ERF - Operational Guidance

The Exceptional Risk Forum has been established by the Leeds Safeguarding Adults Board (LSAB) in recognition that sometimes, despite the best efforts of agencies to work together to intervene and provide support to someone, an exceptional risk to their safety can remain. 

If after the multi-agency safeguarding adults policy and procedures, or other multi-agency processes have been followed, the person remains at exceptional risk to themselves, it may be appropriate for the concerns to be raised with the LSAB Exceptional Risk Forum.

In support of multi-agency efforts to achieve positive outcomes for the person concerned, the LSAB Exceptional Risk Forum can offer agencies with a fresh perspective and multi-agency advice and recommendations as to how that person's risk could be reduced. 

Whilst the Forum will seek to offer advice and recommendations, accountability for practice remains with the agencies involved, which must work within their own roles, functions, policies, procedures and legal duties. It is important to note that the Forum has no funding of its own to support the provision of services.

Please note: The Exceptional Risk Forum is not a replacement for the safeguarding adults procedures (or other multi-agency processes). To raise a safeguarding adults concern, you must contact Adult Social Care

The Exceptional Risk Forum can receive referrals in relation to:

• Any adult aged 18 years or over, 
• Who requires assistance with aspects of their day to day living as a result of a physical or mental impairment or illness (including a mental health condition or substance misuse), and;
• Who lives in circumstances of exceptional risk to themselves despite the best efforts of individual agencies and multi-agency approaches to mitigate those risks

The Forum should not in any way be seen as a replacement for good professional practice, multi-agency working, risk assessment and planning. There is a clear expectation that prior to making a referral to the Forum, agencies will have explored the available options to respond to and mitigate the risks that the person experiences. It is only where these approaches have been tried and have been unsuccessful in mitigating exceptional risk, that a referral to the forum should be considered.

As such, any agency considering whether to make a Referral to the Forum must read and consider the 'Before you make a referral checklist'. Where further areas for exploration or intervention are identified, these should be acted upon before making a referral to the Forum.

There may be exceptional circumstances where an agency has not been able to establish a multi-agency approach, due to an inability to gain the involvement of partner agencies. Where this is the case, providing all reasonable attempts have been made to engage with key partners, a referral could still be made. The referring agency should explain the efforts made and the challenges experienced as part of the referral. However, this may result in advice to escalate the concerns to a member agency for potential resolution rather than the matter being addressed within the forum. 

The Forum works through a planned referral process, with set monthly meeting dates. It cannot offer advice outside of these arrangements and so is unable to respond to emergency or crisis situations. Where such situations arise, these need to be responded to by the responsible agencies within their agreed arrangements and procedures.

Back to Top

The objectives of the Exceptional Risk Forum are to:

• Support agencies to achieve positive outcomes for people in Leeds 
• Provide a supportive multi-agency forum for services working with situations of exceptional risk
• Achieve a partnership-wide understanding of those situations where risk remains 
• Offer solution focused advice and recommendations relating to strategies, approaches, services and resources that will reduce risks 
• Identify best practice learning that can be shared across the Leeds safeguarding partnership.

Back to Top

The Forum will offer advice and recommendations to support agencies managing circumstances of exceptional risk.

• Advice and recommendations made by Exceptional Risk Forum are made by its members, based upon their experience, knowledge, expertise and the available information. 
• Any advice or recommendations made by the Exceptional Risk Forum will be forward looking and solution focused, based upon the presented information. The approach of the Forum is one of seeking to build upon what has tried previously, and hence any advice or recommendations offered should not be interpreted as implying criticism of previous interventions.
• Any advice or recommendations made should be considered by those agencies involved, which remain accountable for their subsequent actions and decisions, including whether or not and how to act on the advice and recommendations provided by the Forum.
• Individual agencies must work within their own roles, functions, policies, procedures and legal duties when considering Forum recommendations.
• In the event that an Exceptional Risk Forum member has agreed to take forward an action, this will be an action for them and their organisation and not the Exceptional Risk Forum as a whole.
• Responsibility for resources, including both access to services and funding lies with the relevant agencies who will have their own processes and eligibility criteria. The Forum itself has no funding of its own to support the provision of services.
• The Leeds Safeguarding Adults Board is responsible for establishing the Exceptional Risk Forum, providing administrative support, and evaluating its effectiveness. It is not responsible for professional/operational practice decisions or agency service provision. 

Back to Top

Unless agreed otherwise by the Forum chair, the usual format for meetings will be as set out below:    

1. Up to 3 referrals will be considered at the Forum; allowing usually, up to 45 minutes’ discussion per referral 

• Referring agency referral presentation (10 minutes)
• Focused discussion and consideration of risk, options and solutions (25 minutes)
• Conclusion and agreement of recommendations (10 minutes). 

The Forum however operates on a flexible basis and consideration may be given to allocating more time where necessary. 

1. Forum recommendations will be confirmed in writing as soon as possible following the meeting, usually same day or next working day.
2. The Exceptional Risk Forum will aim to circulate a fuller Case Record within 10 working days.
3. Unless there are exceptional circumstances, and these are agreed by the Chair, the Forum will only further review and advise on a case if a subsequent referral is made and accepted.

Back to Top

Meetings occur monthly, with referrals circulated to members a week beforehand, providing an opportunity to consider the issues in advance.

The following process should be followed by those making a referral to the Forum: 

1. Discuss and agree the need to make an ERF referral with other members of the multi-agency team and agree appropriate representation to attend.
2. Review the Exceptional Risk Forum 'Before you make a referral checklist' with the multi-agency team and your organisation’s Safeguarding Lead (or your organisation’s Forum member if applicable)
3. Complete the Exceptional Risk Forum referral form (with the approval of your Safeguarding Lead/Forum member) 
4. Submit the referral to LSAB.ERF@leeds.gov.uk
5. Subsequently the referrer will need to be responsible for

• Arranging for other relevant members of the multi-agency team to attend the meeting.
• Sharing the ERF recommendations and Case Record with members of the multi-agency team

Back to Top

The following process will be followed to manage the Exceptional Risk Forum Agenda:

1. The LSAB Strategy Unit will receive and collate referrals
2. Referrals made by core member agencies, approved through their member will be automatically accepted. The core member will need to complete the Screening section of the referral form before submission. 
3. Referrals received by non-core member agencies, will be passed to a nominated core member who will complete the Screening section of the referral form. If uncertain, the person undertaking screening should seek a second opinion from another core member.
4. Where there are more referrals received than can be considered that month, there may be a need to prioritise which of the various referrals are most urgent for consideration at the next meeting. 
5. The LSAB Strategy Unit will send the agenda and referral papers to the Exceptional Risk Forum members a week in advance of the meeting.
6. LSAB Strategy Unit will send out invitations to referrers, a week in advance, explaining what is required of them at the meeting.

Back to Top

All Exceptional Risk Forum members must commit to the Exceptional Risk Forum through regular attendance and willingness to support the Forum to achieve its stated purpose.

Membership of the Forum is subject to change and review. This section sets out current arrangements.

9.1 Chair: 

• Leeds City Council: Adults and Health (LCC)

9.2 Core members:

• Leeds City Council: Adults & Health (LCC)
• Leeds City Council: Housing (LCC)
• West Yorkshire Integrated Care Board (WYICB)
• Leeds Teaching Hospital NHS Trust (LTHT)
• Leeds and York Partnership Foundation NHS Trust (LYPFT)
• Leeds Community Healthcare NHS Trust (LCH)
• Forward Leeds

The Exceptional Risk Forum may however choose to invite any organisation or individual with particular expertise, to join the meeting to assist and to offer advice in relation to a particular referral that is being considered. 

9.3 Seniority and Expertise

• All members whether core or wider members, must be senior enough to represent their organisation and have the authority, knowledge and expertise to advise on referrals considered within the Forum.
• The Forum should not serve as a continuation or a repeat of previous multi-agency meetings. Therefore members will usually be a role that offers senior management oversight, rather than being in a role that involves directly managing their agency's response. 

Back to Top

Exceptional Risk Forum

'Before you made a referral checklist' 

If after the multi-agency safeguarding adults policy and procedures, or other multi-agency processes have been followed, a person remains at exceptional risk to themselves, it may be appropriate for the concerns to be raised with the LSAB Exceptional Risk Forum.

The LSAB Exceptional Risk Forum can provide advice and recommendations in relation to circumstances where there is someone aged 18 or over, who requires assistance with aspects of day to day living as a result of a physical or mental impairment or illness (including a mental health condition or substance misuse) and who is experiencing an exceptional risk to themselves despite the best efforts of individual agencies and multi-agency approaches to mitigate those risks.

The Forum is not however a replacement for good professional practice, multi-agency working, risk assessment and planning. There is an expectation that prior to making a referral to the Forum, that agencies will have explored the available options to respond to and mitigate the risks that the person experiences. It is only where these approaches have been tried and been unsuccessful in mitigating risk, that a referral to the Forum should be considered.

Please note: The Exceptional Risk Forum is not a replacement for the safeguarding adults procedures (or other multi-agency processes). To raise a safeguarding adults concern, you must contact Adult Social Care.

Before making a referral to the Exceptional Risk Forum please reflect on the following issues; and consider if there are further actions for yourself and partners, before making a referral. 

1. The person at risk 

1. Do you know and understand the person’s views, wishes and desired outcomes? Does your approach take these into account?
2. Is the person in need of representation of a friend, relative, or advocate to facilitate their involvement? 
3. Have you provided for the person's communication and support needs to enable them to engage with support arrangements?
4. Have you recognised the person's personal and cultural background? Does your approach actively take these into consideration?

2.  Are the right people and services involved?

1. Are all key services engaged? 
2. Is there an agreed lead person/agency to coordinate actions? 
3. Where an agency is not involved, have you sought to escalate our concerns to gain involvement? 
4. If there are differences of views, have you actively sought to resolve disagreements?
5. Have you considered engaging with the person's relatives, do you have the consent of the person at risk, is it proportional to do so even without the person's consent?
6. Have you considered involving an agency or service that has a role that enables them to befriend and get alongside the person, for example a community group or specialist service?

3. Is a multi-agency approach being followed?

1. Has there been a multi-agency meeting about these concerns?
2. Has there been a multi-agency risk assessment?
3. Has a multi-agency plan for intervention been tried?
4. Has there been a review of this multi-agency approach? Are there other approaches you can try?
5. Have you agreed the need for a referral to the Exceptional Risk Forum with other members of the multi-agency team?

4. Is the person declining support with essential services?

1. Have you sought to build relationships? You may need to build relationships and trust before the person is gradually able to accept support. This can take time.
2. Have you sought to understand and find the person behind the behaviours you are concerned about? Do you know why they decline support, and what is important to them?
3. Have you tried to develop plans alongside the person, starting where they are and with what is important to them?
4. Have you sought to be creative, addressing their particular needs, issues and concerns?
5. Are you working with the person's strengths, at their pace?
6. Have you considered if further interventions are proportionate to the risk, and in accordance with Article 8 of the Human Rights Act 1998 (Respect for Private and Family Life)?

5. Have legal options been considered?

1. Is your practice in accordance with the Mental Capacity Act 2005; consider the principles. Is there evidence to indicate an assessment of Mental Capacity is required? Has this been undertaken?
2. Has there been consideration of seeking legal advice? 
3. Have legal powers of intervention been considered? 

6.  Is there also a risk to others?

1. If there is a risk to a child, have you informed Leeds City Council Children Services of your concerns?
2. If there is a risk to other adults, have you considered how to manage those risks?             

7. How would the Exceptional Risk Forum assist you?

1. Have you considered specifically, why you are making a referral to the Exceptional Risk Forum? 
2. What advice do you want from the forum that you do not currently have? What outcome(s) are you aiming to achieve for the person at risk?

Back to Top

LSAB Exceptional Risk Forum – Referral Routes

The Forum should not be considered a replacement for good professional practice, multi-agency working, risk assessment and planning. There is a clear expectation that prior to making a referral to the Forum, agencies will have explored the available options to respond to and mitigate the risks that the person experiences. It is only where these approaches have been tried and have been unsuccessful in mitigating exceptional risk, that a referral to the forum should be considered.

1. Formal Multi-agency risk assessment and management meeting/processes 

This following list is not exhaustive but is indicative of the range of formal multi-agency process that may be followed, from which a referral to the Forum could be considered.

• LSAB Multi-agency safeguarding policy and procedures
• Care Programme Approach (CPA)
• Domestic Abuse: MARAC
• Care Programme Approach (CPA)
• Care Management: Multi-agency processes
• Anti-Social Behaviour: MARAC
• MAPPA Meeting
• Multi-agency solutions panel (MASP)
• Street support: Multi-agency Meeting

2. Individual agencies & other multi-agency processes

• Individual agencies involved in multi-agency risk assessment and planning – on behalf of that group
• Individual agencies: who despite all reasonable efforts, have been unable to engage partners in a multi-agency approach

       Exception Risk Forum: Confidentiality Agreement

The purpose of the Exceptional Risk Forum is to provide professional advice to services and practitioners, in circumstances where a person is at an exceptional risk to themselves.

Referrers

Referrals to the Exceptional Risk Forum will include confidential personal and special category data about an individual. As such, organisations making referrals to the Exceptional Risk Forum should do so in accordance with the requirements of UK Data Protection Legislation and their organisations' information sharing policy. 

Forum Members (inclusive of all parties invited to attend and provide advice)

Forum Members should treat the information provided to the forum as confidential and use this information only for the purposes for which it has been shared. 

As such, information should only be shared by members more widely where it is necessary for them to do so in order to fulfil their organisation’s responsibilities to the individual at risk and to fulfil their role on the forum, for example, to understand their agency's involvement and to be able to offer advice in the forum meeting.

All referral information must be deleted by Exceptional Risk Forum Members at the end of the meeting. If there is a need for a referral to be made to their organisation's services, this will need to take place outside of the Forum, through established agency referral pathways.

Practice by Forum members must be with due regard to UK Data Protection Legislation.

Media Interest

In the event of media interest with respect to a particular individual referred to the forum, no public statement should be made in relation to advice offered unless this has been agreed in advance by the Chair of the Forum.

Back to Top

 Exception Risk Forum: Confidentiality Agreement

The purpose of the Exceptional Risk Forum is to provide professional advice to services and practitioners, in circumstances where a person is at an exceptional risk to themselves.

Referrers

Referrals to the Exceptional Risk Forum will include confidential personal and special category data about an individual. As such, organisations making referrals to the Exceptional Risk Forum should do so in accordance with the requirements of UK Data Protection Legislation and their organisations' information sharing policy. 

Forum Members (inclusive of all parties invited to attend and provide advice)

Forum Members should treat the information provided to the forum as confidential and use this information only for the purposes for which it has been shared. 

As such, information should only be shared by members more widely where it is necessary for them to do so in order to fulfil their organisation’s responsibilities to the individual at risk and to fulfil their role on the forum, for example, to understand their agency's involvement and to be able to offer advice in the forum meeting.

All referral information must be deleted by Exceptional Risk Forum Members at the end of the meeting. If there is a need for a referral to be made to their organisation's services, this will need to take place outside of the Forum, through established agency referral pathways.

Practice by Forum members must be with due regard to UK Data Protection Legislation.

Media Interest

In the event of media interest with respect to a particular individual referred to the forum, no public statement should be made in relation to advice offered unless this has been agreed in advance by the Chair of the Forum.

Back to Top