6.1 Multi Agency Risk Management (MARM) Framework

1. Introduction

The Multi-Agency Risk Management Protocol (MARM) has been developed by the partners of Trafford Strategic Safeguarding Partnership following learning from local and national Safeguarding Adults Reviews. This guidance sits alongside Trafford’s Multi-Agency Adult Safeguarding Procedures and has been designed to provide guidance on managing cases relating to adults whose circumstances may sit outside of the statutory adult safeguarding framework, but where the level of risk is assessed to be high and may benefit from a multi agency approach.

The Protocol is intended to provide agencies with an overarching framework within which to work. It is the responsibility of each individual organisation to develop more detailed workplace guidance around its implementation. The Protocol does not seek to replace single-agency risk management arrangements and instead seeks to build on and compliment these by providing a multi-agency dimension. Professionals must also refer to relevant statutory frameworks and operational policies which they are required to follow.

1.1 When to use MARM

It is anticipated that this guidance is likely to be useful to professionals who are working with adults experiencing an unmanageable level of risk which is arising from a set of circumstances which create the risk of harm, but not relating to abuse or neglect by a third party such as:

• Vulnerability factors placing them at a higher risk of abuse or neglect including mate crime, network abuse, etc.
•  Self-neglect including hoarding and fire safety.
• Refusal or disengagement from care and support services.
• Complex or diverse needs which either fall between, or span a number of agencies’ statutory responsibilities or eligibility criteria.
•  On-going needs or behaviour leading to lifestyle choices placing the adult and/or others at significant risk.
• Complex needs and behaviours leading the adult to cause harm to others.
•  Impact of domestic abuse, mental health and substance misuse.
• Risks previously addressed via a Section 42 enquiry but for which the need for ongoing risk management and monitoring has been identified.

This guidance must only be used where the adult:

• Has the mental capacity to understand the risks posed to them.
• Continues to place themselves at risk of serious harm or death.
• Refuses or is unable to engage with health and social care services.
• There is NOT an open Section 42 enquiry in place.

The MARM aims to ensure a proactive approach which focuses on prevention and early intervention. Thus the MARM Protocol is different from the statutory Section 42 enquiry process which is intended to respond to a specific incident, sometimes at the point of crisis, where specific statutory criteria are engaged. There are common themes across the two processes, for example both are responding to risk and each is built on the same principles which promote prevention and developing personal resilience, partnership working, making safeguarding personal and adopting strength based approaches.

If the adult does not have mental capacity, the MARM Protocol process is NOT appropriate and Best Interests Decision Making processes should be followed (see Best Interests chapter). However, if there is doubt about the adult’s mental capacity, then the MARM process can be followed, until it is established that an individual does not have mental capacity.

If the risk(s) is not at a level which may lead to serious harm or death, the MARM Protocol process does not apply and should not be followed.

1.2 Inherent Jurisdiction

Adults who have capacity to make decisions which may result in them placing themselves at risk of
significant harm or death may require further judicial intervention to ensure their safety. This is most likely to occur if the adult continually fails to engage with professionals and all other options have been exhausted.

There may be occasions when the Courts are prepared to intervene in the case of an adult, even when they have the capacity to consent, for example, where an adult is receiving undue pressure or coercion from a third party. The Court’s purpose is not to overrule the wishes of an adult with capacity, but to ensure that the adult is making decisions freely.

Legal advice should always be sought when Inherent Jurisdiction may be a factor.

See also Inherent Jurisdiction of the High Court and Inherent Jurisdiction Guidance Note (39 Essex Chambers)

1.3 How to use the MARM Protocol

The guidance should be used flexibly and in a way which achieves best outcomes for the adult. It does not, for example, specify which professionals need to be involved in the process, or prescribe any specific actions that may need to be taken as this will be decided on a “case by case” basis through coordinated multi-agency working; in line with:

• Making Safeguarding Personal (MSP) principles (see Making Safeguarding Personal).
• Information sharing protocols.
• Trafford Council Safeguarding Adults Multi-Agency Policy and Procedures.
• Human Rights Act 1998.
• Care Act 2014.
• Data Protection Act 2018 and UK GDPR.
• Care and Support Statutory Guidance.

2. The Six Principles of Adult Safeguarding

Trafford Strategic Safeguarding Partnership employs the six safeguarding principles in its approach to
its safeguarding responsibilities.

3. Principles of MARM

The MARM Framework cannot be used instead of the safeguarding process. The MARM Framework is for high-risk concerns that have been assessed as not meeting the Care Act 2014, Section 42. If in doubt, contact Trafford Adult Social Care for advice. Further information and guidance on raising a safeguarding concern can be found on the Trafford Council website.

The MARM Framework is not a statutory process, however member agencies of the Safeguarding Adults Board have signed up to the framework and it is expected that their staff will use it. There are no standard agencies that must attend, and in some cases the adult concerned will not be known to Adult Social Care. Consideration should be given to inviting agencies with expertise or who may be able to support the adult e.g., substance misuse, domestic abuse etc. MARM can consider the need for a Care Act Section 9 needs assessment.

3.1 Principles for risk management policy and practice

There are a number of principles which should be applied and integrated into risk management policy and practice across all organisations. These include:

• All agencies and the representatives should work together to achieve the best outcome for the adults they support, whilst satisfying legal, professional and organisational responsibilities and duties.
• Partner organisations should ensure that they have in place mechanisms that enable early identification and assessment of risk through timely information sharing and targeted multi-agency support.
• All staff have a vital role to play in early, positive interventions with adults and families so as to make a difference to their lives, preventing the deterioration of a situation or breakdown of a vital support network.
• Any support offered or provided under the MARM framework will form part of the organisation’s ‘business as usual’ process.
• Timescales adopted will be based on professional judgements about a range of factors including the risk level and complexity of the case, or to work in a way that is consistent with the needs and wishes of the adult.
• Professionals should be aware of the rights of individuals in law and of the statutory duties, powers and responsibilities of local authorities, health, housing, police as well as other agencies.
• Any agency or professional can initiate a multi-agency risk management meeting. However, a responsible manager from that organisation should be involved in the decision-making process.
• A person centred approach should be adopted and responses designed around the needs and wishes of the adult who will be actively encouraged to engage and participate in the in the management of the risks they are experiencing in their day to day life.
• Consideration of mental capacity should be made regularly throughout the process. Where a person is found to lack mental capacity in any area of decision-making, a best interests decision will be made, and this must take into account the adult’s views and wishes in accordance with the Mental Capacity Act Code of Practice.
• A strengths-based approach is at the core of the MARM process. It should be experienced as a collaborative process between the person being supported by services and those offering them support in order to determine an outcome that draws on the person’s strengths and assets.
• The MARM process is designed to protect and support the person’s independence, resilience, ability to make choices and to maximise wellbeing. It will afford opportunities for the individual to be a co-producer of their support rather than solely a consumer of those services.
• It is vital that the adult has as much control and choice as possible, and that process is guided by their needs and circumstances. Personalised information, advice, support and good advocacy are essential components to this.
• Professionals should aim to involve (with the consent of the adult) relatives, carers, friends, etc. as much as possible in the process as a means of building and/or strengthening the adult’s support network.
• Professionals should adopt a flexible, innovative and solution focused approach to mitigating risk. This may involve trying out new ways of working or retrying previous ideas.
• Each agency involved in this process must allocate a lead worker to agree actions and make operational decisions about this case. The multi-agency forum must also identify someone to act as the lead coordinating professional for the process.
• Consideration should be given to involving agencies who have previously provided a service to the adult but have now closed their file as they may hold important information, and may not be aware of any new risks.
• If you are the lead agency, you have the role of ascertaining what other agencies duties are – never make assumptions another agency is already dealing with a situation.
• Effective risk management is underpinned by clear, timely information sharing within and across organisations.
• The multi-agency risk management plan must be proportionate and focussed on the prevention, reduction or elimination of future risk of harm. This plan will be jointly owned by the adult and the
  professionals working with them.
• Professionals will be responsible for recognising, assessing, and recording areas of risk and actively responding to these identified risks. This includes the ongoing monitoring and review of all risks.
• Professionals should seek legal advice from within their own organisation at various stages throughout process as appropriate.
• All decisions and actions taken throughout the process must be accurately recorded, and a note made of all those involved in the decision-making process and the rationale for the decision made. This is to support defensible decision making, a guide to which is outlined in section six.
• Anyone, including adults, their family or carers and professionals, who feel these principles are not being met in practice have the right to make constructive challenge about this. There should also be opportunities for professionals to escalate any concerns both within and across their organisations.
• Appropriate challenge and escalation is an essential 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 Multi Agency Escalation Protocol.

4. Multi-Agency Risk Management Process

Under the MARM protocol, an adult will be considered to be ‘at risk’ where they are unable or unwilling to provide adequate care for themselves and they:

• are unable to obtain necessary care to meet their needs; and/or
• are unable to make reasonable or informed decisions because of their state of mental health or because they have a learning disability or an acquired brain injury; and/or
• are unable to protect themselves adequately against potential exploitation or abuse; and/or
• have refused essential services without which their health and safety needs cannot be met but do not recognise this may be considered unwise or risky.

The nature of any involvement centres on whether the adult concerned has the mental capacity to make decisions that have legal force. A person may have mental capacity and yet disagree with the views of the professional. This is a right that cannot be taken away from someone who has mental capacity. It does not however prevent the professional from entering into a dialogue with the person in order to explore the area of concern.

Concern and the ongoing offer of support is not dependent upon a request by the adult or other persons and is not repudiated by a third party’s refusal to grant access to the adult, or by the adult’s refusal to participate.

An adult’s right to make seemingly unwise decisions which have risks and to refuse support should be
respected. However, the assessment of the person’s mental capacity should include consideration of their executive function as well as their ability to understand.

Information and advice should be provided to the person who (with mental capacity) has refused to accept
support which addresses how to minimise risks as well as how to access support or a re-assessment in the future should they change their mind. It is important that decisions (either by the adult or the agency) are kept under constant review and re-evaluated as circumstances change or new information becomes available.

A toolkit of documents to support this protocol have been developed, including a chronology template with guidance, MARM FAQs, a flowchart, template letters, a guide to chairing meetings, and a meeting minute template.

5. Risk Identification and Assessment

Where an adult declines to engage, and in so doing so is placing themselves or others at risk of serious harm, advice and information should be shared with them about the risk(s) of involvement or non involvement.

Each agency involved with the adult should, as part of usual case management arrangements maintain a chronology of key events and complete and document their internal risk assessment and management plan.

Professional judgement will determine whether or not the level of risk has reached an unmanageable level for the individual organisation. Where this is the case, a multi -agency risk management process should be set in motion. This can be initiated by any agency and by doing so, the instigating agency becomes the lead agency with responsibility for co-ordinating, convening and chairing the initial meeting.

The purpose of the multi-agency risk management process is to ensure timely information sharing between agencies, so as to gain a holistic (multi-agency) overview of presenting risks and to develop a shared risk management plan. Decisions should be recorded and continually reviewed throughout the process.

The multi-agency risk assessment should consider the following aspects of the situation:

This risk assessment may highlight circumstances or risks which would be more appropriately dealt
with under another process such as a care review, Care Programme Approach meeting, multi-agency
risk assessment conference (MARAC), family group conference, Channel Panel, MAPPA or Section 42
enquiry. Where this is the case, the appropriate referrals should be made.

6. Support and Management of the Process

As far as practically possible, the adult should be included and involved in the assessment process and development of a risk management plan to reduce or eliminate the identified risks. Under normal circumstances, the adult should be invited to attend any meetings with them being offered any support needed to enable them to participate fully. This support may also include offering and arranging an advocate if the adult is likely to experience substantial difficulty in participating in the meetings (see Independent Advocacy chapter).

Where the adult continues to refuse all assistance and they have been assessed as having the mental capacity to understand the consequences of this decision, this should be fully recorded. This record should include an overview of the efforts and actions taken by all agencies involved to provide support. A timeline for completion of any actions should also be included.

An assessment of mental capacity should be carried out if appropriate, to determine if the person has
the capacity to make specific decisions. Where a person is unable to agree to have their needs met because they lack the mental capacity to make this decision, then the ‘best interest’ decision making process should be used (see the chapters on Mental Capacity and Best Interests).

If the multi-agency risk management process has not been able to mitigate the risk of any behaviour which could result in serious harm, the professionals involved should consider notifying the relevant authority with safeguarding responsibilities (the local authority) of the steps taken (assuming the multi-agency lead has received consent to share personal information or deems it is necessary due to the exemptions in the Data Protection Act 2018). The local authority should then assess the circumstances of the case as well as the steps already taken to minimise presenting risks in order to determine what if any, further steps are required in accordance with the duty under Section 42 of the Care Act 2014 to undertake a safeguarding enquiry. If further steps are deemed necessary, then these might be undertaken in the context of a statutory safeguarding enquiry process but not necessarily (see Safeguarding Enquiries Process).

In cases of self-neglect, it is important to note that this does not necessarily prompt a Section 42 enquiry and decisions should be made on a case by case basis and will be dependent upon the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support. This process will not affect an individual’s human rights, but it will ensure that respective partner agencies exercise their duty of care in a robust manner as far as is reasonable (see Self Neglect chapter).

7. Stages of the Process

This MARM guidance aims to support an effective, co-ordinated and multi-agency response to those critical complex cases where professionals are often responding to long term and entrenched behaviours. The protocol seeks to facilitate timely information sharing around risk and the development of a shared and holistic risk assessment and management plan.

8. Record Keeping

A record of the process must be maintained throughout the process which is reflective of the key decisions made including what actions will/will not be taken, by whom and the underlying rationale. Practitioners should ensure that their recording in individual cases not only reflects the good practice highlighted in this guidance below but also relevant legal, professional and organisational information governance requirements and standards.

The following guidance explains how information within the MARM process should be recorded in
order to demonstrate defensible decision making:

A defensible decision is one where;

• All reasonable steps have been taken to avoid harm.
• Reliable assessment methods have been used.
• Information has been collected and thoroughly evaluated.
• Decisions are recorded and subsequently carried out.
• Policies and procedures have been followed.
• Practitioners and their managers adopt an investigative approach and are proactive.
• Decisions are defensible if they address the points above, and:
• A contemporaneous, legible record is maintained.
• An approved system and format is used.
• The rationale behind the decision in relation to the circumstances is specified.
• References to relevant legislation and guidance is included.
• Are retained with other records about the individual (or organisation).
• Are ‘signed’ and dated by the person making the record.

9. MARM Flowchart

MARM Flowchart (opens as PDF)

This flowchart should be utilised by any professional who is working with adults experiencing an unmanageable level of risk as a result of circumstances which create the risk of harm, but NOT relating to, abuse or neglect by a third party.

Before calling a MARM, consider if there is a more proportionate multi-agency process to respond to the
presenting circumstances and risks. for example, person-centred planning meeting, care review, family
group conference, Care Programme Approach review, etc.).

An adult at risk places themselves at a serious risk of harm due to:

• Vulnerability factors placing them at a higher risk of abuse or neglect including mate crime,
  network abuse, etc.
• Self-neglect including hoarding and fire safety.
• Refusal or disengagement from care and support services.
• Complex or diverse needs which either fall between or span a number of agencies’ statutory
  responsibilities or eligibility criteria.
• On-going needs or behaviour leading to lifestyle choices placing the adult and/or others at
  significant risk.
• Complex needs and behaviour leading the adult to cause harm to others.
• Domestic abuse, mental health and substance misuse.
• Risks previously addressed via a Section 42 enquiry but for which the need for ongoing risk
  management and monitoring has been identified.

10. Governance

Each agency holding a MARM will be required to notify the Quality Assurance and Performance Officer from the Safeguarding Adults Board who will retain a central record, using the Marm Notification Form. This notification requirement will capture data on the number of MARM meetings held, the agencies engaging in these meetings, details of any escalation and most importantly, allow for the impact and outcomes to be measured. This will be achieved through the completion of the Marm Reflection Form at the conclusion of the process.

The Quality Assurance and Performance Officer will review the data collected and feed this into the Quality Assurance and Performance and Self Neglect sub groups of the Safeguarding Adults Board on a quarterly basis.

An overview of the MARM activity will also be prepared to be included in the annual report of the Board.

11. Legal and Policy Context

Legislation linked to or supporting application of the MARM process:

Care Act 2014
• Section 1 – Wellbeing and prevention
• Section 6 – Carers
• Section 9 – Assessment Section 42 – Safeguarding enquiry (neglect, abuse and self- neglect)

Public Health Act 1936 – This allows the Borough Council to give notice to owners or occupiers of premises if those premises are “in such a filthy or unwholesome condition as to be prejudicial to health”. The notice can require the owner or occupier to clean the premises. If they do not, the District/Borough Council can arrange to carry out the works themselves.

Health Services and Public Health Act 1968 – including S.45 -Duty to make arrangements for promoting the welfare of old people.

Health and Care Act 2022 

Mental Health Act 1983  – This provides a comprehensive legislative framework to support the needs of both children and adults. It is based on the presumption that the right of people who have been assessed as having a ‘disorder or disability of mind or brain’ is safeguarded when they are being admitted to or treated within a psychiatric hospital. In addition, as much care and treatment as possible, both in hospital and outside, should be given on an informal basis – where the individual patient is able to exercise their own judgement in the matter (with certain additional safeguards in place for children and young people) – and in the least restrictive conditions possible. The Act also presumes that the main emphasis of care is care within local communities, not within hospital settings. S.135 specifically provides the authority to seek a warrant authorising a police officer to enter premises if it is believed that someone suffering from mental disorder is being ill-treated or neglected or kept otherwise than under proper control anywhere within the jurisdiction of the Court or, being unable
to care for himself, is living alone in any such place. Mental Health Act 1983 (revised 2007).

Mental Capacity Act 2005– Underpinning the Act are five statutory principles, the most important of which centre on the presumption of capacity unless proven otherwise, and the requirement to enable mentally capable individuals (aged 16+) to make decisions for themselves, even where those decisions may be at variance with what other people and organisations feel would be best. The MCA also provides a statutory framework to enable social care (and allied disciplines) to intervene in the lives of a person (aged 16+) where it can be demonstrated that, in relation to a specific decision that needs to be taken, the person lacks mental capacity to make that decision and therefore a decision needs to be made by a third party in the person’s best interests. From April 2009, the Mental Capacity Act 2005 has made it unlawful to deprive of his/her liberty any adult person lacking mental capacity who is living in a care home or staying in a hospital. This can only be lawful if a Deprivation of Liberty
Standard Authorisation is in place or a decision has been made to this effect by the Court of
Protection. See also Mental Capacity Act Code of Practice.