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Lewisham Safeguarding Adults Board

Plan & Review Stage 3: Multi-Agency Adult Safeguarding Case Conference (MASCC) Guidance

1. What is the purpose of a Multi-Agency Adult Safeguarding Case Conference?

The overarching purpose of a Multi-Agency Adult Safeguarding Case Conference (MASCC) is to bring together all of the relevant stakeholders, so that the Safeguarding Enquiry process can be reviewed, to ensure that the "risk to the adult has been sufficiently reduced, or removed" (although it may also be appropriate for this to 'remain' in some circumstances), before being closed.

This is a shift in terminology and emphasis away from trying to 'substantiate' reports of abuse, which can become combative between professionals and agencies, detracting from the efforts to improve the adult's wellbeing and safety.

See: Multi-Agency Adult Safeguarding Case Conference Meeting Record (Pdf)

Multi-Agency Adult Safeguarding Case Conference Meeting Record (Word)

2. When might a MASCC be needed?

A MASCC will not be necessary in relation to many Section 42 Safeguarding Enquiries, but the following points should be used to help determine if one is required: 

  1. To ensure that in the most complex cases the risk management arrangements that have been put in place are being effective.
  2. Where multiple agencies (including providers) have been involved in offering support and or protection, and ongoing co-ordination is required.
  3. In organisational or institutional cases where other adults may also have also been at risk of abuse or neglect. This may include where issues have affected residents of other Local Authorities.
  4. Where the abuse involved a member of staff/volunteer (position of trust), and this brought into question the safety of other adults, and or the service.
  5. Where there may have been multiple ongoing enquiries by different organisations or other processes, including by Police and the Pressure Ulcer Panels (see section 6).
  6. To consider if other legal or statutory actions or redress are needed. This may include a referral for a Safeguarding Adults Review (SAR - s.44 Care Act 2014).                                                  

How to make a SAR Referral to the Lewisham Safeguarding Adults Board

In some instances a MASCC may be required at short notice following on from an initial Safeguarding Planning Meeting, if the issues identified place the adult at significant risk of harm, otherwise this should be arranged within 10 working days of a decision being made that one is necessary.

See: Multi-Agency Adult Safeguarding Planning Meeting Guidance

With this in mind the following points made under each of the six Safeguarding Principles should be followed to ensure that MASCC’s are utilised effectively and consistently.

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Safeguarding Principle - Empowerment 

What does this mean for the professionals: Adults are encouraged to make their own decisions and are provided with support and information.

What does this means for the adult: "I am consulted about the outcomes I want from the safeguarding process and these directly inform what happens".

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The practitioner who is setting up and chairing a MASCC (see section 3) must ensure that the adult’s views, wishes and opinions are effectively represented, and conduct the meeting in an appropriate manner, using appropriate adaptations if required, allowing for the full participation of the adult and or their representative(s).     

2.1 If the adult does wish to attend the following points must be born in mind:

  • The adult can bring someone to support them at the meeting. This might be a family member, friend or an Advocate (see section 3.2 of the London Multi-Agency Safeguarding Policy and Procedures), and or a legal representative.
  • The meeting is about the adult and their views and wishes. The Chair of the meeting must ensure these are heard and listened to by everyone else.
  • The meeting may need to decide if any additional actions need to take place, and by who, to make the adult safer and improve their wellbeing. This will be a group decision and the adult’s views will form part of this decision.
  • A new Safeguarding Plan may be agreed - this is about how the adult wants to be supported to be safe. Decisions about the adult’s welfare or care will need to be agreed with them.
  • If the adult has been assessed as not having mental capacity to make a particular decision at that time, then it will need to be made in their ‘best interests’, and their views, wishes, feelings and beliefs must still be taken into account. Such decisions must be made in line with the Mental Capacity Act 2005 (Mental capacity should be carefully considered during every safeguarding enquiry- see section 3.1 of the London Multi-Agency Safeguarding Policy and Procedures).

2.2 If the adult does not wish to attend they may:

  • Give their views in writing, or;
  • Ask someone to attend on their behalf, for example an advocate, friend or family member, or;
  • Ask the Safeguarding worker or Safeguarding Adults Manager to pass on their views.

See: Local Government Association - Making Safeguarding Personal Toolkit

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Safeguarding Principle - Prevention 

What does this mean for the professionals: Strategies are developed to prevent abuse and neglect that promotes resilience and self-determination.

What does this mean for the adult: "I am provided with easily understood information about what abuse is, how to recognise the signs and what I can do to seek help".

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2.3 The MASCC should consider:

  • The longer-term health, social care, communication, cultural or other specific needs of the adult at risk.
  • The ongoing support the adult will need.
  • What learning can be shared across agencies to help prevent further re-occurrences (this is also linked to Section 44 of the Care Act 2014 - if the criteria is met).
  • What training or education is also needed to help prevent further re-occurrences of abuse.
  • How information should be recorded and shared in line with the data protection legislation to help prevent further instances of abuse (see section 2.39 of the London Multi-Agency Safeguarding Policy and Procedures).

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Safeguarding Principle - Proportionality  

What does this mean for professionals: A proportionate and least intrusive response is made balanced with the level of risk.

What does this mean for the adult: "I am confident that the professionals will work in my interest and only get involved as much as needed".

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Safeguarding Principle - Protection

What does this mean for the professionals: Adults are offered ways to protect themselves, and there is a co-ordinated response to adult safeguarding.  

What does this mean for the adult: "I am provided with help and support to report abuse. I am supported to take part in the safeguarding process to the extent to which I want and to which I am able".

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  • Any potential risks to children and young people (or other adults at risk) and agreement on who will arrange a Child Protection referral, where necessary (if this hasn’t already been actioned and is applicable).
  • How actions that may be needed to further reduce the future risk of harm to the adult, and or others, will be delivered.
  • Ensure there is clarity about the type of abuse that has occurred and that this is recorded effectively, considering types of abuse that are particularly under-recorded:
    • Organisational Abuse
    • Discriminatory Abuse
    • Modern Slavery
    • Domestic Abuse.
  • The link with other key processes and procedures e.g. personnel issues (including referrals to the Disclosure and Barring Service or a professional or regulatory body); Police investigations; other regulatory processes such as a NHS Serious Incident, and the link to Pressure Ulcer Panels (see section 6).

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Safeguarding Principle - Partnerships 

What does this mean for the professionals: Local Solutions through services working together within their communities.

What does this mean for the adult: "I am confident that information will be appropriately shared in a way that takes into account its personal and sensitive nature. I am confident that agencies will work together to find the most effective responses for my own situation".

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Safeguarding Principle - Accountability

What does this means for the professionals: Accountability and transparency in delivering a safeguarding response.

What does this mean for the adult: "I am clear about the roles and responsibilities in all those involved in the solution to the problem".

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  • That arrangements are in place to feedback the conclusion of the Case Conference and any other relevant information to those who need to be advised and are not in attendance.
  • Where other processes, such as a complaints procedures have been suspended pending the outcome of the enquiry, that these are subsequently resumed.

3. Who can convene a MASCC?

    An Operational Lead/Manager within the London Borough of Lewisham (LBL) can convene a MASCC, or a Service Manager within LBL for more complex or serious cases.  

    Operational leads should seek advice from their senior colleagues if they are in doubt about convening a MASCC.

    4. Who should attend a MASCC?

    There are a wide range of people who may be required to attend a MASCC, including, but not limited to:

    1. The adult and or their representative (see 2.1).
    2. The Safeguarding Adults Manager (SAM) or their equivalent.
    3. The Safeguarding Enquiry Officer.
    4. Police manager.
    5. Other criminal justice agencies.
    6. NHS Trust manager and or relevant specialist.
    7. GP
    8. Care Quality Commission.
    9. Care Provider agency manager.
    10. Relevant LBL and or South East London (SEL) Clinical Commissioning Group (CCG) Commissioner.
    11. Quality Assurance or Contracts Officer from LBL and or SEL CCG.
    12. The person/agency alleged to have caused the harm should have been given the opportunity to submit their representations. If this is an agency, then a manager not directly involved in providing care in the case may be invited to attend.

    MASCC’s should be formally recorded and minutes taken, which should be shared with those attending. This should be completed within 10 working days of the Case Conference.

    5. Practical arrangements

    Whilst there is a need to formally record the minutes from MASCC’s, these Case Conferences should be set up as informally and flexibly as possible to meet the requirements of the adult and or their representative(s), whilst also helping ensure that professionals can contribute when these meetings are being set up at relatively short-notice.

    It may be suitable and appropriate to set these Case Conferences up online using video methods, or via telephone, or by being flexible in utilising meeting rooms that are accessible for those involved.

    Otherwise the chair of the MASCC should consider:   

    1. How to create a comfortable and welcoming environment.
    2. Whether the adult wishes to have a representative(s) with them and whether they will or should have an active or silent role (legal representative). This should be agreed with the adult, their legal representative and the chair ahead of the Conference.
    3. Any communication requirements or other accessibility issues.
    4. Location of facilities such as refreshments and toilets.
    5. How breaks will be agreed, if needed.
    6. Arrangements should the adult require a break or wish to clarify any points covered in the Case Conference.
    7. The adult and their representative(s) should not be required to join a room where other attendees have previously gathered, and where possible they should be in the room before other attendees join, having met and had a chance to talk with the chair ahead of the meeting.
    8. Meetings can also be in multiple parts to make them less intimidating (smaller groups) and more manageable for the adult, and include a separate and wider ‘professionals’ meeting.
    9. Where the venue is the adult’s own home, consideration should be given to how their home will be treated with respect, and how to maintain confidentiality if others not attending the Conference may also be present in the home.

    See: Multi-Agency Adult Safeguarding Case Conference Meeting Record (Pdf)

    Multi-Agency Adult Safeguarding Case Conference Meeting Record (Word)

    6. How do MASCC’s link to Pressure Ulcer Panels and the Provider Concerns process?

        6.1 Pressure Ulcer Panels

        Any Section 42 Safeguarding Enquiry which has commenced as a result of a pressure ulcer related issue will normally be conducted via one of the two Pressure Ulcer Panels in the Borough of Lewisham, which are both overseen by a senior social work practitioner from within LBL.

        If these are routine cases, then a MASCC will not be required, unless one or more of the issues listed in section 2 of this guidance are present in the case.

        If a MASCC is deemed to be necessary in relation to a pressure ulcer related case, then a MASCC should be convened within 10 working days of a decision being made that one is necessary, even if the case has not been brought to a conclusion by the relevant Pressure Ulcer Panel.

        6.2 Provider Concerns   

        As described in section 2, one outcome from a MASCC might be to make a referral to the Provider Concerns process if the criteria for this has been reached (see sections 5.7 & 5.8 of the London Multi-Agency Safeguarding Policy and Procedures). The MASCC may help to identify signs linked to provider concerns, allowing for early supportive actions to be taken by commissioning authorities in supporting social care providers. A referral for the Provider Concerns Process should be made through the applicable Contracts Officer from LBL and or SEL CCG.

        7. Monitoring and review of MASSC’s

        The Operational Lead for LBL will provide operational oversight and monitor all activity linked to the Section 42 Enquiry process, including MASCC’s, in conjunction with the Service Manager with overall responsibility for adult safeguarding within LBL.

        The Service Manager within LBL will provide oversight of MASCC’s (including chairing more complex Case Conferences as required), providing quality assurance to the Lewisham Safeguarding Adults Board through ongoing audit and reporting processes.

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