5.8 Organisational Procedures

The steps outlined in this procedure will be determined locally. Please refer to your local team for further information.

Step 1: Decision to Initiate Provider Concerns

The decision to initiate a Provider Concerns process may be the outcome of a Quality and Safeguarding meeting, or considered through other means for example, consequence of a SAR or a serious concern that meets agreed threshold criteria.

Action

• Immediate checks on welfare of people using the service
• Consult Police about whether there are criminal matters
• Contact placing authorities d.
• Agree Chair and lead organisation
• Appoint Provider Concerns Co-ordinator
• Convene Provider Concerns meeting
• Set up meeting with the Provider
• Map out risk and risk management plan
• Consider commissioning intentions

Risk

A risk management plan should be drawn up and updated throughout the process. Where there are high risk concerns, there will be a need to put in place safeguards and agreed triggers to escalate matters. Risk management to be assured that action will be timely and safeguard people on a sustainable basis is essential. Risk will determine commissioning intentions, and be the evidence base upon how decisions are made.

Risk management for commissioning authorities may be additional visits both announced and unannounced, or training support.

The level of risk should be shared with the provider and frank discussions about any proposed action that might be taken by commissioners, providing adults are not put at further risk by doing so. Providers should be encouraged to find solutions to mitigate against risk. Actions might include providing additional resources to support improvement planning, resourcing training and purchasing new equipment.

Timescale: Actions to be completed in line with individual Local Authority processes.

Step 2: Initial Provider Concerns Meeting

The purpose of the meeting is to:

• Identify and clarify concerns
• Devise a communication strategy about how adults using the service will be informed and updated
• Ensure appropriate advocacy and support
• Listen to the views of the provider
• Safeguarding planning to consider the type of enquiries, leads and timescales
• Risk management 
• Consider commissioning intentions
• Set date for Findings Meeting

Safeguarding planning

Actions need to be able to support a factual based assessment of the validity and likelihood of concerns, their severity and impact, and identify any new concerns. Intelligence as far as possible should be triangulated and the source of information identified and based on:

(a) views of adults using the service

(b) factual information, for example staff rotas and

(c) professional assessment of documentation, for example care plans and risk assessments.

Safeguarding planning will address alleged issues with suggested methodology for enabling decision making about whether improvements are needed or not, and who has the appropriate skills to carry out enquiries.

Communication Strategy

The strategy should address both internal and external communications and will depend on the level of risk. A check list for information might include:

• Senior Management - Need to Know
• Information to the provider and how on-going communication will be managed
• If a suspension on admissions is considered, how this is communicated to front line staff and other commissioners and the public
• Press release
• Briefing for Chief Executives and /or Elected Members
• Consultation with adults who use services, their families and friends
• How information and advice is provided to include adults who fund their own care.

Refer to the Board's Communication Strategy in your area for further guidance.

Meetings with the Provider

The Chair will inform the provider that it is subject to the Provider Concerns process and share as much information as possible, without compromising any subsequent lines of enquiry. They will be informed of the process and provisional timescales if available. If there is a criminal investigation, the provider will be informed in accordance with Police advice.

The Chair and Senior Commissioning Officer should establish regular meetings with the provider. The ethos of meetings should be non-adversarial and promote a culture of partnership ensuring a fair and just process.

Communication with adults who use services

Adults who use services should be provided with the opportunity of shaping and influencing the quality of services and be kept central to the process. In a residential setting, service users and their families may become anxious about increased activity, seeing more visiting professionals etc., and have the right to be informed, but care should be taken not to raise anxiety. Information sharing should always include adults who use services and their carers so that they are able to make informed choices and retain their independence.

Where there is opportunity for presenting to adults who use the service and carers through a meeting, negotiation with the provider should take place about how this is managed. In those instances where adults receive support at home, as part of the safeguarding plan, care management staff (including Continuing Health Care staff) should make targeted visits to (a) ensure that people are safe and (b) record their views so that they are considered in the organisational risk management plan.

Adults should be provided with the means of sharing their experiences independently of the provider, and if it is deemed necessary a link worker for adults and their families should be identified and a dedicated phone line available to raise issues in confidence.

At the very minimum, checks that the provider has taken action in relation to complaints and acted upon service user surveys should be made.

Timescales: Actions will be determined locally. Please refer to your local area for information. Where the concern is about a large organisation or particularly complicated, action may take longer. The provider, however, should be kept informed.

Step 3: Findings meeting

These are held in some areas of Berkshire and may be called a Review Meeting, or may be encompassed in the previous stage. The purpose of the meeting is to:

• Assess and agree the findings from ‘Fact Finding’ enquiries. 
• Draw up issues for a Service Improvement Plan.
• Update the risk management plan and agree safeguarding measures.
• Consider actions to monitor the safety of people and agree triggers to escalate risk, whilst improvements are being made.
• Consider commissioning intentions.
• Preserve information that may be helpful to police investigations.

Where immediate action is needed this should be taken and not be put on hold until the Findings meeting. The Chair should be informed and immediate authorisation for action is made.

Service Improvement Plan

This is the high level plan for measuring the effectiveness of interventions to ensure safety, governance, compliance, clinical effectiveness, referencing throughout the experience of adults using the service and their informal network. The Co-ordinator should set out the concerns and risks, which should also include any concerns in relation to mental capacity and the Deprivation of Liberty Safeguards. It is important to distinguish between what is safeguarding and what are quality issues that may impact on safeguarding and prioritise high risk areas.

If CQC are already involved, there may already be a service improvement plan in place.

Meetings with the Provider

The chair and lead commissioner (if not the chair) should hold a meeting with the provider as soon after the findings meeting as possible.

The Provider will propose actions, leads, timescales and progress to address the concerns within a specified timescale. The Service Improvement Plan will be the agreed reference point for assessing and monitoring progress and both the coordinator and the provider will retain a copy and update it through a series of monitoring meetings. If there is a Contract Monitoring Officer, commissioner or other relevant member of staff they should be part of these meetings.

In the event that the provider advises that they are unable to make the improvements or advises of possible service failure or interruptions, a further meeting with all stakeholders should be convened to assess risks and impact on adults, to determine commissioning based on the risk and safety of adults using the service.

Step 4: Update Meeting (optional)

Further meetings to update stakeholders will be made if and when necessary. Where there are wide reaching, complex concerns, and there is high risk, it is likely that update meetings are needed more frequently. Where there are serious delays by the provider to implement improvements, a further meeting should always be held to consider the level of risk and appropriate action. Focus should be on risk and the impact on adults using the service. It is important to distinguish between what is safeguarding and what are commissioning responsibilities and if further incidents have occurred.

Where there is a high risk and likely need to source alternative provision, commissioners should hold a specific contingency meeting. The chair and the coordinator should be invited.

Timescales for further safeguarding meetings are dependent upon progress of the Service Improvement Plan and the level of risk.

Step 5: Quality Assurance

A quality assurance process should be agreed that will rigorously test whether improvements have been attained and can be sustained. This may involve a range of staff with the right knowledge, skills and experience to assess the viability of the improvements and might be the same staff involved in fact finding so that they can provide a comparative narrative.

Quality assurance activities may include testing an on-call emergency out of hours system by calling at the evening and weekend; assessing the impact of training by competency testing staff; making both announced and unannounced visits.

Feedback from adults and carers will act as a control measure to assess whether there has been any noted difference in the service delivery. This may be obtained from holding a follow up meeting with adults in care settings or from a sample of telephone calls to those adults who said that they had experienced a poor service, to see if their view has changed.

Feedback from other agencies such as CQC may provide additional expertise if required. Support from local Healthwatch may be appropriate, or other locally managed groups for example, Quality Checkers, to add an independent view.

Timescale: Appropriate timescales to complete the quality assurance process should be factored into the strategy

Step 6: Closing the Provider Concerns process

Following evidence based improvement, the process will formally come to an end and the relevant parties including the provider and the CQC will be notified in writing by the chair.

In some instances a ‘lessons learnt’ process with stakeholders should be held. Feedback from the provider, adults and carers will be collated by the co-ordinator. This feedback may be reported to the SAB together with a summary report detailing the concerns, actions, risk management, outcomes and the effectiveness of safeguarding.

Assurances should be made that adults and carers know how to raise any further concerns. It may also be helpful to agree a reviewing and escalation process.