Welcome to this short podcast on behalf of the West Sussex Safeguarding Adults Board about the difference between quality issues and safeguarding. We have created this podcast and the accompanying learning briefing as our Kingswood Organisational Learning Review told us that learning across agencies in this area is needed.
So, firstly, what is the connection between quality and safeguarding, and why is knowing the difference important?
The aim of professionals, service providers, and commissioners should be to provide high-quality care. There are times when care falls short of expected standards, however, these issues could indicate poor practice and poor-quality care rather than abuse or neglect. It is important to identify such issues early as this is key to reducing the risk escalating and the potential of abuse and neglect occurring, which would then need safeguarding interventions. Knowing the difference between quality and safeguarding is important as it enables issues to be managed through the best route and in the most efficient way.
To identify and respond to issues at an early-stage, partnership working and understanding the roles and responsibilities of all those involved with an Adult is essential. Professional curiosity is also necessary to fully understand a situation and the risks to an Adult as risks, including quality concerns are not always immediately obvious. For further learning on professional curiosity, we have a learning briefing and podcast on our website.
So, what do you do if you have an issue or concern you would like to raise?
If you are in doubt as to whether an issue is safeguarding or quality, the Sussex Safeguarding Boards have a Safeguarding Thresholds Guidance. This provides professionals with examples of the different categories of issues and the best course of action for these. It breaks down issues into those which are non-reportable, those which require consultation and those which are reportable issues under safeguarding. This guidance contains examples of quality issues which are frequently raised, inappropriately, as safeguarding concerns and the alternative actions which need to be considered in the first instance.
It is vital that safeguarding and quality issues are shared with the right person or agency in a timely way. This is needed so that appropriate action can be taken to address the safeguarding risks and quality issues. It is also very important that inappropriate referrals to safeguarding don’t delay work needed to address safeguarding risks.
So, what are some examples of the differences between quality and safeguarding?
I will provide you with three examples of quality issues and safeguarding concerns, and how these differ.
Example 1:
- A quality issue could be that the Adult does not receive necessary help to eat or drink on one occasion, or that the food offered is of a poor-quality, unappetising, or culturally unacceptable.
- A safeguarding concern could be that the Adult is continuously offered poor quality, unappetising, nutritionally inadequate, or culturally unacceptable food. Or that there are recurring events where the Adult does not receive the necessary help to eat or drink.
Example 2
- A quality issue could be that an assessed need is not documented in a care plan, such as a liquid diet being required due to swallowing difficulties. However, the provider identifies this and addresses it before any harm occurs.
- A safeguarding concern could be a failure to specify in a care plan how an assessed need must be met, which leads to an inappropriate action or inaction which results in harm, for example, the adult choking.
Example 3
- A quality issue could be that an Adult falls causing minor injury, however, appropriate medical intervention is sought and given, and the existing falls risk assessment or care plan are reviewed.
- A safeguarding concern could be than an Adult falls and injury occurs, however, there is no specific assessment of falls risk in place, no appropriate medical intervention is sought or given, and no plan is made to review the care plan.
There are more examples of the difference between quality and safeguarding provided in the Sussex Safeguarding Adults Policy and Procedures, the link to this is in the accompanying learning briefing and on our website.
So, where can you go to get more information about quality within care services?
The Care Quality Commission, often referred to as CQC, is responsible for the inspection of care services. They consider if a service is safe, effective, caring, responsive and well-led. On their website CQC have useful advice and guidance about what good care looks and examples of this in all care services that they inspect, which are: care homes, care agencies, hospitals, GP practices and dental practices.
So, what can CQC do if services are not meeting standards?
CQC can use a range of enforcement powers where registration requirements are not met in services, with poor or inadequate standards of care. CQC have both civil powers, to keep adults safe, and criminal powers to hold providers to account. CQC work with partner agencies to consider the use of these powers. In the most urgent and high-risk cases CQC can use enforcement powers, to close services, further information of which is available on the CQC website.
So finally, and importantly, how do you raise a quality issue?
In the first instance, quality concerns should be reported directly to the provider of the service for example the care home, GP surgery or hospital.
If the quality concern does not improve, is of a significant level, indicates abuse or neglect, or has a potential future impact to the adult or others, this also needs to be reported to the agency responsible for commissioning or regulating the service.
West Sussex County Council is currently implementing a new pathway for reporting quality concerns; in the interim, various routes can be followed.
- Concerns can be reported to the Care Quality Commission.
- Concerns about GPs or NHS services can be reported to the Integrated Care Board .
- If the person has an allocated Social Worker, quality concerns can be reported to them. If you are not sure whether the person has a Social Worker, you can call 01243 642121 or email socialcare@westsussex.gov.uk.
- If concerns relate to possible abuse or neglect of an adult this must be raised with the local authority via the online safeguarding form.
Links to all the above agencies websites and further details can be found in the learning briefing accompanying this podcast.
If quality issues about a provider become persistent or high risk, this may require a safeguarding concern or, a discussion at our Quality Assurance and Safeguarding Information subgroup. This group seeks to:
- Improve the safety of services through early information sharing and intervention
- Plays a key role in prevention and escalation of risks
- Ensures clarity on the leadership and management of concerns raised
- Act as an interface between individual and organisational safeguarding and quality practice
- Develops and maintains a picture of the quality and safety of the care market
So, overall, please do think carefully of whether the issue you have is one of quality or safeguarding to make sure that you follow the correct route to raise your concerns. As mentioned, it is critical that those who are being abused or neglected are identified and responded to quickly and one way you can help this is making sure quality issues are not inappropriately raised as safeguarding concerns.
Thank you for your time to listen to this podcast, and we appreciate your support to make a real difference to the Adults we are supporting in West Sussex.