. We respect the independent status
of LINks, and the different roles we play in holding services to account for the care
they provide. We recognise the need to maintain public confidence in both our
organisations, and to be open and transparent about how we cooperate and when
we need to work separately. We strive to use our resources effectively, avoiding
duplication of effort.
About this briefing
This briefing describes:
• Key messages in our work with LINks on safeguarding concerns.
• CQC’s approach to safeguarding – our protocol and what this means in practice.
• CQC’s approach to monitoring the Mental Health Act 1983.
• Monitoring the Mental Capacity Act 2005 Deprivation of Liberty Safeguards.
• How LINks and CQC can share information about safeguarding concerns.
• Examples of LINks and CQC working together on safeguarding issues.
• Learning for Healthwatch.
Key messages
LINks play a key role in identifying concerns about people’s safety and sharing these
with local and national bodies who can act to stop poor care.
The first contact for sharing safeguarding concerns is with the local authority. The
local authority safeguarding team has the primary coordinating responsibility for the
safeguarding of people using services. It helps to also inform CQC of safeguarding
concerns, so we can take any regulatory action needed as soon as possible.
There are a number of examples of LINks sharing safeguarding concerns (mainly in
adult social care) with CQC that have led to action. These have included immediate
responsive inspections, using information to inform our planned inspection, and
helping our work with the local authority to coordinate local concerns about care.
LINks are encouraged to also share concerns they have about people’s experiences
of being detained under the Mental Health Act 1983 and where there are concerns
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about the use of the Deprivation of Liberty Safeguards. Any wider use of restrictive
practices in mental health services and services for people with a learning disability
should also be shared with CQC as soon as possible.
Partnership working between the LINk, the local authority, the police and CQC is key
to effective action on safeguarding concerns. LINks who are directly involved in local
safeguarding boards and meet jointly with the local authority and CQC can work
more effectively to help ensure concerns are acted upon.
LINks need regular feedback on CQC and local authority responses to safeguarding
alerts or concerns, and assurance that the information they have shared has been
considered and acted upon where necessary. This includes responses to both
named and anonymous concerns.
CQC’s approach to safeguarding
“Safeguarding is the responsibility of whole communities and depends on the
everyday vigilance of everyone who plays a part in the lives of children and
adults in vulnerable situations to ensure that people are kept as safe from
harm as possible.” (Care Quality Commission, Our safeguarding protocol: The
Care Quality Commission’s responsibility and commitment to safeguarding,
CQC 2012.)
Safeguarding means protecting people’s health, wellbeing and human rights, and
enabling them to live free from harm, abuse and neglect. It is fundamental to creating
high-quality health and social care.
CQC’s safeguarding protocol explains CQC’s role in the safeguarding process and
how we work with other agencies. It sets out the importance of the relationship with
LINks as a route for information sharing about safeguarding issues.
CQC will not tolerate care which fails to meet the expected standards of quality and
safety we regulate. We use our enforcement powers to stamp out poor practice
where we find it. Any form of abuse, harm or neglect is unacceptable and should not
be tolerated by the provider, the staff, the regulators or by members of the public.
CQC’s role is to reduce the risk of abuse from occurring in the first place; dealing
with incidents when they do occur, and supporting people afterwards. We protect
and promote the rights of people who use health and social care services.
Our primary role is to make sure providers have appropriate systems in place to
safeguard people who use the service and that those systems are implemented and
followed in practice.
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Outcomes 7-11 of the government standards of quality and safety set out what
providers should do to make sure that people who use the service, members of staff,
and those who visit are as safe as they can be and that risks are assessed and
managed appropriately. The outcomes focus on:
• What the provider needs to do to ensure the human rights and dignity of people
are respected.
• How they should identify and respond when people are in vulnerable situations.
• What the provider should do to make sure that the premises and equipment they
use to provide care, treatment and support are safe and suitable.
More information about the standards we inspect can be found at:
www.cqc.org.uk/public/what-are-standards/government-standards
Effective safeguarding also requires providers to meet a range of the other standards
we inspect, for example:
• Robust recruitment and vetting processes for staff.
• Having enough well trained, competent and supported staff.
• Providing effective and appropriate treatment.
• Having systems in place that allow people who use services and their
representatives to feedback concerns.
• Ensuring that people using the service are respected and as fully involved as
possible in their care and support.
CQC may be involved locally in information sharing, safeguarding strategy meetings,
local safeguarding boards and serious case reviews. Local CQC managers maintain
regular contact with the safeguarding leads within their local authority areas.
Where we are considering or taking regulatory action, CQC shares all relevant
information with the local safeguarding partnership on a regular basis. This is the
multi-agency team who are responding to the safeguarding incident. We will also
pass safeguarding information on in a timely manner to the local authority and/or the
police.
Safeguarding and monitoring the Mental Health Act 1983
CQC monitors the use of the Mental Health Act 1983 to protect the interests of
people whose rights are restricted under the Act. We do this in three main ways:
• Mental Health Act commissioners, who visit patients detained in hospital and
meet with them in private to find out about their experiences and ensure that their
care and treatment complies with the Mental Health Act and the Mental Health
Act Code of Practice.
• Thematic reviews or visits to focus on specific aspects of the Mental Health Act.
LINKs and CQC working together – 3: Working together where we have concerns for people’s safety 4

• A discretionary role in investigating complaints from patients subject to the Mental
Health Act.
CQC also provides the Second Opinion Appointed Doctor (SOAD) service under the
Mental Health Act. SOADs visit detained patients in specific circumstances, defined
by the Mental Health Act, to provide a second opinion on prescribed medical
treatment.
Monitoring the Mental Capacity Act 2005 Deprivation of Liberty
Safeguards
CQC also has a duty to monitor the operation of the Mental Capacity Act 2005
Deprivation of Liberty Safeguards (DoLS). We are developing our approach to
monitoring this relatively recent legislation. We currently do this in three main ways:
• Compliance inspectors talk to individuals subject to DoLS and to the staff caring
for them as part of their inspections of care homes and hospitals.
• We are piloting a process for obtaining information from supervisory bodies
through interviews and data collection. Supervisory bodies (local authorities and
PCTs) are responsible for the management and quality assurance of the DoLS
system in their area.
• We conduct an annual review to compare the notifications we receive about
people subject to DoLS with data sent to the national NHS and Social Care
Information Centre. This is to identify variations in the use of DoLS between
regions.
CQC and Ofsted joint inspections – safeguarding children
From June 2013, we will begin our new joint inspection programme of child
protection arrangements. These inspections will be carried out over three years and
will look at the multi-agency arrangements for the protection of children in all local
authority areas around England. CQC's role will focus on the contribution of health to
child protection arrangements.
How LINks and CQC can share information
about safeguarding concerns
Sharing the safeguarding concern
LINks should share safeguarding concerns with their local authority safeguarding
team as soon as possible after identifying the concern, and the police where
necessary. It is the local authority and the police, who have the primary responsibility
for the safeguarding of people using services. The safeguarding team and/or the
police will pass any safeguarding concerns to CQC if they relate to services we
regulate.
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It is also helpful if LINks share the concern with CQC – either by ringing 03000
616161 or contacting your local CQC contact. If there is more than one local
manager in your LINk’s local authority area, you need to share the information with
the manager responsible for the area in which the concern is identified. This will help
us to identify as soon as possible whether we need to take any action in our own
right. We will always do this in cooperation with other key local agencies including
the local authority and the police where necessary.
If your LINk happens to share a safeguarding concern with CQC before the local
authority is alerted, the LINk should also inform the local authority as soon as
possible. CQC will also check the authority is aware of the concern, and consider
what action we may need to take, if any.
Anonymous concerns
Your LINk may share safeguarding concerns which identify the person who provided
the information. In other cases, the person or people may wish to remain
anonymous. In either case, it is important that you share the information with the
local authority in the first instance, and then with CQC.
You can also inform people who contact the LINk with concerns about care that they
can ring CQC directly on 03000 616161. CQC will take them through a series of
steps to discuss their information and whether they remain anonymous.
Handling safeguarding concerns
CQC manages safeguarding information from NHS and social care services in the
same way. We also have a process for dealing specifically with whistleblowing,
where the information we receive is from a person actually working in a regulated
service. We have information about whistleblowing on our website at:
www.cqc.org.uk/sites/default/files/media/documents/20120117_whistleblowing_quick
_guide_final_0.pdf
Wherever the information comes from, we identify the information as either a
safeguarding alert or a safeguarding concern. A CQC safeguarding alert is where
CQC is the first agency receiving the information and/or there is a need for CQC to
take immediate action. The inspector responds on the same working day and the
local council is informed.
A CQC safeguarding concern is other safeguarding information where CQC is not
the first agency to receive this information. There may be no need for us to take
immediate regulatory action. We will assess the risk identified and decide if we need
to take action. Safeguarding concerns are responded to within two working days of
receipt of the information – in other words, the risk is assessed in this time.
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CQC will give the LINk feedback when it is possible to do so, about our response to
the concern. It may not be possible to provide feedback for a period of time, if action
is being taken against a service or an individual or individuals. Our inspection reports
will also indicate if we have used safeguarding information to inform or direct the
inspection.
Examples of LINks and CQC working together
on safeguarding issues
“A concern was raised by a LINk about an adult social care service; this was
dealt with by the inspector for this service and the local authority team. We
worked together to help ensure good outcomes for people.”
(CQC manager)
East Sussex LINk
The LINk has been developing protocols for sharing and following up safeguarding
concerns with the local authority and CQC. It bases its work on the multi-agency
policy on dealing with safeguarding issues. It attends the local safeguarding group
meetings and the Quality Monitoring Team to feed into commissioning issues.
It has been working through specific examples of safeguarding concerns it has
received and tracking the LINk process for managing them, and getting feedback on
what has happened as a result.
For example, the LINk received information from a potential employee of a care
home who identified concerns during a visit to the service about manual handling of
residents; poor use of equipment; staffing levels and the use of agency staff; nutrition
and the training of staff in food hygiene. The information was shared with the local
safeguarding team and with CQC. The whistleblower wished to remain anonymous.
As a result of this example, the LINk has been exploring how different agencies can
respond to alerts from the LINk, where there is no named individual connected to the
safeguarding alert.
In another example, the LINk identified concerns about the use of restrictive
practices in a care home. A resident was blocked into their bed with chairs. The LINk
raised their concerns with the service, the local authority and CQC.
The LINk has worked with the local authority to ensure its enter and view volunteers
receive safeguarding training and have an understanding of DoLS and the Mental
Capacity Act. A LINk volunteer explained:
“It makes so much difference having this training, so that when we do a visit,
we feel we can spot a concern if we see one.”
Contact: Elizabeth.mackie@thecountylink.net
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Lincolnshire LINk
The LINk has direct contact with the safeguarding board and with CQC about
safeguarding issues. It has worked with CQC to establish its role on the local
safeguarding information sharing board and attends this meeting. It has raised a
concern about a local residential care provider and shared this with the safeguarding
board and CQC, which has used the information to inform inspection activity.
The safeguarding and DoLS team in the county have worked with the LINk to
contribute to LINks enter and view training.
The LINk has agreed a Working Practices Protocol with CQC which includes what
the LINk will do if it identifies a concern about care. The LINk may not investigate a
concern further itself, but to follow the agreed pathway below to ensure that the
legal, monitoring and enforcement procedures are followed.
Lincolnshire LINk’s Pathway for Responding to a Report of Concern
Note: if undertaking a
visit at the time of the
concern, please
continue the visit and
follow the procedures
immediately after the
visit.
Enter & View SOURCE General Public
LINk Chair
Log the issue
with LINk HOST
Contact: Nicola Tallent, Nicola.Tallent@shaw-trust.org.uk
Immediately Report Issue or Concern to
LINk HOST
LINk host contact details here
Safeguarding – Not Your Decision – Make the Call
Make a Safeguarding ALERT – telephone no. here
CQC Named
LINk Contact
Quality
Assurance
What will happen? The Issue will be assessed and a level of urgency agreed
and action taken. Feedback as to the action taken should be given to the
LINk, For Example. An immediate visit was made, or a visit had been
scheduled.
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Devon LINk
Devon LINk has been developing its use of enter and view, working closely with the
local CQC manager and the local authority. A training session delivered by the
Devon safeguarding team on the local authority’s safeguarding procedures now
forms part of the training package for LINk authorised representatives.
The LINk was alerted to a safeguarding concern by a participant. The concern
related to a care home for people with dementia. The front door of the care home
was being left open and on at least one occasion a resident had wandered out of the
home without staff knowledge. The local authority was alerted to the issue and the
LINk shared the information with CQC. As part of the response, CQC undertook a
responsive inspection and the information was used in the CQC inspection report of
the service and informed CQC action.
Contact: Lorna Davis, lorna.davis@edvsa.org.uk
A number of other LINks have raised concerns about individual care homes as a
result of visits or feedback from local people – including Kensington and Chelsea,
Sefton and East Riding of Yorkshire LINks. This information has been used by CQC
in various ways – including undertaking a responsive review to the home, feeding
into CQC inspectors’ risk assessment prior to a planned inspection, and helping to
direct the focus of inspections.
Learning for Healthwatch
Healthwatch can take the following steps to ensure it is well placed to manage
safeguarding concerns:
• Understand the local safeguarding protocol in the local authority, the police and
CQC’s safeguarding protocol and whistleblowing procedures.
• Establish Healthwatch’s relationship with the local safeguarding team and its role
on the local safeguarding board.
• Develop a Healthwatch safeguarding protocol, liaising with the local authority,
police and CQC.
• Develop a standard package for volunteers about what safeguarding means, and
more detailed guidance for authorised representatives on safeguarding alerts and
protocols for action during visits.
• Agree with the local authority how training will be provided for Healthwatch staff
and volunteers on safeguarding. This should include adult and children
safeguarding issues, DoLS, people’s rights when detained under the Mental
Health Act 1983 and the use of the Mental Capacity Act 2005.
• Agree with CQC’s local manager how Healthwatch is given feedback on
safeguarding concerns it raises.
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Further information
• Our safeguarding protocol: The Care Quality Commission’s responsibility and
commitment to safeguarding (at www.cqc.org.uk/public/what-arestandards/safeguarding-people)
• Deprivation of liberty safeguards – annual monitoring reports and guidance are
available at www.cqc.org.uk
• A guide for LINks: How LINks can work with the Care Quality Commission (June
2011) available free to order or download at www.cqc.org.uk
• Healthwatch England at www.healthwatch.co.uk
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