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Safeguarding Adults - Board Report 2014 - 2015 Page 2 of 24

Executive summary: This paper provides the Annual Report for Safeguarding Adults on the progress for 2014 – 2015 against a number of specific elements and highlights key risks and issues. It also gives detail to how Moorfields Eye Hospital NHS Foundation trust is monitored and assessed on its performance both internally and externally in regards to Safeguarding Adults.

Related trust Objective: Improving patient safety and satisfaction.

Risk and Assurance: Maintaining effective safeguarding arrangements increases the safety of our patients and the quality of the services we provide, supporting the achievement of objective.

Legal implications/regulatory requirements: Safeguarding Adults is governed by regulatory requirements which includes the “No Secrets; Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse”; the “Protecting adults at risk; London multi-agency policies and procedures to safeguard vulnerable adults for abuse”; in addition to relevant multi-agency guidance to safeguard adults for Kent and Medway, Hertfordshire and Bedfordshire where Moorfields have satellite sites. These give guidance on how to protect vulnerable adults from harm and how agencies should respond if they have concerns about a vulnerable adult.

Actions for the trust Board: This report updates the trust Board on progress following the 2013-2014 report and is brought to the Board for information prior to dissemination to Islington CCG. The Board is asked to receive this report as assurance that the trust is maintaining effective systems and processes to safeguard adults.


Section

Content

Page

1.

Introduction a) Governance and Accountability Arrangements b) Safeguarding Adults Self-Assessment and Assurance

(SAAF) c) Key messages for the board d) Key Achievements during 2014 – 2015 e) Challenges during 2014 - 2015 f) Priorities for 2015 – 2016

5 5 - 6

6

6 - 7 7

7 - 8 8

2.

Safeguarding Adults Activity 2014 – 2015

8 - 10

3.

Policies and Procedures a) Definition of an adult at risk b) National, London and local policies and procedures

10 - 11 11 – 12

4.

Participation in Safeguarding Adults Committees and Networks

12

5.

Safeguarding Adults Training a) Safeguarding adults mandatory training compliance

figures – 2014/2015 b) Risk areas

13

13

6.

Employment Practice a) Compliance with Disclosure and Barring Service (DBS)

checks b) Safeguarding Adults (including Children) statement in job

adverts and job descriptions c) Allegations against staff d) Safer recruitment practice e) Workforce (as at 31.03.2015)

14 14

14

14 14 15

7.

Mental Capacity Act a) Policy and local arrangements b) Training and Awareness

15 15 16

8.

Domestic Violence a) Policy and Local arrangements b) Training and Awareness

16 17 17


Section

Content

Page

9.

Learning Disabilities a) Policy and local arrangements b) Learning Disabilities Monitor Requirements for NHS

Foundation trusts c) Training and Awareness d) Review of enquiries and complaints for Learning

Disability patients

18 18

18 – 19

20 20

10.

Dementia a) Policy and local arrangements b) Training and Awareness

20 20 21

11.

PREVENT a) Policy and local arrangements b) Training and Awareness

21 21

21 - 22

12.

Summary

22

Appendix 1: References

23 – 24

Glossary of Terms CQC Care Quality Commission ASC Adult Social Care DBS Disclosure and Barring Scheme

(Formerly Criminal Records Bureau) ISAPB Islington Safeguarding Adults Partnership Board


1. Introduction Safeguarding vulnerable adults from abuse is everyone’s responsibility and requires strong partnership relationships to ensure that there are safeguards against harm, abuse, neglect and poor practice. All patients who access health care services should be supported to make informed decisions about their health care and have control over their lives, even when their ability to make a decision may be impaired. Protecting adults from abuse has continued during 2014/2015 by ensuring as far as possible, that each allegation is of abuse is managed under the ‘Protecting Adults at Risk; London Multi-Agency policies and procedures to Safeguard adults from abuse guidance’ (PAN London Guidance) and other relevant local multi-agency guidance’s relevant to satellite sites outside of London. This annual report will give an account of the work that has been undertaken by the trust over the past year (April 2014 - March 2015) in respect of its responsibility to protect and ensure the safety of adults at risk who receive healthcare within the Moorfields Eye Hospital NHS Foundation Trust. The report highlights progress against objectives within the work plans and provides an overview on the trust’s position against statutory requirements. a) Governance and Accountability Arrangements

Executive Board Level

Director of Nursing and Allied Health Professions

Tracy Luckett

Safeguarding Lead (from January 2015)

Safeguarding Adults Lead

Edwina Curtis

Safeguarding Adult Lead (from April 2014 to January 2015)

Lead Nurse for Clinical Innovation and Safety

Carmel Brookes

The Executive Lead for Safeguarding (Director of Nursing and Allied Health Professions) is the representative for Safeguarding Adults on the trust Board and also chairs the trust’s Safeguarding Adults at Risk Group. The Lead Nurse for Clinical Innovation and Safety held the role as the Safeguarding adults lead until the appointment of the salaried trust Safeguarding Adults Lead on January 2015, which was a key objective for the 2014/2015 reporting year. Support, guidance and supervision are provided to the Safeguarding Adults lead by the designated professional for Safeguarding Adults in Islington CCG.


The trust’s Safeguarding Adults at Risk group holds meetings bi-monthly and is chaired by the Executive Lead for Safeguarding. The group monitored the trust’s action plan in line with the Safeguarding Adults Assurance Framework (SAAF) for 2014/2015 which contributed to the trust’s update to the Islington Safeguarding Adults Partnership board on our progress with the SAAF. The group provides assurances and accountability structures and a forum for anonymised discussions of incidents raised to identify themes, trends and learning. This is also shared as appropriate with the Serious Incident Panel, Clinical Governance Committee and the Clinical Quality Review Group (CQRG) and included in the trust’s Quality and Performance report.

There were 32 incidents raised during 2014 – 2015, on the trust wide incident reporting system Ulysses, which related to vulnerable adults and included disclosures or concerns of abuse. When appropriate, these cases are discussed at the Serious Incident Panel and any learning from incidents, safeguarding adult’s investigations and serious case reviews are shared with staff through training and at the Safeguarding Adults at Risk Group. Complaints are reviewed and discussed with the Safeguarding Adults Lead where there are, or may be, safeguarding adult concerns. There have not been any complaints raised during the 2014/2015 reporting year which highlighted safeguarding adults concerns. The Safeguarding Adults Lead reviews and scrutinises newly published guidance and considers any implications to staff and services within in the trust, including potential review of current policies and procedures. The Lead Nurse for Innovation and Safety completed an audit on Safeguarding Awareness; Reporting Concerns for adults. This was presented and feedback to the Safeguarding Adults at Risk Group in September 2014. During 2014 – 2015, an audit was submitted for A review of the application of the Mental Capacity Act in practice at Moorfields Eye Hospital NHS Foundation Trust which is due to be reported on in September 2015. The audit is still ongoing and final results have not yet been captured.

b) Safeguarding Adults Self-Assessment and Assurance (SAAF)

The Safeguarding Adults Self-Assessment and Assurance Framework (SAAF) was completed in January 2015 by the Lead Nurse for Clinical Innovation and Safety and ratified by the Director of Nursing and Allied Health Professions. This was then reviewed by the London Borough of Islington Safeguarding Adults Board to give assurance to the board about Safeguarding at the hospital.

c) Key messages for the Board

This report demonstrates that:

Systems, processes and policies are continuously being reviewed to ensure that they comply with local and national guidance

A training strategy is in place and being delivered


A comprehensive work plan is in place and being monitored by the Safeguarding Adults at Risk group

Risks, when identified, are being managed appropriately The safeguarding adults agenda is immense and responsibilities are

broad and far reaching both internally and externally to the trust d) Key Achievements during 2014 – 2015

The priorities set out for the 2014 – 2015 year were achieved as follows.

Recruitment of a full time Safeguarding Adults Lead (commenced in post in January 2015)

Domestic Violence training rolled out to high risk areas such as the Accident and Emergency department.

Domestic Violence trust policy implemented Hand-out produced for non-clinical staff detailing how to identify indicators

of abuse for safeguarding adult at risk; details on how to report a concern; and information about the pathways of care for patients that have dementia and learning disabilities and information on the friends and family test to increase training compliance and awareness

Pocket prompt developed to raise awareness about Mental Capacity, with input from the trust Corporate Affairs Advisor and distributed to clinical staff.

Continued engagement with the UCLP/MEH dementia awareness project Completion of trust wide audit on staff awareness of raising a

safeguarding alert/concerns Monthly supervision established for the Lead Nurse for Clinical Innovation

and Safety Continuation of dementia training and the dementia policy developed and

implemented Introduction of the PREVENT (anti- terrorism) agenda within the trust Ensured that all commissioned services have an SLA which can

demonstrate that the Mental Capacity Act is complied with Trust’s Staff Supervision Policy updated to support effective safeguarding Ensured that information is obtained from staff about their experience of

working in the service, including the practice of exit interviews and improvements are made as a result

Trust continued to ensure that the patient was central to the decision making process in relation to safeguarding adults concerns

e) Challenges during 2014 - 2015

As a specialist tertiary service, the trust’s patient groups come from a wide geographical area which requires networking, relationship building and partnership working with a variety of external agencies which provides challenges around understanding the support individual agencies can provide to vulnerable adults in their local area. The ambulatory care model also reduces the time that vulnerable adults are in contact with the trust which reduces the time in which abuse can be identified and managed in combination with high volumes of adult outpatients which increases the risks.


The Mental Capacity Act has also been identified as not being applied robustly and consistently across the trust which has highlighted trust training and development needs across the organisation. Mandatory compliance for Safeguarding adults training has gradually improved throughout the year, however still remains a challenge. Safeguarding adults training is currently being provided to staff at a basic awareness level and not to specific competence levels according to staff roles which includes training around how to make a referral and recognise vulnerability which increases risks to safeguarding vulnerable adults within the trust.

f) Priorities for 2015 – 2016

Ensure that Safeguarding Adults policies and procedures continue to be robustly reviewed in line with local and national guidance

Ensure that satellite sites have Safeguarding Adults standard operating procedures which include local agency contact details

Improve knowledge and application of the Mental Capacity Act in practice across the trust, which includes training/resources as a key priority

Review service level agreements at satellite units in relation to safeguarding adults

Implement the Safeguarding adults training strategy which is in line with the training framework guidance

Develop “Safeguarding Snippets” In-house Newsletter Develop a Safeguarding Champions model within the trust Further develop the domestic violence/abuse agenda across the trust Continue to improve operational pathways for vulnerable adults (including

Safeguarding adults; domestic violence; dementia and learning disabilities) within the trust to be in keeping with guidance and create consistency across the organisation

Increase provision within the safeguarding adults team to include administrative support as well as specialist advisory roles (i.e. domestic violence, mental capacity, dementia, learning disabilities)

Continue to develop the Prevent Agenda within the trust Ensure the trust is Care Act compliant for Safeguarding adults

2. Safeguarding Adults Activity 2014 – 2015 During 2014/2015, the trust’s safeguarding adults lead was informed of 22 safeguarding adult referrals made to local authorities in regards to concerns of abuse. This is a reduction from the previous years where there were 54 referrals made, however figures from previous years included the number of referrals made to local authorities for assessment where there may not have been concerns of abuse. For example, this included cases where a vulnerable patient was referred to the local authority for assessment by the trust; however there were no Safeguarding adults concerns related to the case. The graph below records the comparative number of safeguarding adults’ referrals made to local authorities for this year and previous years and the categories of abuse the concerns raised in 2014/2015 related to. There continues to be a trend that City Road has the highest number of referrals (16), compared


to 14 from satellite sites which is felt to attributed to the high number of presentations relating to physical abuse in the Accident and Emergency department at City Road.

During Quarter 4 of the 2014/2015 reporting year, there was an increase in the number of enquiries to the Safeguarding Adults Lead for advice and support. This highlighted the increased awareness of staff around safeguarding adults’ issues, including Mental Capacity concerns. This trend is consistent with the 2013/2014 reporting year where there was a small increase in telephone contact requesting advice and support in regards to mental capacity and consent and wider social issues. This information is very helpful to support the safeguarding adults group to agree the priority actions for the forthcoming year.

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Safeguarding Adults Referrals 2014‐2015 Categories of Abuse


During this annual period, there has been one request made to a local authority for authorisation of a Deprivation of Liberty Safeguard for a Moorfields’ patient at Moorfields at St George’s Hospital. The Deprivation of Liberty Safeguards (DoLS) are a part of the Mental Capacity Act 2005 and aim to ensure that people in hospitals or care homes are supported in a way that does not inappropriately restrict their freedom and ensures that if they are deprived, this is done in a safe and least restrictive way. This is an increase from the previous reporting years where we had not had any recorded referrals from the trust for DoLS. There was also one recorded referral made for Independent Mental Capacity Advocate (IMCA’s) within the trust during 2014 – 2015 relating to a decision about serious medical treatment. IMCA’s are also a part of the Mental Capacity Act and are a legal right for people over 16 who lack mental capacity and who do not have an appropriate family member or friend to represent their views. This again is an increase on previous reported years where there had been no recorded referrals for IMCA’s by the trust.

3. Policies and Procedures a) Definition of an adult at risk An adult aged 18 years or over may be at risk if they:

are elderly or frail due to ill health, have a physical disability or cognitive impairment

have a learning disability have mental health needs including dementia are unable to demonstrate the capacity to make a decision and are in

need of care and support have a long term illness/condition are subject to abuse (domestic violence)

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Quarter 4 Enquires to Safeguarding Adults Lead

Safeguarding Concerns

Missing Patients

Mental Capacity

Domestic Violence

Mental Health

Vulnerable patients

Other


The London multi agency policy sets out the principles and values that organisations should adopt. In summary the main points include a duty to:

report in a timely way any concerns or suspicions that an adult at risk is

being or is at risk of being abused ensure that the dignity, safety and well-being of the adult at risk is given

priority work under the guidance of their own internal operational procedures ensure staff are familiar with policies, know how to recognise abuse and

how to report and respond to it. b) National, London and local legislation, policies and procedures

Over the past year, there have been a number of developments in the National policies in regards to Safeguarding Adults. The No Secrets (2000) continues to underpin the safeguarding adults’ agenda as well as the PAN London Safeguarding Adults Procedures and guidance for satellite sites outside of London, such as Bedford, Watford, Hertfordshire, Kent and Medway. The Care Act 2014 received Royal Accent (as the Care and Support Bill) and makes legal provisions about safeguarding adults from abuse or neglect and the partnership between local authorities, the police and the NHS to protect vulnerable adults from 1 April 2015. The Act identifies 3 additional categories of abuse (Domestic Violence; Modern Slavery; and Self-Neglect) and specifies the need for NHS organisations to work with local authorities to safeguard adults from abuse; engage in safeguarding adults’ partnership boards which are now a requirement; and to implement duty of candour. Lessons learnt from enquiries such as the Themes and lessons learnt from NHS investigations into matters relating to Jimmy Saville; Independent Report for the Secretary of State for Health (February 2015) have highlighted the need to make safeguarding integral to care and the culture of an organisation. The themes and learning highlighted across NHS trusts included security and access arrangements, including celebrity and VIP access; the role and management of volunteers; safeguarding; raising complaints and concerns (by staff and patients); fundraising and charity governance; and observance of due process and good governance. The Counter Terrorism and Security Act 2015 received Royal Assent in February 2015 and became an Act which includes legal duty to NHS. The Act states that MEH as a specified authority must:

Assess risk of radicalisation in their area or institution Develop an action plan to reduce this risk Train staff to recognise radicalisation and extremism Work in partnership with other partners Establish referral mechanisms and refer people to Channel Maintain records and reports to show compliance


The department of health also updated guidance for professionals for Female Genital Mutilation Risk and Safeguarding (March 2015) explaining new legislative requirements under the Serious Crime Act 2015, including mandatory reporting around FGM.

4. Participation in Safeguarding Adults Committees and Networks Moorfields Eye Hospital (MEH) NHS Foundation trust is represented on the appropriate external safeguarding committees as well as within internal meetings and can demonstrate full engagement and commitment to multi-agency working. The trust is a member of the Islington Safeguarding Adults Partnership Board, which is attended by The Executive Lead for Safeguarding and the Safeguarding Adults Lead. In May 2014 the trust gave an update to the board on Moorfields’ progress against ‘The Six Cs’, the Nursing Strategy for England describing the ‘Here to Help” initiative, the use of the ‘Helping Hand’ stickers, recruiting for values by using a competency questionnaire and how the trust communicates with its patients and staff by using the Friends and Family Test and staff clinical governance days. The trust also attended the Board’s Community Safeguarding Conference, “Compassionate Care and Safeguarding” which was held in June 2014 as well as the Prevention Workshop and Partnership Challenge event, which both focused on ways we can improve safeguarding practice across agencies and also support vulnerable patients. The Lead Nurse for Clinical Innovation and Safety (April 2014 – January 2015) and the Safeguarding Adults Lead (January 2015 – present) continue to be active members of the relevant Islington Safeguarding Adults board subgroups, including the Learning and Development subgroup and the Communications and Policy subgroup. The Named Nurse for Child Protection and the Lead Nurse for Clinical Innovation and Safety was also a member of the Violence against Women & Girls (VAWG) Network and attended the meeting held in April 2015 which focused on the new NICE guidance for Domestic Violence. The Safeguarding adults lead is also an active member of various PAN London networks, including the NHS Safeguarding Adults Leads Network and Prevent Leads Network; and NHS Dementia Leads Network.


5. Safeguarding Adults Training

a) Safeguarding Adults Mandatory Training Compliance Figures - 2014/2015

(provided by the Learning and Development Team)

b) Risk areas

The trust is committed to meeting its target of 80% compliance in

Safeguarding Adults’ training. Mandatory training figures for Safeguarding Adults were consistently above the 80% between April 2014 – November 2014 and fell below the target between December 2014 – March 2015, which is felt to be directly related to the transfer to a new learning and development system and mostly non-clinical staff not having this training requirement allocated to their profile. To address this deficit, it was agreed that a safeguarding adult leaflet would be developed and could be accessed via Insight. Staff accessing this leaflet would gain compliance for 1 year to allow them to attend training.

The National Competence Framework for Safeguarding Adults developed by

Bournemouth University (2010) was produced to establish a more efficient and consistent approach to safeguarding practice. The framework was devised to offer a baseline for standards of competence but also a means of benchmarking training across different agencies. MEH currently only provides Level 1 Safeguarding Adults training and a training strategy has been developed to implement Level 2 and Level 3 Safeguarding adults training within 3 years.

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Safeguarding Adults Mandatory Training Figures 2014 ‐ 2015


6. Employment Practice

The trust abides by the good practice Safer Recruitment Guidance for NHS Employers, National safer recruitment and employment practices including the ISA.

a) Compliance with Disclosure and Barring Scheme (DBS) checks:

The Criminal Records Bureau (CRB) and the Independent Safeguarding Authority (ISA) merged in 2012 to form the Disclosure and Barring Scheme (DBS). A DBS check prevents unsuitable people from working with children and vulnerable adults. This includes anyone involved with the provision of health services, whether in paid employment or as a volunteer. Changes to eligibility criteria for certain posts to be exempt from DBS checks came into being in 2014.

This continues to be undertaken by the Human Resources department. All new employees and internal promotions in positions that require DBS

checks are required to complete a check prior to employment/promotion. Renewal of DBS checks for existing eligible staff is undertaken every 3

years. There was one case reported to the Safeguarding Adults Lead in the year

2014 – 2015 regarding DBS disclosures, however the decision from the DBS was overturned

b) Safeguarding Adults (including Children) statement in job adverts and job

descriptions

All job adverts and job descriptions make reference to Safeguarding Vulnerable Adults and Children and Young People

Work is being undertaken to pilot the inclusion of an individualised safeguarding adult and children’s objective in all staff appraisals

c) Allegations against staff

There is a Named Senior Officer with overall responsibility for ensuring the

organisation has appropriate arrangements in place for the management of allegations against staff and volunteers.

During the year 2014 – 2015 there have been no reported allegations within the trust.

d) Safer recruitment practice

These specific documents demonstrate the trust’s commitment to manage relevant concerns. Human resources staff support managers in using these documents to manage any of the issues using the processess outlined:

Capability Policy and Procedure Disciplinary Policy Recruitment, Selection and Appointment of Staff Policy


Whistleblowing Policy

e) Workforce (as at 31.03.2015):

Trust wide, of staff in positions that require a Disclosure and Barring Scheme (DBS) check, 100% have a current valid check.

For those requiring an Enhanced DBS - 100% are up-to-date. There is a process in place to ensure up and coming renewal registrations

are captured and followed through for example GMC, NMC, GPhC, General Optical Council and HCPC.

The trust workforce vacancy figure is an average of 11% - vacancies are filled through internal or external methods.

Further discussions are currently underway within the trust regarding the eligibility criteria for DBS exempt checks stipulated to ensure the changes do not have the potential to place children and/or adults at risk.

7. Mental Capacity Act The Mental Capacity Act 2005 is an empowering legislation which gives statutory rights to people who may lack capacity and puts the person at the centre of the decision making process. The Act protects people around their rights to make unwise decisions and uses a ‘best interests’ process to ensure that the person is central to the specific decision being made, which also provides protection of vulnerable adults from harm. The Mental Capacity Act 2005 is an essential part to the decision making process and also an integral part of the consent process within health care settings. During this reporting year, it has been identified through case enquires and a clinical audit that there needs to be more of a consistent application of the Mental Capacity Act across the trust sites. This has highlighted potential risks for the trust and established the need for Mental Capacity to be a key priority for the trust in 2015/2016. A training and development strategy has also been established to reduce this risk and improve knowledge and the application of the Act within the trust.

a) Policy and local arrangements

As one of the key objectives for the year to raise awareness about Mental Capacity, with input from the trust Corporate Affairs Advisor, a pocket prompt was developed and distributed to all clinical staff. This was also a key action from an ombudsman report which related to a patient from the trust. This has assisted staff to understand their roles and responsibilities and the framework for assessment and decision making under the Mental Capacity Act. The development of a trust Mental Capacity Policy has been commenced with input from the Islington Mental Capacity Act/Deprivation of Liberty Safeguards Officer and the MEH Safeguarding Adults at Risk group. This is hoped to be finalised by August 2015.


b) Training and Awareness

Basic awareness training of the Mental Capacity Act 2005 is provided in the Safeguarding Adults’ mandatory training which is attended by all staff on a 3 yearly basis. Specific basic awareness for the Mental Capacity Act 2005 has also been developed within the trust and been delivered by the Safeguarding Adults Lead and the trust’s Corporate Affairs Advisor which started in March 2015. On the 31 March 2015, 28 staff had received specific basic Mental Capacity Act training with a clear plan to provide training at various clinical governance, service meetings as well as bespoke sessions to relevant teams.

During 2015 – 2016 the roll out of additional advanced training is being proposed and it is hoped that by the end of March 2016, 80% of all clinical staff within the trust will have had awareness training of the Mental Capacity Act 2005 and be confident in recognising the need for, and completing an assessment of Mental Capacity and completing a best interest’s decision.

8. Domestic Violence

Domestic violence and abuse is a complex issue that needs sensitive handling by a range of health and social care professionals. The cost, in both human and economic terms, is so significant that even marginally effective interventions are cost effective. Women and men can experience this type of violence in heterosexual and same-sex relationships (NICE 2014). Domestic Violence can be defined as any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse:

Psychological Physical Sexual Financial Emotional

This definition includes so called “honour” based violence, female genital mutilation (FGM) and forced marriage and is clear that victims are not confined to one gender or ethnic group. (Home Office 2013) During the reporting year, the Safeguarding Adults Lead was made aware of 19 disclosures of domestic violence from patients coming into the trust. It is worth noting that not all these patients were referred to the local authorities as safeguarding concerns due to the patient’s expressed wishes for this not to be referred to the local authority.


The further development of the Domestic Violence agenda within the trust is a key priority for the 2015/2016 year which has been influenced by the high number of disclosures relating to domestic violence.

a) Policy and Local arrangements

The trust developed a new Domestic Violence/Abuse policy which was ratified in January 2015 which includes practical guidance for staff when supporting a patient who has disclosed domestic violence. The Care Act 2014 which comes into effect on the 1 April 2015 will now include Domestic Violence as a recognised category of abuse. Domestic violence – includes psychological, physical, sexual, financial, emotional abuse so called ‘honour’ based violence.


As a result of the Domestic Violence Commissioning for Quality and Innovation (CQUIN) for 2014 / 2015 and as one of the key achievements for this year, 116 staff have attended face to face sessions within the 2014/2015 year. Staff feedback indicated that staff found the training very useful and assisted to develop their knowledge. This feedback has been useful to determine the key priorities for 2015/2016 to continue to improve the domestic violence agenda within the trust which will include developing partnership working with local domestic violence agencies. Achievement of this CQUIN resulted in a payment of £400,000 to the trust.

From *58% (67) of the evaluation forms received:

Two free text comments received:

“The training course was very beneficial and the information provided was extremely interesting”.

"Informative, though provoking and awareness raising".

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March 2010. There are specific pathways for different services within the trust for example; Outpatients, Accident & Emergency, Day Care, Theatres.

2. Does the NHS foundation trust provide readily available and

comprehensive information to patients with learning disabilities about the following criteria; Treatment options Complaints procedures and; Appointments

Moorfields easy read Outpatient Visit and Surgery Visit leaflets are available. Easy read appointment template is available for use in all areas. Condition specific easy read leaflets provided by See Ability (Learning Disability charity for the visually impaired) are available. Easy read PALS and Complaints leaflets are available for patients and their relatives.

3. Does the NHS foundation trust have protocols in place to provide suitable

support for family carers who support patients with learning disabilities?

There are clear provisions for the support of family and other carers within the Learning Disability policy (2014), including provision for support in case of accompanying overnight admissions.

4. Does the NHS foundation trust have protocols in place to routinely include

training on providing health care to patients with learning disabilities for all staff? Basic awareness training for staff around working with patients with learning disabilities is included within Safeguarding Adults Training which is mandatory for all staff which is refreshed every 3 years. There is also e-learning for all staff in regards to working with patients with learning disabilities available on insight which all staff are encouraged to complete as part of local induction and/or professional development. Each clinical area has an appointed Learning Disability Champion to act as a support and resource for their area.

5. Does the NHS foundation trust have protocols in place to encourage

representation of people with learning disabilities and their family carers? The Learning Disabilities policy (2014) has a protocol and provision which includes encouragement of representation of people with a learning disability and their family and carers within trust Boards, local groups and other relevant forums within the trust (e.g. the Equality and Diversity steering group).

6. Does the NHS foundation trust have protocols in place to regularly audit

its practices for patients with learning disabilities and to demonstrate the findings in routine public reports?


There are audit protocols in the policy including complaints monitoring, use of patient passports and patient experience questionnaires.

c) Training and Awareness

All staff are encouraged to complete the online e-learning for learning disability awareness with assessment as a part of a robust local induction. Upon successful completion of the package, it is recorded on the learning and development training staff database. During the reporting year (1 April 2014 – 31 March 2015), 275 staff have completed the Learning Disabilities training and at the end of the reporting year, 12.8% of trust staff have completed the e-learning.

d) Review of enquiries and complaints for Learning Disability patients During 2014/2015 there have been no recorded enquiries or complaints from patients identified as having a learning disability in regards to their experiences within the trust highlighted to the Safeguarding Adults Lead.

10. Dementia

"Dementia is a significant challenge for the NHS with an estimated 25% of acute beds occupied by people with Dementia, their length of stay is longer than people without dementia and they are often subject to delays on leaving hospital. Whilst work is underway nationally to improve the nature of outcome data, the process measure of dementia risk assessment will set an effective foundation for appropriate management of patients allowing significant improvements in the quality of care and substantial savings in terms of shorter lengths of stay.”

(Department of Health April 2012) a) Policy and Local arrangements

The trust’s “Caring for Patients with Dementia” policy was reviewed and updated in September 2014. This included a revision of the pathways for patients with dementia as well as the introduction of the Royal College of Nursing and Alzheimer’s Society’s “This is Me” leaflet. A key priority for the 2015/2016 year is to continue to improve the pathway for vulnerable patients within the trust, which includes patients with Dementia.

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It is important to note that the priority areas/boroughs can change and reflects the latest intelligence situation and world events. a) Policy and Local arrangements

The trust policy in regards to Prevent is currently being written and being ratified and agreed at relevant groups within the trust. These policies are in line with the Counter Terrorism and Security Act 2005 and the Prevent Strategy from HM Government.


All NHS staff, health care students or volunteers who are in contact with patients, the public or staff in commissioning (Clinical Commissioning Group or Area Team) and provider organisations are required to have basic prevent awareness training. This can be provided through existing Level 1 Safeguarding adults training on a 3 yearly cycle. Basic awareness training is currently being provided to staff through face-to-face Safeguarding adults (Level 1) training. At the end of March 2015, 920 staff have received basic Prevent awareness training.

The NHS England Prevent training and Competencies Framework recommends that staff requiring Level 3 and above safeguarding adults training will also be required to complete a workshop to raise awareness of through Prevent Awareness Training and Workshop to Raise Awareness of Prevent (WRAP) or HealthWRAP training, which is currently not provided within the trust, nor is it an e-learning package. This training gives a more in-depth introduction to the Prevent and Contest strategies, as well as how to identify vulnerability and make referrals to local agencies. There are currently 3 staff trained in the trust around WRAP or HealthWRAP training and the strategy aims by the end of 2017 for other appropriate staff to be identified and trained by either internal or external WRAP trained staff. Annual updates/briefings will also be developed for those staff who are trained. As a three year strategy to increase compliance in line with the recommendations it is proposed that by the end of 2018, Level 1 Safeguarding adults training will continue to include basic awareness training which will link with the 3 year training cycle. External agencies as above may be used to facilitate training to other groups of staff as felt appropriate by the trust. External agencies such as the London Metropolitan police and the London Borough of Islington PREVENT lead may be used to facilitate training.

12. Summary

This report outlines the work that has been carried out in relation to Safeguarding adults across the trust from the 1 April 2014 to 31 March 2015. This report demonstrates the breadth of activity and the variation of safeguarding issues that may arise for the people who access our services.


Safeguarding is everyone’s responsibility. The Safeguarding adults’ agenda has continued to develop significantly over the 2014 – 2015 year within the trust, particularly with the recruitment of a Safeguarding adults’ lead. During 2014/15 practice has been strengthened and further embedded into practice so that staff are equipped to recognise and respond to concerns of abuse and to support to ensure that individuals are safe and free from harm. The trust has been successful and evidenced this through the development of training and awareness-raising for Safeguarding adults, domestic violence, dementia, Prevent and the Mental Capacity Act. The key priorities for 2015 – 2016 identify the key actions to continue to guide and develop the practice of Safeguarding adults within the trust over the coming year. The Board is asked to note this report


Appendix 1

References

Bedfordshire and Luton Multi-Agency protocol for safeguarding vulnerable adults (March 2008) http://www.luton.gov.uk/Business/Lists/LutonDocuments/PDF/Adult%20social%20care/APPENDIX%209%20Safeguarding%20Protocol.pdf

Care Quality Commission Regulation 13 Safeguarding service users from abuse and improper treatment. http://www.cqc.org.uk/content/regulation-13-safeguarding-service-users-abuse-and-improper-treatment#legislation-links

Counter Terrorism Strategy (CONTEST) (HM Government) https://www.gov.uk/government/publications/counter-terrorism-strategy-contest

Female Genital Mutilation Risk and Safeguarding; A Guide for Professionals (March 2015) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/418564/2903800_DH_FGM_Accessible_v0.1.pdf

Multi-agency safeguarding adults policy, protocols and guidance for Kent and Medway (updated 1 April 2015) http://www.kent.gov.uk/__data/assets/pdf_file/0018/11574/multi-agency-safeguarding-adults-policies-protocols-and-guidance-kent-and-medway.pdf

National Competence Framework for Safeguarding Adults developed by Bournemouth University (2010)

No Secrets; Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse (2000) https://www.gov.uk/government/publications/no-secrets-guidance-on-protecting-vulnerable-adults-in-care

PREVENT Strategy (2011) (HM Government) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/97976/prevent-strategy-review.pdf

Protecting Adults at Risk; London Multi-Agency policies and procedures to Safeguard adults from abuse guidance’ (PAN London Guidance) (January 2011)

Safeguarding Adults at Risk; The multi-agency policy, procedure and practice for working with adults at risk of abuse or neglect in Hertfordshire (March 2015) http://www.hertsdirect.org/docs/pdf/s/hcs666i9.pdf

The Care Act 2014 (HM Government) http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted

The Counter Terrorism and Security Act 2015 (HM Government) http://www.legislation.gov.uk/ukpga/2015/6/contents/enacted

The Mental Capacity Act 2005 (HM Government) http://www.legislation.gov.uk/ukpga/2005/9/contents Themes and lessons learnt from NHS investigations into matters relating to Jimmy Saville; Independent Report for the Secretary of State for Health (February 2015)