Emergencies and Unplanned Events

Whenever a person being supported goes into the community independently, any risk that they could go missing should be assessed, using evidence and not assumption.

See: Risk Assessment (person-centred)

Some factors that could increase the risk:

• They have a health condition that can cause confusion, memory or orientation issues;
• They have severe depression or suicidal thoughts;
• They are easily influenced by others;
• Their capacity or ability to be independent in the community fluctuates;
• They have gone missing before.

If there is a risk, an emergency plan should be developed and kept with their individual care or support plan. Wherever possible, the plan should be developed with the person. This will enable them to understand the concerns and consider the best way to reduce risks for themselves. If this is not possible, the person should still be made aware of the plan.

The plan should set out the circumstances when the police should be contacted, and anyone else that needs to be notified e.g. family members.

Depending on the person’s needs and level of risk, the plan could include the following steps:

1. Try to contact the person directly;
2. Check the building and garden to make sure that the person is not hiding/trapped anywhere;
3. Check that the person isn’t disoriented in a nearby street;
4. Try to establish if there is a logical explanation e.g., have the buses been delayed;
5. Contact family to see if the person is with them, or if they know what may have happened;
6. Find out if the person has been admitted to a local hospital;
7. Call the police to report that the person has gone missing and follow any advice given.

1. Ask the person where they are going and when they plan to be back;
2. Check they have their mobile phone and that it is charged;
3. Ask them to let you know if they are running late, or their plans change;
4. Make a note of what they are wearing.

The person doesn’t have to provide you with this information, but if they do it can help the police a great deal should they go missing.

Any information that is provided should be proportionately recorded so that you don’t have to rely on memory alone.

If you have concerns about where the person is going, discuss these with your manager. For example, you may be worried that they are meeting someone who may be exploiting them financially.

These are police protocols which have been implemented around the country for recording information around people who are at risk of going missing.

They include a range of helpful information about the person that can be used by the police when trying to locate them.

This includes:

1. A recent photograph of the person (or photographs if their appearance changes);
2. Their date of birth and age;
3. A full description of the person, including race, ethnicity, gender, height, hair colour, glasses, facial hair, scars, tattoos etc.;
4. Details of any health conditions and medication - is this time sensitive?
5. Communication needs/style;
6. Previous addresses;
7. Known contacts and their contact details (friends/family);
8. Favourite places, including places of worship;
9. Interests;
10. Travel patterns - do they use buses, trains and how far are they likely to travel?
11. Phobias and anxieties.

Whenever a person is at risk of going missing, the relevant protocol should be completed and kept with their individual care or support plan, alongside any emergency plan that has been developed.

The protocol should be reviewed and updated whenever the information changes.

Herbert protocol: use when the person has dementia

Winnie protocol: use in any other circumstances

Both protocols should be downloadable from the local police website. However, if not available the service can create its own template.

1. Remain calm;
2. Quickly locate any emergency plan relating to the situation;
3. Follow the instructions in the plan.

If there is no emergency plan, the following steps are reasonable in most cases:

1. Try to contact the person directly;
2. Check the building and garden to make sure that the person is not hiding/trapped anywhere;
3. Check that the person isn’t disoriented in a nearby street;
4. Try to establish if there is a logical explanation e.g., have the buses been delayed;
5. Contact family to see if the person is with them, or if they know what may have happened;
6. Find out if the person has been admitted to a local hospital;
7. Call the police to report that the person has gone missing and follow any advice given.

Depending on the circumstances in which the person has gone missing, there could be a legal requirement to notify the Care Quality Commission or the local authority.

For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.

A Hospital/Health passport is a document that is given to health professionals when a person is going to hospital. It supports health practitioners to quickly understand the person’s current health and social care needs, so that any necessary adjustments can be made to ensure they are met during their time in hospital.

A passport contains important information about the person, including personal details, current health conditions and the medication they are taking.

The passport also includes additional information about the support that a person normally receives, their likes and dislikes and any wishes and preferences they have about medical treatment provided to them.

For example:

• Communication style, including how to know if they are happy, upset and in discomfort/pain;
• Communication aids and techniques used;
• Known anxieties, how these are shown and how best to support the person;
• General likes and dislikes - do's and don’ts;
• Any support with mobility;
• Any support with eating and drinking, and nutritional needs e.g., allergies, special diet;
• Any support with continence.

If the person has an Attorney or a Deputy appointed to make decisions about their care or treatment, their contact details should be documented on the passport.

If the person has prepared an Advance Statement or has an Advance Decision to Refuse Treatment, this should also be clearly recorded.

Anyone with a diagnosed learning disability should always have a Hospital/Health passport, but it is good practice for everyone being supported by a social care provider to have one, especially if they lack capacity to make decisions around care or treatment, have specific communication needs or complex care needs. This will reduce the risk of miscommunication during an emergency and help ensure their needs are met and wishes upheld.

The person’s GP should be able to tell you if there is a locally developed Hospital/Health Passport template that can be used. If the person has a Community Learning Disability Nurse, they will be able to provide a template and support with the development of the passport. Alternatively, the service may develop their own.

An example template can be accessed at the Together for Short Lives website. 

Hospital/Health passports should be easily accessible in an emergency. They should also be reviewed regularly, and always when the person’s health needs or medication changes.

If the person has a Hospital/Health passport, this should always be provided.

If there is no passport, a copy of the person’s individual care or support plan should be provided.

In all cases, urgent or pertinent information should also be provided verbally - it is unlikely that the health professional will be able to read written information straight away. For example, if the person is anxious in hospitals, or if they are due an important dose of medication soon.

Any medication that the person is currently prescribed should also accompany them to hospital.

If an ambulance is called and you feel that the person will need staff support on the way to hospital and during admission, this should be communicated to the ambulance staff along with the rationale behind this. For example, if the person is very anxious and the presence of a familiar face will help reduce this anxiety and any associated risk of harm to the person or others. In most cases, your support will be welcomed but this is ultimately the decision of the ambulance personnel.

Any personal effects that the person needs or wants should be taken to them after any emergency treatment is completed. Family may do this, but if there is no informal network (or family are not available), staff may need to.

Depending on the person’s needs, they may require social care support while in hospital. For example, with eating and drinking. Legally, it is the responsibility of the NHS to provide all the support that the person needs whilst they are in their care. However, the capacity of health staff to do this is often limited. Family and friends may be willing and able to step in, but if the person has no informal networks (or they are not able to support), the registered person should contact the commissioning body to discuss whether the service can be resourced to provide this.

You should always notify anyone that the person specifically asks you to notify.

You should always notify the person’s next of kin. They will often take responsibility for notifying other family members and friends, but you should be prepared to assist with this task if the need is urgent and there are a lot of people to inform.

If the person has an Attorney or Deputy with legal responsibility for making decisions about care or treatment, they should be notified.

If the registered person was not present at the time, they should be notified and any advice that they give about staff actions required should be followed.

Any relevant professionals involved in the person’s care or treatment should also be notified, as they may need to work with health practitioners in hospital to ensure that specific needs are understood and met. For example, a Social Worker, Speech and Language Therapist, Clinical Psychologist, Clinical Psychiatrist, Physiotherapist or Dietician.

If the person has a learning disability, the local Community Learning Disability Nursing Team (or named nurse if allocated) should be notified. They can take steps to ensure that the hospital understands the needs of the person and can also monitor that these are being met.

Depending on the circumstances leading up to the unplanned hospital admission, there could be a legal requirement to notify the Care Quality Commission or the local authority. For example, if there are concerns about abuse or the police were involved.

For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.

To reduce the risk of staff shortages, the registered person should be proactive in determining the number and range of skills required in the service. The staffing level and skill mix should be reviewed continuously and adapted to changing needs and circumstances.

For further information and guidance, see Skills for Care: Guide to safe staffing.

The registered person should develop procedures to be followed in an emergency or other unplanned staffing shortage that make sure sufficient and suitable staff are deployed to cover both the emergency itself and the routine work of the service. For example, if several staff are ill at the same time, or there is an adverse weather event that means staff cannot get to work.

These procedures could include strategies such as knowing the availability and whereabouts of skilled staff, having an on-call rota, having pre-agreed contingency arrangements with the commissioning organisation, ascertaining whether temporary family support is an option in an emergency etc.

Notifying the CQC

The CQC must be notified of any event that stops the service from running safely and properly. This includes being unable to meet people’s needs safely due to staff absence. Where emergency procedures are not effective in managing a staff shortage, the CQC must be notified.

See: Events that stop a service running safely and properly.

Notifying the commissioning organisation

If any staffing level issues are anticipated, they must be brought to the attention of the local authority (or other commissioning organisation). If done in a proactive way, it may be possible for a local resolution to be found for the affected period without putting people at any risk of neglect or other harm. For example, the local authority may be able to source support from its internal provision, arrange short term support from another care provider or arrange for a person to spend time away from the service or home.

If a staff shortage means that the service is currently unable to safely meet the needs of the person that it is contracted to support, the commissioning organisation has a duty to ensure that eligible needs are met and must make alternative arrangements if it considers it necessary to do so.

Raising a safeguarding concern

If a staff shortage results in harm occurring to the person being supported, a safeguarding concern should be raised.

For further information, see: Disclosure and Raising a Concern.

Duty of candour

The duty of candour requires the service (and every individual employee) to be open, honest and transparent, including when things go wrong. If the duty of candour applies, information must be shared with the ‘relevant person’ as set out in the duty of candour process.

For guidance, see: Duty of Candour.

There should be an emergency plan setting out what staff should do in the event of a power cut.

The plan should set out any specific actions regarding care and support equipment that relies on electricity. For example, hoisting equipment, oxygen and portable equipment that requires regular charging.

The plan should include relevant telephone numbers, including the national information and advice line for power cuts (Tel: 105), the number of the electricity supplier and the number for the local authority.

All the practical things that may be needed during a power cut should be stored together and easily accessible. For example, portable heaters, torches (and batteries), hot water bottles, blankets, foil blankets, gloves, hats etc.

The Priority Services Register is a free support service offered by energy suppliers and network operators to help people in vulnerable situations.

Anyone on the register can receive advance notice of planned power cuts and priority support in an emergency. This can include the provision of emergency heating or cooking facilities.

To find out more about who is eligible to register, and how to do so see: The PSR.

First and foremost, remain calm and take time to reassure people what is happening and that everything will be back to normal soon.

The 3 biggest issues for most people will be:

1. Darkness, if it is night-time;
2. Being cold;
3. Being hungry and thirsty.

There are additional issues for staff which could include equipment failing, perishing food items etc.

Darkness

Make sure that torches are available with the right size batteries.

Being cold, hungry and thirsty

Being in a cold environment is not only unpleasant, but prolonged exposure to cold temperatures can cause hypothermia. This is potentially life threatening. Additionally, a body temperature of 95 degrees Fahrenheit or lower can cause health problems such as kidney issues, heart attacks, liver damage, particularly in older adults and those with existing health conditions.

Wherever possible, it is useful for everyone to stay in the same room. Make sure doors and windows are closed and block up any draughts. These measures will increase the overall temperature of the room.

Support people to wear blankets (including foil blankets if available), hats, scarves, gloves and extra layers of clothing to help stay warm. If cooking appliances are gas, boil saucepans to fill hot water bottles or make hot drinks. If not, check whether any local amenities, such as a local café, are open and have power - can they support with filling up flasks or hot water bottles?

If a hot meal is planned but cannot be cooked, decide whether to order warm food in from a local café or take-away. Make sure there are plenty of snacks so people can keep their energy levels up.

Equipment

Do not try to use any equipment that relies on electricity if there has been a power cut - it will not work and trying to use it could put you or the person being supported at risk.

If it is not possible to move or handle someone safely, the occupational therapy service should be contacted as a matter of urgency for support with alternative equipment or strategies.

If oxygen, or another essential medical treatment/therapy is not available, the person’s GP should be contacted. If the surgery is closed, call 101 and seek advice. Paramedics may need to attend with a backup cylinder, or the person may need to be supported for a short term in an alternative environment.  

Refrigeration

UK Power Networks state that if the doors remain closed, food should keep fine for 4-6 hours in a refrigerator and 15-24 hours in the freezer.  

Beyond this, items may start to become perishable. Do not take risks. Never use any food item when you believe that its safety for human consumption has been compromised. 

Where medication is refrigerated, the GP should be contacted for advice about using the medication prior to giving it.  

If a power cut is likely to be prolonged, the energy company or the local authority may be able to provide a backup generator.

You should contact them to explain the specific needs of the person/s being supported and any support they can provide. Local authorities have a duty under the Civil Contingencies Act 2004 to help in emergency situations.

Depending on the impact of the power cut, there could be a legal requirement to notify the Care Quality Commission.

For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.

If a care home service must temporarily close to address damage to property, the local authority must be informed.

Under the Care Act 2014, if the local authority arranged the service following a needs assessment, it must make alternative arrangements for the interim period. This is with one caveat - if the person’s family agrees to provide the required accommodation and care. To decide what is best, the local authority will liaise with the person and their family about available options.

If the local authority did not arrange the service (i.e., if the person is self-funding) the local authority is still required to offer support and may decide to exercise its statutory power to make alternative arrangements.

Depending on the impact of the event, there could be a legal requirement to notify the Care Quality Commission.

For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.