Director of Nursing and Patient Safety

Transcription

1 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST SAFEGUARDING ADULTS AT RISK ANNUAL REPORT Report to the Trust Board 27 September 2016 Sponsoring Director: Author: Purpose of the report: Key Issues and Recommendations: Director of Nursing and Patient Safety Safeguarding Adults Lead and Head of Safeguarding The purpose of this report is to provide both assurance and evidence to the Somerset Partnership NHS Foundation Trust Board that the Trust is fulfilling its statutory responsibilities to safeguard adults at risk. the Care Act 2014 was implemented from 1 st April This had a huge impact on adult safeguarding both nationally and locally changing the process and view on how to approach safeguarding work. This has had a massive impact on not only how the Sompar safeguarding service works but also on its workload; the Care and Support Statutory Guidance was published in March 2016 (HM Gov 2016) and replaces the previous version (October 2014). The amendments take into account regulatory changes and feedback from the sector (see Appendix A for further detail re these changes); the Trust has a Head of Safeguarding who manages an integrated Safeguarding Service that covers: Safeguarding Adults; Safeguarding Children; Multi- Agency Risk Assessment Conferences (MARAC); Multi- Agency Public Protection Arrangements (MAPPA); PREVENT (the NHS statutory response to the governments CONTEST -Counter Terrorism Strategy) and Domestic Homicide Reviews (DHR s.); the Safeguarding Adults Team has two team bases. One within the Bridgwater Police Centre as part of the Multi-Agency Safeguarding Hub (MASH) and one within Holly Court in Yeovil. The team provide safeguarding adults & children, MARAC, MAPPA and PREVENT cover across the county; September 2016 Public Board - 1 -

2 : the Trust s Safeguarding Adults Team has undergone significant redevelopment to increase resilience of the service with team members becoming generic safeguarding professionals whilst maintaining specific areas of expertise; admin hours (due to retirement / resignation = 38hrs/ week) have been reconfigured to enable the appointment of a fourth Safeguarding Professional on 30hrs / week; Somerset County Council (SCC) Safeguarding Adults Team reconfigured their service provision and their expectations of partners following the implementation of the Care Act 2014 from April This has led to a significant increase in the number of referrals and notifications of Trust staff to undertake Section 42 enquiries on behalf of the SCC Safeguarding services. This has had a massive impact on the workload of the Safeguarding Adults Team; the Trust s Safeguarding Adults Team now participates in weekly MASH meetings with the Police and SCC Safeguarding. This process requires further strategic development to ensure its efficacy and effectiveness in early shared decision making regarding high risk vulnerable adults; long term sickness (nine months and ongoing) of 1 WTE Safeguarding Adults Professional has resulted in untenable levels of workload pressure on the remaining team members when this is coupled with the increase in workload being fourfold already; the Safeguarding Adults at Risk Policy has been revised and restructured to reflect the major changes and developments to safeguarding adults as a result of the Care Act 2014; the Trust s Domestic Abuse policy is currently under review as a result of actions highlighted within DHR 10 and SAR Ms C; September 2016 Public Board - 2 -

3 the Trust s Safeguarding Adults Training programme has been completely revised to reflect the competency levels set out in the NHS Intercollegiate Training Framework (2016) referenced within the Care and Support Statutory Guidance This new framework has been phased in since Sept Training levels have been maintained at 92 % throughout the year. However now that a new training plan is in place the training profiles for all staff will be updated that will mean the compliance figure will drop dramatically initially but the training provision will start to address this in the coming months. Somerset Partnership has participated in three Safeguarding Adult Reviews (SAR-previously known as Serious Case Reviews) in the last year and contributed (via the production of IMRs and chronologies) for a further 5 potential SARs. Two of these cases are currently being progressed as SARs. The other three cases have all received some investigatory multi agency response. Somerset Partnership has participated in three Domestic Homicide Reviews (DHRs) in the last year and participated in the information sharing and consideration of a further 3 potential DHRs. We await the Home Offices view on whether these other cases will require a DHR process. Actions required by the Board: The Trust Board is asked to accept this report as evidence that Somerset Partnership NHS Foundation Trust has in place arrangements to safeguard adults at risk in line with our responsibilities set out within the Care Act 2014 and the requirements set out in the Standard NHS Contract The Trust Board is requested to: a) note the improvements made during and those scheduled for implementation during b) note the level of excessive workload of the existing safeguarding service staff and consider proposals for service development. September 2016 Public Board - 3 -

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5 SAFEGUARDING ADULTS AT RISK ANNUAL REPORT Safeguarding Adults Lead September /14 Safeguarding Adults Annual Report July 2015 Public Board - 5 -

6 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST SAFEGUARDING ADULT'S ANNUAL REPORT CONTENTS Section Page 1 PURPOSE 7 2 INTRODUCTION 7 3 NATIONAL STRATEGY AND GUIDANCE 8 4 DUTIES AND RESPONSIBILITIES 10 5 SOMERSET SAFEGUARDING ADULTS BOARD 10 6 SAFEGUARDING ARRANGEMENTS WITHIN SOMERSET PARTNERSHIP 11 7 SAFEGUARDING ADULTS SERVICE Safeguarding Adults Team Activity Somerset Adults Multi Agency Safeguarding Hub (MASH) Whole Service Concerns Domestic Abuse and MARAC Process MAPPA PREVENT SARs and DHRs 22 8 CQC INSPECTION SEPTEMBER 2015 AND SAFEGUARDING ADULTS 24 9 POLICIES AND COMMUNICATION SAFEGUARDING ADULTS AT RISK TRAINING SAFER RECRUITMENT NEXT STEPS RECOMMENDATIONS 27 Appendix A Changes made to Chapter 14 Safeguarding in revised version of Care and Support Statutory Guidance September 2016 Public Board - 6 -

7 SAFEGUARDING ADULTS AT RISK ANNUAL REPORT PURPOSE 1.1 The purpose of this report is to provide both assurance and evidence to the Somerset Partnership NHS Foundation Trust Board that the Trust is fulfilling its statutory responsibilities to safeguard adults at risk. 1.2 The purpose of this report is to also inform the Trust Board of Safeguarding Adults activity during the period 1st April 2015 to 31 March INTRODUCTION 2.1 This report provides the Trust Board with assurance that Somerset Partnership is meeting its statutory duties placed on it through the Care Act 2014 and the Counter-Terrorism and Security Act Somerset Partnership has a responsibility to safeguard and protect those adults who are deemed to be at risk, other patients, staff and the public. 2.3 Safeguarding means protecting people 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 adults wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action (Care and Support Statutory Guidance DoH revised March 2016). 2.4 The Trust s Safeguarding Service promotes the adults wellbeing in their safeguarding arrangements. People have complex lives and being safe is only one of the things they want for themselves. Professionals should work with the adult to establish what being safe means to them and how that can be best achieved. Professionals and other staff should not be advocating safety measures that do not take account of individual well-being (14.8). Well-being is defined in Section 1 of the Care Act (2014) as follows: 2.5 Well-being, in relation to an individual, means that individual s well-being so far as relating to any of the following: personal dignity (including treatment of the individual with respect); physical and mental health and emotional well-being; protection from abuse and neglect; 2015/16 Safeguarding Adults Annual Report July 2016 Public Board - 7 -

8 control by the individual over day-to-day life (including over care and support, or support, provided to the individual and the way in which it is provided); participation in work, education, training or recreation; social and economic well-being; domestic, family and personal relationships; suitability of living accommodation; the individual s contribution to society. 2.6 The aim of the Trust safeguarding service is to advice and support staff to respond to safeguarding concerns that must be personal to the individual in accordance with the Care Act Statutory Guidance (2015/2016). Making Safeguarding Personal means it should be person-led and outcome-focused. It should engage 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 quality of life, wellbeing and safety. 3. NATIONAL STRATEGY AND GUIDANCE 3.1 The Care Act 2014 received Royal Assent on 14 May 2014 and came into force from 1 April The Act sets out the local authority s responsibility for protecting adults with care and support needs from abuse or neglect, for the first time in primary legislation. The Care and Support Statutory Guidance (published in October 2014 and revised in March 2016) and Chapter 14 Safeguarding replaces the previous statutory guidance relating to adult safeguarding ( No Secrets Department of Health 2000). The Care Act 2014 is vital to ensure clear accountability, roles and responsibilities for helping and protecting adults with care and support needs who are experiencing, or at risk of, abuse or neglect as a result of those needs. Local authorities are given a lead role in coordinating local safeguarding activity. 3.2 The Act sets out a clear legal framework for how local authorities and other parts of the system (including health providers) should protect adults at risk of abuse or neglect. The Local Authorities new safeguarding duties mean that they must: lead a multi-agency local adult safeguarding system that seeks to prevent abuse and neglect and stop it quickly when it happens; make enquiries, or 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; September 2016 Public Board - 8 -

9 establish Safeguarding Adults Boards, including the local authority, NHS and police, which will develop, share and implement a joint safeguarding strategy; carry out Safeguarding Adults Reviews when someone with care and support needs dies as a result of neglect or abuse and there is a concern that the local authority or its partners could have done more to protect them; arrange for an independent advocate to represent and support a person who is the subject of a safeguarding enquiry or review, if required. 3.3 The following six key principles, as set out in many national Safeguarding Adults documents - most recently the Care and Support Statutory Guidance (2014), must underpin all adult safeguarding work: Empowerment People being supported and encouraged to make their own decisions and informed consent. I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens. Prevention It is better to take action before harm occurs. I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help. Proportionality The least intrusive response appropriate to the risk presented. I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed. Protection Support and representation for those in greatest need. I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want. Partnership Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me. Accountability Accountability and transparency in delivering safeguarding. I understand the role of everyone involved in my life and so do they. 2015/16 Safeguarding Adults Annual Report July 2016 Public Board - 9 -

10 4. SOMERSET PARTNERSHIP NHS FOUNDATION TRUST DUTIES AND RESPONSIBILITIES 4.1 The Trust s Safeguarding Service works in partnership with the Somerset County Council (SCC) Safeguarding Adults Team to protect adults and to implement the Care Act 2014 in respect of safeguarding; 4.2 The Trust has a clear Safeguarding Adults at Risk policy and operational process in place enabling early identification and assessment of risk through timely information sharing and targeted multiagency intervention. The Head of Safeguarding & Safeguarding Adults Lead take a proactive role in informing the development of SCC operational processes to ensure these align with the work of the Trust. 4.3 When as employers the Trust becomes aware of allegations against staff in the context of safeguarding adults and children - we act in accordance with our duty to correct this and protect the adult from harm as soon as possible implementing the Managing Allegations against Staff in the Context of Safeguarding Adults and Children Policy. The Head of Safeguarding is the single point of contact for the management of this policy with partner agencies. The policy will be updated to reflect the awaited department of health guidance on how this element of the Care Act 2014 will be implemented across public bodies. 4.4 The Revised PREVENT duty Guidance (July 2015) provides detail of the Counter-Terrorism Act 2015 and the Trusts responsibilities regarding the need to work with partner agencies to prevent people being drawn into terrorism. The Safeguarding Adults Lead is the Trusts Lead for PREVENT. 5. SOMERSET SAFEGUARDING ADULTS BOARD (SSAB) 5.1 The Care Act 2014 sets out statutory duties for Safeguarding Adults Boards including the appointment of an independent chair which the board appointed in Somerset Partnership NHS Foundation Trust is represented on the SSAB by the Head of Safeguarding. 5.3 The SSAB has specific sub groups for reviewing and considering all areas that impact on safeguarding adults including: training, policies and procedures and learning lessons. These groups are listed below and are attended by the Safeguarding Adults Lead. September 2016 Public Board

11 Table 1: Group Somerset Safeguarding Adults Board Somerset Safeguarding Adults Board Executive Policy and Procedures Sub-Group Learning & Development Sub-Group Quality Assurance Sub- Group Title Director of Nursing and Patient Safety / Head of Safeguarding Head of Safeguarding Safeguarding Adults Lead Safeguarding Adults Lead & Head of Learning & Development Safeguarding Adults Lead 5.4 The SSAB rebranded itself during and developed a new website which was launched in April This provides information for the public and professionals, including policy and procedures information and practice guidance and learning from recent SCR / SARs undertaken within the county. 6. SAFEGUARDING ARRANGEMENTS WITHIN SOMERSET PARTNERSHIP Board Lead and Assurance Arrangements 6.1 The Director of Nursing and Patient Safety is the Executive lead with responsibility for safeguarding adults and children. The Trust has a Non- Executive Director who has specific responsibility for Safeguarding adults and children. The Trust has had a Head of Safeguarding in post since September The Trust has an integrated Adults and Children Safeguarding Steering Group which is chaired by the Head of Safeguarding. The Group s Terms of Reference were reviewed in light of the integration and the purpose of the group is to: monitor and review safeguarding processes for both children and adults at risk; identify any risks within Sompar services and take appropriate action; promote and develop evidence-based practice; monitor progress on internal/external action plans from management reviews within the specified timeframes; ensure lessons learnt are disseminated to appropriate staff groups and that practice is developed and improved; monitor serious untoward incidents that relate to safeguarding children and adults at risk; 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

12 develop and implement a rolling programme of audit based on national and local policy and the Trust s annual clinical audit programme to ensure that agreed safeguarding standards are maintained and to ensure improvements in systems and practice; develop and agree action plans in relation to audits and as a result of clinical incidents to address other key issues and achieve effective implementation of both child and adult safeguarding policies; evaluate effectiveness of action plans and outcomes; make recommendations for service improvements as appropriate; submit and receive information from the Local Safeguarding Children Board and Local Safeguarding Adults Board and their sub-groups. 6.3 Membership includes the Executive Lead, Head of Safeguarding, Named and Designated Professionals for Safeguarding, Heads of Division, Children and Young Peoples Services, representation from both Adult services and Mental Health services. 6.4 The table below sets out the key meetings that the Safeguarding Adult service ensures there is representation and there frequency throughout the year. Table 2: Group Frequency Title MAPPA Avon & Somerset Strategic Management Quarterly Head of Safeguarding Board MAPPA Avon & Somerset SMB Health & Social Care Sub Group Somerset Domestic Abuse Strategic Development Group Somerset PREVENT Board Multi Agency Public Protection Arrangement Meetings Multi Agency Risk Assessment Conferences PREVENT -CHANNEL Meetings Multi-Agency Whole Service Concern Meeting and service specific whole service concern meetings Quarterly Quarterly Head of Safeguarding- Chair & Safeguarding Adults Lead Safeguarding Adults Lead 6 monthly Safeguarding Adults Lead 3 per month Safeguarding Adults Professionals 4 per month Safeguarding Adults Professionals As and when basis Safeguarding Adults Lead in response to need. As and when basis Head of Safeguarding & in response to need. Safeguarding Adults Lead September 2016 Public Board

13 6.5 Outcomes and learning from Serious Case Reviews/Safeguarding Adults Reviews and other serious and Near Miss incidents are monitored quarterly at the Safeguarding Steering Group, Clinical Governance Group and Serious Incidents Requiring Investigation Group (SIRI Group.) 6.6 The Safeguarding Adults Lead has been establishing quarterly attendance (and providing written reports for the months in between) at key best practice meetings to feed learning back to relevant work areas and will continue expanding that attendance at these meetings when capacity allows. 7. SAFEGUARDING ADULTS SERVICE 7.1 The current Safeguarding Adults Lead has been in post since August 2015 and had at that point a team of 2.4 WTE Band 7 Safeguarding Adults workers (2 full-time and 1 working 15hrs / week) in post. 7.2 Historically, these workers had individual areas of speciality and responsibility ie. MARAC, PREVENT, MAPPA and Adult Safeguarding Leads. Since in post the Safeguarding Adults Lead has revised the allocation of responsibilities across the team to increase team resilience and improve safeguarding service provision. This has been achieved by supporting the band 7 staff to become generic Safeguarding Adults Professionals with shared skills across the safeguarding spectrum. 7.3 Following a successful application to reconfigure the staffing budget (released through the retirement of 1 WTE Band 4 administrator in Sept 2015 and moving on of another 0.3 WTE band 3 administrator in December 2015), the Safeguarding Service successfully recruited internally to an additional 30 hours / week Band 7 Safeguarding Adults Professional in Feb This does unfortunately means that admin support to the team, particularly the Head of Safeguarding is very limited. 7.4 Currently the Safeguarding Adults Team consists of the Safeguarding Adults Lead and 3.2 WTE Band 7 Safeguarding Adults Professionals plus shared administrative support shared with Safeguarding Children s Service. However, due to a 4 week period of sickness by one worker and the long term sickness of the other WTE since October 2015 the service has been provided with 2.2 WTE Safeguarding Adults Professionals and the Safeguarding Adults Lead. N.B This part of the service not only covers all of the Safeguarding Adults work but also leads on all of the MARAC, MAPPA, PREVENT and Whole Service Concerns (WSC) work as well the Safeguarding Adult Reviews and Domestic Homicide reviews. 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

14 7.5 Safeguarding Adults Team Activity The process for data recording safeguarding activity within Somerset Partnership underwent significant redevelopment during Quarter 3 and Quarter Data collated by the Trust Safeguarding Service reflects the local and national picture of increasing demands for safeguarding and protection of adults at risk services with a noticeable increase of contacts made on a daily basis to each member of the team by the workforce N.B the SCC Safeguarding Team has increased from two to 22 over the last year but the only increase in the Sompar Safeguarding Service has been.8 of a post from reconfiguring admin hours. The increased SCC team has resulted in a high level of contact to the Sompar team for advice and guidance in relation to our patients. Historically, prior to the Care Act implementation, the safeguarding process would have been directly managed by CMHT managers in partnership with the Sompar Safeguarding Team, thus decision making to safeguard patients was made by those working with the patients as opposed to a third party in the local authority Table 3 below sets out the number of client related contacts the Team has received in Quarter 3 and , how many Datix reports were received and how many alerts were made to SCC Safeguarding via Somerset Direct in the same time frame. Table 3: Contacts made, Datix received and alerts made to Somerset County Council Safeguarding via Somerset Direct Quarter 3 and Total number of contacts to Sompar Safeguarding Adults Service Number of Datix received Number of alerts to SCC September 2016 Public Board

15 7.5.5 Table 4 sets out alerts reported to SCC Safeguarding via Somerset Direct by Sompar workers through quarter 3 and Table 4: Alerts made by service area within Sompar Table 5 highlights the categories of abuse as reported by Sompar staff. This data collection will be refined further in to provide further information on location of abuse and alerts raised against other providers. Table 5: Alerts by category of abuse Domestic Abuse Organisational Self-neglect Neglect Financial Sexual Emotional Physical 0 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar Throughout the Trust has experienced numerous delays in receiving the feedback regarding threshold decisions, actions and outcomes from Somerset County Council Safeguarding Adults Team, who now hold a statutory responsibility to lead on the decision making. This has been raised with the local authority and will continue to be monitored closely will see the Safeguarding Service produce data relating to the number of Section 42 the LA cause Sompar staff to undertake on their behalf. 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

16 7.5.8 The Datix incident recording system has been utilised to record all safeguarding adult concerns and referrals to Somerset County Council. The quality of monitoring and response to safeguarding related Datix reports has improved following the implementation of this new system from the 1 st April The new system also enables the team to have a clear oversight of all safeguarding referrals. From August 2016 we will introduce a new referral form for referrals to SCC. This will replace the current use of the Datix system so this will not constitute additional work for operational teams. Table 6: Datix referrals received into Safeguarding Adults Team Qtr 1 Qtr 2 Qtr 3 Qtr Table 7 demonstrates a 100% increase in number of Datix received and processed within the Safeguarding Adults Team during the past year reflecting an increased awareness, and subsequent workload within the safeguarding service, across the Trust of recognising and reporting adult at risk related concerns. This constitutes a 400% rise on previous year, pre implementation of the Care Act. Table 7: Total Number of Datix received by Sompar Safeguarding Adults team by Year The Safeguarding Service has experienced some significant difficulties in receiving all Datix reports submitted by staff during , especially September 2016 Public Board

17 during Quarter 4. This has meant that the team have not been fully informed of all referrals made to SCC Safeguarding and has affected their ability to support staff through the safeguarding referral process and identify trends in reporting of concerns This reliance on Datix reporting is planned to be minimised going into with the anticipated introduction of a written referral form (which will negate the need for a separate Datix report apart from when reporting exceptions bringing our Datix reporting more in line with that of the children s safeguarding service). 7.6 Somerset Adults Multi Agency Safeguarding Hub (MASH) Somerset Partnership Safeguarding Adults Professionals have been participating as key contributors, alongside Somerset County Council Safeguarding and Police Safeguarding Coordination Unit, to the adult MASH since being established in November Positive outcomes hoped to be achieved through implementation of an adult MASH are: that a single referral point could be developed that would ensure better co-ordination between agencies leading to an improved service for adults at risk and their carers ; a faster, more co-ordinated and consistent responses to new safeguarding concerns about adults at risk; a greater emphasis on early intervention with the adult at risk at the centre of the enquiries; closer partnership working with less duplication of effort; a reduction in the number of inappropriate referrals and re-referrals; improved communication and information sharing between agencies Further work is required at this time to develop the processes and framework around this multi-agency approach which will be taken forward in Whole Service Concerns During the last 12 months Sompar Safeguarding Service and staff from local DN and CMHT/ OPMHT have been involved in supporting the local Authority / CCG led Whole Service Concerns / Quality Improvement process for 20 local nursing and residential home providers. This is a 20% increase on (see Table 8). 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

18 Table 8: Cases of WSC involving Sompar Staff The role of the Trust s health professionals is often to increase support to that provider with the aim of improving services offered as well as providing assessments that inform the risk assessments and decision making of Somerset County Council. The Safeguarding Service oversee the Trust s participation in this process through coordinating reviews of residents grids, liaising with local team managers and attending and feeding back from WSC/ QIP meetings where safeguarding issues are significantly concerning or complex. Safeguarding professionals also ensure that any wider learning from this process is shared across the Trust to develop professional safeguarding practice further Two nursing homes closed with very short notice in the past year and the Trust s Safeguarding and local DN teams worked closely with CCG and SCC Safeguarding to ensure all reviews were up to date so clear levels of need were available to assist in sourcing and securing safe and appropriate alternative accommodation for these residents. 7.8 Domestic Abuse and MARAC process Research has shown that domestic abuse disproportionately affects vulnerable adults. Within Sompar Trust staff are responsible for the identification of domestic abuse cases and the completion of a SafeLives risk assessment. Dependent on the outcome, and with support of the Safeguarding Service, staff will then identify whether the risk score warrants referral into either the Somerset Integrated Domestic Abuse Service (SIDAS) or Multi Agency Risk Assessment Conference (MARAC). This referral is made via the Safeguarding Adults Professional who quality assures the risk assessment information and referral form and supports staff throughout the referral process During domestic abuse cases were considered for MARAC in Somerset. 671 of those cases were accepted, taken forward and discussed at MARAC representing a 75 % acceptance rate for referrals. The Safeguarding Adults team undertake the client research (which includes victim / perpetrator and all children for each case) prior to each of the four September 2016 Public Board

19 monthly MARAC meetings. They also represent the Trust at the meetings and lead on any actions tasked to Sompar staff resulting from the meeting Data collection for Sompars contribution to the MARAC process has been under development and Quarter provides the first full quarter of data relating to this. The Safeguarding Adults Team contributed to the discussion of 147 MARAC cases during quarter 4 of Four of these cases were referred by Somerset Partnership frontline staff. The number of cases by MARAC area are as follows: Table 9: Quarter Number of MARAC cases by area These 147 cases resulted in 509 individuals (victim / perpetrator and children within the family) being researched by the Safeguarding Service for information relevant to ongoing risk management and safety planning. The four MARAC meetings in Quarter 4 generated 62 individual actions for the Safeguarding Adults Professionals to enact and ensure completion. 7.9 MAPPA Previously the Trust s operational responsibilities for MAPPA (Multi Agency Public Protection Arrangements for Dangerous and Registered Sex Offenders) and MARAC (Multi Agency Risk Assessment Conferences for high risk domestic violence cases) had been split with one person covering MARAC and the other covering MAPPA & PREVENT. This was reviewed during quarter 3 and MARAC, MAPPA and PREVENT work is now undertaken by all Safeguarding Adults Professionals within the Safeguarding Service Level 2 MAPPA case discussions are held three times a month in Somerset and focus on the development of a strategy to reduce the risk posed and manage the offender in the community. The MAPPA will formulate a Risk Management and Decision Plan which addresses all of the risks identified and tasks agencies with executing their responsibilities Safeguarding Adults Professionals fulfil the Trusts statutory obligation to have mental health representation at these meetings by attending each 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

20 meeting, and providing support to frontline staff (care coordinators / lead professional etc) in the multi -agency risk management process for MAPPA. The Safeguarding Adults Team undertake the necessary research similar to that of the MARAC process but will also include research any known associates as well as victim/s (may be multiple victims) and the offender themselves. Table 10: Number of MAPPA Meetings held and attended by Sompar Safeguarding Service staff and number of cases discussed The drop in number of cases discussed (see table 10) is due to the MAPPA Coordination Team changing the process for deciding which cases need to be discussed at MAPPA Level 2. This raising of the bar regarding eligibility for level 2 cases are meant that only the most complex, difficult to manage cases are now being accepted at MAPPA level 2 meeting Sompar have been asked to contribute to the MAPPA Coordination review process of all new MAPPA level 2 referrals with mental health concerns on a monthly basis. Once established this will provide valuable learning regarding the threshold decision making process that we will also be able to share and further improve the quality of own staffs referrals into Level 2 MAPPA An audit of the 250 MAPPA eligible cases that are identified as known to the Trust was undertaken in April The results of the audit were extremely positive with 95% of MAPPA risk management being of good quality with appropriate alerts and risk assessments recorded on the patients RiO record. The re-audit has been delayed this year due to ongoing staff shortages within the team Prevent The Prevent strategy, published by the Government in 2011, is part of the overall counter-terrorism strategy, CONTEST. The aim of the Prevent strategy is to reduce the threat to the UK from terrorism by stopping people becoming terrorists or supporting terrorism. In the Act this has simply been expressed as the need to prevent people from being drawn into terrorism. September 2016 Public Board

21 The Counter- Terrorism and Security Act (2015) places a duty on certain bodies ( specified authorities - which include NHS Foundation Trusts), in the exercise of their functions, to have due regard to the need to prevent people from being drawn into terrorism The Prevent Duty Guidance (2015) sets out the expectations for the specified authorities by identifying best practice for each of the main sectors and describes ways in which they can comply with the duty. It includes sources of further advice and provides information on how compliance with the duty will be monitored The Safeguarding Adults Lead, as the Trusts Prevent Lead, is responsible for implementing Prevent within the Trust. To comply with the duty staff are expected, as result of their training, to recognise and refer those at risk of being drawn into terrorism to the Safeguarding Service who may make a referral into the Channel programme The Safeguarding Adults Lead attends the county wide, multi-agency Prevent board bi-annually (chaired by Safer Somerset Partnership who has statutory responsibility to lead the Channel Process) and contributes to the county wide developments relating to our Prevent responsibilities The Trust has agreed to participate in the completion of a Prevent Audit in Quarter 1 of The results of this will help inform future Prevent related work within the Safeguarding Service and will be monitored through the Safeguarding Steering Group The intercollegiate guidance, Safeguarding Children and Young people: roles and competences for health care staff includes Prevent information and identifies competencies for all healthcare staff against six levels. The draft NHS Safeguarding Adults: Roles and competences for health care staff Intercollegiate Document (Feb 2016) (referenced in the revised Care and Support Statutory Guidance March 2016) also includes Prevent information and competencies at all five levels. Prevent has now been included in mandatory Safeguarding Adults training at level 1 and 2 which will ensure Trust compliance with these expectations. 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

22 Referrals into PPU Requests for info from PPU Channel Referrals Accepted into Channel Table 11:Sompar Referrals into Prevent and Channel Panel Process There have been seven referrals over the past two years to the Police Public Protection Unit (PPU - Police Specialist Counter-Terrorism Team) in Bristol for consideration of further referral into the CHANNEL process (a multiagency approach to identify and assess nature and extent of risk and provide support to individuals who are at risk of being drawn into terrorism). This is an increase on which saw three referrals (see Table 10) One case presented to the Channel panel was accepted for ongoing support via this process, all other cases received Prevent Case Management from within the PPU (multi agency working to identify and reduce risks to the vulnerable adult). The Safeguarding Service have shared information on a further six cases requested by the PPU where Prevent related concerns has been highlighted by other agencies SARs and DHRs Somerset Partnership has participated in three Safeguarding Adult Reviews (SAR-previously known as Serious Case Reviews) with Service input from across the Trust including Learning Disabilities, Mental Health and Community Health services. Two SARs were completed within and the third is ongoing into Table 12 sets this in the context of the last 5 years and Sompar s requirement to contribute to Safeguarding Adults Reviews (SARs). September 2016 Public Board

23 Table 12: Sompar involvement in LA led SARs for past 5 years The Safeguarding Adults Lead has worked as Panel member on the two completed SARs and the Head of Safeguarding is panel member for the third. Working with the Independent chairs and the SSAB Practitioner briefing notes have been developed to share the wider learning from the completed SARs and a Multi-agency, to which frontline Sompar Staff were invited to attend, was held in June Key themes were identified, through the completed SARs, which include selfneglect, sexual exploitation, domestic abuse, use of Mental Capacity Act and the impact that acquired brain injury has on decision making During the Safeguarding Adults service has contributed (via the production of IMRs and chronologies) to a further 5 potential SARs. Two of these cases are currently being progressed as SARs. The other three cases have all received some investigatory multi agency response The Trust has participated in three Domestic Homicide Reviews (DHRs) in the last year and participated in the information sharing and consideration of a further 3 potential DHRs (see Table 13 below). We have 3 ongoing action plans that the Safeguarding Adults Lead is leading on with oversight being provided from the Safeguarding Steering Group. Sompar safeguarding service awaits the Home Offices view on whether the other potential DHR cases will require a full DHR process. Table 13: Sompar input into DHR cases by year 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

24 8. CQC INSPECTION SEPTEMBER 2015 AND SAFEGUARDING ADULTS 8.1 Following the CQC inspection in September 2015 the Safeguarding Adults service worked closely with the Learning Disabilities service through undertaking the following: as an integral part of the case review process, the Head of Safeguarding confirmed that there are appropriate Safeguarding arrangements in place for this service and wider across the Trust; the Safeguarding Adults Lead undertook a deep dive review of Learning Disabilities cases where there was a Safeguarding alert / risk, compiled a report if the findings and fedback this to the Learning Disabilities Improvement Board, Operational Health Managers Meeting and the four locally held weekly Learning Disability RAPID meetings; the Safeguarding Adults Lead updated the Learning Disabilities health leads in relation to safeguarding processes, including escalation of safeguarding concerns, via the LD Improvement group and through attendance at their whole service away day; Safeguarding Adult Lead worked with Lead Nurse for Learning Disabilities to produce a guidance flowchart on Datix completion in relation to safeguarding concerns to use alongside the Trust wide Referral Pathway; Safeguarding Adults Lead worked with the SCC Safeguarding Team Manger to develop and provide a multi-agency Level 3 Safeguarding Adults training specific for the CTALDs which was attended by 75 Sompar and Local Authority CTALD employees. 9. POLICIES AND COMMUNICATION 9.1 The Safeguarding Service regularly uses the What s On newsletter to highlight and reinforce safeguarding developments. 9.2 The Safeguarding Service fully utilises the intranet to provide up to date safeguarding information for all areas of the services work. 9.3 A Safeguarding Referral Pathway has been established by the Head of Safeguarding in partnership with other providers and commissioners. This pathway supports staff when referring cases to Somerset County Council via Somerset Direct. This has been reviewed and updated by the Head of Safeguarding and from August 2016 the new processes will be implemented in partnership with Somerset County Council Safeguarding Service. This will September 2016 Public Board

25 be the second time that this process change has been led by the Somerset Partnership Safeguarding Service. 9.4 A sticker has been developed and circulated to all existing staff teams and is issued to all new starters as part of their induction programme on the back of their ID badge. This promotes the new single point of contact number for the Safeguarding Service and reminds all staff that the safeguarding service is there to support them in addition to their line manager. 9.5 The following Safeguarding Adult related Trust Policies, Protocols and Guidance are currently under review: Safeguarding Adults at Risk Policy; Managing Allegations in the context of the safeguarding children policy and the Safeguarding Adults at Risk Policy; Domestic Abuse Policy. 10. SAFEGUARDING ADULTS AT RISK TRAINING 10.1 The Trust s Safeguarding Adults Training programme has been completely revised to reflect the competency levels set out in the NHS Intercollegiate Training Framework (2016) referenced within the Care and Support Statutory Guidance This new training framework has been phased in since Sept 2015 with the introduction of 3 core levels (1-3) which replaces the previous Level A and A+ plus bespoke levels at 4 and 5. This also brings our framework in line with what we are being expected to report to the CCG and what is set out within the NHS England Prevent Training competencies The new level 1-3 Safeguarding training framework has been developed, including e-learning at levels 1 and 2, by the Safeguarding Adults Lead alongside Head of Safeguarding and the Learning and Development team and will be available from July 2016 alongside a face to face training programme The combined Safeguarding Adults and Children Training Strategy and Policy will detail the safeguarding adult at risk training available to staff and the training matrix will indicate the staff groups required to attend each level of training with the frequency Training levels at level A have been maintained at 92 % throughout the year. On 31 March 2015 training attendance figures were 92% for Level A staff have received Prevent training relevant to their roles (at either level 1 or 2 Safeguarding Adults training). 2015/16 Safeguarding Adults Annual Report July 2016 Public Board

26 10.6 However now that a new training plan is in place the training profiles for all staff will be updated that will mean the compliance figure will drop dramatically initially but the training provision will aim to start to address this in the coming months. 11. SAFER RECRUITMENT 11.1 Disclosure and Barring Service, (DBS), checks, (formerly Criminal Records Bureau checks), are undertaken by the Trust for all staff and volunteers who are recruited to work with vulnerable adults and anyone who manages or supervises such staff or has access to information systems that include information about children All Trust s job descriptions reflect the requirement by the organisation for its staff to have a sound understanding and knowledge of the safeguarding procedures and processes and this is included within a statement within the job descriptions The Managing Allegations against Staff in the context of Safeguarding Children and Safeguarding Adults at risk policy has been utilised on nine occasions in the last 12 months (compared with six in ). The Head of Safeguarding Leads or coordinates these investigations and has provided practice supervision to the Local Authority Designated Officer (LADO) for non- health cases. 12. NEXT STEPS 12.1 The Safeguarding Service will continue to develop and refine data capturing systems to accurately record safeguarding activity and outcomes The Safeguarding Service will continue to work across all services to support staff in their understanding of safeguarding Review and update Sompar Safeguarding Referral Pathway to reflect changes in processes implemented by Somerset County Council Safeguarding Service Lead on the development and formalisation of processes in relation to the adult MASH alongside SCC Safeguarding and police SCU The Prevent Lead to work with the Named Nurse for Children s Safeguarding to promote the understanding and recognition of Prevent amongst the Childrens and young people directorate to reflect the data available from this year s referral rates which highlight the greatest number of concerns being identified within the under 18 age group Ensure ratification of the Trust MAPPA policy and embed into the organisation via provision of refreshed MAPPA training programme, September 2016 Public Board

27 dissemination through relevant best practice groups and publicise information re updates of Trusts newsletter What s On Complete follow up audit on MAPPA eligible cases to provide comparative data to inform training development Development and provision by Sompar Safeguarding Service of in-house domestic abuse training focusing on the elements of coercion and control and recent association criminal legislation The Safeguarding Service will continue to support the ongoing development of the Multi Agency Safeguarding Hub (MASH) at the Bridgwater Police Centre The Trust have been asked to contribute to the MAPPA Coordination review process of all new MAPPA level 2 referrals with mental health concerns on a monthly basis. Once established this will provide valuable learning regarding the threshold decision making process that we will also be able to share and further improve the quality of own staffs referrals into Level 2 MAPPA What s On will continue to be utilised to raise the profile of safeguarding and to assist staff in their safeguarding duties Work with Children s team to develop information leaflet and poster for staff to highlight services offered by Sompar Safeguarding Service and reiterate contact details to compliment the sticker already in place on the back of staff ID badges The Trust Board will continue to receive an annual report providing assurance that Somerset Partnership is complying with its responsibilities to safeguard adults at risk. 13. RECOMMENDATIONS 13.1 The Board is asked to accept this report as evidence that Somerset Partnership NHS Foundation Trust has in place robust arrangements for safeguarding adults at risk in accordance with The Care Act 2014 and the statutory PREVENT guidance However consideration needs to be made in relation to additional staff resource being provided to counteract the substantial increase in workload of the team following the implementation of the Care Act 2014 and associated statutory guidance as well as the statutory PREVENT and MAPPA duties that have resulted in all members of the service, without exception, continually working excess hours and one member of the team being long term sick since October /16 Safeguarding Adults Annual Report July 2016 Public Board

28 September 2016 Public Board

29 APPENDIX A Changes made to Chapter 14 Safeguarding in revised version of Care and Support Statutory Guidance 2016 Most revisions have been made for reasons of accuracy or clarity. Some are more substantial, reflecting learning through the first period of implementation and feedback from stakeholders and partners: clarification added to reinforce that, ordinarily, an enquiry under Section 42 of the Act is not appropriate where people are failing to care for themselves. Section 42 is primarily aimed at those suffering abuse or neglect from a third party. We commissioned research that evidences best practice with those who self-neglect - that is published by SCIE; updated definition on domestic violence to reflect new legislation; additional information in relation to financial abuse to reflect significant increases in internet, postal and doorstop scams and crime; section on reporting and responding to abuse and neglected has been amended to highlight the need for practitioners to consider the need for criminal investigations and take advice if necessary. Forensic evidence can be lost if a crime is not reported or investigated quickly enough; reporting and responding to abuse and neglect amended to remind LAs that they have powers even where they do not have duties - adult safeguarding is one area where this may be significant; inclusion of cross references to Chapter 1 to reinforce the prevention agenda (better to prevent abuse than act after the event) and remind practitioners that it is important to identify and manage risk of abuse and neglect, even where those concerns are not the presenting issue; SAB annual reports section amended to include new guidance around allegations about people in positions of trust - to provide clarity but also emphasis that this is a responsibility of LAs and other partners, as well as the large and diverse independent provider sector. Important link made to children's safeguarding and considering risk in the round; SAB annual reports section amended to encourage LAs to use existing tried and tested surveys to understand the experience of carers and service users who have been involved in a safeguarding process; the Need to have a Designated Adult Safeguarding Manager (DASM) has been removed. The need to have DASMs proved confusing and contradictory and distracted from improving practice. The original guidance confused the strategic and operational roles of potential DASMs - a danger in cutting across local arrangements or duplicating them. We now concentrate on roles and functions rather than job titles; 2015/16 Safeguarding Adults Annual Report July 2016 Public Board