Vulnerable Adult Risk Management VARM What is Vulnerable

Vulnerable Adult Risk Management (VARM)

What is Vulnerable Adult Risk Management (VARM)? It is a framework to facilitate working effectively with adults who have capacity, are at risk due to self-neglect, non engagement and where that risk may lead to ‘significant harm or death’ This process should not affect an individual’s human rights but seeks to ensure that the relevant agencies exercise their duty of care in a robust manner and as far as is reasonable and proportionate.

Criteria for VARM In order to consider a person for a VARM meeting all the following criteria should apply: Care and support needs (whether they are met or not) Mental Capacity Self neglect and non engagement Risk of significant harm or death The definition of self-neglect can vary considerably across professions. For the purposes of VARM however, self-neglect can be any of the following: • Neglecting to care for hygiene, health and surroundings and this may include behaviour such as hoarding • Inability to protect themselves by controlling their own behaviour, this can include drug and alcohol dependency where there also needs for care and support • a refusal of essential services

What is Significant Harm? For the purpose of the guidance significant risk of harm is defined as harm that impacts on the person’s physical and or emotional health and wellbeing with long term or permanent consequences.

Capacity This VARM guidance is only to be used where the adult has the mental capacity to understand the risks but continues to place themselves at risk of serious harm or death. Where the adult lacks capacity, the ‘Mental Capacity Act’ should take over and action should be taken under ‘Best Interests’.

The VARM should not be seen as a substitute to legislation and existing processes. Agencies should follow existing legislation and their internal processes, including: The Mental Capacity Act The Mental Health Act Safeguarding Adult Enquiries MAPPA MARAC

VARM Self Neglect Definitions The inability to care for one’s self and/or one’s environment, including hoarding Refusal of essential services Failure to protect one’s self from abuse by a third party (where “normal” adult safeguarding processes are not applicable or sufficient). In these cases, the Local Authority will need to oversee the VARM

Who initiates a VARM? Any agency can initiate/lead on VARM meetings, and this does not necessarily need to be Adult Social Care. However, where the concerns reach the “Incident Indicating Harm/Impact” section of the Safeguarding Adults Thresholds Guidance relating to self-neglect, and there is indication that the adult at risk may be unable to take steps to protect themselves due to their care and support needs, the Local Authority should always be part of VARM process.

Alternative pathways to VARM In the case of an assessed lack of capacity, the Mental Capacity Act (MCA) Guidance should be used to work in the person’s ‘best interests’ If the level of risk within the person’s situation is assessed as lower, it may be appropriate to consider an alternative approach, such as ongoing case management Where risk is due to abuse by a third party this must be considered under Safeguarding processes

VARM Process Establish capacity Develop/Review the Support/Action Plan Action plan/support implementation Review Independent review process Closure of VARM

Within the MAPP there are templates for each meeting stage. These should be followed by the lead agency when chairing a VARM Support Planning meeting q. Introductions q. Background to the circumstances of the VARM by the referring agency q. Consent & Capacity q. Views and wishes of the adult and relevant professionals/contacts/family q. Identify Risks q. Identify Actions q. Appoint a person to contact the client if not in attendance q. Organise Review Date and Contingency plan The VARM meeting will develop the VARM Action Plan to see what options are available for encouraging engagement with the Adult.

VARM Support Planning Meeting Record The Support Planning Meeting will be completed fully and circulated as soon as reasonably possible to all interested parties including the GP. This ensures that all involved in supporting the adult have access to the action plan and agreed actions within it. Individual Agencies will ensure that this information is held on the person’s record. Actions agreed at the VARM need to be initiated immediately by partner agencies and must not rely on the minutes being distributed.

Having established a ‘Support Plan’, the adult at risks’ resistance to engagement should be tested by; the introduction of the ‘Support Plan’ by; the person or the agency most likely to succeed This would have been decided at the ‘Support Planning Meeting’

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. 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/consideration.

Independent Review Process Given the risk often inherent in the situations of people where the VARM process is used, a multi-agency independent review process has been agreed. This will apply to cases where: • The VARM process has been on-going for over 6 months, and there has been no reduction in the high level of risk to the person, despite efforts by the VARM multi-agency group • The person has been referred to the VARM process more than twice in a year The purpose of the process is for a professional, independent to the VARM process, to review how it has been managed in order to identify whethere any other actions the VARM multi agency group could take to try and work with the person to reduce risks, and/or all reasonable steps have been taken to try and achieve this. Please note: the review process is not for use where any concerns have been identified about the engagement of agencies within the VARM process, please refer to the escalation guidance below.

Independent Review Process A profession will be allocated by the Review Sub-Group (with decision making authority). They will then: • Contact the Chair of the VARM meetings to obtain an overview of the person’s case and VARM process so far including previous VARM meeting minutes • Attend the next VARM meeting • Review the case from their agency perspective and provide feedback to the next VARM meeting. Feedback should include actions identified as required and reasons for these, and also good practice identified The referral form is accessible within http: //www. llradultsafeguarding. co. uk/resources/local-guidance-and-templates/ For Leicester City then email the form to LSAB@leicester. gov. uk For Leicestershire and Rutland email the form to sbbo@leics. gov. uk Any suggested actions from the reviewing professional should be discussed and steps to achieve these agreed with the agencies present at the VARM meeting. Where there any queries about the actions identified they should be identified at the VARM meeting and clarification sought from the reviewing professional.

When working with an adult under the VARM guidance, there must be agreement by all professionals involved in the case that this is no longer required before this process is closed. The main reasons for closure would be: The adult at risk is now engaging with professionals to reduce the risks The risk is reduced to a level that there is no longer a risk of significant harm or death The adult at risk is deceased

Templates to Support VARM • • • Record of Initial VARM Meeting – word version (updated April 2019) Record of Review VARM Meeting – word version (updated April 2019) Referral for VARM Independent Review Process