Milton Keynes Adults Safeguarding Board Annual Report 2016/17

Transcription

1 Milton Keynes Adults Safeguarding Board Annual Report 2016/17 Safe, well, cared for together we can make a difference Safe and well cared for together we can make a difference Page 1 of 53

2 Contents Introduction to the 2016/17 annual report 3 Foreword 4 What is safeguarding adults? 5 Making Safeguarding Personal 8 Introduction to Milton Keynes Safeguarding Adults Board 9 Case studies 10 Safeguarding in numbers 12 What have we done in our safeguarding strategy to help and protect adults? 13 What has each partner organisation done to contribute? 16 What has each subgroup done? 34 So how did we do? A summary of 2016/17 41 What will we do? Looking forward what are our priorities? 42 Training 43 Appendix A MKSAB representatives and attendance 45 Appendix B MKSAB budget 46 Appendix C Milton Keynes safeguarding adults performance 47 Acronyms 52 Your comments 53 Page Where to go for help If you have a concern about an adult at risk of abuse and they are in immediate danger you should contact the relevant emergency services by ringing 999. If the adult you are concerned about is not in immediate danger you should report your concern by completing an Adult Safeguarding Alert. If you know or believe a crime has been committed you should also contact the Police. If you are not sure whether abuse is happening you can telephone the Access to Adult Health and Social Care Team to discuss your concerns. Contacts: Safeguarding Adults Monday to Friday from 8:30am to 5:00pm T: In an emergency, outside of these hours (& Bank Holidays) T: E: ascat@milton-keynes.gov.uk Safe and well cared for together we can make a difference Page 2 of 53

3 Introduction to the 2016/17 annual report Milton Keynes Safeguarding Adults Board is required by law, under the Care Act 2014, to produce an annual report. The report must set out what we have done during the last year to help and protect adults at risk of abuse and neglect in Milton Keynes, as well as areas for development. Safe and well cared for together we can make a difference Page 3 of 53

4 Foreword This is my first full year annual report as the Independent Chair of Milton Keynes Safeguarding Adults Board, and I am proud to present it. The Board has developed steadily over the last year, with the work of the subgroups being both constructive and supportive of the Board s objectives. We have worked hard to consolidate the Board s work programme, to build on the excellent first couple of years, and to become a Board which ensures that the key safeguarding priorities for Milton Keynes are properly delivered, well-co-ordinated, and their effectiveness properly understood and assured in a clear, constructive and appropriately challenging way. The hard work and energy has been impressive all year. This has been against a background of reduced resources, increasing demands and significant system change, not least for NHS partners. As a Board we have maintained an overview of these issues, we have done some good work developing guidance on identifying and responding to Modern Slavery, and raised expectations in relation to effective management of Deprivation of Liberty Safeguards and Mental Capacity assessments. We have reviewed how well we are ensuring practice reflects the Making Safeguarding Personal standards, and we have completed our first Safeguarding Adults Review, applying the learning to a range of practice changes. The major changes to the way the Board functions in 2017/18 will provide exciting opportunities to build on, further consolidate and strengthen what we are doing, and ensure we rapidly become a highly effective Board. This also means we will complement the work of partner colleagues on the Health and Wellbeing Board and the SaferMK Board, avoid duplication, and focus on the core functions of performance and quality assurance, system intelligence, supporting service co-ordination, service design, development and commissioning, learn from practice in order to improve continuously, and develop a high quality safeguarding workforce. I am proud to be a part of the Milton Keynes system of support to adults at risk, and to have the privilege of leading the adult safeguarding arrangements. Thank you to everyone for all you have done in 2016/17 and for what I know you will achieve in 2017/18. Jane Held Independent Chair September 2017 Safe and well cared for together we can make a difference Page 4 of 53

5 What is safeguarding adults? Safeguarding means protecting an adult s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult s wellbeing is promoted. Safeguarding duties apply to an adult who: Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect. Provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult. Address what has caused the abuse or neglect. Has needs for care and support (whether or not the local authority is meeting any of those needs); Is experiencing, or at risk of, abuse or neglect; As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse or neglect. The aims of adult safeguarding are to: Prevent harm and reduce the risk of abuse or neglect to adults with care and support needs. Stop abuse or neglect wherever possible. Safeguard adults in a way that supports them in making choices and having control about how they want to live. Promote an approach that concentrates on improving life for the adults concerned. Safe and well cared for together we can make a difference Page 5 of 53

6 What constitutes abuse and neglect? Abuse can happen anywhere, for example, in someone s own home, in a public place, in hospital, in a care home, or in college. It can take place when an adult lives alone or with others. Abuse can take many forms including: Physical abuse; Domestic violence; Sexual abuse; Psychological abuse; Financial or material abuse; Modern slavery; Discriminatory abuse; Organisational abuse; Neglect and acts of omission; Self-neglect. Paid staff or professionals and volunteers; Strangers. Local authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult who meets the criteria, or is at risk of, being abused or neglected. An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place. Anyone can perpetrate abuse or neglect, including: Spouses/partners; Other family members; Neighbours; Friends; Acquaintances; Local residents; People who deliberately exploit adults they perceive as vulnerable to abuse; Safe and well cared for together we can make a difference Page 6 of 53

7 Six key principles underpin all adult safeguarding work: Key Principle Description What this means to people who live in Milton Keynes Empowerment People are supported and encouraged to make their own decisions and give informed consent. I am asked what I want as an outcome from the support I get and safeguarding process that takes place, and what I want directly informs what happens. Prevention It is better to act before harm occurs. I get clear simple information about what abuse is, how to recognise the signs and what I can do to get help. Proportionality Protection Partnership Accountability The least intrusive response possible that meets the risk presented appropriately. Support and protection for those in greatest need. Local solutions through services and communities working together. Communities can play their part in preventing, detecting and reporting abuse and neglect. Accountability and transparency in delivering safeguarding. I know professionals will only get involved as much as they need to, they will work in my best interest and listen to my view of the risks I face. I get help and support to report abuse and neglect, to get the abuse to stop, to take actions myself where possible and to take part in my own protection plans and action much as I want to. I am confident staff will treat my information sensitively and only share what they have to. I am confident that professionals will work together with me to get the best results for me. I understand the role of everyone involved in my life and so do they. Safe and well cared for together we can make a difference Page 7 of 53

8 Making Safeguarding Personal In addition to the six key principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised. Making Safeguarding Personal means it should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving their quality of life, wellbeing and safety. 2016/17 update MKC Adult Social Care has begun the process of embedding Making Safeguarding Personal into its processes. We have added questions to the safeguarding alert form to remind the person completing the form to consider and record the individual at risk s views. If the alert is screened for further enquiries then the worker is required to reflect the views of the individual at risk throughout the process. Making Safeguarding Personal aims to put the individual or their representative at the heart of an enquiry. It is not about consent as there could be wider concerns. For this reason it has been a complex process to introduce. Information in this section has been taken from Safeguarding section 14 of the Care Act To read the document in its entirety please go to: Safe and well cared for together we can make a difference Page 8 of 53

9 Introduction to Milton Keynes Safeguarding Adults Board The main objective of a Safeguarding Adults Board (SAB) is to assure itself that local safeguarding arrangements and partners act to help and protect adults in its area who meet the criteria. A SAB has a strategic role; it oversees and leads adult safeguarding across the locality and will be interested in a range of matters that contribute to the prevention of abuse and neglect. A SAB has three core duties: It must publish a strategic plan for each financial year that sets how it will meet its main objective and what the members will do to achieve this. The plan must be developed with local community involvement, and the SAB must consult the local Healthwatch organisation. Milton Keynes Safeguarding Adults Board (MKSAB) meets quarterly. It is a multi-agency group and its core members are Milton Keynes Council, Milton Keynes Clinical Commissioning Group, and Thames Valley Police. Other members include the National Probation Service, Thames Valley Communication Rehabilitation Company, Buckinghamshire Fire and Rescue Service, South Central Ambulance Service NHS Foundation Trust, Milton Keynes University Hospital NHS Foundation Trust, Central and North West London NHS Foundation Trust, and members representing service users and carers. A full list of Board members and attendance can be found at Appendix A. Details of the MKSAB budget can be found at Appendix B. MKSAB is supported by five subgroups which carry out the day-today work in order to help deliver the strategic plan. Organisation of MKSAB 2016/17 It must publish an annual report detailing what it has done during the year to achieve its main objective and implement its strategic plan, and what each member has done to implement the strategy as well as detailing the findings of any safeguarding adults reviews (SARs) and subsequent action. Milton Keynes Safeguarding Adults Board Subgroup Chairs It must conduct any SAR in accordance with Section 44 of the Care Act Communications & Engagement Subgroup Mental Capacity Act & Deprivation of Liberty Safeguards Subgroup Quality Assurance Subgroup Safeguarding Adults Review Subgroup Training, Education & Development Subgroup Safe and well cared for together we can make a difference Page 9 of 53

10 Case Study 1 Financial Abuse A safeguarding alert was raised due to concerns about possible financial abuse. The concerns raised were around how the adult at risk s son managed her money, and about him not seeming to buy food or clothes for his mother. There were also concerns that there were money transfers from her account to her son s, which didn t seem to link to bill payments. These totalled 2,100 and he stated they were to pay off his debts. He stated, Mum wanted to help out, bless her. He stated he had Power of Attorney and was able to do this. Advice was sought and the Police were notified of these concerns. The adult at risk was spoken to about the money her son had taken from her bank account. She said she had never given her permission, and was worried about her finances. She was reassured and advised that support would be offered to her. As a result of the investigation, clothes and shopping are now being provided to the adult at risk via Adult Social Care. This investigation is currently sat with the Police as they are collating information to establish whether the adult at risk s son has broken the law. Case Study 2 Domestic Abuse Report received from Thames Valley Police a woman reported an assault on her grandmother. The adult at risk and her husband are both 85 years old. The adult at risk has recently been diagnosed with dementia and has slight memory issues. Her granddaughter arrived to take her out and noticed she had a bruise on her face. The adult at risk stated she has been punched in the face by her husband. The adult at risk was removed from the property and went to reside with her granddaughter. Due to their vulnerabilities, the Police ensured she had taken all her mobility aids and medications etc. with her, and completed a welfare check on her husband. Her husband informed officers that he had taken an overdose of prescription medication, and he was taken to hospital as a precaution. Neither party would provide statements to the Police, nor were there any witnesses. A social worker was allocated to the case. The adult at risk did not want to return home, and the property she was in with her granddaughter was deemed unsuitable being as she struggled to get to the bathroom or use her walker in the house. The social worker supported the adult at risk to explore her wishes and options. She is currently in residential care. She has settled in well, she hasn t asked about her husband, nor has he visited her, but her family have been to see her. Safe and well cared for together we can make a difference Page 10 of 53

11 Case Study 3 Self-Neglect We received both an ambulance alert and a safeguarding alert stating that this person was not looking after himself at home, and was at risk of serious and enduring self-neglect caused by alcohol abuse. He was admitted to hospital. The outcome was that the Access Team worked with Housing and the person concerned to address any debts, health concerns, and property maintenance. This resulted in the team being able to work with this person for a whole year, which meant the adult at risk s property has improved, and he is no longer at risk of immediate eviction. Case Study 4 Modern Slavery We received an alert from a person wanting support to retrieve his documents from his employer. This person was not classed as an adult at risk as defined by the Care Act 2014, as he has no care and support needs, but we still shared this information with SaferMK and the Police, who then supported him to get his documents back. This was a potential modern slavery case that community policing were made aware of, so that they could follow up any concerns. Modern Slavery Task and Finish Group Milton Keynes Safeguarding Adults Board instructed a working group to undertake a piece of work to ensure we were fulfilling our duties under the Modern Slavery Act Through their research the group were also able to complete a corporate statement to support Milton Keynes Council in meeting its statutory requirements. The group was multi-disciplinary including partners from Thames Valley Police, Milton Keynes Clinical Commissioning Group, Milton Keynes Council (Children s Services, Adult Social Care and Policy & Performance), SaferMK, and Milton Keynes University Hospital. Every organisation carrying on a business in the UK with a total annual turnover of 36m or more is required to produce a slavery and human trafficking statement for each financial year. The statement must outline the steps taken to ensure modern slavery is not occurring within their supply chains, or within their own organisation. The offences encapsulated in the Act are slavery, servitude and enforced or compulsory labour, and human trafficking. The group achieved two outcomes; first that a Modern Slavery organisational statement was developed; second that a pathway for referrals into the Safeguarding Adults Team was agreed. A program of training will be implemented throughout the coming year to support adherence to the Act. Safe and well cared for together we can make a difference Page 11 of 53

12 Safeguarding in numbers In Milton Keynes in 2016/17: We received 2795 concerns that someone was at risk of abuse. 7% more than last year. 31% of the concerns we took action on were regarding neglect and acts of omission, whilst 20% were regarding physical abuse. 44% of abuse took place in the adult s own home. 21% of abuse took place in a residential care home. 2% of abuse took place in a public place. 70% of abuse was against people from a white British background. 63% of abuse was against people aged % of the concerns we took action on proved abuse did (or probably did) take place. 26% proved abuse didn t happen. 319 reported incidents of abuse needed us to take action under safeguarding. 55% of abuse was against women. 45% of abuse was against men. Like last year, the figures show that more abuse takes place against women than against men however, the figures also show a 10% decrease for women (compared to 65% last year), but a 10% increase for men (compared to 35% last year). 26% less than last year. These figures have been taken from the annual safeguarding performance information. The full report can be found at Appendix C. Safe and well cared for together we can make a difference Page 12 of 53

13 Our strategic goal is: What have we done in our safeguarding strategy to help and protect adults? TO WORK COLLECTIVELY AND WITH COMMON PURPOSE, WISELY AND EFFECTIVELY, TO MAKE SURE THE PEOPLE OF MILTON KEYNES ARE AS WELL SUPPORTED AND PROTECTED FROM NEGLECT, ABUSE AND EXPLOITATION AS POSSIBLE. Our current strategic plan runs from 2016 to 2019, and sets out our four strategic priorities to help and protect people in Milton Keynes. These objectives are as follows: Our priority This means By 2019 this will look like Governance, leadership, assurance and system accountability A strong well led Board with explicit governance arrangements. Senior leaders working together on the Board. A Board which assured by the quality of safeguarding in Milton Keynes. A Board which is transparent, and accountable to the people of Milton Keynes. A golden thread of accountability from the Board to frontline professionals and across all strategic partnerships. A public website reporting transparently on the work of the Board. The Board s impact on practice is making a demonstrable difference to people s lives. Collective responsibility for influencing the Health & Wellbeing Board and commissioners. Effective assurance to the Board about how services are designed and delivered and how collective resources are used. All frontline staff understand their Safe and well cared for together we can make a difference Page 13 of 53

14 Partnership rationalisation Practice improvement, and effectiveness The right number of partnership boards and bodies in Milton Keynes. A clear relationship between those partnership boards. A cradle to grave approach to safeguarding practice (whole family, whole community, all age models of practice). Clear leadership of cross cutting priorities, work-streams and workforce development. Effective use of scarce resources. The avoidance of duplication. A shared workforce development programme. Common workforce practice standards. High quality performance management and quality assurance work. Learning from what we do well, not so well and get wrong. We are working to improve through understanding how well we are doing and what difference we are making. accountabilities, professional and practice standards and what to do when they are concerned about an individual. Joint effort put into shared priorities. Clear responsibilities for specific priorities. Effective use of limited capacity, and financial resources. A whole city approach to improving the lives of those who live in Milton Keynes. Statutory functions are fulfilled properly and structures are minimised. ONE MK focussed on its people not its services. Confident competent staff supporting vulnerable people. A shared language, shared behaviours, shared values and principles. High quality practice meeting all six principles well. Making a real difference to people s lives, welfare, safety and outcomes. Safe and well cared for together we can make a difference Page 14 of 53

15 Stakeholder engagement and capacity building The Board has community and lay representatives supporting it. The Board has lay and stakeholder contributions to all its work streams. We work with specific communities of interest and stakeholders on specific issues and areas on concern. We recognise the different values and priorities of different communities. Communities can play their part in preventing, detecting and reporting abuse and neglect. We do nothing for people without involving them. Our communities are active partners in our work. Communities know and understand about adult safeguarding and know what to do if they are worried. We know what it is like to be supported and safeguarded. The Board s work is inclusive and all adults get equal advice, care and support. The Board champions practice that does not discriminate and is alert to perverse consequences from well-meaning decisions. Safe and well cared for together we can make a difference Page 15 of 53

16 What has each partner organisation done to contribute? MILTON KEYNES COUNCIL ADULT SOCIAL CARE (CORE MEMBER) We provide information and advice, short term support to help people stay independent, and longer term support for people with more complex needs. The Care Act 2014 sets out the legal framework for how local authorities should protect adults at risk of abuse or neglect. Our Safeguarding Adults Team has the lead responsibility for making enquiries, or to request others to make them when they think an adult with care and support needs may be at risk of abuse or neglect, and they need to find out what action may be needed. What have we done? In January 2017 the Safeguarding Adults Team joined the successful Multi-Agency Safeguarding Hub (MASH). Work is now continuing to build on the co-location to develop our working practices across safeguarding adults and children and colleagues in the NHS and Police. We have developed a new on-line alert tool for professionals, and this has improved our response time in terms of responding to alerts. In 2016/17 there was a particular focus on safeguarding concerns in care homes in Milton Keynes and we have seen a number of suspensions and one home closure. Milton Keynes Council (MKC) Adult Services Safeguarding Adults Team and the Contract Monitoring Team have worked with Milton Keynes Clinical Commissioning Group, the Care Quality Commission and when necessary, Thames Valley Police, both to safeguard residents when necessary, and to support care homes to improve care and quality. We reviewed the DoLS service and invested significantly to ensure that we manage the applications in a timely way. We have continued to transform our Learning Disability Service following public consultation in 2015/16. Our Short Breaks Service now provides to people with profound and multiple learning disabilities and people who have behaviours of concern. We worked closely with service users and their family carers who were accessing short breaks to identify creative choices for alternative support. We have worked with the British Institute of Learning Disabilities to introduce Positive Behaviour Support (PBS). All Joint Learning Disability staff have received PBS training alongside staff from the private and voluntary sector. The train the trainer model has continued throughout the year and been further developed with the introduction of the City and Guilds accredited Certificate in Education and Training now being offered with specific reference to safeguarding adults. Safe and well cared for together we can make a difference Page 16 of 53

17 How well have we done it what difference have we made? We have authorised 735 DoLS. This means that we ensured that the level of care these people were receiving in either care homes or hospital was in their best interests. If not we have worked with people and their families to ensure other ways to support people in the least restrictive ways are found. We continued to support most people in their own homes. Numbers of older people moving into care homes fell by 30% in 2016/17. We will work more closely with care homes to make sure everyone who should have a DoLS authorisation has one in place. We will implement Making Safeguarding Personal, which focuses on achieving meaningful improvement to people s circumstances rather than just an investigation. We will strengthen the way we manage safeguarding referrals through more effective and efficient processes by developing a single front door process. We have invested in our services supporting people coming out of hospital, and social care delays in hospital discharge have fallen significantly in the last year making sure people get home or to the most suitable destination to meet their needs as quickly as possible. Next steps We are going to audit our response to safeguarding alerts to find out if we are consistent and using the right thresholds to determine whether an alert needs to progress to a Section 42 enquiry. We will be reviewing our safeguarding thresholds for enquiries and working with colleagues to improve the quality of alerts. We will embed robust processes to ensure Deprivation of Liberty Assessments are completed in a timely way. Safe and well cared for together we can make a difference Page 17 of 53

18 MILTON KEYNES CLINICAL COMMISSIONING GROUP (CORE MEMBER) The Clinical Commissioning Group (CCG) is the clinically-led statutory NHS body responsible for the planning and commissioning of health care services in Milton Keynes. The CCG has responsibilities to continually seek to improve the quality of care. The CCG safeguarding duties include ensuring safeguarding is integral to all our commissioning functions; assuring and supporting commissioned services to deliver effective safeguarding practice, and work with our partnership in accordance with the Care Act The NHS commissioning landscape is complex. Though CCGs commission the majority of health care services, some parts of the health system are commissioned by NHS England, for example, Primary Care, secure psychiatric inpatient provision, and inpatient Child and Adolescent Mental Health Services. Public Health also commission some health services, for example, health visiting, school nursing, sexual health, and substance misuse services. The CCG Safeguarding Team works to ensure a cohesive approach to safeguarding with partners, providers, commissioners and our safeguarding networks. What have we done? The following offers highlights of the work carried out by the CCG during 2016/17: The CCG Safeguarding Adults Lead chaired the MKSAB Quality Assurance subgroup the work of this group is referenced elsewhere in this report. The CCG has also been an active member of the Safeguarding Adults Review, Training, Education and Development, and DoLS/Mental Capacity Act (MCA) subgroups. The CCG has worked with the partnership as it develops the newly integrated model for safeguarding under Milton Keynes (MK) Together. MKCCG will be a core member of the new Board and its programmes of work. The CCG has worked through the MASH Board to extend the MASH to Safeguarding Adults. The CCG Care Home Quality Monitoring Nurse will be providing weekly input to the MASH. The CCG worked with providers and MKC to improve the quality of care in nursing homes and domiciliary care providers. The CCG has worked with commissioned services across the year to assure and support their safeguarding arrangements and compliance with MCA and DoLS. The CCG Primary Care Nurse and Named GP worked to support Primary Care s role in safeguarding. This included a joint safeguarding event attended by over 200 Primary Care Safe and well cared for together we can make a difference Page 18 of 53

19 staff. This supplements forums for practice leads, guidance, and a quarterly newsletter. The Designated Nurse for Safeguarding also developed and implemented a primary care safeguarding children IT template, which will be extended to safeguarding adults. The CCG took part in the NHS England pilot of a safeguarding self-assessment framework. MKCCG s selfassessment against the assurance tool was 93% as green and the remaining 7% as amber. The amber ratings related to capacity within the CCG s safeguarding team and improving training rates of CCG staff. The CCG is implementing the Transforming Care programme - acting on learning from Winterbourne View. The CCG has developed processes for National Learning Disability Mortality Review this will be rolled out in 2017/18. How well have we done it what difference have we made? Transforming Care Milton Keynes continues to meet and exceed its NHS England trajectories for moving people with a learning disability out of hospital. This means people who had been in long term hospital care are cared for in community settings. The CCG has supported the Council s work with the British Institute of Learning Disabilities, and the roll out of PBS training for Joint Learning Disability Service and provider organisations. There have been no new admissions to hospitals since December 2015, and none of the people who have been discharged have been readmitted. Joint work with Police The Police investigation of a care home benefitted from the involvement of CCG nurses. This enabled the Police to gather evidence to support a decision about prosecution. Learning from safeguarding cases led to the Designated Adult Safeguarding Manager (DASM) producing guidance on when to involve the Police in safeguarding matters. There is evidence that referrals from care homes to the Police has increased. Primary Care Work with Primary Care has improved knowledge and supporting systems within GP practices. Comments from practices include: They are a good team. I recently had to do a chronology which I have never done before, but the PCSSN was so helpful and sat with me for a good few hours to help me complete it. I definitely have a better understanding of safeguarding. The swift advice provided by the Primary Care Safeguarding Nurse and Named GP was excellent. Not only did I have a clearer idea of Safe and well cared for together we can make a difference Page 19 of 53

20 how to proceed with my patient, I also felt confident that no one was at risk and that I had good support from the safeguarding team. I was given some good tips and also had follow up s to ensure I was still doing the right thing for my patient. Great keep up the good work! Care Homes and Domiciliary Care Introducing root cause analysis for pressure sores has empowered care providers to critically evaluate care delivery enabling learning opportunities and identify any improvements that need to be made. This is overseen by the MKC Safeguarding Adults Team and the CCG Quality Monitoring Nurse. Monitoring visits by the CCG to oversee safeguarding have strengthened the safeguarding processes that providers have in place. The joint work between the CCG and MKC has resulted in some improvements in record keeping and the numbers of safeguarding investigations that providers have been able to complete. Next steps Work with the integrated Milton Keynes Safeguarding Board and across the Sustaining Transformation Plan footprint to make the most effective use of resources. Work with our providers, commissioners and partners to ensure our work is informed by the views of adults. Formalise the governance of safeguarding assurance for Primary Care as part of the CCG s wider delegated commissioning arrangements. Build on the quality of care for people with Learning Disability through our Transforming Care plan, introducing the national Learning Disability Mortality Review process and increasing numbers of annual health check. Introduce a multi-agency approach to self-neglect for nonengaging capacitous adults. Extend the SystmOne safeguarding template to adults. The CCG worked with the Coroner s office to contribute to the care homes newsletter on the coroner s involvement where a person who has a DoLS authorisation dies. We also provided guidance on use of covert medication so that people who lack capacity have their rights protected. Safe and well cared for together we can make a difference Page 20 of 53

21 THAMES VALLEY POLICE (CORE MEMBER) Thames Valley Police (TVP) is the largest non-metropolitan police force in England and Wales. We police the counties of Berkshire, Buckinghamshire and Oxfordshire, serving a diverse population of more than two million, plus the six million visitors who come to Thames Valley each year. The TVP force area is divided up into 12 Local Policing Areas (LPAs): Aylesbury Vale Chiltern and South Buckinghamshire Milton Keynes Wycombe Bracknell and Wokingham Reading Slough Windsor and Maidenhead West Berkshire Cherwell and West Oxfordshire Oxford South Oxfordshire and the Vale of White Horse We are committed to working together to make our communities safer. We will do this by preventing and thoroughly investigating crime, supporting victims, and bringing offenders to justice. With our people, public and partners we will build stronger, more resilient communities, and will provide a modern police force which meets the needs of the public we serve. View the full Force Commitment for more information. The Police and Crime Commissioner has published the full Police and Crime Plan for Thames Valley, which outlines the priorities for the area and how we will work with partners to achieve them. View the full Police and Crime Plan and the Thames Valley Police Delivery Plan for more information. We aim to: Cut crimes that are of most concern to the community. Increase the visible presence of the Police. Protect our communities from the most serious harm. Improve communication with the public in order to build trust and confidence within our communities. Tackle bureaucracy and develop the professional skills of all staff. Reduce costs and protect the front line. To foster the trust and confidence of our community, we will: Take pride in delivering a high-quality service and keeping our promises. Engage, listen and respond. Learn from experience and always seek to improve. LPA Teams are responsible for response and deployment, community engagement, problem solving, early help, anti-social behaviour, hate crime, gangs and problem crime groups, Multi- Safe and well cared for together we can make a difference Page 21 of 53

22 Agency Public Protection Arrangements (MAPPA), and mental health. The Protecting Vulnerable People Team take care of investigations into child abuse, domestic abuse, vulnerable adults, missing people and the management of violent and sexual offenders. What have we done? Continued contribution to the Safeguarding Board, transition to MK Together Model, and sub-committees; Full contribution to SAR reviews, both preparation, recommendations and publication; Single agency SaVE (Safeguarding, Vulnerability, Exploitation) programme rolled out for front line staff, specialists, and senior leaders. Focusing on hidden harm for those most vulnerable in the community (adults and children). Collaborative work with SaferMK to raise awareness of domestic abuse. Training was given to around 200 professionals and included the hard hitting performance from Alter Ego named Behind Closed Doors. A plenary session was also added to discuss issues raised. Domestic Abuse Champions launched; The LPA and SaferMK jointly funding a Community Safety Officer; Introduction of Hate Crime Champions initiative to increase reporting and safeguard vulnerable individuals from diverse communities; New Operation Model implemented. The investigative hub has been specifically designed to increase our safeguarding capabilities by providing improved response to those with greatest need; Continued mental health triage and new health care worker (funded by Central and North West London NHS Foundation Trust - CNWL) in custody; Through care home investigation, we have enhanced knowledge/experience and expertise in Care Act legislation; Continued leadership in the Multi-Agency Risk Assessment Conference (MARAC) process, reviewing in partnership 231 cases from April 2016-March 2017; Supporting Adult Social Care into the MASH. Safe and well cared for together we can make a difference Page 22 of 53

23 How well have we done it - what difference have we made? Feedback from training has been positive and raised awareness across our teams about the importance of working together to achieve positive outcomes of vulnerable people. It was felt that training required a Subject Matter Expert to add value to our training. This has been facilitated for phase two of the training package. Next steps The New Command Team on the LPA and PVP need to imbed and become integral to the Safeguarding Board structure by understanding and contributing to the priorities set. All other initiatives are recent and will need to be reviewed to determine how good they are and what difference has been made as a result. Safe and well cared for together we can make a difference Page 23 of 53

24 Here follows a selection of reports from the wider SAB membership. BUCKINGHAMSHIRE FIRE AND RESCUE SERVICE Over the past decade the Fire & Rescue Service, nationally and locally, has been successful in reducing overall incidents and subsequent injuries to members of the public. In order to maintain this reduction, the Fire Service has identified the main causes of fire and appreciates that it must collaborate closely with partners to improve these factors e.g. the elderly are statistically more at risk from fire, as are those who are socially isolated, or who have alcohol or drug issues. Whilst working with partners to support a wider prevention agenda, reducing the causes and impact of fire remains at the core of Fire Service activities. The Fire Service seeks to add value to the work of others, and uses its position as an organisation which is trusted by the public to support access to those communities at risk and support safeguarding of adults and young people. What have we done? The Fire Service has altered its delivery model. Prevention work used to be delivered by a dedicated central team, but this has been replaced by a much smaller central team who support station-based, operational staff to deliver this work as part of their core activities. The nature of the Prevention work has also changed. Home Fire Risk Checks are still delivered to those members of the public requesting them. Along with legislative changes and national safety campaigns, this has resulted nationally in over 92% of households having smoke detectors. However, the operational staff have started to work differently. Those people who become non-ambulant are at greater risk from fire, and so crews have worked with the NHS in Milton Keynes to gain a better understanding of falls prevention, and how to refer those at risk from falling to the relevant organisations. The intention is to change the Home Fire Risk Checks to Safe and Well Visits to recognise the added value operational staff can deliver whilst being in somebody s home. This supports the Making Every Contact Count approach and the wider safeguarding agenda. This process will evolve as more partners work with us to identify the most appropriate care pathways. We will also use our data to target those we feel are most at risk from fire as we know that those people are much more likely to have complex needs. Our frontline staff are now all dementia aware, and have all been subject to the Disclosure and Barring Scheme to reassure the public and our partner organisations. The Fire Service has always worked with young people and will continue to support activities encouraging people to increase their physical activity and nutritional awareness. We also run courses aimed at supporting self-esteem, Safe and well cared for together we can make a difference Page 24 of 53

25 school attendance, and so on. We work closely with schools and colleges who identify those young people we can best support in their transition to becoming adults. One relatively new course is aimed at those young people who are moving from living in care, to independent living. Working closely with MKC, young people are identified and asked to attend a two-day programme at a Milton Keynes fire station. During their time there, they will work with the operational crews to undertake some basic DIY skills, financial management advice, basic food preparation and cooking skills, and any other elements relevant to that specific group, all to support them in maintaining their tenancies. How well have we done it what difference have we made? Traditionally we have not been efficient at evaluating our progress, but we are working to address this. We have asked for feedback from young people and teachers on our courses, which improves the delivery of future courses. However, we know we need to do more and we are working with national Fire Service bodies to identify best practice. We are also seeking support from academic organisations to provide more robust scrutiny for this work. with other organisations, and so we are working on this specific aspect. Next steps Use our data to improve our use of resources in targeting those at risk from fire. Share data with partners to create a greater understanding of societal risk to support safeguarding adults. Work with partners to reduce overall risk through effective joint working, joint intervention visits etc. Create evaluation tools to prove improvements and risk reduction. Evolve the Safe and Well processes to incorporate more information, further staff training, and better understand referral pathways to support partners and to ultimately make people safer. We feel we make a difference, but we cannot always prove it. By using our data in a more analytical way we can start to evaluate whether our activities improve outcomes based on predictive data, but this could be improved further by more effective data sharing Safe and well cared for together we can make a difference Page 25 of 53

26 CENTRAL & NORTH WEST LONDON NHS FOUNDATION TRUST Central and Northwest London (CNWL) NHS Foundation Trust provides Community Health services and Mental Health services in Milton Keynes. The Community Health services provide a wide range of services for children and adults with physical health problems in Milton Keynes. Services include Community Nursing, Universal Children s Services, Podiatry, Intermediate Care, Dental Services and Specialist Therapies ranging from Speech and Language to Neurological Rehabilitation. The Mental Health services provide acute mental health, older adult and rehabilitation in-patient services alongside a variety of community-based services, which support, care and treat people with a wide range of mental disorders. The teams within these services are supported by the Trust s local safeguarding team to deliver their safeguarding responsibilities to both adults and children. What we have done? The Trust identified a number of key objectives for safeguarding adults in 2016/17, which are listed below: Increasing awareness of the Mental Capacity Act and Deprivation of Liberty Safeguards amongst front-line staff; Improved data collection around Safeguarding Adult concerns and Deprivation of Liberty Safeguards authorisations; Stronger governance to enhance consistency with regard to adult safeguarding processes across the Trust; Improved training provision. Within the Milton Keynes services there has been significant work completed in order to achieve these objectives. How well have we done it what difference have we made? MCA and DoLS Local audits and inspections, including external inspections, indicate that understanding of the MCA has increased across all services. MCA does however remain a focus area to ensure that understanding and application of MCA is embedded in practice. This has been driven through MCA/DoLS refresher and induction training, which is adapted to the context of the service whilst ensuring the principle messages are maintained. Data collection There has been a drive to ensure that all safeguarding adults concerns are recorded on the Trust s incident reporting system (datix). Evidence suggests that this is now happening on a more Safe and well cared for together we can make a difference Page 26 of 53

27 consistent basis, with all incidents being recorded on this platform. Additionally the safeguarding team has been supporting teams to understand the functionality of datix in regard to the safeguarding referral process, with good effect and positive impact for service users. Governance The Safeguarding Adults and MCA specialist for Milton Keynes has now been substantively in post since September 2016, supported by the substantive Divisional Director of Nursing. The recruitment into these two posts has brought stability and strengthened the associated governance. The wider Trust team is now also fully recruited to, which supports sharing of information and importantly lessons learnt from both within and external to the Trust. The local safeguarding forum in Milton Keynes is now attended by CCG safeguarding representatives, which supports governance and associated accountability. The Trust also completes an annual safeguarding adult self-assessment and assurance framework for the local CCG. This has been competed for 16/17, with a small number of actions requiring additional input. Training Compliance with training has improved, with Milton Keynes services reporting compliance for adult safeguarding as follows: Training Levels Adult and Children Most recent figures as at April 2017: Milton Keynes Adults L1 3yr 98% L2 3yr 96% In addition the Trust is committed to ensuring all clinical staff are trained in Prevent - this is a key objective for 17/18. Through improved compliance with training and increased awareness we have seen a greater understanding amongst staff of their role and responsibilities in regard to safeguarding; this is reflected in safeguarding referral numbers and incident reporting. This would suggest that staff now have the knowledge to protect their patients and service users on a more consistent basis. Next steps To deliver Trust adult safeguarding objectives for 17/18 once agreed. To integrate safeguarding adults and children in Milton Keynes. To develop mechanisms to ensure the service users voice is heard in safeguarding processes. To ensure compliance with Prevent training. To ensure compliance with the safeguarding assurance framework for 17/18. Safe and well cared for together we can make a difference Page 27 of 53

28 To continue to strengthen partnership working in Milton Keynes. HEALTHWATCH Healthwatch Milton Keynes provides local people with an independent voice on health and social care issues, influencing the way services are planned, provided and delivered. Our statutory role as defined in the Care Act 2014 is to review the annual plan of the Safeguarding Adults Board. Next steps Healthwatch Milton Keynes became an independent Charitable Incorporated Organisation (CIO) in January As a newly independent organisation our next steps will be to revise our safeguarding procedures and provide refresher training for all our volunteers. We will also be tracking the new structure for the Safeguarding Boards to establish how we may best contribute and discharge our statutory responsibilities. What have we done? In Milton Keynes the MKSAB recognises Healthwatch as providing a monitoring role on the Board. We also have a more general interest in safeguarding as an essential element of the health and wellbeing of the public we aim to represent, as well as ensuring the staff and volunteers of the organisation follow safeguarding procedures in their contact with the public. We have no responsibilities for investigating safeguarding incidents, only referencing to the appropriate agencies. We have discharged our responsibilities by being represented on the MKSAB (100% attendance) and some of its subgroups. We have also arranged safeguarding training (provided by MKC) for those volunteers who are preparing to participate in the Enter-and-View programme for the monitoring of local health and social care facilities. Safe and well cared for together we can make a difference Page 28 of 53

29 MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST Milton Keynes University Hospital NHS Foundation Trust (MKUHFT) occupies a 60-hectare site to the south of the city centre. We serve Milton Keynes and surrounding areas. The hospital has approximately 400 in-patient beds, and provides a broad range of general medical and surgical services. We have a busy Emergency Department that manages all medical, surgical and child health emergencies. We continue to expand our services to meet the needs of the local population including opening a new ward, and the new main entrance. MKUHFT has been rated by England's Chief Inspector of Hospitals as Good overall, following an inspection by the Care Quality Commission. The rating of Good was awarded to the Trust for being effective, caring, responsive and well-led following an inspection in July Our vision is to be the healthcare provider of choice for the people of Milton Keynes and surrounding areas. We aim to deliver the right treatment, in the right place, at the right time. What have we done? We work closely with the neighbouring safeguarding agencies and share our knowledge and experience, as well as learning from them. We are proactively involved in training and education across boundaries as demonstrated when the Safeguarding Adults Lead took part in delivering training to GPs in Milton Keynes arranged by the local CCG. This experience has further promoted a positive working partnership with our GP practices. The feedback received from the GPs was very positive. MKUHFT is represented by the Director of Patient Care and Chief Nurse at the quarterly Milton Keynes Safeguarding Adults Board, and the Adult Safeguarding Lead Nurse attends all of the SAB subgroup meetings to ensure participation in developments and changes, and to information share between the committees and the Trust. The safeguarding adults training (level 1 and level 2) continues to remain as face to face training to enable staff to ask those difficult questions, get to know the safeguarding team, and for the trainer to monitor staff knowledge through participation and conversation. The overall staff training compliance for safeguarding adults has reached 94%, and for Mental Capacity Act we are at a 93% Safe and well cared for together we can make a difference Page 29 of 53

30 compliance rate. This training frequently receives very positive feedback from all staff groups. The number of patients the Trust has identified with potential safeguarding concerns increases year on year. This has included identifying and supporting victims of domestic abuse, neglect and financial abuse, to victims of modern slavery. The Trust has a positive relationship with the other safeguarding agencies, which allows for timely response and support once concerns are identified. How well have we done it what difference have we made? MKUHFT Adult Safeguarding is reviewed yearly by the MKCCG, looking at specific aspects within safeguarding and measured against each, with a statement this year of the Trust is robust in its safeguarding. This was in part demonstrated by the variety and increased numbers of adult safeguarding alerts raised by all staff groups: - In 2016/ contacts were managed by the Lead Nurse compared to 471 contacts in 2015/16. - In 2016/17 MKUHFT raised 228 adult safeguarding alerts, compared to 176 adult safeguarding alerts in 2015/16. This demonstrates that staff are recognising and raising more appropriate safeguarding alerts. The number and detail of the DoLS have also increased: - In 2016/ DoLS were applied for, doubling the number of applications made in 2015/16 when 70 DoLS applications were made. MKUHFT assisted in information gathering for one Milton Keynes Domestic Homicide Review - we were not directly involved in the investigation. Patient experience is a key focus for MKUHFT and we positively engage with the patients and their families with whom we have contact. The team has received positive patient, relatives and staff feedback about the support and impact that our involvement can have at a very stressful time. The team were awarded Team of the Year in 2016 by Milton Keynes University Hospital, which we remain very proud of. Safeguarding adults and children continue to work seamlessly together with the shared vision to work collaboratively to promote the safeguarding strategy; think of safeguarding the family and not singularly the adult or the child, as demonstrated with the continuation of the MKUHFT safeguarding committee. This is now being reflected in the combining of the Safeguarding Boards in Milton Keynes. Safe and well cared for together we can make a difference Page 30 of 53

31 This year MKUHFT commissioned an independent audit of safeguarding adults and children, which gave assurance on the robustness of the service with few suggested recommendations. Next steps The safeguarding team will continue to maintain the high standard of service we uphold in MKUHFT and the important support to not only our patients, families and staff, but also to our partner agencies. The MKUHFT Adult Safeguarding Lead is working with partner agencies to review and identify areas for development to meet the needs of our patients. This includes a role in the new tender for the next Advocacy Service. MKUHFT is constantly looking at the services we provide to ensure they are inclusive and meet the needs of our patients and their families. Improving patient experience and involvement is embedded across the Trust and the team play a key role in supporting this work. Provision of information and support is paramount, and MKUHFT have developed bespoke adult safeguarding and mental capacity information leaflets for use by patient, families and carers to offer extra assurance around these processes and who they can contact for support in MKUHFT and the partner agencies. The safeguarding team is constantly looking to improve the services and to use technology and innovation to make a positive impact on the experience of our patients and their families. Safe and well cared for together we can make a difference Page 31 of 53

32 THAMES VALLEY COMMUNITY REHABILITATION COMPANY The Thames Valley Community Rehabilitation Company (TVCRC) is one of 21 CRC s created as part of the Ministry of Justice s Transforming Rehabilitation agenda in We are a statutory organisation managing low and medium risk individuals age 18 or over and subject to Community Orders, prison sentences or post release licence in the community across the Thames Valley region (Berkshire, Buckinghamshire and Oxfordshire). Our practice team is divided into three cohorts; a cohort dedicated to working with female service users, a cohort working with males age 18-25, and a cohort working with males age 26 and over. We manage approximately 550 service users in Milton Keynes. At the start of the 2016/17 year, the members of the Safeguarding Adults Board in Milton Keynes attended a development day (April 2016). One of the tasks in this was to consider what good would look like. Some of the elements agreed by the group included: - to have a good quality framework; - to have assurance mechanisms to support this framework; - for the Board to work on the basis of high support and high challenge ; - For all agencies to be able to produce evidence and assure themselves in respect of adult safeguarding. What have we done? During the Board meeting (September 2016) we undertook a task to inform the strategic plan. Amongst the key priorities identified was the need to ensure the DoLS audit is brought back to Board meetings for assurance purposes, as it was recognised this is an area that has brought challenges for most safeguarding adult boards nationally. This has become a regular feature of Board meetings with particular focus on the DoLS action plan and the transparency this brings with all agencies able to use the challenge/support approach. It was also noted the need for data to be used to identify concerns and to produce a risk register. This is progressing through the Quality Assurance subgroup and the development of Fibonacci data pulled from liquid data, an ongoing important part of the assurance processes. Amongst the initiatives/roles involving staff of TVCRC during 2016/17, TVCRC have operated a Football Fitness programme to encourage positive healthy lifestyles for our service users. We are involved in a pilot project in Milton Keynes to increase the number of Mental Health Treatment Requirements given to vulnerable individuals sentenced in court, and we potentially provide employment, training and education support to all the adults we work with across the region. We chair/attend the Integrated Offender Management scheme, which has a focus on intensive Safe and well cared for together we can make a difference Page 32 of 53

33 support for those prolific offenders wanting to make positive change. Quality Assurance subgroup to work on the data set measures and other assurance processes. How well have we done it what difference have we made? A good example has been the establishing of the Modern Slavery Task and Finish Group from the Board. Some of the key development from this group was to raise the profile of the Modern Slavery issue, to consider a strategic action plan, to establish pathways for training in Milton Keynes on this subject, to identify and share best practice from other high performing areas in the country, and of course to enable the various agencies of Milton Keynes to come together to also share knowledge, understanding and practice. The outcome has been to develop a statement on Modern Slavery for the Safeguarding Board, which provides objectives, actions and measures so we have a framework which can be assured. Next steps A significant part of the business planning and development of the Milton Keynes safeguarding work in the later part of 2016/17 has been the move to the new MK Together approach. The final Board meeting of the 2016/17 year focused on the integration of this new structure and the need to identify the requisite attendance for this framework. The next step for TVCRC in terms of safeguarding in Milton Keynes will be to participate in the new Joint Safe and well cared for together we can make a difference Page 33 of 53

34 What has each subgroup done? Joint Communications & Engagement Subgroup The Joint Communications and Engagement Subgroup was formed in 2016 when the two separate subgroups for the adults and children s safeguarding boards were merged. The aim was to create a single group that could pool resources, avoid duplication and create a closer working relationship and cohesion between the work of the boards. What have we done? The group held three meetings during the year. Reviewed and streamlined membership of the group to ensure key partners were invited. Managed the design and production of the Safeguarding Adults Annual Report. The report was well received by all partners. Managed design and production of a SAR executive summary. Refreshed the Milton Keynes Safeguarding Children Board s (MKSCB) posters on neglect, child sexual exploitation, physical punishment, and female genital mutilation. These were reissued to schools and other organisations. How well have we done it what difference have we made? Meetings successfully brought the two elements adults and children together. Those who attended embraced the new way of working. Attendance at meetings proved difficult for some members, which unfortunately meant that partners were not well represented on the subgroup. Time specific tasks were carried out successfully, such as the production and publication of the annual report. Safeguarding communications activity took place throughout the year, however the majority of this was carried by individuals within organisations rather than through partnership working. Next steps The subgroup will no longer operate in its current form. Under the new arrangements for MK Together, communications for the board will be project-based, calling on communications expertise from the appropriate organisation/officer. Communications will be an item on the agenda of the project groups, with the chair responsible for contacting communications as necessary. Safe and well cared for together we can make a difference Page 34 of 53

35 Mental Capacity Act/Deprivation of Liberty Safeguards subgroup This group monitors compliance with the MCA 2005 and DoLS across all of the partner agencies in terms of safeguarding adults in Milton Keynes. The group works to ensure that everyone working with an adult who may lack capacity to make specific decisions complies with the Act when making decisions, or acting for that person, and support is provided to people in the least restrictive and most supportive way. The group is multi-agency and includes providers from the care home sector and from contracted advocacy services for Independent Mental Capacity Advocates, which reports into the meeting. What have we done? In 2016/17 we received 840 DoLS applications, a 36% increase from the previous year. We reviewed the DoLS service in 2016 and invested significantly to ensure that we manage the applications in a timely way. The DoLS subgroup has monitored the service improvement plan during the year. There has been a significant improvement in the service. 207 individuals received MCA awareness training via MKC training programme during 16/17 (116 MKC staff, 80 private and voluntary sector care staff and 11 volunteers). 24 managers received MCA for Managers training during 16/17 (7 MKC managers and 17 P&V sector managers). We have worked closely with our advocacy provider PoHwer to improve the information we receive about referrals to the advocacy service, identify gaps, and focus on areas of improvement. The subgroup received the findings of an audit of how we are managing DoLS in Milton Keynes. The subgroup has developed an improvement plan and this is monitored by the group. The audit finding and action plan were also reported into the Safeguarding Adults Board. We analysed and reported on the number of qualified and practising Best Interest Assessors in Milton Keynes. Following this we have increased the number of BIAs we have from 20 to 33, which includes development of a framework agreement, so we can use independent BIAs more easily. We have increased the number of DoLS signatories from 5 to 15. The number of referrals for advocacy from MKUHFT increased over the year. How well have we done it what difference have we made? Training compliance figures for 2016/17 in relation to the % of Social Care/Health staff who have attended some form of MCA training (level dependent upon role) over the previous three years are: - MKC 88% - MKUHFT 93% - CNWL 90%. All three figures show an increase on the previous year. Safe and well cared for together we can make a difference Page 35 of 53

36 We have developed a framework agreement for Independent BIAs, which has enabled us to increase capacity and progress to allocating all outstanding work. Following the audit report a detailed action plan was produced. Within five months we have moved from a weak audit rating to satisfactory and we reduced the back log of DoLS from 197 to 85. We have developed a quarterly specialist BIA forum to share good practice. We have authorised 735 Deprivation of Liberty Safeguards. This means that we ensured that the level of care these people were receiving in either care homes or hospital was in their best interests. If not we have worked with people and their families to ensure other ways to support people in the least restrictive ways are found. Next steps A more robust performance management framework needs to be developed for the service. Review the quality checking processes and introduce a programme of quality audits. Review referral processes for advocacy and reasons for low numbers of referrals. With the development of MK Together and the review of the subgroups across the Adults and Children s Safeguarding Board in 2017/18, the MCA/DoLS group will report into the Quality Assurance subgroup where the development and quality of this work will be monitored. Course feedback Very in depth but practical, really helped applying to various situations and scenarios. Good discussions will enhance my skills when completing an MCA assessment. Has given me a better understanding of how to assess capacity and the confidence to do so. Safe and well cared for together we can make a difference Page 36 of 53

37 Quality Assurance subgroup This subgroup is responsible for the Quality Assurance (QA) objective identified in the Safeguarding Adults Strategy: Ensure Robust policies and procedures are in place and develop performance monitoring of safeguarding practice across organisations to ensure continuous improvement. What we have done? During 2016/17 the QA subgroup: Provided a regular summary of the safeguarding activity in Milton Keynes, including a comparison to previous years and progress to-date. Completed an audit of responses to the Making Safeguarding Personal questions. Provided information on care homes and domiciliary providers accessing MKC safeguarding training. Received recommendations from two Domestic Homicide Review (DHRs), asking agencies to confirm their action plans. The QA subgroup has provided guidance to the Performance subgroup on the adult data fields required. How well we have done it what difference have we made? The QA subgroup includes representation from Health, Social Care, Police, Probation, Mental Health, Learning Disabilities, and Healthwatch. We continue to evolve the information that is collected in relation to safeguarding adults and how this is reported to the Safeguarding Adults Board Provided assurance to the Board in relation to the recommendations and actions from the DHRs. The QA group undertook a review of Making Safeguarding Personal across MK, and made further recommendations to the Board on how this could be improved. Learning from safeguarding cases led to the DASM producing guidance on when to involve the Police in Safeguarding matters. Following approval from the SAB this is being distributed across Milton Keynes. Next steps The MK Together approach provides an opportunity for the quality assurance processes for both adults and children to be more aligned. An integration task and finish group has been established, supported by the CCG DASM, and during 2017/18 shared performance arrangements will be agreed. Safe and well cared for together we can make a difference Page 37 of 53

38 Safeguarding Adults Review subgroup MKSAB recognises the importance of using learning to improve the service that we provide to people who are supported through the multi-agency safeguarding adults policy and procedures. Section 44 of the Care Act 2014 places a duty on MKSAB to arrange Safeguarding Adult Reviews (SARs). A safeguarding adult review is not an inquiry into how an adult died or was harmed, and does not try to find out who is to blame - that is the job of the Police, criminal courts or the coroner. This subgroup considers requests for a review of a safeguarding adult s case where it is indicated that there is learning that can be gained about how agencies individually or collectively acted to prevent or respond to abuse or neglect of an adult at risk. What have we done? In 2016/17 we received three new referrals. We completed the Adult A SAR the final report of the SAR was reported to the Safeguarding Adults Board in December 2016, and was referred to the QA subgroup in March 2017 for monitoring of delivery. We produced a Learning Bulletin following the Adult A SAR. How well have we done it - what difference have we made? Through the Safeguarding Adults Review held for Adult A, the subgroup learnt that information sharing between the agencies involved was not as good as it should have been. The subgroup has therefore produced a learning bulletin, which will be disseminated amongst staff at each of the agencies, and which it is hoped will help to improve communication. The SAR on Adult A resulted in a number of recommendations for the agencies involved; some have already been actioned. The action plan has been formally handed over to the QA subgroup for monitoring. It is hoped that the implementation of the recommendations will ultimately make a significant difference to, and improve, the way we safeguard and protect adults at risk. Next steps With the development of MK Together and the review of the subgroups for adults and children across Milton Keynes Safeguarding Board in 2017/18, the SAR subgroup will report into the QA subgroup, where the development and quality of this work will be monitored. Safe and well cared for together we can make a difference Page 38 of 53

39 Training, Education and Development subgroup The Care Act 2014 requires that practitioners must have specialist & ongoing training to keep up their legal literacy; all staff must be aware of adult abuse & neglect & where & how to report any concerns; a competency based training & workforce development strategy is required including MCA & DoLS. The Training, Education and Development (TED) subgroup leads on the strategic planning and oversight of learning and development activities in accordance with the priorities of the MKSAB. The Board s training strategy is based on the National Competence Framework for Safeguarding Adults (University of Bournemouth) and uses that framework as a benchmark for the minimum standards expected in Milton Keynes. In practice this means that TED group members are responsible for ensuring that their own agency programmes meet these standards and the group s role has been to monitor compliance, review single agency quality assurance systems, and ensure that any changes due to national or local learning are adopted promptly. There is no multi-agency training programme for adult safeguarding. The group has had very stable representation from most of the Board s key strategic partners throughout the year. What have we done? Each agency has continued to resource and deliver their own large in-house programmes of safeguarding training in accordance with the strategy requirements (see compliance levels below) Safeguarding Compliance Levels 1st April st March MKUHT MK Council CNWL CCG Prevent awareness (level 1) training has been embedded into agency training programmes. Safeguarding adults provider forums for P&V care agencies have been facilitated. Topics discussed included Making Safeguarding Personal & the referrals process. Trained trainers have had access to regular (quarterly) training standardisation & continuing professional development throughout the year. City & Guilds Level 3 Certificate in Education & Training programme has been developed specific to safeguarding adults and 11 trainers trained. QA standards for in-house trainers developed and observations started Safe and well cared for together we can make a difference Page 39 of 53

40 200 primary care staff received safeguarding awareness training as part of their protected learning time. Carer & Volunteer safeguarding adults training standards developed & workbook trialled with Headway & MacIntyre. Now I have a better understanding of the Care Act and the link between MCA and Safeguarding has been my greatest learning experience. Team Leader Supported Housing How well have we done it what difference have we made? Continued to improve training compliance rates at awareness level. Increased the number of trained trainers in the P&V care sector. Developed closer working relationships with the MKSCB training & development group. Establishing training opportunities with primary care staff was a significant breakthrough. Ensured that more P&V care agencies are able to deliver high quality in house safeguarding training to their staff because they have their own trainer. Raised awareness about the Prevent agenda by including basic details in the safeguarding adults awareness training package. Provided opportunities for discussion between the P&V care sector and MKC on safeguarding issues. Next steps With the establishment of a new joint adults and children s training subgroup next steps will include: Consult on and develop a robust safeguarding competency framework, incorporating the existing safeguarding adults competency framework. Conduct a joint training needs analysis. Deliver a joint safeguarding conference, aimed at safeguarding children, young people, and adults at risk. Introduce new QA measures for the train the trainer programme. Explore how we can move forward with Prevent training. It s given me more confidence in having a framework to be able to deliver the training with confidence. I have the stories around safeguarding but training has given me support about the pace and preparation, how to check the understanding and if you ve delivered at the right level to the recipient. Service Co-Ordinator Learning Disabilities Safe and well cared for together we can make a difference Page 40 of 53

41 Milton Keynes Safeguarding Adults Board Business Plan 2016/17 In 2016/17 our business priorities were: Undertaking a governance review jointly with MKSCB, rationalising systems and work groups as appropriate to release capacity. This has been completed. Developing an outcome based performance and quality assurance framework jointly with MKSCB and generating and using good quality data and system intelligence. This has been completed. An outcomes based accountability framework has been adopted. Responding to emerging safeguarding risks (Modern Slavery) jointly with MKSCB and SaferMK. Work has begun and is ongoing a Council statement and tools have been agreed. Discussions are still taking place with TVP. Embedding making safeguarding personal and developing more person-centred practice across all partner agencies. Work has begun in terms of revisiting the language used on forms. Building up capacity within the third sector and community groups and ensuring service user s experiences inform the Board s work. Work has not yet begun. This priority has been carried forward to 2017/18. Developing a coherent multi-agency approach to learning, workforce development and practice competence. In progress - there is now a joint Adult and Children s Learning & Workforce Development subgroup Developing and communicating clarity about safeguarding thresholds and practice understanding of different forms and models of safeguarding interventions. Work has not yet begun a project group needs to be set up. This priority has been carried forward to 2017/18. Business as usual communication and engagement. This has been completed, but remains an ongoing requirement. So how did we do? A summary of 2016/17 What have we done? Overall Milton Keynes Safeguarding Adults Board achieved a significant amount during 2016/17. This report demonstrates that the Board was well established and had agreed a budget by the beginning of the year; it had established a comprehensive work programme led by a number of active sub-groups. Work on establishing and embedding Making Safeguarding Personal was particularly important, as was some work led by Adult Social Care on understanding the quality of alerts. Work on modern slavery was underway and a relationship with Children s Services was growing by the end of the year. The Board s first Safeguarding Adults Review was also nearing completion. Safe and well cared for together we can make a difference Page 41 of 53

42 How well have we done it? Qualitatively there is some evidence that we have done well over the year in terms of undertaking and completing the actions and priorities we set ourselves. It is clear that we have built strong relationships and significantly strengthened working together. We have not however been particularly strong in terms of really understanding or evaluating the amount of work done, or its quality, as a Board, as individual agencies, and collectively in terms of the effectiveness of safeguarding practice. What difference have we made? Because of our limited qualitative data and very limited quality assurance activity, we find it challenging to fully evaluate the impact of the Board s work in terms of safeguarding policy, processes, or frontline practice. However this gap is now fully recognised and work to rectify it was well underway by the end of the year. What will we do? Looking forward what are our priorities? Our business priorities in 2017/18 are: 1. Develop a clear annual assurance cycle for all partner agencies; 2. Developing a coherent multi-agency approach to learning, workforce development and practice competence; 3. Developing and communicating clarity about safeguarding thresholds through a proper threshold model; 4. Developing practice understanding of different forms and models of safeguarding interventions; 5. Building up capacity within the third sector and community groups; 6. Ensuring service user s experiences inform the Board s work; 7. Embedding making safeguarding personal and implement; 8. Communication and engagement with service users, families, communities and staff; 9. Responding to emerging safeguarding risks (Modern Slavery); 10. Joint themed audit of services to children and adults living with Domestic Violence. Safe and well cared for together we can make a difference Page 42 of 53

43 Training Update 2016/17 has been a challenging year in respect of maintaining the levels of safeguarding, MCA and DoLS training provided in previous years. The absence of key personnel such as the lead trainer and Adult Safeguarding Manager for a significant part of the year resulted in a maintenance approach to the training offered, rather than the development of new activities. Significantly there has been an increase of 18% in the compliance rates evidenced for MKC staff attending awareness level safeguarding training since 15/16. Improved data collection related to training activity, particularly within the Learning Disabilities Service, means that we have been able to evidence activity that has in reality taken place in previous years, but not been documented robustly. What have we done? Provided training to 410 staff from P&V care agencies across Milton Keynes (*courses detailed in table 1 on page 44). Provided tailored training for different areas of service provision for both MKC in-house services and external providers on DoLS (see table 1 on page 44). Trialled joint training sessions for adults and children s services staff on domestic abuse and honour based violence & forced marriage. Safe and well cared for together we can make a difference Page 43 of 53