4.5 Stage 5: Evaluation and Outcome

1. Introduction

Throughout adult safeguarding enquiry processes, information and risk should be evaluated regularly, and the enquiry plans adapted or changed as new information becomes available or if circumstances change. However, at some point, all necessary enquiries will have been made and the Lead Agency will be in a position to decide what action is required in the adult’s case.

As with planning processes, evaluating the outcomes of enquiries, and deciding what action is needed in the adult’s case, should be done with the full participation of the adult, or their representative or advocate as appropriate.

2. Managing and Evaluating the Enquiry

When considering the management of any enquiry and evaluating what action is required in the adult’s case, the following factors should be considered:

• the adult’s needs for care and support;
• the adult’s risk of abuse or neglect;
• the adult’s ability to protect themselves or the ability of their networks to increase the support they offer;
• the impact on the adult, their wishes;
• the possible impact on important relationships;
• potential of action increasing risk to the adult;
• the risk of repeated or increasingly serious acts involving children, or another adult;
• the responsibility of the person or organisation that has caused the abuse or neglect; and
• research evidence to support any intervention.

If the adult has the mental capacity to make informed decisions about their safety and they do not want any action to be taken, this does not preclude the sharing of information with relevant professional colleagues. This is to enable professionals to assess the risk of harm and to be confident that the adult is not being unduly influenced, coerced or intimidated and is aware of all the options. This will also enable professionals to check the safety and validity of decisions made. It is good practice to inform the adult that this action is being taken unless doing so would increase the risk of harm.

When evaluating the adult’s needs for care and support, if a needs assessment under the Care Act 2014 has not already taken place, it will be necessary to evaluate whether it should be offered, and in certain cases, undertaken despite refusal where it may appear that the adult has needs for care and support, and is experiencing or is at risk of abuse or neglect.

In some cases, evaluating the outcomes of enquiries and deciding what action is needed will be straightforward. However, there will be complex cases that will require careful consideration and negotiation amongst involved parties to enable the lead agency to come to a decision about the action required in the adult’s case. This could be, for example, due to conflicting views between involved people and agencies, finely balanced or high risk situations, outcomes the person wants that could interfere with the rights and freedoms of others.

3. Evaluation / Outcomes Meetings

An evaluation / outcomes meeting may be required in order to gather relevant people together to discuss the outcomes of the enquiries and gain views on what actions are required in the adult’s case. Evaluations / outcomes meetings should be organised and planned carefully to promote meaningful involvement of the adult. The role of the chair is to:

• ensure decisions take account of the wishes, needs and desired outcomes of the adult;
• enable all parties at the evaluation / outcomes meeting to participate;
• ensure the views of all relevant parties are represented;
• ensure decision making is fair and objective, and;
• provide challenge where required, in order to ensure good practice is achieved.

The chair of the evaluation / outcomes meeting will facilitate discussions and decision making in respect of:

• the formal enquiry report;
• whether, on the balance of probabilities, abuse or neglect has occurred;
• the desired outcomes of the adult;
• the assessment of risk;
• safeguarding plan and any further actions required;
• how any safeguarding the plan is reviewed and monitored.

4. Deciding what Action is Required and Concluding the Safeguarding Adult Enquiry

The adult safeguarding enquiry will conclude when the local lead agency has made a decision about:

• whether any action is required in the adult’s case, and if so;
• what action and by whom.

As part of the decision making process to conclude the adult safeguarding enquiry, the lead agency will also make a decision about whether a safeguarding plan is required, or not.

A safeguarding plan may not always be required, for example, the outcome of the enquiry may be that no action is required in the adult’s case, or that ongoing risks can be managed or monitored through single agency processes, for example assessment and support planning processes, community policing responses, health service monitoring.

Where no safeguarding plan is required in order to manage ongoing risk of abuse or neglect to the adult, this procedure will end. However, provision of information and advice and / or other actions may need to continue under other processes, for example, addressing potential risks from people who are employed in positions of trust, referrals to the Disclosure and Barring Service, ongoing contract compliance or regulatory inspection  /action.

A safeguarding plan will usually be required where the risk of abuse or neglect is, for example:

• ongoing;
• complex;
• unstable;
• risk of harm to the adult or others is significant;
• other factors such as coercion, undue influence, or duress add to the complexity and uncertainty of the risk, and that the risk cannot be managed appropriately or adequately by other processes.

These types of situations will require a greater level of scrutiny and review, usually within a multi-agency context.

Decisions about actions required should always be made with the full participation of the adult, or their representative or advocate if the adult has substantial difficulty or lacks mental capacity to participate in the decision making process.

The adult’s desired outcomes should directly inform the decision making process, and wherever possible, decisions about actions should be led by and be designed to achieve these outcomes. Sometimes adults can express unrealistic outcomes, and there should be negotiation with the adult throughout the enquiry process to support the adult to understand what outcomes are achievable, and fit with their views and wishes.

However, there will be occasions where the desired outcomes of the adult cannot be met or where doing so would cause unacceptable risk of harm to the adult or others. The duty of care to safeguard the adult will always need to be balanced with their right to self-determination. Such situations will require careful negotiation with the adult and involved others, and all decisions should be discussed and explained to the adult in a way they can understand.

In cases where the adult is not able to understand and make safe decisions, restrictions on the adult’s choices and lifestyle may need to be considered. Any support or decision that is designed to restrict unsafe choices or behaviour needs to be lawful, proportionate, and the least restrictive. Positive risk taking frameworks and theory should be applied (see Managing Risk).

Conclusions of the adult safeguarding enquiry and decisions about action required should be recorded clearly and be defensible. Defensible decision making means providing a clear rationale based on legislation, policy, models of practice or recognised tools utilised to come to an informed decision based on the information known at that time. Accurate, timely, concise, specific, appropriate recording will support your decision making and provide justification for actions taken.

When the adult safeguarding enquiry is concluded, feedback on the outcomes should be shared with the following agencies / individuals as appropriate:

• the adult;
• their representative or advocate;
• the person / agency who raised the adult safeguarding concern;
• the person / agency who were identified as the potential source of risk;
• key partner agencies;
• any other involved stakeholder agency / individual.

The consent of the adult to share information should be gained, and usual information sharing rules apply.

4. Possible Outcomes for the Adult

The following are possible outcomes for the adult who is experiencing or at risk of abuse or neglect:

• increased monitoring;
• removed from property or service;
• Care Act assessment and services;
• civil action;
• Court of Protection;
• change of appointeeship;
• management of access to finances;
• referral to advocacy scheme / Independent Mental Capacity Adovate;
• referral for counselling;
• increase / different care package;
• action under Mental Health Act ;
• review of direct payments / support;
• management of access to alleged perpetrator;
• declaratory relief (where a matter needs clarifying by the courts);
• referral to complaints procedure;
• service user refused intervention;
• guardianship;
• Safeguarding Adults Review (SAR);
• action by placing authority;
• review of care plan / risk assessment;
• no further action;
• other please specify.

5. Possible Outcomes for the Person Alleged to have Caused Harm

• criminal prosecution;
• police action;
• disciplinary action;
• community care assessment / service;
• management of access to alleged victim;
• referral to Disclosure and Barring Service;
• referral to professional body;
• action by Care Quality Commission;
• continued monitoring;
• counselling / training / treatment;
• referral to court mandated treatment;
• action under Mental Health Act;
• review of care plan / risk assessment;
• action by placing authority;
• management action / supervision / training;
• carers assessment;
• Safeguarding Adults Review (SAR);
• no further action;
• contract of agency suspended;
• other (please specify).

6. Adults Safeguarding Plan: Overview

6.1 Definition

An adult safeguarding plan is the agreed set of actions and strategies that are designed to support and manage ongoing risk of abuse or neglect for an adult with care and support needs.

6.2 Purpose of the plan

The purpose of an adult safeguarding plan is to formalise and coordinate the range of actions to protect the adult, and to support the adult to recover from the experience of abuse or neglect.

Adult safeguarding plans should be individual, person-centred and outcome-focused.

In relation to the adult this should set out:

• what steps are to be taken to assure their safety in future;
• the provision of any support, treatment or therapy including ongoing advocacy;
• any modifications needed in the way services are provided (for example same gender care or placement; appointment of an Office of the Public Guardian deputy);
• how best to support the adult through any action they take to seek justice or redress;
• any ongoing risk management strategy as appropriate; and,
• any action to be taken in relation to the person or organisation that has caused the concern

6.3 Who should formulate the plan

The local lead agency will take responsibility for organising and coordinating the formulation of the adult safeguarding plan. The Care and Support Statutory Guidance does not specify who or which agency should be responsible for monitoring and reviewing adult safeguarding plans. However, for all adult safeguarding plans, a lead professional should be identified who will monitor and review the plan. In most cases this will be the safeguarding enquiry lead from the local lead agency.

The adult safeguarding plan should identify who is involved in the plan, and outline individual roles and responsibilities in relation to the plan.

Following an adult safeguarding enquiry, where the local authority has decided that it should itself take further action, then it will be under a duty to do so.

6.4 Timeliness and risk

The adult safeguarding plan should follow naturally from concluding the adult safeguarding enquiry and decisions on what actions are required in the adult’s case. There should be no delay between concluding the enquiry and formulating the plan.

This procedure does not specify specific timescales for monitor and review of the plan. Timescales for monitoring and review of the plan should be set individually when formulating the plan, and should reflect the circumstances and level of risk involved. Local guidance may outline more specific timescales.

6.5 Formulating the plan

In most cases there will be a natural transition between deciding what actions are needed in the adult’s case at the end of the enquiry episode, into formalising what these actions are and who needs to be responsible for each action – this is the adult safeguarding plan. The plan should outline the roles and responsibilities of all individuals and agencies involved, and should identify the lead professional who will monitor and review the plan, and when this will happen.

Adult safeguarding plans should be person centred and outcome focused. Adult safeguarding plans should be made with the full participation of the adult, or their representative or advocate as appropriate. Wherever possible, adult safeguarding plans should be designed to reflect and aim to achieve the desired outcomes of the adult.

Adult safeguarding plans should not be paternalistic or risk averse. Plans should reflect a positive risk taking approach and be clear how the plan will promote the wellbeing of the adult.

The Mental Capacity Act 2005 directs that agencies must presume that an adult has the capacity to make a decision until there is a reason to suspect that capacity is in some way compromised; the adult is best placed to make choices about their wellbeing which may involve taking certain risks.

Where the adult may lack capacity to make decisions about arrangements for enquiries or managing any abusive situation, then their capacity must always be assessed and any decision made in their best interests (see Mental Capacity). If the adult has the capacity to make decisions in this area of their life and declines assistance, this can limit the intervention that organisations can make. The focus should therefore be on harm reduction. It should not however limit the action that may be required to protect others who are at risk of harm.

There will be occasions where the desired outcomes of the adult cannot be met or where doing so would cause unacceptable risk of harm to the adult or others.

Adult safeguarding plans will need to balance the duty of care to safeguard the adult with their right to self-determination. In cases where the adult is not able to understand and make safe decisions, the adult safeguarding plan may need to include restrictions on the adult’s choices and lifestyle. Any support or decision that is designed to restrict unsafe choices or behaviour needs to be lawful, proportionate, and least restrictive.

6.6 Actions to be included in an adult safeguarding plan

Adult safeguarding plans can cover a wide range of interventions and should be as innovative as is helpful for the adult. The Care and Support Statutory Guidance states that in relation to the adult, safeguarding plans should set out:

• what steps are to be taken to assure their safety in future;
• the provision of any support, treatment or therapy including ongoing advocacy;
• any modifications needed in the way services are provided;
• how best to support the adult through any action they take to seek justice or redress;
• any ongoing risk management strategy as appropriate; and,
• any action to be taken in relation to the person or organisation that has caused the concern.

Outcomes for adult safeguarding plans can be as high level or detailed as the circumstances require, and as the law allows. Actions should aim to be S.M.A.R.T.

• Specific – try to be very clear about exactly what action is going to be taken. Name the person / people responsible for each action.
• Measurable – clearly quantify or demonstrate that the action or outcome has been achieved.
• Achievable – make sure that you are able to attain the action or outcome.
• Realistic – try to make sure that the planned action is the most practical way to achieve the required improvement.
• Time constrained – make sure the time period in which each action will be accomplished is stated.

The adult safeguarding plan should include, relevant to the individual situation:

• positive actions to promote the safety and wellbeing of an adult, and for resolution and recovery from the experience of abuse or neglect; and
• positive actions to prevent further abuse or neglect by a person or an organisation.

The safeguarding plan should also include consideration of what triggers or circumstances would indicate increasing levels of risk of abuse or neglect for individual/s, and how this should be dealt with (for example who to contact or how to escalate concerns).

Support measures for adults who have experienced abuse or neglect, or who are at risk of abuse or neglect, should be carefully considered when formulating the adult safeguarding plan. Mainstream support service provision (for example mainstream domestic abuse support services or Victim Support) should be considered as well as specialist support services (for example specialist psychology services).

The role of the police and related support measures should be considered where an adult may be going through the criminal justice process, including use of Intermediaries, Independent Domestic Violence Advisors (IDVAs), and Independent Sexual Violence Advisors (ISVAs).

Where there is a potential for criminal prosecution it is important to ensure that support provided to the adult (some types of counselling or psychology support in particular) will not interfere with criminal processes and evidence. This should be discussed as part of planning processes, and guidance can be obtained from the Crown Prosecution Service on a case by case basis should this be a possibility.

Related Documents

See Local Forms, Letters, Leaflets

Safeguarding Adult Evaluation Outcomes Record