4.7 Multi-Agency Risk Management (MARM) Process for Oversight of Adults at High Risk

1. Introduction – What is Bury MARM Strategic Risk Panel?

The MARM Strategic Risk Panel has been established as a result of learning from a Safeguarding Adults Review (SAR) completed by Safeguarding Adults Board.

The Safeguarding Adults Board has a statutory duty to ensure that there is an effective multi-agency response to safeguard our most vulnerable adults and that measures are in place to prevent abuse.

The panel provides a multi-agency risk enablement approach to advise and support in situations where an adult is at risk of death, severe harm, or significant harm due to self-neglect AND where the established processes for single agency / multi agency responses have been unable to reduce the level of risk.

The panel provides a multi-agency platform at a senior level to discuss adults who are deemed to be at a significant high risk, at the point where a Section 42 enquiry and other multi-agency processes under the Care Act 2014 have not enabled the risks to be reduced or stabilised. The panel will discuss adults who have been assessed as having mental capacity in relation to the decisions they are making that are causing the risk.

Key principles of the MARM Strategic Risk Panel:

• To work with a framework of choice and control to empower and recognise Human Rights, strengths, wishes and feelings.
• To comply with the requirements of the Care Act 2014 and Mental Capacity Act 2005 at all times.
• To ensure proportionality – benefits against risk/ applying positive risk-taking approach.
• To embrace collaboration- strengthen multi agency connectivity and partnership working.

The panel has an advisory and supportive function, and it should be noted that agency statutory duties and responsibilities remain with the relevant agencies. The panel acts to ensure that all statutory responsibilities have been met (see Appendix 1 for an overview of relevant legislation.)

The panel is co-ordinated by Bury Council Adult Social Care (ASC), who have the statutory responsibility to co-ordinate a safeguarding response under the Care Act 2014.

1.1 Making Safeguarding Personal

See also Making Safeguarding Personal chapter.

The panel will not seek to reverse decisions previously agreed by staff and manager, rather it will offer a reflective space for consultation, reconciliation, problem-solving and agreement in cases where the levels of risk raise concerns. The panel will ensure legal advice is sought wherever necessary.

The panel will not seek to change assessments that have been made, although it may make recommendations that require alternative resources/ further financial consideration. The panel is NOT a forum for discussing low level concerns which should be managed in accordance with existing single agency / multi agency systems and processes such as Bury Safeguarding Adults Policies and Procedures and single agency policies to manage risk.

The panel works from a strength-based approach, working to enhance choice and control, so it is essential that the person has been made aware of the intention to discussion their situation and the concerns at the panel and that they are given the opportunity to express their views and wishes that can be represented at the panel.

Government guidance on information-sharing states that:

“Information can be shared legally without consent, if a practitioner is unable to, cannot be reasonably expected to gain consent from the individual, or if to gain consent could place a child at risk.

Relevant personal information can be shared lawfully if it is to keep a child or individual at risk safe from neglect or physical, emotional, or mental harm, or if it is protecting their physical, mental, or emotional wellbeing.”

1.2 Core functions of the panel

• To share concerns about high risk and critical risk cases involving multiple agencies in a timely way to increase the safety, health and wellbeing of individuals.
• To ensure a lead agency and professional has been identified and are supported through a multi-agency risk assessment and risk action plan that provides professional support to those at risk.
• Verify that any actions are covered by a legal framework or is lawful to improve agency accountability.
• Verify that all statutory duties are met.
• Suggest options that will enhance the range of possibilities available to professionals to improve the outcome for the adult (this could involve agreement to commission/agree services to address identified issues with engagement or support).
• To discuss barriers in practice and suggest creative solutions and the value of bespoke support, possibly outside current services model or where the adult might not be eligible under standard criteria, to support that adult.
• To verify that multi-agency risk management arrangements have been followed, and all practical steps have been taken to prevent severe harm, or death.
• Support the creation of risk management plans that seize opportunities for engagement and/or monitoring of the well-being of the adult e.g. outreach opportunities, support from the community and locality input.
• To enable professionals to clarify and agree the level of risk and accountability with senior leaders.

The MARM Strategic Risk Panel will operate within the Bury Safeguarding Adults Policies and Procedures and the MARM Protocol guidance.

2. Responsibilities and Accountabilities of Bury MARM Strategic Risk Panel

2.1 Single agency responsibilities

Each agency maintains its statutory responsibilities and duties to protect adults.

All partner agencies are responsible for ensuring the information they provide at the panel is accurate and up to date to ensure that decision making about levels of risk considers all relevant circumstances.

Given the adults being referred to this panel are at significant risk, partner agencies must commit resources to ensure that they have representation at the panel as required and that each agency allocates sufficient resources to act on recommendations from the panel.

2.2 MARM Strategic Risk Panel members responsibilities

The decision for determining if the adult meets the criteria will be determined by the panel Chair and panel members. Other panel members will be consulted as appropriate.

Feedback to the referrer will be given for all referrals, including those that do not meet the criteria for the panel, where suggestions for further work should be made.

2.3 Delegation of actions agreed at the panel

Adult Social Care (ASC) representatives will often be the referrer of an adult to the panel due to their statutory role in co-ordinating adult safeguarding responses. The ASC representative will, where appropriate, delegate agreed panel actions to the relevant partner agency in accordance with the Care Act and the Safeguarding Adults Policies and Procedures.

2.4 Administration of the panel

Administration of the panel is shared between Adult Social Care and the Safeguarding Adults Board.

See Appendix 2 for more information.

2.5 Responsibilities of the referrer

The referrer must consider the referral checklist (See Referral Form and Referral Checklist) before submitting a referral and must also:

• ensure the information provided is accurate and up to date.
• ensure that the adult being referred has been made aware of the referral and that their wishes and views have been sought and are expressed on the referral form.
• ensure that the referral has been agreed at principal manager level.
• ensure attendance at the panel of appropriate people from their organisation to fully present the complexity of the adult’s situation.
• ensure that outcomes and actions from the panel discussion are fed back to the multi-agency forum from which the referral to the panel was made (actions should be delegated to partners as appropriate).
• oversee/gain updates on agreed work/actions and provide a monthly update.

3. Interaction with Other Risk Panels (e.g. Multi Agency Risk Assessment Conference, Multi Agency Public Protection Arrangements, CHANNEL)

In principle, there is no reason why an adult could not be considered by more than one panel, however this would need to be considered on an individual basis, with a clear rationale for the benefits of referring to more than
one panel. It is expected that referrers as part of ongoing safeguarding enquiries will have already explored connections to other high risk panels including MARAC and MAPPA where relevant.

See also Multi-Agency Public Protection Arrangements (MAPPA) and Multi-Agency Risk Assessment Conferences (MARAC).

4. How does the Panel Operate?

4.1 Criteria for referral to the MARM Strategic Risk Panel

Referral to the panel should be made when all other responses, both single agency and multi-agency have been pursued as per single and multi-agency policies, and, for whatever reason, agencies have not managed to successfully engage and work with the adult to reduce and manage the identified risks.

In addition, this must result in either:

• An on-going risk that the person may die with no intervention; or
• An on-going risk of severe abuse or neglect to self; or
• Risk of permanent physical or mental harm which will result in a
  reduced quality of life; and
• Support has been accessed via MARM protocol and the individual is
  on the Risk register.

4.2 Frequency and format of the panel

The panel meets monthly with each meeting being scheduled for no more than 3 hours.

In exceptional circumstances, the panel may need to meet in-between the monthly scheduled meeting to discuss a particularly urgent case. These meetings will be kept to a minimum and consideration will be given to the
required make-up of the panel for such a meeting.

It should be noted that the panel is not an appropriate forum for responding to emergency situations. Agencies have their own procedures to respond to these, and the panel offers more of a reflective review of a situation and is not intended as an emergency response.

It is envisaged that a maximum of five referrals will be discussed at any meeting with an opportunity to review a maximum of five cases. (20 mins discussion for each case). If there are more than five referrals in each month, then a decision to prioritise will be made by the panel chair.

4.3 Decision to refer

The referral would usually be when the adult is receiving support via the MARM protocol. The referrer will need to evidence on the referral form that there has been a significant and sustained attempt to engage the adult through the MARM protocol and evidence of a multi-agency approach for the panel to consider the referral.

Referrals should be made when all other responses, both single agency and multi- agency have been pursued as per single and multi-agency policies, and, for whatever reason, agencies have not managed to successfully engage and work with the adult to reduce and manage the identified risks.

4.4 Referral process – who refers?

See also: Multi Agency Risk Management (MARM) Strategic Risk Panel – Referral Form and Referral Checklist (opens in Word)

Referrals should be agreed by a senior member of staff usually at service manager level. For example, in Adult Social Care if the referral is made by the Allegations and Risk Team Manager/AP Complex risk or appropriate Team Manager then this must be following a discussion and agreement with the Principal Manager/ Head of Safeguarding completing the referral form.

The referral form must be completed in full, confirming that key relevant records are up to date and clarifying where these records are stored (e.g. Liquid Logic or Paris or other recording system).

Key documents to be referenced on the referral form are:

• The minutes of the multi – agency risk meeting where the decision to refer was made outlining the risk and rational for the referral.
• Risk assessment documentation.
• Mental capacity assessment documentation where relevant (see Mental Capacity and Deprivation of Liberty chapter).

Please note copies of these will need to be submitted with the referral. The referrer should also ensure that where any legal advice has been given that this is noted on the referral form. The legal advice itself should not be included with the referral as it is privileged information.

The referral form is submitted to [email protected] for the attention of the MARM Strategic Risk Panel.

4.5 Who reviews the referral?

All referrals are received by the SAB Business Unit, and then referrals are initially triaged by the chair of the panel and panel members. If the Business Unit feels that there is an immediate risk to the adult, they will advise the referrer to refer into safeguarding under the Care Act and raise with Head of Safeguarding (see Responding to Signs of Abuse and Neglect)

4.6 SAB Business Unit

In preparation for the panel meeting, the SAB Business Unit will:

• Ensure/confirm all required documentation is up to date and contact the referrer to:
  • clarify any issues as required.
  • confirm that the referral will be discussed at the panel.
  • confirm which agencies need to be in attendance for the referral to be discussed at the panel.
  • ensure the adult is aware of the panel discussion and that their views are known (if appropriate).
  • give feedback on suggested actions if the referral is not assessed as suitable for discussion at the panel.

4.7 Referrals that are not accepted for the panel

Where referrals do not meet the criteria for the panel, feedback will be given to the referrer about why it does not meet the criteria and suggestions for actions or the approach to be taken will be given.

4.8 Format of the panel case discussion

Review of the referral

The panel will use a checklist to review the referral, and ensure a consistent approach to frame the discussion in the panel meeting. This same approach is also taken for information requested on the referral form.

• Update/review of actions taken (for adults already discussed at panel this will be an update of the action log)
• Update/review of the risk assessment – this will give an overview of how actions have / have not reduced the risks, and what the current key risks are and the likelihood of them occurring and the severity of the risk.
• Has legal advice been sought? If so, what specifically was asked and what was the response?
• Are all the agencies involved who have a role and are they engaging/attending meetings?

Managing the risk

• Managing the risk – what is working, and what are the opportunities to do something differently.
• What are the barriers/issues that you are not managing to progress?

Making Safeguarding Personal

•  What does the adult want? What do they feel would make the biggest difference?
• Are there friends and family that the adult engages with, or who would like to be more involved and who we can work with (with the adult’s consent or if this in the adult’s best interests).

4.9 Recommendations at panel

Where recommendations are made which have resource implications, the agency that holds the statutory responsibility for this cost needs to agree with the recommendation. All recommendations and agency actions will be recorded on the action log.

4.10 Deciding who is discussed in the panel meeting

The week before the panel meeting, once all the updates for the adults have been reviewed, a decision is made about how to allocate the two hours slot for the meeting based on risk and any new referrals.

It is important that all updates are submitted in the timeframe requested in order to ensure that the agenda can be set for the meeting, allocating time to the most at-risk adults.

The referrer will also be asked in their update:

• if, in their opinion, the adult should be discussed at this panel’
• if ,in their opinion, the adult’s situation will require discussion at more than one panel meeting.

The panel will discuss adults in the subsequent panel meeting in the following circumstances:

• If the risk remains at ‘red’ where there is an evidential concern that the adult is under coercion and is not making a free decision;
• where the panel feels that this is required due to the individual circumstances or level of risk;
• A rag rated score will be applied to all adults on the action plan that will identify the level of current risk considering all factors including the progression of actions and engagement by the adult.

4.12 Deciding that an adult no longer needs to be discussed at the MARM Strategic Risk Panel

Any adult requiring discussion at more than one meeting will be reviewed based on the update in the action log and risk assessment. In most instances there will be a discussion at the panel to make the decision that an adult no longer meets the criteria for the panel, however, in some instances, where this is very clear, for example as a result of a significant reduction in risk this decision will be made outside of the meeting.

4.13 Escalation

Appropriate challenge and escalation is an essential part of being part of partnership working and professional responsibilities to achieve high standards. On occasion, this may necessitate challenging poor practice when staff in one partner agency have concerns about the way in which staff within another agency are delivering their practice. In such circumstances, there must be a respectful challenge about the action or inaction taken. For
guidance on resolution of disagreements, please refer to the Multi Agency Escalation Process.

5. Membership of Bury MARM Strategic Risk Panel

The panel is chaired by the Head of Safeguarding for Adult Social Care, deputised by panel members, as necessary.

The following agencies are represented at the Strategic Risk Panel:

• Adult Social Care (ASC), Bury Council
• NHS Greater Manchester Integrated Care Board (Bury)
• Greater Manchester Police (GMP)
• Bury Probation Service
• Greater Manchester Mental Health
• Northern Care Alliance
• Pennine Care
• Bury Housing
• Achieve alcohol and substance misuse services.
• Bury Allocations

This list includes members of the Community Safety Partnership, which will be represented by the respective agencies above. The Strategic Partnerships Manager (Bury Council) will also attend to ensure strategic alignment and opportunities for learning between this panel and the Community Safety Partnership.

All members should be of suitable seniority, have expertise to respond and act accordingly to the request of high-risk cases, and be able to make decisions on behalf of their organisations (this should be determined by individual agencies represented). Partners should prioritise attendance at the panel as it cannot be effective without all relevant agencies being in attendance.

The panel may also from time to time co-opt representatives from other agencies (e.g. children’s services) depending on the expertise required.

The panel does not have legal representation, as it is recognised that individual agencies will have different legal support. There is an expectation that where legal views have been sought by individual agencies these will be noted on the referral form and highlighted at the panel discussion.

6. Governance

The panel is accountable to the Safeguarding Adults Board. The panel will report to the subgroups of the Safeguarding Adults Board as appropriate relating to learning from cases or identified trends.

Opportunities for learning will link through to the Community Safety Partnership and its subgroups to use the learning from the MARM Strategic Risk Panel.

All panel members will be expected to disclose any declarations of interests relevant to cases discussed at the panel. Decisions on managing these interests sit with the Panel Chair.

Appendix 1 – Legislation Overview

This legislation is to be used by panel members and agencies to support decision making regarding management of high-risk cases prior to any referral to the MARM strategic panel.

Care Act 2014

The Care Act 2014 sets out adult safeguarding duties, which apply to an adult who has needs for care and support (whether or not the local authority is meeting these) and who is experiencing, or is at risk of, abuse or neglect AND as a result of those care and support needs is unable to protect themselves from either the risk or the experience of abuse or neglect.

This definition needs to be considered when applying the Strategic Risk Panel process. Adult safeguarding duties include:

• Local authorities to coordinate safeguarding enquiries
• Cooperation between the local authority and relevant partners
• Establishing a Safeguarding Adults Board,
• Undertaking Safeguarding Adults Reviews,
• Sharing information
• Protecting property of adults being cared for away from home.
• The six principles are:
  • Empowerment – Presumption of person led decisions and informed consent.
  • Prevention – It is better to act before harm occurs.
  • Proportionality – Proportionate and least intrusive response appropriate to the risk presented.
  • Protection – Support and representation for those in greatest need.
  • Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing, detecting, and reporting neglect and abuse.
  • Accountability – Accountability and transparency in delivering safeguarding.

Mental Capacity Act 2005

See also Mental Capacity and Deprivation of Liberty  chapter

Five key principles to determine mental capacity

• Principle 1: A presumption of capacity – every adult has the right to make their own decisions and must be assumed to have capacity to do so unless it is proved otherwise. This means that it cannot assumed that someone cannot make a decision for themselves just because they have a particular medical condition or disability.
• Principle 2: Individuals are supported to make their own decisions – a person must be given all practicable help before they are treated as not being able to make their own decisions. This means that every effort should be made to encourage and support people to make the decision for themselves. If lack of capacity is established, it is still important that the person is involved as far as possible in making decisions.
• Principle 3: Unwise decisions – people have the right to make decisions that others might regard as unwise or eccentric. A person cannot be treated as lacking capacity for this reason. Everyone has their own values, beliefs and preferences which may not be the same as those of other people.
• Principle 4: Best interests – anything done for or on behalf of a person who lacks mental capacity must be done in their best interests.
• Principle 5: Less restrictive option – someone making a decision or acting on behalf of a person who lacks capacity must consider whether it is possible to decide or act in a way that would interfere less with the person’s rights and freedoms of action, or whether there is a need to decide or act at all. Any intervention should be weighed up in the particular circumstances of the case. The powers to provide care to those who lack capacity are contained in the Mental Capacity Act 2005. Professionals must act in accordance with guidance given under the Mental Capacity Act Code of Practice when dealing with those who lack capacity, and the overriding principal is that every action must is carried out in the best interests of the person concerned.

Where a person who is self-neglecting and/or living in squalor does not have the capacity to understand the likely consequences of refusing to cooperate with others and allow care to be given to them and/or clearing and cleaning of their property a best interest decision can be made to put in place arrangements for such matters to be addressed. A best interest decision should be taken formally with professionals involved and anyone with an interest in the person’s welfare, such as members of the family (see also Self Neglect and Hoarding and Best Interests chapters).

The Mental Capacity Act 2005 provides that the taking of those steps needed to remove the risks and provide care will not be unlawful, provided that the taking of them does not involve using any methods of restriction that would deprive that person of their liberty. However, where the action requires the removal of the person from their home then care needs to be taken to ensure that all steps taken are compliant with the requirements of the Mental Capacity Act. Consideration needs to be given to whether any steps to be taken require a Deprivation of Liberty Safeguards application; see Mental Capacity and Deprivation of Liberty chapter.

Emergency applications to the Court of Protection

An urgent or emergency court order can be applied for in certain circumstances, e.g. a very serious situation when someone’s life or welfare is at risk and a decision must be made without delay. However, a court order will not be
obtained unless the court decides it’s a serious matter with an unavoidable time limit. Where an emergency application is required, relevant legal advice must be sought.

Inherent Jurisdiction

There have been cases where the Courts have exercised what is called the ‘inherent jurisdiction’ to provide a remedy where it has been persuaded that it is necessary, just and proportionate to do so, even though the adult concerned has mental capacity. In some self-neglect cases, there may be evidence of some undue influence from others who are preventing public authorities and agencies from engaging with the adult concerned and thus preventing them from addressing issues around self-neglect and their environment in a positive way.

Where there is evidence that an adult who has capacity is not necessarily in a position to exercise their free will due to undue influence then it may be possible to obtain orders by way of injunctive relief that can remove those barriers to effective working. Where the adult concerned has permitted another to reside with them and that person is causing or contributing to the failure of the person to care for themselves or their environment, it may be possible to obtain an Order for their removal or restriction of their behaviours towards the adult concerned. In all such cases legal advice should be sought.

See also Inherent Jurisdiction of the High Court chapter.

Human Rights Act 1998

The Human Rights Act 1998 came into force in the United Kingdom in October 2000. It is composed of a series of sections that have the effect of codifying the protections in the European Convention on Human Rights into UK law.

All public bodies (such as courts, police, local governments, hospitals, publicly funded schools, and others) and other bodies carrying out public functions must comply with the Convention rights. There are three key
articles that public bodies need to consider when applying the Strategic Risk Panel model in practice:

Article 5: Right to Liberty & Security – A right to personal freedom. The government cannot take away your freedom by detaining you without good reason – even for a short period unless you are mentally ill.

Article 8: Right to Privacy: Everyone has the right for his private and family life, his home, and his
correspondence. There shall be no interference by a public authority with the exercise of this right except such as in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of
health or morals, or for the protection of the rights and freedoms of others.

Article 14: Prohibition of Discrimination: The enjoyment of the rights and freedoms set forth in the European Convention on Human Rights and the Human Rights Act shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth, or other status.

See also Equality, Diversity and Human Rights in a Safeguarding Context

Common Law

Common Law allows for the intervention, without consent, to save life or avoid serious physical harm based upon the principle that the action is reasonable and can be professionally justified as immediately necessary for the purpose of saving life or preventing serious physical harm. Conversely, not to act in such circumstances of the utmost gravity could be deemed negligent.

Every Child Matters (2003)

For the purpose of the Strategic Risk Panel, the five outcomes for Every Child Matters are embedded and will be considered when an adult who is at risk of significant harm or death, is responsible for the care of a child/ren. The five outcomes are universal ambitions for every child and young person, whatever their background or circumstances:

• Be healthy.
• Stay safe.
• Enjoy activities.
• Make a positive contribution.
• Achieve economic wellbeing.

Working Together to Safeguard Children

For the purpose of the Strategic Risk Panel, the welfare of children needs to be considered and will apply when an adult who is at risk of significant harm or death is responsible for the care of a child. Working Together to Safeguard Children emphasises that effective safeguarding systems are those where:

• The child’s needs are paramount, and the needs and wishes of each child, should be put first, so that every child receives the support they need before a problem escalates.
• All professionals who come into contact with children and families are alert to their needs and any risks of harm that individual abusers, or potential abusers, may pose to children.
• All professionals share appropriate information in a timely way and can discuss any concerns about an individual child with colleagues and local authority children’s social care.
• High quality professionals are able to use their expert judgement to put the child’s needs at the heart of the safeguarding system so that the right solution can be found for each individual child.
• All professionals contribute to whatever actions are needed to safeguard and promote a child’s welfare and take part in regularly reviewing the outcomes for the child against specific plans and outcomes.
• Local areas innovate and changes are informed by evidence and examination of the data.

Effective safeguarding arrangements in every local area should be underpinned by two key principles:

• Safeguarding is everyone’s responsibility: for services to be effective each professional and organisation should play their full part; and
• A child-centred approach: for services to be effective they should be based on a clear understanding of the needs and views of children.

Environmental Health

Environmental Health Officers in the local authority have wide powers/duties to deal with waste and hazards. They will be key contributors to cross departmental meetings and planning, and in some cases e.g. where there are no mental health issues, no lack of capacity of the person concerned, and no other social care needs, then they may be the lead agency and act to address the physical environment.

Remedies available under the Public Health Acts 1936 and 1961 include:

• power for LA to remove accumulations of rubbish on land in the open air (section 34)
• power of entry/warrant to survey/examine (sections 239/240)
• power of entry/warrant for examination/execution of necessary work (section 287)
• power to require vacation of premises during fumigation (section 36)
• power to disinfest/destroy verminous articles at the expense of the owner (Section 37)

Remedies available under the Environmental Protection Act 1990 include:

• litter clearing notice where land open to air is defaced by refuse (section 92a)
• abatement notice where any premise is in such a state as to be prejudicial to health or a nuisance (sections 79/80)

Other duties and powers exist as follows:

• Town and Country Planning Acts provide the power to seek orders for repairs to privately owned dwellings and where necessary compulsory purchase orders.
• The Housing Act 2004 allow enforcement action where either a category 1 or category 2 hazard exists in any building or land posing a risk of harm to the health or safety of any actual or potential occupier or any dwelling or house in multiple occupation (HMO). Those powers range from serving an improvement notice, taking emergency remedial action, to the making of a demolition order.

Local Authorities have a duty to take action against occupiers of premises where:

• there is evidence of rats or mice under the Prevention of Damage by Pests Act 1949.
• he Public Health (Control of Disease) Act 1984 Section 46 sets out restrictions in order to control the spread of disease, including use of infected premises, articles and actions that can be taken regarding infectious persons.

Housing – landlord powers

These powers could apply in Extra Care Sheltered Schemes, Independent Supported Living, private-rented or supported housing tenancies. It is likely that the housing provider will need to prove the tenant has mental capacity in relation to understanding their actions before legal action will be possible. If the tenant lacks capacity, the Mental Capacity Act 2005 should be used. In extreme cases, a landlord can take action for possession of the property for breach of a person’s tenancy agreement, where a tenant fails to comply with the obligation to maintain the property and its environment to a reasonable standard. This would be under either under Ground 1, Schedule 2 of the Housing Act 1985 (secure tenancies) or Ground 12, Schedule 2 of the Housing Act 1988 (assured tenancies). The tenant is responsible for the behaviour of everyone who is authorised to enter the property.

There may also be circumstances in which a person’s actions amount to antisocial behaviour under the Anti-Social Behaviour, Crime and Policing Act 2014. Section 2(1)(c) of the Act introduces the concept of “housing related nuisance”, so that a direct or indirect interference with housing management functions of a provider or local authority, such as preventing gas inspections, will be considered as anti-social behaviour. Injunctions, which compel someone to do or not do specific activities, may be obtained under Section 1 of the Act. They can be used to get the tenant to clear the property or provide access for contractors. To gain an injunction, the landlord must show that, on the balance of probabilities, the person is engaged or threatens to engage in antisocial behaviour, and that it is just and convenient to grant the injunction for the purpose of preventing an engagement in such behaviour. There are also powers which can be used to require a tenant to cooperate with a support service to address the underlying issues related to their behaviour.

Powers of Entry

The following legal powers may be relevant, depending on the circumstances:

• If the person has been assessed as lacking mental capacity in relation to a matter relating to their welfare: the Court of Protection has the power to make an order under Section 16(2) of the MCA relating to a person’s
  welfare, which makes the decision on that person’s behalf to allow access to an adult lacking capacity. The Court can also appoint a deputy to make welfare decisions for that person.
• If an adult with mental capacity, at risk of abuse or neglect, is impeded from exercising that capacity freely: the inherent jurisdiction of the High Court enables the Court to make an order (which could relate to gaining access to an adult) or any remedy which the Court considers appropriate (for example, to facilitate the taking of a decision by an adult with mental capacity free from undue influence, duress or coercion) in any circumstances not governed by specific legislation or rules.
• f there is any concern about a mentally disordered person: Section 115 of the MHA provides the power for an approved mental health professional (approved by a local authority under the MHA) to enter and inspect any
  premises (other than a hospital) in which a person with a mental disorder is living, on production of proper authenticated identification, if the professional has reasonable cause to believe that the person is not receiving proper care.
• If a person is believed to have a mental disorder, and there is suspected abuse or neglect: Section 135(1) of the MHA, a magistrates court has the power, on application from an approved mental health professional, to allow the police to enter premises using force if necessary and if thought fit, to remove the person to a place of safety if there is reasonable cause to suspect that they are suffering from a mental disorder and (a) have been, or are being, ill-treated, neglected or not kept under proper control, or (b) are living alone and unable to care for themselves.
• Power of the police to enter and arrest a person for an indictable offence: Section 17(1)(b) of PACE.
• Common law power of the police to prevent, and deal with, a breach of the peace. Although breach of the peace is not an indictable offence the police have a common law power to enter and arrest a person to prevent a breach of the peace.
• If there is a risk to life and limb: Section 17(1)(e) of the PACE gives the police, the power to enter premises without a warrant in order to save life and limb or prevent serious damage to property. This represents an emergency situation, and it is for the police to exercise the power.

Anti-Social Behaviour 2003 (as amended)

Anti-social behaviour is defined as persistent conduct which causes or is likely to cause alarm, distress or harassment or an act or situation which is, or has the potential to be, detrimental to the quality of life of a resident or visitor to the area. Questions about whether an application for an Anti-Social Behaviour Order would be appropriate should be made to the Designated Police Officer (it may be appropriate to involve the police in the multi-agency work), the Registered Social Landlord or the local authority.

Misuse of Drugs Act 1971

Section 8 (this creates an offence if the occupier of premises permits certain acts to take place on the premises)
‘A person commits an offence if, being the occupier or concerned in the management of the premises, he knowingly permits or suffers any of the following activities to take place on those premises.

• s8 (a) Producing or attempting to produce a controlled drug.
• 8 (b) Supplying or attempting to supply a controlled drug to
  another or offering to supply a controlled drug to another.
• 8 (c) Preparing opium for smoking.
• 8 (d) Smoking cannabis, cannabis resin or prepared opium

Mental Health Act 1983

Sections 2 and 3 of the Mental Health Act 1983 Where a person is suffering from a mental disorder (as defined under the Act) of such a degree, and it is considered necessary for the patient’s health and safety or for the protection of others, they may be compulsorily admitted to hospital and detained there under Section 2 for assessment for 28 days. Section 3 enables such a patient to be compulsorily admitted for treatment.

Section 2 – Admission for Assessment

Duration of detention	28 days maximum
Application for admission	By Approved Mental Health Professional or nearest relative. Applicant must have seen patient within the previous 14 days.
Procedure	Two doctors (one of whom must be section 12 approved) must confirm that: 1. The patient is suffering from a mental disorder of a nature or degree which warrants detention in hospital for assessment (or assessment followed by medical treatment) for at least a limited period. and 2. S/he ought to be detained in the interests of his/her own health or safety or with a view to the protection of others.

Section 3 – Admission for Treatment

Duration of detention	Six months, renewable for a further six months, then for one year at a time
Application for admission	By nearest relative or Approved Mental Health Professional in cases where the nearest relative consents, or is displaced by County Court, or it is not ‘reasonably practicable’ to consult him
Procedure	Two doctors must confirm that: 1. The patient is suffering from a mental disorder of a nature or degree which makes it appropriate for him/her to receive medical treatment in hospital. and 2. It is necessary for his/her own health or safety or for the protection of others that he/she receives such treatment, and it cannot be provided unless s/he is detained under this section; and Appropriate treatment is available to him/her Procedure: Under section 20, Responsible Medical Officer can renew a section 3 detention order if original criteria still apply, and treatment is likely to ‘alleviate or prevent a deterioration’ of patient’s condition.

In cases where patient is suffering from mental illness or severe mental impairment but treatment is not likely to alleviate or prevent a deterioration of his/her condition, detention may still be renewed if s/he is unlikely to be able to care for him/herself, to obtain the care s/he needs or to guard himself against serious exploitation Section 117 allows for aftercare following a section 3 detention in certain circumstances

Section 7 of the Mental Health Act 1983 – Guardianship

A Guardianship Order may be applied for where a person suffers from a mental disorder, the nature or degree of which warrants their reception into Guardianship (and it is necessary in the interests of the welfare of the patient or for the protection of other persons.) The person named as the Guardian may be either a local social services authority or any applicant.

A Guardianship Order confers upon the named Guardian the power to require the patient to reside at a place specified by them; the power to require the patient to attend at places and times so specified for the purpose of medical treatment, occupation, education or training; and the power to require access to
the patient to be given, at any place where the patient is residing, to any registered medical practitioner, approved mental health professional or other person so specified. In all three cases outline above (i.e. Section 2, 3 and 7)
there is a requirement that any application is made upon the recommendations of two registered medical practitioners.

Section 135 Mental Health Act 1983

Under Section 135, a Magistrate may issue a warrant where there may be reasonable cause to suspect that a person believed to be suffering from mental disorder, has or is being ill-treated, neglected, or kept otherwise than under proper control; or is living alone unable to care for themselves. The warrant, if made, authorises any constable to enter, if need be, by force, any premises specified in the warrant in which that person is believed to be, and, if thought fit, to remove them to a place of safety.

Section 135 lasts 72 hours and is for the purpose of removing a person to a place of safety, with a view to the making of an application in respect of him under part ll of this Act, or of other arrangements for his treatment or care. Please note, it is this latter broader purpose that could be more applicable to abuse / neglect situations.
where the person does not appear like they require a psychiatric hospital admission. There are also a range of places of safety (see s.135 (6) which may be useful for these situations.

Section 136 Mental Health Act 1983

Section 136 allows police officers to remove adults who are believed to be
“suffering from mental disorder and in immediate need of care and control” from a public place to a place of safety for up to 72 hours for the specified purposes. The place of safety could be a police station or hospital.

Domestic Abuse Act 2021

The Domestic Abuse Act strengthens the support and protection to victims of domestic
abuse whilst seeking to prevent offending and bringing perpetrators to justice.

The Act:

• creates a statutory definition of domestic abuse, emphasising that domestic abuse is not just physical violence, but can also be emotional, controlling or coercive, and economic abuse.
• provides for a new Domestic Abuse Protection Notice and Domestic Abuse Protection Order.
• places a duty on local authorities in England to provide accommodation based support to victims of domestic abuse and their children in refuges and other safe accommodation.
• creates a statutory presumption that victims of domestic abuse are eligible for special measures in the criminal, civil and family courts.
• extends the controlling or coercive behaviour offence to cover post-separation abuse.
• extends the offence of disclosing private sexual photographs and films with intent to cause distress (known as the “revenge porn” offence) to cover threats to disclose such material.
• creates a new offence of non-fatal strangulation or suffocation of another person.
• clarifies, by restating in statute law, the general proposition that a person may not consent to the infliction of serious harm and, by extension, is unable to consent to their own death.
• enables domestic abuse offenders to be subject to polygraph testing as a condition of their licence following their release from custody.
• places the guidance supporting the Domestic Violence Disclosure Scheme (“Clare’s law”) on a statutory footing.
• provides that all eligible homeless victims of domestic abuse automatically have ‘priority need’ for homelessness assistance.
• ensures that where a local authority, for reasons connected with domestic abuse, grants a new secure tenancy to a social tenant who had or has a secure lifetime or assured tenancy (other than an assured shorthold tenancy) this must be a secure lifetime tenancy.
• prohibits GPs and other health professionals in general practice from charging a victim of domestic abuse for a letter to support an application for legal aid.
• provides for a statutory code of practice relating to the processing of domestic abuse data for immigration purposes.

Animal welfare

The Animal Welfare Act 2006 can be used in cases of animal mistreatment or neglect. The Act makes it against the law to be cruel to an animal and the owner must ensure the welfare needs of the animal are met. Powers range from providing education to the owner, improvement notices, and fines through to imprisonment. The powers are usually enforced by the RSPCA, Environmental Health, or DEFRA.

Fire

The fire brigade can serve a prohibition or restriction notice to an occupier or owner which will take immediate effect (under the Regulatory Reform (Fire Safety) Order 2005). This can apply to single private dwellings where the criteria of risk to relevant persons apply.

Appendix 2: Process for Managing Bury MARM Strategic Risk Panel

NB: HoS are responsible for arranging cover in their absence and advising the SAB Business Unit at [email protected] 

Adult Social Care (ASC) Head of Safeguarding (HoS) when screening the circumstances of the adult
ASC Head of Service (HoS) / SAB Business Unit	Update the referrer if the referral to the Strategic Risk Panel has been assessed as not meeting criteria – ensure action plan in place advise how and when to re-refer. Consult with referrer following the panel – ensure actions from panel are embedded in multi-agency risk plan and that updates are fed back before next panel meeting. Initial review of referral and additional documentation. Recommendation regarding proposed outcomes.
ASC Head of Service (HoS)	Any further information required/any further consultation with other panel members e.g. health. Who to attend panel if applicable.

ASC Head of Safeguarding (HoS) triage the adult circumstances and decide on 1 of 3 outcomes:

Outcome 1: Adult circumstances meets criteria and will be discussed at panel

AAB Business Unit to maintain a record of cases going to the Strategic Risk Panel and the outcome of the decision. SAB Business Unit to include referral and documentation in the agenda for the next MARM Strategic Risk Panel and circulate papers. SAB Business Unit will invite the referrer to attend the panel. If the referrer is unable to attend, the MARM Strategic Risk Panel will continue with their considerations.

Outcome 2: Adult Circumstances may meet the criteria, but additional information is required

Business Unit will request additional information from referrer. Once decision has been made that adult will be discussed at the MARM Strategic Risk Panel, Process as stated in ‘Outcome 1’ will then be followed.

Outcome 3: Adult does not meet the criteria

ASC HoS will make decision as to whether criteria has been met. If criteria has not been met the referrer will be informed with rationale as to why, by the Business Unit. The Responsible Agency should ensure that a robust multi-agency action plan is in place for each adult. The Referrer to be made aware that the referral can be re-submitted if circumstances change, and the risk is increased, or other S42 processes have been followed unsuccessfully. The referrer to be made aware that another referral form would need to be completed if the case is re-referred, and to ensure all assessments are up to date.

Management of the MARM Strategic Risk Panel Documentation

Records will be maintained by the SAB Business Unit, with restricted access. Records will be shared at the MARM Strategic Risk Panel when required for members to have oversight of all referrals. All meetings will take place online and will be recorded, and action notes and decisions will be recorded by SAB Business Unit and circulated to all attendees and other professionals where appropriate

Agenda Planning and management of the MARM Strategic Panel (Managed by the SAB Business Unit)

Panel will be held on a monthly basis. Last day of referrals will be the Monday week prior to the Panel meeting The circumstances of each adult will be triaged as it is received. For practitioners presenting information to the panel, invites will be sent by SAB Business Unit once the decision has been made that the adult will be presented to the panel with an allocated timeslot. The agenda will be arranged and approved by the chair and will be sent out one week before the panel by SAB Business Unit. All panel members will be invited to all the panel discussions to contribute. Panel members are to email [email protected] if they wish to send apologies for any panel but will try and arrange a deputy (where possible). Agreed actions and decisions will be shared after each panel.

Management of decisions and actions (Managed by the SAB Business Unit)

Notes of decisions, rationale and agreed actions with timescales will be recorded during the panel meetings. The risk register is updated following the meeting. The presenter will be asked to provide an update on the adult, any actions and risks from their referral – highlighting key points for the Strategic Panel to consider All action and updates need to be submitted via the [email protected] inbox and cc Head of Safeguarding by the agreed date set by the panel. This is to enable the overall level of risk to be reviewed in preparation for the next panel. The practitioner will be expected to provide an update on the identified risks and advise whether the risks remain, and a further discussion is needed at the next panel. Panel members should send any apologies at the earliest opportunity to [email protected]