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Multi-Disciplinary Meeting when risk identified as moderate or high/critical

The multi-disciplinary meeting is an integral element of the self-neglect pathway. A multi-disciplinary meeting will be required when the risk has been identified as moderate or high/critical.

The principles for arranging a multidisciplinary meeting are to consider:

  • Capacity and consent
  • Indications of mental health issues
  • The level of risk to the adult’s physical health
  • The level of risk to their overall wellbeing
  • Risk of tenancy or mortgage breach
  • Effects on other people’s health and wellbeing
  • Serious risk of fire
  • Serious environmental risk e.g. destruction or partial destruction of accommodation
  • Support planning

Suggested membership

  • Adult at risk and their representative(s)/advocate(s)
  • County Durham and Darlington Fire and Rescue Service
  • North East Ambulance Service
  • Primary, Acute and Community Health Care Services
  • Hospital Trusts
  • Adult Social Care
  • Children’s Social Care
  • Environmental Health
  • Durham Constabulary
  • Housing
  • Care Agencies
  • Community/Voluntary Sector/ Community Networks
  • Own organisation legal services.

Guidance for a multi-disciplinary meeting:

The lead agency is responsible for convening the meeting and making arrangements such as venue, chairing and minute taking and will make arrangements to involve the individual concerned using the most appropriate agency to support them.

  • The multi-disciplinary meeting is collaboratively owned by participating agencies operating in Darlington. The meeting should be chaired by the most appropriate agency.
  • Every effort must be made to engage with the individual and to enable them to communicate their views to the meeting.
  • If the individual does not wish to attend the meeting, representatives will need to consider how their views and wishes are to be presented at the meeting e.g. by the appointment of a formal invitation extended to an informal advocate.
  • Participants from all agencies identified should attend the meeting with an understanding of their responsibilities to share relevant information in order to reach an agreement on the way forward.
  • It is important to ensure that any actions agreed comply with legislation and statutory duties. Legal representation at the meeting may need to be considered to facilitate discussions around relevant legal options. This may include application to the Court of Protection where there are concerns about mental capacity or to the High Court (Inherent Jurisdiction) where the individual is believed to be mentally capacitated.
  • An action plan should be developed and agreed by members of the meeting. Where there are disagreements about any aspects of the plan, these should be resolved by consultation with a Senior Manager from the lead agency.
  • The Chair of the multi-disciplinary meeting will ensure confirmation of timescales for implementing contingency plans, so that where there is legal and professional remedy to do so, risk is responded to and harm is reduced/prevented.
  • The Chair is not responsible for ensuring that identified action points are correctly followed up. It is the responsibility of the lead practitioner/each agency representative to ensure identified actions are implemented and followed up.

Outcomes of the meeting will include the following:

  • An action plan - including plans and escalation process
  • Agreement of monitoring and review arrangements and who will do this
  • An agreement of a communication plan with the individual or other key people involved
  • An agreement regarding which agency(s) will take the lead in the case, and
  • Agreement of any trigger points that will determine the need for an urgent multi-agency review meeting or referral to the Risk Enablement Forum (REF).

The person at the centre of the concern will be informed, irrespective of the level of their involvement to date, using a method of communication which is best suited to the individual taking into account any and all of their communication needs. It will set out what support is being offered and/or is available and providing an explanation. Should this support be declined, it is important that the individual is aware, should they change their mind about the need for support, then contacting the relevant agency at any time in the future will trigger a reassessment. Careful consideration will be given to how this written record will be given; and where possible explained to the individual.

The multi-disciplinary meeting may decide to reconvene a further meeting for the purpose of revisiting the original assessments, particularly in relation to the individual’s current functioning, risk assessments and known or potential rates of improvement or deterioration in:

  • The individual,
  • Their environment, or
  • In the capabilities of their support system.

Decision specific mental capacity assessments will have been reviewed and are shared at the meeting. Discussion will need to focus on contingency planning based upon the identified risk(s).

It may be decided to continue providing opportunities for the individual to accept support and monitor the situation. Clear timescales must be set for providing opportunities and for monitoring and who will be involved in this.

Where possible, indicators that risks may be increasing will be identified and that will trigger agreed responses from agencies, organisations or people involved in a proactive and timely way.

A further meeting date will be set at each multi-agency review until there is agreement the situation has become stable, and the risk of harm has reduced to an agreed acceptable level.

If agencies are unable to implement support or reduce risk significantly, the reasons for this will be fully recorded and maintained on the individual’s file, with a full record of the efforts and actions taken. In these circumstances, legal advice should be considered on a case by case basis.