- Providers should work actively with other agencies to protect the health, safety and welfare of service users.
- Care should be integrated and information shared across partner organisations.
- Providers should know who the principal care provider is as they have the main responsibility for service users' care.
- There should be suitable arrangements in place for transferring service users between services to ensure continuity of care.
- Providers should carry out appropriate risk assessments when moving service users between providers.
- Providers should be able to manage and respond to major incidents and emergency situations.
Regulation 12.2 of the Health and Social Care Act 2008 Regulations 2014 requires that where responsibility for the care and treatment of service users is shared with, or transferred to, other health and social care providers, then providers must work together to ensure continuity of care to protect the health, safety and welfare of the service user.
There are a number of elements involved in complying with Regulation 12. These are:
- working actively with others
- providing integrated care and sharing information
- knowing who the principal care provider is as they have the main responsibility
- having suitable arrangements in place for transfer between services
- undertaking appropriate risk assessments when moving service users between providers
- being able to manage and respond to major incidents and emergency situations.
Working actively with others
CQC expects that providers will work actively with others, both internally within their own service and externally with other services, to make sure that care and treatment remain safe for people using services. Care providers must be able to evidence that they have worked with others to ensure safe care and treatment. This means keeping detailed records of contact with others and the outcome.
If external agencies are not co-operative, the care provider must be able to evidence that they did everything reasonably pos-sible to work with the external agency. This may involve referring the external agency to CQC where non-cooperation results in risk to the safety of people receiving care.
Providing integrated care and sharing information
When two or more services provide care for a service user, or where there are integrated services, they should have appropriate arrangements in place for sharing relevant information promptly and in line with current legislation and guidance. They should also plan and deliver care in partnership. To make this happen in practice, all providers should develop information-sharing policies and procedures that work in practice. Such policies and procedures should be shared with staff and their effectiveness audited. All parties should be aware of the requirements on organisations who keep information and data on people, such as the requirement to register as a data controller with the Information Commissioner's Office (https://ico.org.uk/).
Know which provider is responsible
When more than one provider is responsible for the safety of a person using services, the responsibility for providing safe care rests with the principal care provider at the time it is given. Social care providers must have robust systems and procedures in place to cover situations such as when a person using their service is admitted to hospital. During a journey to hospital in an ambulance, the ambulance service is the primary care provider. But the social care provider takes the person to hospital, then they are responsible for the person using the service. Effective information-sharing and handover notes will provide vital evidence that the social care provider has discharged their responsibilities under this part of Regulation 12(i).
Make suitable arrangements for transition
Suitable arrangements should be in place to support service users who are in a transitional phase between services and/or other providers. A typical situation where this may apply would be the transfer of a person between different social care providers, for example from home care to care home or between care homes. Suitable arrangements may include assessing and admitting the person, including obtaining the care plan and risk assessment from the previous provider, in order to evidence that they have met this aspect of Regulation 12(i).
Carry out appropriate risk assessments
When service users move between services or providers, the provider must carry out an appropriate risk assessment to make sure the service user's safety is not compromised. This includes when they move between other bodies that may not be registered with CQC, such as the police. This is designed to minimise the risk to the person from the move. Risk assessments should be objective and preferably quantitative (scored). Risk mitigation should focus on reducing the likelihood of causing harm. Decisions about a move between services or providers relating to people who may lack mental capacity to make that decision for themselves must be made in accordance with the Mental Capacity Act 2005. This requires that a 'best interests' decision is made with regard to the move between services. Care providers must remember that any deprivation of liberty safeguards authorisations are specific to the setting and are not portable if a service user moves between services.
Manage and respond to major incidents
To make sure that people who use services are safe and any risks to their care and treatment are minimised, providers must be able to respond to and manage major incidents and emergency situations. These include having plans in place with other providers or bodies in case of events such as fires, floods, major road traffic accidents or major incidents, and natural disasters. The Civil Contingencies Act 2004 requires that local authorities and the NHS put plans in place to deal with such emergencies. These agencies contract with social care providers to deliver services and it is almost always a contractual requirement that social care providers have in place business continuity plans to:
- identify risk
- quantify the level of risk (severity and likelihood)
- put in place measures to mitigate the risk.
If a social care provider did not have such a plan in place and a person using their service was harmed by an event such as a care worker not attending due to adverse weather conditions, the social care provider would be in breach of Regulation 12(i). The Health and Safety Executive would consider action for a breach of the Health and Safety at Work Act 1974.
Compliance with Regulation 12(i) Working with other agencies can be achieved easily by developing and implementing policies and procedures for: information-sharing, admission and transfer, risk management and a business continuity plan. These policies and procedures should be reviewed regularly to check that they are effective.
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