Adult protection significant case reviews: interim framework

Initial Case Reviews

An Initial Case Review is an opportunity for the Adult Protection Committee to consider information relating to the case, determine the course of action and recommend whether a Significant Case Review or other response is required.

An Initial Case Review should not be escalated beyond what is proportionate taking account of the severity and complexity of the case. The process and its timescales should not detract from agencies taking whatever urgent action is required to protect any other adult who may be at risk of harm. When a case meets or appears to meet the criteria above an Initial Case Review should always be undertaken. Where time limits are referred to it is important that they are adhered to. If there is difficulty with a time limit the report should record the reason for the delay. Support for staff may need to be considered.

Adult Protection Committees should develop their own local operating protocol for handling Initial Case Reviews which should identify who has delegated authority to accept the initial notification, instruct any further information-gathering and make a decision on whether to proceed to a Significant Case Review. Each local Initial Case Review operating protocol should be agreed with the Chief Officers' Group or equivalent. It should firmly reflect this national framework but retain sufficient flexibility to suit local structures.

Summary of the Initial Case Review Process

Step 1: Potential significant case notified to Adult Protection Committee as soon as practicable after the event or when a series of events suggests a Significant Case Review maybe appropriate.

The Initial Case Review Notification form should be used (Annex 2): This includes:

• a statement about the current position of the adult, and if they are alive, what actions have been or will be taken on their behalf
• a brief description of the case and the basis for referral
• any other formal proceedings underway or completed (see page 6 and Annex 1)
• a summary of agency/professional involvement
• contact details

When complete the Initial Case Review Notification Form should be passed to the Adult Protection Committee coordinator or nominated person who notifies all agencies or persons involved with the adult using the Initial Case Review template (in Annex 3).

Step 2: Agencies gather information and submit a report to the Adult Protection Committee or mandated sub group (this refers to the initial review and remains generic as areas may have different local arrangements; for example, a Quality Assurance Subgroup of an Adult Protection Committee) as soon as possible, but no longer than the time period agreed with the Adult Protection Committee, using the Initial Case Review Report template (Annex 3).

The information gathering process should include:

• a summary of involvement including background
• an outline of key issues
• a chronology
• any identified elements of good practice
• any identified areas for improvement
• details of any inter-related processes, investigations or reviews and any particular complexities (e.g. from the Procurator Fiscal, Police or any other agency, about cases where there are ongoing, or likely to be, criminal proceedings, Fatal Accident Inquiry or disciplinary proceedings) Details of any underlying or cross-cutting issues (this may involve consideration of any other agencies that should have been involved)

If agencies cannot reasonably complete the Initial Case Review Report for the Adult Protection Committee within the suggested times, this and the reasons for this should be recorded.

Step 3: The Adult Protection Committee coordinator or nominated person liaises with other agencies where there are parallel processes taking place or the case is cross local authority or cross UK. It will be necessary to establish points of contact and to gather the most up-to-date information from these other agencies to inform the Adult Protection Committee's decision on whether, and when, to proceed or not.

Step 4: The Adult Protection Committee or mandated sub group, meets to consider the information as soon as possible, or the Convenor convenes a meeting of all the agencies to consider this and reports back to the Committee or sub group. They will either make a decision on whether or not the case proceeds to Significant Case Review or request further information from agencies to be provided as soon as possible/within an agreed time period,. Having a considered chronology and a timeline for this stage can help with decision making and identifying information gaps.

Step 5: The Adult Protection Committee or mandated sub group decide whether or not to proceed to a Significant Case Review. A Significant Case Review should only be undertaken when the criteria are met, where there is potential for significant corporate learning and where a Significant Case Review is in the best interests of adults at risk and in the public interest. Where the Adult Protection Committee cannot agree whether or not to progress to a Significant Case Review, this could be resolved by giving the Adult Protection Committee Convener the final decision or casting vote. Following consideration there are several potential outcomes:

• a Significant Case Review should be carried out
• a Significant Case Review, or a decision on this, may be deferred until the outcome of another investigation, review or process is known, if necessary
• the Adult Protection Committee may decide that no Significant Case Review is needed but follow-up action by one or more agencies is required if, for example, local protocols need to be reinforced. The Adult Protection Committee may want to draw appropriate guidance to staff's attention or to review training or protocols around a particular theme. They may also decide to initiate local action to rectify an immediate issue or to undertake single agency action. Follow-up action should be agreed and scheduled into the Adult Protection Committee's future work programme.
• where the Adult Protection Committee is satisfied there are no concerns and there is no scope for significant corporate learning or the information provided indicates that appropriate action has already been taken, they may decide to take no further action

Step 6: Reporting the outcome to the Chief Officers' Group or equivalent The Adult Protection Committee advises and makes recommendations to the Chief Officers Group or equivalent on the outcome of an Initial Case Review and any decision to proceed to a Significant Case Review.

Step 7: Notification and recording of decisions. All decisions (including no further action) and the reasons for these decisions should be recorded by the Adult Protection Committee. A report, using the headings in Annex 3 and a record of decision-making should be compiled. Each Adult Protection Committee should maintain a register of all potentially significant cases referred to it in order to evidence the decisions made; monitor the progress of the reviews undertaken; monitor and review the implementation of recommendations; and identify contextual trends (e.g. prevalence of substance misuse).

A written record of the decision should be sent to all agencies directly involved with the adult and stored appropriately. Each agency should ensure that the outcome and decisions are noted within the relevant clinical and care governance structures. If a decision is made to proceed to a Significant Case Review, the Adult Protection Committee should advise the adult and/or family/carers of its' intentions.

Notification should be sent to the Care Inspectorate, using part B of the initial case review report (Annex 3), and, if appropriate for parallel processes, to other relevant parties (for example, Crown Office and Procurator Fiscal Service). By receiving and collating decisions made by Adult Protection Committees in respect of Initial Case Reviews, the Care Inspectorate will be better able to understand and report on the relationship between Initial and Significant Case Reviews and factors that influence decision-making. This should help ensure that the framework is being applied effectively.

The assumption throughout is that an Adult Protection Committee should proceed as speedily as feasible at all stages of an Initial Case Review and a Significant Case Review, and that agencies should proceed likewise. It is important that reviews are carried out timeously, not least to reduce stress on the adult; their family or carers; and on the staff involved. The complexity or circumstances of certain cases may result in the preferred timescales not being met.