MJ Nomination Category: Innovation in Social Care Hull Multi Agency Safeguarding Hub (MASH) Humber NHS Foundation Trust
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1 A MJ Nomination 2014 Category: Innovation in Social Care Hull Multi Agency Safeguarding Hub (MASH) Humber NHS Foundation Trust City Health Care Partnership Protecting Communities, Targeting Criminals
2 Hull Multi Agency Safeguarding Hub (MASH) Adult safeguarding has received increasing attention over the past decade, and remains a government priority (Ministerial Statement May 2011). Developing good models of safeguarding practice is of prime importance for local authorities to ensure that attempts to protect people thought to be at risk of abuse, mistreatment and neglect are effective, but do not over-protect them or deprive them of their human rights. While the government is keen to promote choice and control in adult social care, with plurality of provision, it sees adult safeguarding as part of the new vision for social care (Ministerial Statement May 2011). There is a need to consider the practice of safeguarding in local authorities following the review of No Secrets but also in the new arrangements for social care where other sectors may have greater roles in what have been traditional social services roles, such as assessment, care planning and interventions. What is evident already is that over the last two decades several different models of adult safeguarding at the level of front line practice have emerged. One of the key variations has been the degree of specialisation and particular ways in which this has been implemented. Another variable is the degree of involvement of and joint working with different agencies such as the NHS and the Police. In 2011 Hull developed a Multi-Agency Safeguarding Hub (MASH), this consists of an integrated team which represents lead agencies, these include; Social care (Adult & Children), Police, Mental Health, Fire and Rescue and Community Health Services. This service is located in one building and has the ability to access the data bases from all contributing partners. 2
3 Clearly demonstrated service outcomes with sustainable performance improvement in quality Single point of access for all safeguarding concerns and referrals providing a multi agency immediate response, reducing bureaucracy for victims, families, carers and professionals. Improved decision making process which includes adult social care and police decision makers reviewing concerns and referrals on a daily basis. This reduces risks to the individual, supports professionals and services in supporting the vulnerable adult. The decision informs a multi agency response and interim protection plan which is developed in consultation with the vulnerable adult, their family or carers as appropriate, and the professionals who know and support them. The principle no decision about me, without me is paramount. We have developed a multi agency investigation framework primarily focusing on the strengths and assets of the vulnerable adult, underpinned by the newly introduced risk enablement policy. This approach has led to a reduction in repeat victims across the city and a greater feeling of safety for people who use adult social care services as demonstrated by the Adult Social Care Outcome Framework return The integrated approach has impacted on staff moral, joint understanding of roles and responsibilities in safeguarding investigations. This has resulted in a reduction in duplication of effort with regard to safeguarding assessment including, telling their story once for victims and professionals reporting concerns or abuse. The MASH supported by the Safeguarding Adult Partnership Board has embedded safeguarding as a responsibility across all service areas and not just across adult social care. A recent example of this is agencies working together to integrate Serious Untoward investigations and safeguarding investigations which is made possible by the broad representation of professionals across the MASH. We have also introduced the concept of phone before form This actively encourages anyone to ring the MASH directly and speak to a safeguarding practitioner about the incident they have a concern about. This is in real time and the help and advice has reduced the number of inappropriate referrals, increasing efficiency and saving time and resources Three years on, the Safeguarding Adult Partnership Board has reviewed its policies and procedures to reflect the positive integrated working practices and learning to date. This has resulted in a streamlined and simplified procedure which has been reduced to 42 pages from 162. Before the MASH was created agencies charged with protecting vulnerable adults were working in isolation. They had separate accommodation across the City, separate information systems and a narrow single agency view of the risks an individual faced. The performance improvements in quality are tangible which are: integrated team in one building, reduction in front and back office support. Lastly, at the start of this development, Hull had one of the highest numbers of deaths of vulnerable people due to fire fatality. By placing a dedicated member of Fire and Rescue staff within the MASH has provided the opportunity to identify high risk vulnerable groups from social care, target interventions and in doing so reduced fire deaths to zero between 2011 and
4 Innovation in methods of delivering care and support This strategic approach has established, as a priority, the protection of vulnerable adults and children across the City. For example, providing financial abuse training to financial institutions within Hull. At the Annual Safeguarding Conference, the Office of Public Guardian presented. Following this a memorandum of understanding was agreed which enabled Hull to be a champion for Lasting Power of Attorney. The MASH has developed thresholds which supports and guides professionals and services in understanding and identifying abuse and provides information regarding signposting of concerns into the single point of access. The MASH has enabled the principles of personalisation to be embedded within a multi agency context. This ensures the vulnerable adult, their family and carers, are placed at the centre of the decision making and support process. The team is committed to ensuring the voice of the vulnerable adult and those that represent them is central to all interventions and decisions. 4
5 Sustainable long-term efficiency savings Hull has not had a fire related death in 2 years. Each death is personal tragedy and costs statutory services around 2 million. Three lives have been saved by the installation of domestic sprinkler systems in homes of vulnerable adults identified through the MASH at a saving of 6 million. Integrating agencies in a single service delivery model has made savings in the front and back office and reduced duplication of effort. Services designed around the needs of service users and carers Hull is currently engaged with two research programmes focusing on outcomes. We have reviewed the existing processes from reporting a concern, investigation and outcome meetings placing the vulnerable person at its centre. This ensures the vulnerable adult has as much control over the process and outcomes as possible. Case Study Mr F This is a serious case of Domestic Violence and financial abuse, the perpetrator is the nephew. Following investigation risks to the vulnerable person remained, because Mr F decided he did not wish to take further Police action against his nephew. Measures were put in place to reduce the risk however it was not completely eliminated. It has been reported that social workers across the country have tried to eradicate risk and impose their own solutions to the lives of those they support. The underpinning principle of the MASH is to empower the person to live their own lives whilst recognizing this may involve a level of risk. 5
6 Methods and practice that are replicable and contribute to best practice Given the importance placed on safeguarding as part of the development of good social care and other services, understanding the impact of adopting different models will be of great value for practice as well as local and national policy in this area. The Hull MASH is one of six Local Authorities to be evaluated by the Social Care Workforce Research Unit - King's College London. The MASH has been reviewed by the Home Office and Association of Chief Police (ACPO) specifically looking for good practice in multi agency working and information sharing. The Hull MASH was identified as Good Practice by this project team. The MASH has supported the development of an outcome meeting framework which is chaired by an independent professional and seeks to facilitate a clear and agreed decision along with the vulnerable adult as to whether abuse or neglect has occurred. The outcome meeting develops and agrees a protection plan which recognises and builds on the strengths and assets of the vulnerable adult along with the people who support them. Police colleagues presented at a national criminal justice conference in Aylesbury regarding the benefits of the MASH. 6
7 Case Study - Kathleen Just under five weeks after being fitted, a domestic sprinkler system installed in the home of Kathleen, an 81 year old woman, is believed to have saved her life after it activated due to an over-heating chip pan. At 11.16pm on bank holiday Monday May 7th, Humberside Fire and Rescue Service received a call from Lifeline informing them of minor internal flooding to a house in Spring Bank, Hull, due to a domestic sprinkler system operating. On arrival, the attending officer established that the cause had been due to a chip pan being left unattended and the sprinkler had done exactly what it is designed to and had prevented a fire from developing. Daryl Oprey, Head of Safety, from Humberside Fire and Rescue Service, who also attended the house said: "We have been working in partnership for some time in order to provide sprinklers to those most at risk from fire. Whilst it is always bad news when anyone has a fire, I am delighted that Kathleen has remained safe as a result of having the sprinkler system. Having encountered many similar situations in my 27 years of service, I know that the oil in this chip pan was very close to igniting. However, the sprinkler did what it should and suppressed any fire, ensuring that the occupier was safe also causing minimal damage to the room and house." Hull Daily Mail 12th May
8 A culture of quality and continuous improvement Integrating staff from a range of agencies has enabled staff to access agency data systems, sharing information has been crucial in being able to target interventions and understand outcomes across a range of front line services. The Acute Trust locally has recognized the value of an integrated approach across safeguarding and is currently planning to transfer a staff member into the team. The MASH along with Hull Safeguarding Adult Board has developed a local threshold tool which supports a consistent approach to identifying abuse and provides guidance with regard to the level and severity of abuse and risk and how best to manage this. The implementation of the threshold tool has reduced the amount of inappropriate referrals into the team and enabled resources to be targeted to those at most risk. The threshold tool has also developed a more inclusive culture of protection across community services promoting the principle that safeguarding is everyone s business 8
9 Collaborative working with partners, third party providers and commissioners The Safeguarding Adult Partnership Board has consulted vulnerable people and people who support them, partners and providers on the effectiveness of the MASH hosting 4 stakeholder events for 256 people. The outcome has been very positive with specific feedback on the phone before form and people feeling that personal contact and access to immediate support are much improved from the previous model. The phone before form actively encourages anyone to ring the MASH directly and speak to a safeguarding practitioner about the incident they have a concern about. This is in real time; providing help and advice, including next steps and protection planning if appropriate. The model has been endorsed by the Care Quality Commission as it provides a transparent and consistent approach across a diverse provider community e.g. acute hospital, residential care and community services. 9
10 MJ Nomination 2014 Category: Innovation in Social Care thank you for reading our submission Humber NHS Foundation Trust City Health Care Partnership Protecting Communities, Targeting Criminals
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