1. Introduction

This chapter summarises the Emerging Concerns Protocol which was developed via the Health and Social Care Regulators Forum (the forum) to enable organisations and partners to act early, where there are concerns. Click on the link to view the full protocol, including the list of partners involved.

The following organisations are some of the signatories of the protocol:

The protocol states ‘All of the partners who have signed up to this protocol share the common objective of ensuring that health and social care professionals and systems across the UK serve to protect the public, whilst maintaining the health, safety and well-being of the professionals themselves, those using services, families and carers.’ (p 3)

The forum states it expects providers and professionals, as well as itself, to work together to provide the best possible care. It emphasises that sharing concerns at the right time can make it easier to understand the links between pieces of information, which can indicate a problem is emerging. The forum believes that information sharing systems can be improved as well as being more transparent about working for people receiving care, professionals and health and care providers. Working together more effectively can reduce unnecessary burdens. The aim of the protocol is to strengthen and encourage good practice.

2. Purpose of the Protocol

The purpose of the Emerging Concerns Protocol is:

  1. to provide a clear mechanism for organisations to share information that may indicate there are potential risks to people who use services, their carers, families or professionals. This may include:
  • situations which may indicate future risk, but are not currently urgent;
  • cultural issues within health or social care settings that may be noted, but would not necessarily be raised through other formal systems;

2. helping staff decide when to escalate information of concern with one or more organisations;

3. provides a support mechanism to enable an organisation to share emerging concerns and pull together a cross-organisation panel when:

  • it is the most appropriate response; and
  • there are no other mechanisms in place to ensure the most relevant people can have the appropriate discussions at the right time; and
  • the emerging concern is not being adequately managed via other arrangements or structures.

3. Principles

‘The following principles have been agreed across all organisations acting as signatories:

  • organisations model an open culture in which staff can speak up about concerns;
  • organisations should be transparent about how the protocol is used, whilst maintaining confidentiality of content (in all directions, including the National Quality Board, providers, public, registrants);
  • organisations are explicit about confidentiality agreements and parameters (including working with information shared by third parties);
  • organisations involved will maintain and respect individual organisation’s executive autonomy;
  • the protocol must work within the law, including any restrictions on information sharing that are included in each signatory’s statutory role;
  • the protocol should be short and simple, with a focus on feasibility;
  • the protocol will be developed through a collaborative, partnership approach between organisations;
  • no issue will be too small for an organisation to consider using the protocol;
  • the model developed should be linked to other tools in the system such as the Quality Risk Profiling Tool and existing Memoranda of Understanding.’ (p4-5)

4. The Process for Responding to Emerging Concerns

4.1 Categories of concern

Concerns may come into three categories:

  1. concerns about individual or groups of professionals;
  2. concerns about healthcare systems and the healthcare environment (including the learning environments of professionals – see the full protocol for more information);
  3. concerns that might have an impact on trust and confidence in professionals or the professions overall.

4.2 How to use the protocol

To help staff and organisations decide whether the concern they have comes within the remit of the protocol, it asks a number of questions.

Click on Using the Protocol for guidance questions as to when an issue is appropriate for the protocol. These are:

  • is there an immediate threat?
  • is there a public protection concern?
  • is it relevant to any other forum?
  • is it a one off or is more systemic?
  • is it relevant to professional or system regulation?
  • is there a safeguarding risk?
  • where does the risk of harm come from?
  • could the information bring one or more professions into disrepute?

The diagram suggests possible actions for each of the above questions.

4.3 Process summary

Click on the link to view the Emerging Concerns Process Summary Diagram

The process is made up of the following steps.

  1. An organisation (organisation A) has a concern.
  2. Staff from organisation A should evaluate the information using the Grading Tool: A Review of Information Within Organisation A.
  3. Staff in organisation A should discuss who they need to share the information with, and who they need information from.
  4. They should contact the relevant organisations as in point 3 above.
  5. All organisations involved should record the information in their internal systems. Organisation A who raised the concern is responsible for formal recording of use of the emerging concerns protocol (see Section 6, Recording Requirements).
  6. A Regulatory Review Panel (RRP) meeting should be held. This should be coordinated, chaired and minuted by organisation A, using the Regulatory Review Panel Template Agenda.
  7. The RRP record should be shared with all partners and the Forum secretariat (for monitoring and reporting and learning lessons for next Forum).

Any organisation that is a partner in the protocol can initiate use of the protocol.

4.4 Regulatory Review Panel

Once organisation A decides that the information of concern is to be shared, it should contact other relevant partners, record the relevant information and arrange a Regulatory Review Panel (RRP) meeting. The RRP should use the Regulatory Review Panel Template Agenda.

This is an opportunity for key people from relevant organisations to hear and share the information of concern. This discussion should help develop a picture of the concern, and agree appropriate and coordinated intervention.

The RRP itself does not have specific legal powers as a panel; it is a voluntary group established by the forum signatories. As individual organisations retain their respective powers and restrictions under their own legislation however, this allows members of the RRP to take appropriate action.

5. Safeguarding

This protocol does not take priority over safeguarding procedures. Any organisation that suspects an adult is at risk of or experiencing abuse or neglect must follow its safeguarding procedures for managing these types of concerns (see Trafford Safeguarding Adults Procedures, Safeguarding Enquiries chapter). Nobody should wait to activate the protocol instead of acting on safeguarding concerns; immediate action should always be taken where necessary.

6. Recording Requirements

See also Case File Recording and Record Audit chapter

Each organisation involved in the use of the protocol should ensure records are made on their own system.

Each organisation should be able to report on:

  • the number of times they have initiated use of the protocol;
  • anonymised information about information shared;
  • RRPs convened;
  • RRPs attended;
  • actions as a result of the protocol.

The minimum information expected to be stored includes:

  • dates;
  • providers, professionals, others involved;
  • partners contacted;
  • actions agreed and taken;
  • decisions to call / not call RRP.

7. Sharing Personal Data

See also Annex C of the protocol and Information Sharing and Confidentiality chapter

When using the protocol, mostly there should not be a need to share personal data about individuals. Organisations convening an RRP however must ensure that only those who need to know the information should attend if personal information is to be shared in the panel.

Any processing of personal data is subject to the requirements of the Data Protection Act 2018 and the General Data Protection Regulation (see Data Protection: Legislation and Guidance chapter).

Appendix 1: Using the Protocol

Click here to view Using the Protocol

Appendix 2: Emerging Concerns Protocol Summary Diagram

Click here to view Emerging Concerns Process Summary Diagram

Appendix 3: Grading Tool

Click here to view Grading Tool: A Review of Information Within Organisation A

Appendix 4: Regulatory Review Panel Template Agenda

Click here to view Regulatory Review Panel Template Agenda

Appendix 5: An example of protocol use

Click here to view An example of Emerging Concerns Protocol Use

Appendix 6: Determine How to Use the Protocol

Click here to view Determine How to Use the Protocol

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