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HOUNSLOW SAFEGUARDING ADULTS
ANNUAL REPORT 2012/2013
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Foreword by Donald McPhail Chair of Hounslow Safeguarding Adults Board
The year 2012-2013 has brought issues of national concern about the quality of care and abuse of adults to public attention with the publication of reports highlighting major concerns relating to both residential care and hospital care. These reports have focused the work of the board and of it's sub committees. The Hounslow Safeguarding Adults Board has continued to work, through training and providing information, to increase the recognition of the safeguarding needs of vulnerable adults in the
Borough, and although this is work that is never completed, it is clear that the efforts of staff and volunteers have increased awareness across the professional network. As elsewhere, there has been a substantial amount of organisational change for the board to understand and take account of, and in particular the progress towards the introduction of clinical commissioning groups has been reported to the board and future links clarified. The direction of travel for safeguarding adults boards has been made clear by central government, and it's commitment to establish safeguarding adults boards within a statutory framework has reinforced the need for the board to focus on it's effectiveness in overseeing the safeguarding activity of agencies, individually and collectively, to safeguard adults at risk. The annual report for 2012-2013 demonstrates that the board is responding to the key safeguarding issues of the day, but that there is a need to target it's future work to meet the enhanced expectation of boards when they are placed on a statutory footing.
Donald McPhail Independent Chair of the Safeguarding Adults Board
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Contents –
1. Introduction
4
2. National Context
5
3. Local Context
5
4. The role of the SAB and its Sub Groups
7
5. Safeguarding Team Structure and Roles
10
6. Adult Abuse Awareness Team
11
7. Partnership working - Police and Domestic Violence
13
8. Partnership working - Community Safety Partnership
14
9. Partnership working - Commissioning and PCT
14
10. Partnership working - Fire Brigade
16
11. Partnership working - Hounslow and Richmond Community Healthcare NHS Trust
17
12. Partnership working - Hounslow Homes
18
13.
Partnership working with - WLMHT 19
14. Safeguarding Adults Training
21
15. Safeguarding Adults Champions
21
16. Case Studies
22
17. Publicity and Promotion
23
18. Hounslow Adult Abuse Awareness Week 2013
23
19. Mental Capacity Act (MCA) and Deprivation of Liberty Standards (DoLS)
24
20. Performance on last year’s objectives
28
21. Action Plans for 2012/13
29
22. Conclusion
31
Appendix 1 – SAFEGUARDING ADULTS HEADLINE FIG.
App 1
Appendix 2 – SAFEGUARDING ADULTS TRAINING DATA
App. 2
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1. Introduction Adults at risk are defined within ‘Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse’ as:- ‘People over 18 years of age who are or may be in need of community care services by reason of mental health, age or illness, and who are or may be unable to take care of themselves, or protect themselves against significant harm or exploitation. The term replaces ‘vulnerable adults’. The aim of working together to safeguard adults at risk is to make sure that:- The needs and interests of adults at risk are always respected and upheld. The human rights of adults at risk are respected and upheld. A proportionate, timely, professional and ethical response is made to any adult
at risk who may be experiencing abuse. All decisions and actions are taken in line with the Mental Capacity Act, 2005. It also aims to make sure that any adult at risk maintains:- Choice and Control. Safety. Health. Quality of life. Dignity and respect. The Safeguarding Adults Board and those responsible within the partner organisations for leading on safeguarding adults take these aims seriously and work together to deliver a response which puts the adult at risk at the centre of their thinking and planning. This means being clear about what they want to happen from the start.
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2. National Context Following the 2009 review of the ‘No Secrets’ guidance, new legislation relating to adult protection was promised by the government and the draft Care and Support Bill is currently working its way through parliament. Those working to protect adults at risk have welcomed its intention to place Safeguarding Adults Boards on a statutory footing, which we believe will help partner agencies to identify resources, as part of their key objectives, and prioritise safeguarding adults as a requirement rather than a commitment. Many people are however disappointed that key recommendations from the review, such as a right of access to an adult who is believed to be suffering abuse, and a legal duty for agencies to notify local authorities of adults who may be suffering abuse, have not been included in the bill. On April 1st 2013 Primary Care Trusts were abolished, with the bulk of their responsibilities transferred to the new Clinical Commissioning Groups. The PCTs’ role within the Deprivation of Liberty Safeguards (DoLS) process, as supervisory bodies for DoLS authorisations within all hospital settings was transferred to local authorities. Within Hounslow this has had minimal input as the local authority have managed the DoLS process on behalf of the PCT since the legislation was first enacted. In May 2013 the Government published a statement of policy on Adult Safeguarding setting out a statement of principles for Social Services, Housing, Health, the Police and other agencies to use, for both development and assessing its effectiveness of their local safeguarding arrangements. The statement also describes, in broad terms, the outcomes for adult safeguarding for both individuals and organisations. Local Authority Social Services continues to face through many changes and many new challenges. Funding constraints, changes to legislative frameworks and new Government guidance impact increasingly on the day to day work of frontline staff and management. It is essential that those involved with adults at risk know about the changes and learn from good practice in implementing new national and local strategies to safeguard adults at risk. To this end, we regularly update our awareness training and use our newsletter to make sure that everyone is aware of new developments. We also disseminate new reports, practice guidance etc to the relevant teams, via their managers. 3. Local Context Since 26th September 2011, Hounslow has been working to a unified policy, along with all of the Greater London boroughs; ‘Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse’, also known as the Pan-London Policy. The policy draws together best practice from all 32 Greater London boroughs, providing a clear, comprehensive and unified set of procedures across all areas and agencies. Following an extensive training programme at the time of its introduction, the Pan London policy is now well-established in Hounslow, and has been supported by the publication in October 2012 of ‘Protecting Adults at Risk: Good Practice Resource’ a report and web resource produced by the Social Care Institute for Excellence. The introduction of a common London-wide policy has
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been found to reduce confusion for agencies such as the emergency services who may work across several boroughs and to save money on training costs because safeguarding training is now ‘portable’ across all London boroughs. During the past year, Hounslow have been part of a pilot scheme around engaging service users in adult safeguarding and using their feedback to improve practice. The existing resident feedback project has been enhanced & redesigned as a result of knowledge gained from participating in this project. Management of Hounslow’s Mental Capacity and Deprivation of Liberty Safeguards (DoLS) responsibilities is integrated within the Safeguarding Adults Team. This includes managing our rota of DoLS Best Interest Assessors, and ensuring that the Borough responds to requests for Urgent and Standard DoLS Authorisations and completes a range of assessments and documentation within the legal timeframes. From April 2013 the local authority has been the supervisory body for authorisations within hospital settings, as well as residential and nursing home settings. The safeguarding team also monitor Hounslow’s Independent Mental Capacity Advocates contract, which is currently held with PoHwer. Hounslow’s Safeguarding Adults Team provides support to, and takes direction from Hounslow’s multi-agency Safeguarding Adults Board. The team’s role is predominantly to provide advice, support, training and consultancy to professionals and volunteers from a range of agencies that provide services to adults at risk within the borough. The safeguarding team monitor and quality assure all open safeguarding cases. Safeguarding investigations into alleged abuse or neglect of an individual are normally led by a social worker or CPN from the appropriate team, who has been trained in the investigation of adult abuse. The Consultant Practitioners lead on cases of institutional abuse, normally work in partnership with other departments where there are establishment concerns, and also form part of the membership of any Serious Case Reviews.
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4. The role of the Safeguarding Adults Board and its sub-groups This section gives an overview of the Safeguarding Adults Board and its three sub-groups:- Safeguarding Adults Board The Multi-agency Safeguarding Adults Board meets quarterly. The purpose of the Safeguarding Adults Board is to promote, inform and support safeguarding adults work. Members of the board are senior officers within their organisation and have sufficient seniority to represent their organisation with authority, make multi-agency agreements and take issues back for action. Members of the board ensure that priority is given to the prevention of abuse and that adult safeguarding is integrated into other community initiatives and services and has links with other relevant inter-agency and community partnerships.
Quality Assurance and Performance Sub Group The Quality Assurance Sub Group consists of representatives from several partners, including London Borough of Hounslow, Hounslow and Richmond Community Healthcare, West Middlesex University Hospital and Hounslow Homes. This group has developed and introduced the new framework and key partner organisations have now completed their self-assessment. The self-assessment has helped each organisation identify how they currently quality assure their services and identify any ways in which they would like to develop this further. The collated information from all completed self-assessments has produced a joint action plan for the whole partnership and will help to facilitate joint and shared working between partners wherever possible. The sub group will monitor progress on the action plan and ensure the Safeguarding Adults Board is kept aware of developments.
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Safeguarding Adults Board Training Sub Group Over the last year the Safeguarding Adults Sub Training Group has lost a number of members due to the changes in roles and responsibilities, however we have also gained some new members and now have representation from Children’s Safeguarding, Hounslow Homes and Housing Services. The main areas that they have been working on have been:
Reviewing training delivered in 2012-13 Identifying training requirements for the 2013-14 across the various areas Capturing attendance for training and reviewing Joint working with other Local Authorities How to implement and adapt Bournemouth University National Capability
Framework for Safeguarding Adults to fit in with Hounslow induction process, staff probation and appraisal
How to tackle non attendance and should we charge for non attendance at training
E-learning programme and how this may work as an introduction to the safeguarding subject area and to fit into a wider programme of learning and development
Although the year has been challenging and not all desired outcomes have been achieved for each of the strands, the group has maintained momentum and is looking forward to the yea r ahead. With the other agenda’s coming to the fore we must not lose sight of what we are doing to implement on each area and embrace new ways of working.
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Multi Agency Safeguarding Adults Practitioner’s Group. The Safeguarding Adults Team organises the Multi Agency Safeguarding Adults Practitioner’s Group, which meets quarterly and is chaired by one of the Consultant Practitioners for Safeguarding, MCA and DoLS. The Multi Agency Safeguarding Adults Practitioner’s Group is for all staff in Hounslow who work with vulnerable adults. This includes Health Teams, Social Services Teams, Community Teams, Care Homes, Nursing Homes, Domiciliary Care Agencies, Private Providers of care, Voluntary Groups and Advocacy Groups. This meeting is for practitioners to discuss any topic related to adult abuse and safeguarding. It is also an opportunity for the Safeguarding Adults Team and practitioners to share useful information and raise concerns about the application of the policy and has a valuable peer review function. Issues involved in complex adult abuse cases are discussed using anonymised case studies either provided by the chair or brought to the group for discussion by other group members. The Practitioners Group is well attended by staff from a wide range of agencies and organisations. Recent topics of interest have included the implication of the draft Care & Support Bill, changes to the Disclosure and Barring Scheme for those who work with vulnerable groups, changes to safeguarding reporting and recording practice in Hounslow following the change to IAS Protocol and implications of new case law especially in relation to Mental Capacity and the Deprivation of Liberty Safeguards..
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5. Safeguarding Team Structure and roles.
Safeguarding
Adults and MCA/DoLS
Team Business Support Officer
Safeguarding Quality and
Performance Manager
Safeguarding
Adults Development Coordinator
Safeguarding
Adults and MCA/DoLS
Team Consultant Practitioner
Safeguarding
Adults and MCA/DoLS
Team Consultant Practitioner
Monitors & quality assures safeguarding reports, minutes
& case notes Leads on quality assurance
including monthly file audits of ASC and mental health
safeguarding cases, resident experience feedback and partner agencies QA self
assessments. Responds to reports, queries
& requests for advice from professionals, adults at risk &
members of the public. Develops & delivers training
programmes Undertakes departmental QA
tasks unrelated to safeguarding as required
Respond to reports, queries & requests for
advice from professionals, adults at risk & members of
the public Act as lead person in
institutional abuse investigations or very
complex cases. Take part in Serious Case
Reviews Manage DoLS for
Hounslow (Health & LA) & are qualified as BIAs
Manage Hounslow’s IMCA contract
Develop & deliver training
Co-ordinate publicity/promotional
events inc. stalls and AAA week,
workshops, training & conferences. Key role in producing & distributing leaflets,
posters, training materials, reports & quarterly newsletter. Manages & supports the work of our AAA
volunteers team Delivers
safeguarding training
Safeguarding Team Manager
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The roles and responsibilities of the Safeguarding Adults Team include:-
Support to SAB to deliver the aims and objectives in its Business Plan.
Being a reporting point for all staff working with vulnerable adults in Hounslow when they are concerned that adult abuse may be happening.
Being a contact point for service users, carers and families to report abuse and to ensure that a referral is made to the relevant team.
Giving advice, support and guidance when there has been an adult abuse allegation.
Being a contact point for general advice on safeguarding adults and MCA/DoLS issues.
Providing/facilitating Adult Abuse Awareness training sessions to staff, carers and volunteers working with adults at risk in Hounslow.
Co-ordinating and providing training for managers and for staff investigating abuse allegations.
Monitoring data in relation to adult safeguarding and DoLS.
Publicising and promoting safeguarding adults throughout Hounslow in order to raise awareness and encourage reporting of adult abuse.
Organising the Safeguarding Adults Board and the Multi-Agency Safeguarding Adults Practitioner’s Group.
Monitoring Hounslow’s IMCA Contract
Supporting the implementation of the Mental Capacity Act through training, awareness raising and advice
Taking the lead in serious and complex cases of adult safeguarding.
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6. Adult Abuse Awareness (AAA) Team The “Adult Abuse Awareness Team” volunteers continue to raise awareness of adult abuse every month by running information stands in public places, health facilities and community settings such as libraries, supermarkets, hospitals and Gurdwaras. This year we have recruited another 4 volunteers from the learning disabilities & physical disabilities client groups, which take our total number of volunteers to 12. The team were nominated and presented with Certificates of Recognition at this year’s Community Safety HERO’s awards and they grab the runners up place alongside other volunteering Groups in the community. The AAA team ran an information stall at this year’s biggest community event the 10th Annual ‘London Mela’, which attracted over 80,000 people from all over London, including Hounslow and Ealing. A workshop was arranged in October to train the volunteers in taking part in the Safeguarding Residents Feedback Questionnaire, which asks residents who have been subject to a Safeguarding Investigation, to give their views and thoughts about their experiences of our Safeguarding Adult Services and how we can make improvements. After a very successful event for the Alzheimer’s Society where the volunteers performed a series of plays about adult abuse, the volunteers were asked to deliver peer training on Safeguarding Adults to service users at Heston House. The training was on the theme of scams and financial abuse & was very well-received. Safeguarding Adults team have recently joined up with the Community Safety team to train our AAA team Volunteers to raise awareness about antisocial behaviour issues such as domestic violence, hate crime, financial scams, nuisance neighbours etc. The training session was organised by the Community Safety Team which was very successful. The Volunteers now work alongside the Community Safety Team and signpost residents seeking assistance to other relevant services.
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7. Partnership working – Police and Domestic
Violence The Hounslow Police Community Safety Unit (CSU) is responsible for the investigation of domestic violence and other hate crime based on a person’s race, religion, disability or sexuality. The CSU also work in partnership with other agencies to safeguard vulnerable adults. The most vulnerable in our community deserve protection from exploitation and abuse by those entrusted to their care and they should be able to rely on them to keep them safe. The MPS have updated their guidance to all officers on identification, support and care to adults at risk. It gives clear guidance to police officers and staff about the multi agency investigative approach necessary to arrest and bring perpetrators to justice for crimes committed. Hounslow BOCU CSU adopts a multi agency approach in the investigation of adults at risk cases. The CSU works with other agencies to respond to high risk cases developing a joint strategy. This approach to dealing with safeguarding adults at risk cases has created good working relationships with other agencies. Hounslow BOCU CSU has also raised awareness of adults at risk crimes/incidents for frontline staff by ensuring that frontline officers fully understand the definition of a ‘Vulnerable Adult’. Raising awareness has been achieved by frequent training sessions, circulation of any changes to current policy advice and referring colleagues to the CSU website on the MPS intra net where all available information relating to the subject of adults at risk can be found. Also CSU practitioners will attend the scene, address or venue of any reported case of an adult at risk and take full ownership of such investigation. For 2012 - 2013 in the Borough of Hounslow there were 21 reported cases relating to vulnerable adults - a marked improvement in the reporting of such cases compared to 12 in 2011-2012 and only one in the previous year. The breakdown of these figures shows that 9 of these involved theft from
vulnerable adults, 7 were subject to assaults and the remainder involved a variety of offences involving fraud, criminal damage and other specified offences.
The CSU aims to contact all vulnerable persons within 24 hours of the matter being reported. Utilising the services of Safer Neighbourhood Teams to conduct further reassurance visits and patrols in areas where a crime against a vulnerable person has occurred. All adult at risk crime allegations reported to police are flagged to make the monitoring and review of such allegations more effective. The Community Safety Unit is being restructured in 2012-13 in line with the MOPAC’s Local Policing Model. However this will not result in any decrease in staff in the CSU. The Unit will maintain a dedicated Safeguarding lead to oversee investigations involving vulnerable adults reinforcing strict adherence to the MPS Standard Operating Procedure for the investigation of crimes relating to adults at risk through timely reviews of such reports and also creating detailed investigation plans.
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8. Partnership working – Community Safety Ongoing police training and awareness raising ensuring
officers recognise and adequately respond to Disability Hate Crime and record information on these incidents on the police system.
True vision website has been established for DHC third party reporting. Link to this website to be placed on Hounslow Metropolitan Police website
In strengthening the multi agency partnership working there have been a number of Domestic Violence and Sexual Violence awareness training sessions delivered to mental health workers at Lakeside Mental Health Centre. This will assist in supporting victims of domestic violence who are affected with mental health issues.
An agreement has been made between the Hounslow Mental Health Service and Refuge to deliver domestic violence outreach sessions at one of the mental health venues in Hounslow in 2013-2014
The new Hate Crime Support Service began taking referrals from May 2012. Since May they have received a total of 42 referrals by March 2013. Staff are available in Hounslow on Mon-Wed, 10am-4pm to give advice and support to any victim of hate crime resident in the borough. Support is available via the five agencies delivering the service for the reminder of the time. The five agencies are Disability Network Hounslow, Ealing Equality Council, Outwest LGBT Group, Ealing CVS and West London LGBT Project.
Community Safety and partners have been working to implement the Hate Crime Prevention Action Plan 2012-2013.
9. Partnership working – Clinical
Commissioning Group (Formerly Commissioning and PCT)
Throughout the majority of 2012/13, Hounslow Primary Care Trust (PCT) has been represented at the Board by Sue Jeffers (Managing Director) and Mary Crawford (Deputy Borough Director/Head of Joint Commissioning). As the PCT (shadow Board) prepared for authorisation as a Clinical Commissioning Group (CCG), with responsibility for health commissioning for the majority of services for the Hounslow registered population, it confirmed that the Board would wish to be advised of significant safeguarding concerns at the earliest opportunity, usually in Part II of this meeting. Action plans and updates would usually be reported to, and monitored by, the Quality Committee - a sub Committee of the Board. An example is that the Winterbourne View action plan will be dealt with in this way. The Board is supported in its safeguarding work by (Jonathan Webster’s title) based in the CWHH Collaborative and commissioning managers based in the Commissioning Support Unit
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A CCG lead GP for adult safeguarding has been identified and has established the need to ensure effective policies are in place across primary care. In November 2012, a Hounslow Education and Training (HEAT) event focused entirely on safeguarding (adults and children). GPs, practice nurses and managers all attended this event. Following this, the LBH Adult Safeguarding Team and CCG Children’s Safeguarding lead have agreed a plan to support practices. Safeguarding continues to be a standard item on contract management meetings. Where relevant, findings are shared and addressed jointly with LBH. The CCG has agreed to continue a focus on the quality of health input to and monitoring of care homes. It has extended the funding of a care home pharmacist and a project to improve monitoring of care homes with LBH. Key areas of action/attention for the forthcoming year will include:
Improved knowledge and awareness of adult safeguarding and effective policies in primary care
Reviewing arrangements for a medication admission service to vulnerable people living in the community
An ongoing focus on refining a joint approach to monitoring care homes with LBH and to improving the availability of primary health services to residents
Ensuring the safe return to those people currently placed out of the borough but returning to a (usually) less intensive local service
Preparing for personal health budgets ensuring learning from those areas that have piloted them and Local Authorities
Reviewing the learning disability self assessment health returns of the local NHS Trusts to ensure the CCG Quality Committee is sighted on these and working with the Commissioning Support Unit to ensure areas of concern are addressed.
The CCG Board will work with NHS England over serious untoward incidents (SUIs) in primary care to ensure it is aware of these and learning shared. It is anticipated that some SUIs may raise safeguarding issues the Board will wish to address.
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10. Partnership working – London Fire Brigade Key safeguarding adults developments, achievements and challenges for London Fire Brigade Hounslow over the past 12 months 2011-12. The awareness of London Fire Brigade staff, following on from previous training, has increased and allowed staff to raise concerns when vulnerable adults have been encountered, directly with relevant agencies. Issues raised by London Fire Brigade at the Safeguarding Adults Board have included vulnerable and mentally frail people living alone, and hoarding. Safeguarding Adults Board membership attained by the LFB Borough Commander and Community Safety Station Manager. Good working relationships have been maintained and deepened with SAB partners as Brigade understands the partnership aims, and supports where possible. 10.1 Challenges SAB seeking funding from partners as the London Fire Brigade itself faces financial constraints. Brigade re-organisation and pressures on existing staff mean that SAB is one of many partnership initiatives supported by a small number of staff. .
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11. Partnership working with Hounslow and Richmond Community Healthcare NHS Trust
Achievements
HRCH completed a second NHS London Safeguarding Adults Assessment Framework in 2012. This year the self-assessment was validated by the North West London Cluster and the South West London Cluster. The assessment process allowed the organisation to review progress from the initial self-assessment and identify areas that need further development over the coming year. These areas for development have been incorporated into the Trust’s Safeguarding at Risk Work Programme as have comments made by the Clusters.
It has been agreed to increase capacity in Adults Safeguarding, as a result funding has been identified for a dedicated post. This post is currently out to advertisement. When appointed this post will allow HRCH greater participation in the Adult Safeguarding sub groups for both Hounslow Borough and Richmond Borough as well as ensuring a specific resource to implement all aspects of the work programme.
HRCH took part in an assessment of their partnership role on the Richmond Safeguarding Adults Partnership Board. As well as the assessment rating the overall Board performance the Trust was given organisation specific feedback which will be used more broadly and fed into the HRCH Adults at Risk work programme.
Internal procedures are in place to support staff with safeguarding. These procedures are being updated to incorporate PREVENT referrals.
Supervision of staff involved in safeguarding alerts, investigations or meetings has been recognised within the new HRCH clinical supervision policy currently under review.
One of the challenges identified last year was the low number of staff who had undertaken Safeguarding Adults at Risk training. Following a concerted campaign HRCH has improved the uptake of this training and now 90.88% of staff are trained.
Challenges Although there has been significant improvement in the number of staff
undertaking Safeguarding Adults at Risk training the target level set by HRCH Board is 95%, therefore work needs to continue to ensure this target is met. It is intended to incorporate the training on the corporate induction. Work also needs to take place to ensure that any future training meets the need of front line clinical staff.
Training levels for Mental Capacity Act /Depravation of Liberty Safeguarding (MCA/DoLS) are not clear but thought to be low. HRCH needs to establish the level of staff that have received training and develop a programme to ensure that all appropriate staff who have not attended any training do so.
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The internal systems for collecting information on the number of safeguarding alerts and the number of DoLs referrals has yet to be established.
HRCH needs to establish local performance metrics for Adults at Risk and DoLs, so that progress and quality standards in these areas can be monitored.
HRCH needs to ensure that Safeguarding Adults at Risk information on their website is in an accessible format or available in different languages.
A route needs to be identified for gaining user and carer feedback in Adults at Risk cases.
Further work needs to be undertaken to address the PREVENT agenda.
12. Partnership working with
Hounslow Homes. Hounslow Homes is the London Borough of Hounslow’s arms length housing management company that is responsible for managing and maintaining 16,000 council homes in the borough. Hounslow Homes joined the Safeguarding Board in 2011 and in taking up membership have been reviewing their approach to safeguarding and vulnerability. We have agreed to adopt the Pan London definition of an “Adult at Risk” to form part of our policies and produces when dealing with tenants with vulnerabilities to mirror the approach of other key agencies in this area. We have supported the work of the Positive Risk Panel, and staff are encouraged to refer cases to this panel. We continue to review and improve our work regarding safeguarding issue and over the last twelve months we have completed the following:- Raise awareness of vulnerability within the organisation “Departmental
Champions “ identified to take lead on vulnerability – achievement Tenancy Services department re-structured and an additional post included to
focus on Vulnerability – achievement Identified tenants with a learning disability and sent out core documents to them
in easy read - achievement Review and developed joint working protocols with key agencies in the Council
- Achievement Identify vulnerable families affected by Welfare reforms and provided targeted
support- achievement. Review and extended the role of Linkline Services to provide more support to
elderly tenants across the borough - achievement Vulnerability and the related safeguarding issues and are now core issues for the organisation, and we are keen to engage in joint working with other agencies to support tenants who may fall into this category. Over the next year we intend to reconfigure our housing management service and move to a generic model where Housing Officers manage smaller patches thus enabling front line staff more time to focus on vulnerability issues.
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13. Partnership working with West London Mental Health Trust Achievements
West London Mental Health has made progress developing safeguarding adult governance arrangements in the last year. The Trust has developed quality assurance measures for safeguarding that are reported to the Trust board on a monthly basis. Measures include awareness of numbers of safeguarding adult referrals made by staff in the organisation and linking this to our incident review processes.
In addition, the organisation’s awareness of adult safeguarding matters has been informed by establishing a Trust-wide Safeguarding Adult Governance Forum. This meeting is embedded in the Trust clinical governance structure and has representation from Local Authority Safeguarding Adult Teams in all the London Boroughs in which the Trust delivers services. This assures a degree of transparency about the Trust’s performance. This is now enhanced by including the Safeguarding Adult Lead from the local CCG in the membership of the meetings.
WLMHT completed a second Safeguarding Adults Self-Assessment Assurance
Framework in 2012. The submission was presented to the Hounslow Safeguarding Adult Board and validated centrally by NHS-London additionally. The Trust was identified as an example of best practice on a range of outcomes by the overview report produced by NHS London.
WLMHT has put considerable resource into developing mandatory training and
review of Safeguarding adults Training was part of this drive to increase staff knowledge levels. The content of the training has been reviewed in line with latest guidance and training levels for safeguarding adult awareness training is consistently managed at levels above 80%. The staff training has been benchmarked in an external validation exercise and we were reviewed to be performing amongst the top Trust for achievement of mandatory training compliance.
The Trust has recently reviewed its Safeguarding Adult Policy and Procedures as
an interim measure pending a major revision of the policy which is underway. It is anticipated that the policy will support staff development and knowledge and will enhance partnership functioning by facilitating and clarifying the expectations for staff of the Trust. This revision will include additional guidance on PREVENT.
The Trust has commissioned a review of Safeguarding Adults across the
organisation by an external auditing agency to identify relative strengths and weaknesses in relation to safeguarding performance. The report will be considered by the Trust board and recommendations for development will be used to strengthen existing processes and resources.
Although the PREVENT agenda needs to be developed in the Trust, staff
awareness is increasing and the Trust has made its first referral using the Channel Protocol.
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Challenges
Safeguarding Adult capacity remains an issue as the Trust recognises the incremental increase in expectations placed on staff in respect of their responsibilities and duties relating to safeguarding adults. It is expected that the full audit of safeguarding procedure will inform the development of resource.
The organisation’s knowledge of the use of Mental Capacity Act /Depravation of
Liberty Safeguarding (MCA/DoLS) is not fully developed. This has been identified as an area for review over the coming year. Systems for collecting information about this activity need to be developed.
The intranet pages informing staff about relevant safeguarding adult information
has been re-designed but due to capacity issues the implementation has been delayed. This will be prioritised as it forms a core route for communication with, and informing staff about, best and current practice.
User involvement in Safeguarding Adults is not yet well-established. The Trust
has started to collect information about user experience routinely and this dataset will be developed to include information about safeguarding. In addition, a service-user leaflet providing information about adult safeguarding needs to be developed.
The PREVENT agenda needs to be embedded in the Trust Safeguarding Training
and plans are under way to develop this resource.
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14. Safeguarding Adults Training London Borough Hounslow continually strives to deliver a wide range of learning and development interventions to support the workforce to maintain quality service delivery to meet its priorities and/ or emerging priorities in safeguarding adults to protect the most venerable residents in Hounslow. In 2012-13 the Safeguarding Training Sub group reviewed all The Safeguarding Adults training plan and stream line the training to meet identified need, some of which has been delivered in partnership with London Borough of Richmond. 15. Safeguarding Adults Champions / Peer Trainers Hounslow has rebranded the role of Safeguarding Champion to Peer Trainer. This role is now being reviewed as we have lost a further four staff last year. A recent recruitment campaign was undertaken within Hounslow and with our partners to see if we could identify staff who would be able to take on this role for Hounslow and act as lead for their organisation. Five staff were identified as be able to fulfil this role once they have undertaken the relevant training to up skill them. If this campaign can be taken forward in 2013-14 we can build on our successful Peer Trainer programme which was delivered across 2011-12 & 2012-13 this will increase the number of sessions we can deliver across Hounslow and its partners. The current 5 Champions provide Safeguarding Adults Awareness training for Hounslow Council, the Health Service, the Independent Sector, the Voluntary Sector and other organisations including the Police and Fire Service.
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16. Case Studies. Mr ‘Jones’ (not his real name) was in his early sixties and had been living alone in his small flat for many years. There were longstanding concerns about his ability to maintain his tenancy and about whether he was vulnerable to being exploited by those around him, and he had a great deal of support from his housing provider and from his neighbourhood police. Mr Jones did not present as having any issues re his mental capacity. It was felt possible that he may have mental health issues however he was never assessed, as he did not wish to engage with services. Concerns were raised after Mr Jones was seen looking dishevelled and begging in a local shopping centre. It was discovered that ‘Ed’ a local man who was well known to the police for drug-related offences had moved into Mr Jones’ flat and was allowing his friends and acquaintances to use it also. The flat was in a filthy condition, with no heating, little furnishings and no food. Mr Jones was initially very reluctant to accept support, but eventually he disclosed that Ed asked him regularly for money and that he gave him most of his benefit money. He said that he had invited Ed into his home but he no longer wanted him there and was afraid to ask him to leave. It was established that Mr Jones was being financially and emotionally abused. With police assistance, the unauthorised ‘guests ‘were cleared from Mr Jones’ flat. Concerns remained about the poor condition of the flat and about the risk of Mr Jones allowing people who would exploit him back into his flat. After a lot of persuasion, Mr Jones agreed to a trial stay in sheltered accommodation. After one day in a clean, warm and fully-equipped flat within a sheltered block, Mr Jones chose to return to his old flat and has declined further support. One of the challenges of safeguarding work with adults is that many of the adults who we support make choices about how they wish to live their lives, which to others may appear dangerous or unwise. Legally, if someone is an adult, and if they have mental capacity to fully understand the choices they are making, then no-one has the right to stop them doing so even if they may be placing themselves at risk.
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17. Publicity and Promotion In addition to the Hounslow Adult Abuse Awareness Week, the Safeguarding Adults Team has an ongoing programme of various publicity and promotional activities, throughout the year such as information stands, quarterly newsletters, drama and putting features in the local press and on the Hounslow Council Website. Safeguarding adults at risk from abuse has become an area of increased media interest in recent years. Within the last year TV coverage and notably 2 Panorama documentaries exposing abuse in care settings, have raised public awareness about Safeguarding Adults. Our information stalls also distribute a small range of free promotional items such as pens, coasters etc. which carry our logo and contact details. The team continues to represents Hounslow on the London Safeguarding Adults Coordinators Network and MCA DoLs London Lead’s meetings. 18. Adult Abuse Awareness Week 2013
Hounslow’s 8th Annual Adult Abuse Awareness Week is taking place on week commencing 10th June 2013. The event will be launched by the Mayor of Hounslow, Councillor Gupta, with a coffee morning for service users and staff of Community Access Service and an afternoon tea at Age UK Brentford. A variety of training workshops for all staff and volunteers working with adults at risk are being held throughout the week; including Domestic Violence and Safeguarding, Self Neglect, Role of the IMCA and Financial Abuse. Information stalls at the Hounslow Treaty Centre and West Middlesex Hospital are being held during the week. Alongside our annual flagship event for Service Users and Carers there is also a staff conference organised for everyone working with vulnerable client groups. It which will feature local and national speakers on a range of topics and a series of drama illustrating adult abuse scenarios which are written, directed and performed by our Adult Abuse Awareness Volunteers with the assistance of two members of the Safeguarding Adults Team.
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19. Mental Capacity Act and Deprivation of Liberty Standards 19.1 How does Hounslow respond to DoLS requests? In March 2009 it was agreed that the Supervisory Bodies - Primary Care Trust (PCT) and Local Authority (LA) would meet their responsibilities regarding the Deprivation of Liberty Safeguards through a joint MCA/DoLS office, with the Local Authority taking the lead and managing the office. This office is situated within the Safeguarding Adults Service. Since March 2010 the DoLS office became part of this integrated team and has an overall Team Manager. Within this team there are 3 Best Interest Assessor’s (BIA) who also carry out Safeguarding adults work and are supported by an Administrator. This team manages a small list of approved Section 12 Doctors (for DoLS). In addition to this there are 6 BIA’s employed across WLMHT and LA who hold other substantive portfolios of work alongside their Best Interest Assessor roles. All BIA’s and approved Section 12 Doctors practising in Hounslow have successfully completed annual Continuing Professional Development (CPD) requirements in respect of DoLS since completing their initial training resulting in the respective Supervisory Bodies being confident in their skills. Although a further 5 BIA’s were trained in January 2012 which gave us a total of 13 BIA’s, this number has reduced over the year due to long term sickness, maternity leave and other staff not attending the refresher training. In addition to Social Workers and Approved Mental Health Professionals the team benefits from the expertise and knowledge of an Occupational Therapist. The team has a total of 9 BIA’s to cover the DoLS work in Hounslow on a rota basis. Over the previous year the Safeguarding Service has jointly facilitated a Bi-monthly Best Practice Meeting with the London Borough of Richmond for BIA’s. 19.2 Number of people benefitting from Deprivation of Liberty Safeguards in
Hounslow. In the fourth year April 2012 – March 2013 Hounslow received a total of 33 requests for DoLS authorisations. This means that a total of 33 people who it is deemed are being deprived of their liberty have been independently assessed and considered by best interest assessors and or Section 12 Doctors. The total number of annual applications received over the previous three years by Health and Social Care in Hounslow had been relatively equal. However with just 29 requests for residents in care homes and only 4 requests for patients in hospital beds, there has been a slight decrease in Local Authority referrals this year and a marked 66.6% reduction in PCT referrals compared with last year (See chart below). The reduction in PCT referrals is likely to be attributed to the closure of a specialist unit for older people with Mental Health problems, who are now often placed in a registered care home and although possibly funded by the PCT, would be classified as Local Authority for the purposes of DoLS. Also there is a greater awareness within the general hospitals and therefore less inappropriate referrals are being
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made. However this needs further scrutiny to ensure that patients are not being unlawfully deprived of their liberty in hospitals. Local Authorities are the supervisory body for requests in respect of residents in care homes and PCT’s are the supervisory body for requests in respect of patients in hospital beds.
The chart below gives all referrals for the past 4 years
The following table shows the number of requests in more detail and shows the outcome of the assessments by those that were granted and not granted. PCT Requests Granted Not Granted WMUH 0 2 Lakeside MHU 0 0 Brain injury rehabilitation unit 0 1 Ashford Hospital 0 1
LA Requests Granted Not Granted Care Homes 17 12
The majority of authorisations granted have been for a period of 6 months or less. Where an authorisation is not granted other actions have often been taken, including an urgent review for the resident, assessment under the Mental Health Act or safeguarding referral.
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Of the 29 Local Authority referrals, 10 have been for placements commissioned out of borough as follows: Surrey 6, Kingston 1, Berkshire 1, Essex 1 and Hillingdon 1. A number of these referrals have been repeat referrals. This year our local BIA’s have managed to complete most of these out of borough assessments, with the exception of Essex where it was necessary to commission the local DoLS team in Essex to complete the required assessments. This was due to time restraints and distance required to travel. 19.3 Type of disorder Analysis of the DoLS authorisation requests received for both LA and PCT shows that 58% were for individuals with a dementia. Similar to last year, the majority of requests received have been for older adults with dementia living in care homes. Hounslow have seen a slight decrease in the number of requests for adults with Learning Disabilities compared with the previous year of 7.
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19.4 Independent Mental Capacity Advocate’s (IMCA’s) and paid representatives. Every individual who is subject to a DoLS request is entitled to an IMCA even though they may have family or friends to support them. In practice many of those subject to a DoLS assessment have friends and family who decline the offer of an IMCA and who seek to advocate for their family member themselves. Consequently of the 33 assessments completed by Hounslow, 7 individuals subject to a DoLS request had involvement from a DoLS IMCA. Any individual who is subject to a DoLS authorisation (where that application is approved) may have a Paid Representative appointed if they do not have family or friends who are able to take on the role of Relevant Persons Representative. Just 3 individuals in Hounslow had a Paid Representative appointed during this financial year. Case Study – Client A
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Client A is 97 year old lady diagnosed with Alzheimer’s; she was living in the community but was placed in a care home as an ‘emergency’ measure following concerns regarding whether A’s grandson, who stayed with her on and off, was coping with providing care. A was placed in a care home shortly before Christmas; she clearly objected to the fact that she was at the care home and being prevented from leaving, A’s grandson was also being prevented from taking her home, despite his request to do so. An urgent DoLS was thus initiated by the care home. A wished to return to her home and be with her grandson; she stated that no one had explained to her properly why she had been taken to the care home and even after it has been explained since, A made it very clear that she did not agree with the reasons and did not feel that removing her from her home was not the solution. The care home / managing authority, whilst being aware that they were depriving A of her liberty, did not wholly agree with how the situation had been handled by social services or that they should have accepted A in the first place. By initiating the DoLS process and liaising with the IMCA and other assessors, the care home sought advice and as a result had increased awareness and knowledge regarding how they might deal with a similar situation in the future in the interests of the client. The IMCA represented A’s clearly stated wishes to both the Best Interest Assessor and Supervisory Body after meeting with A in private, reviewing the relevant documentation, and meeting with the management of the care home within the urgent time frame given. The deprivation of liberty was authorised for a duration of 2 weeks, with the condition attached that A would be supported to return home with appropriate measures to manage any perceived risks within that time frame, sooner if possible. Learning outcomes for the care home to clearly express concerns to the supervisory body as soon as they are noted by staff to improve services for the client as a whole.
20. Performance on last year’s outcomes
Actions for 2012/13
Target Date
1. Ensure smooth transition to new Adult Social Care system in respect of Safeguarding Adults and MCA/DoLS, when new TRIO system is being implemented.
OUTCOME: Due to IT delays in implementation these modules have not yet “gone live”. Configuration of system is in final stages and staff training is planned
March 2013
2. Develop an induction pack and briefing arrangements for all new members of the Safeguarding Adults Board.
OUTCOME: Content identified – to be distributed to SAB in
draft for comment
December 2012
3. Implement the champion’s scheme with an emphasis on peer training and re-launch the scheme. Paper to be presented to the Board.
OUTCOME: Developed outline and proposal – interviewed and selected potential peer trainers – currently awaiting a decision from LBH senior management about commissioning train the trainer
March 2013
4. Recruitment to expand the AAA volunteers group and produce a programme of events held during 2012/13
OUTCOME: Achieved
March 2013
5. Auditing the use of Mental Capacity Act within Adult Social Care.
OUTCOME: Currently exploring IT options
March 2013
6. Mental Capacity Act (MCA)/DoLS Information to be put on Hounslow Councils Website.
OUTCOME: Currently exploring IT options
March 2013
7. Review data collection of Safeguarding Adults information to match all the requirements of Department of Health data collection.
OUTCOME: Achieved
March 2013
8. Review and refine Safeguarding Adults reports to SLT and SAB to ensure that it is relevant to all agencies that are represented on the Partnership Board. Reports to include case audit key themes.
OUTCOME: Achieved
March 2013
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9. Embedding Mental Capacity Act into Care Management
Practice, through training. Deliver MCA/DoLS awareness training to HRCH.
OUTCOME: Achieved and ongoing
March 2013
10. Information Sharing Policy for Positive Risk Panel.
OUTCOME: Discontinued Positive Risk Panel due to change in LBH structure
September 2012
11. Increase the update of ‘in depth’ and ‘Managing Safeguarding Investigation’ training in Community Mental Health Teams.
OUTCOME: Achieved (as evidenced in WLMHT NHS SAAF)
May 2013
12. Following completion of the quality assurance Self Assessment Framework (SAF), a quality improvement action plan is to be developed and signed off by the Board.
OUTCOME: Completed
March 2013
13. Development of training strategy for Board adoption OUTCOME: Ongoing
July 2013
14. Further develop work ensuring that user experience is central to Safeguarding Adults policy and practice. Analyse results from our user engagement project and report to Board
OUTCOME: Achieved and ongoing
Mar 2013
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21. Action Plans for 2013/2014.
Actions for 2013/14
Target Date:
1. Ensure smooth transition in respect of Safeguarding Adults module for IAS/Protocol
September 2013
2. Ensure smooth transition in respect of MCA/DoLS module for IAS/Protocol
September 2013
3. Develop an induction pack for all new members of the Safeguarding Adults Board.
June 2013
4. Implement the champion’s scheme with an emphasis on peer training and re-launch the scheme. Await decision outcome from LBH senior management. Paper to be presented to the Board.
March 2014
5. Auditing the use of Mental Capacity Act within Adult Social Care.
March 2014
6. Mental Capacity Act (MCA)/DoLS Information to be put on Hounslow Councils Website.
March 2014
7. Further develop resident feedback work – build on last year’s project – ensure that user experience is central to Safeguarding Adults policy and practice
March 2014
8. Contribute to the development of Hounslow’s multi-agency safeguarding hub (MASH)
March 2014
9. Contribute to development work in respect of the proposed Integrated Care Organisation for adult social care
March 2014
10. Research and identify an effective package of e-learning to deliver Safeguarding adults basic awareness to all staff
March 2014
11. Develop working relationship between the Safeguarding Adults Team and the new Clinical Commissioning Group GP lead
March 2014
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22. Conclusion Adult abuse does happen. Hounslow is continuing to make progress to ensure that adult abuse is reported, investigations are carried out and, most importantly, the abused adult receives support. Numbers of cases reported has increased during the past year from 540 cases reported in 11/12 to 618 cases being reported in 2012/13. Safeguarding adults is everybody’s business. It is vital to be aware that everyone has a part to play in promoting good practice when dealing with adult abuse within Hounslow’s varied communities. People have a right to be safe and we all share the responsibility for helping that to happen.
SAFEGUARDING IS EVERYONE’S BUSINESS
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Safeguarding Adults Headline Figures April 2012 – March 2013
Appendix 1 Notifications Received
816
6
2721 21 19 19
12 15 13 13
33 35
2331 28
2432
22
12
36 3227
0
Apr‐12 May‐12 Jun‐12 Jul‐12 Aug‐12 Sep‐12 Oct‐12 Nov‐12 Dec‐12 Jan‐13 Feb‐13 Mar‐13
10
20
30
40Alerts
Investigations
816
6
2721 21 19 19
12 15 13 13
33 35
2331 28
2432
22
12
36 3227
0
10
20
30
40
Apr‐12 May‐12 Jun‐12 Jul‐12 Aug‐12 Sep‐12 Oct‐12 Nov‐12 Dec‐12 Jan‐13 Feb‐13 Mar‐13
Alerts
Investigations
46%
52%
2%
Male
Female
<not known>
Gender
Notifications
Received (Teams) Substantiated 5 5 4 3 2 1 0 0 0 0 0 0
Teams
OP East OP West OP
Review CLDT ILT WMUH MH East MH West MH OP SG Team Other
TOTAL
Classified as alerts 23 33 11 76 13 8 5 2 1 7 10 189 Classified as investigations 50 63 24 99 30 12 13 16 6 12 11 336 of which out of borough (alerts / invests) 2/2 0/2 3/11 20/29 1/1 0/0 0/0 0/1 0/0 1/1 2/0 0 TOTAL 73 96 35 175 43 20 18 18 7 19 21 525
Instances by ethnicity April 2012 - March 2013
325
55
50
100
150
200
250
300
350
1423
5 6 411
2
2310 5 4
13 11 14
0
1.1 ‐ White: British
1.2 ‐ White: Irish
1.3 ‐ White: Other
2.1 ‐ White and Black Caribbean
2.3 ‐ White and Asian
2.4 ‐ Any Other Mixed Background
3.1 ‐ Asian: Indian
3.2 ‐ Asian: Pakistani
3.3 ‐ Bangladeshi
3.4 ‐ Asian: Other
4.1 ‐ Black: Carribean
4.2 ‐ Black: African
4.3 ‐ Black: Other
5.2 ‐ Other Ethnic Group
6.0 ‐ Not Stated
Unknown - 2 -
Case conclusion of completed referrals, by age and primary client group of vulnerable adult.
Substantiated Partly Substantiated Not Substantiated Not Determined /Inconclusive
Physical disability, frailty and
sensory impairment (Total)
8 5 11 9
Mental Health (Total) 11 4 4 5
Learning Disability 60 0 21 28
Substance misuse 1 0 1 0
Other Vulnerable People 0 1 0 0
Age Group 18-64
Total 18 - 64 80 10 37 42
Total 65-74 12 2 7 12
Total 75-84 29 5 19 15
Other Age Groups
Total 85 and over 30 5 26 32
Total Total 18 and over 151 22 89 101
- 3 -
- 4 -
8 315
44
14 18 18 23
202
12
168
0
50
100
150
200
250
Alleg
ed Pe
rpet
rator
's Ow
n Hom
e
lege /
Adult
Ed /
Wor
k Day
Cent
re/S
ervic
eGe
nera
l Hos
pital
Nursi
ng Ca
re H
ome (
Perm
anen
t)Pu
blic P
lace
Resid
entia
l Car
e Hom
e
Shelt
ered
Acco
mod
ation
Supp
orte
d Acc
omm
odat
ion
Vulne
rable
Adult
's Ow
n Hom
e
Vulne
rable
Adult
's Re
lative
's Ho
me
Not k
nown
Location of Suspected Abuse March 2012 - April 2013
Safeguarding Figures 2012-13 (Apr 2012 - Mar 2013)
2 hr Awareness (Safeguarding Team/Champions) Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Total Courses Held 4 13 10 8 Total Attendees 76 237 140 132 London Borough of Hounslow 14 113 16 25 Hounslow Homes West Middlesex Hospital 15 3 Hounslow and Richmond Healthcare 6 WLMHT NHS 1 43 47 Independent Providers 47 108 80 56 Voluntary Organisations 6 1 4 Emergency Services (Police/Fire) Prison / Probation Service 76 237 140 132
Role of the Manager Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Total Courses Held 0 0 1 1Total Attendees 11 12London Borough of Hounslow 1 3Hounslow Homes West Middlesex Hospital Hounslow and Richmond Healthcare WLMHT NHS 3 3Independent Providers 7 5Voluntary Organisations 1Emergency Services (Police/Fire) Prison / Probation Service 0 0 11 12
1 Day In-depth Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Total Courses Held 0 1 1 4Total Attendees 20 17 46London Borough of Hounslow 13 7 19Hounslow Homes 1 1West Middlesex Hospital 1 Hounslow and Richmond Healthcare WLMHT NHS 1 14Independent Providers 6 7 11Voluntary Organisations 1 1Emergency Services (Police/Fire) Prison / Probation Service 0 41 17 46
Assessment and Investigations Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Total Courses Held 0 0 1 1Total Attendees 13 13London Borough of Hounslow 10 13Hounslow Homes West Middlesex Hospital Hounslow and Richmond Healthcare WLMHT NHS 3 Independent Providers Voluntary Organisations Emergency Services (Police/Fire) Prison / Probation Service 0 0 13 13
- 2 -
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Managing Safeguarding Adults Investigations (SAM) Apr-Jun Jul-Sep Oct-Dec Jan-Mar
Total Courses Held 0 1 0 1Total Attendees 9 11London Borough of Hounslow 7 11Hounslow Homes West Middlesex Hospital Hounslow and Richmond Healthcare WLMHT 2 NHS Independent Providers Voluntary Organisations Emergency Services (Police/Fire) Prison / Probation Service 0 9 0 11
