Kent Community Health NHS Foundation Trust. Safeguarding Annual Report for 2016/17

Transcription

1 Kent Community Health NHS Foundation Trust Safeguarding Annual Report for 2016/17

2 Table of Contents Executive Summary Introduction Safeguarding Infrastructure Children Adults Mental Capacity Governance and Assurance Arrangements Inter-agency Collaboration Kent Safeguarding Children Board (KSCB) Kent Corporate Parenting Group (KCPG) Kent and Medway Safeguarding Adults Board (KMSAB) KCC Central Referral Unit (CRU) Safeguarding Children Introduction Strategic Context The Kent (and beyond) Picture Child Protection Specialist Community Public Health Nursing (SCPHN) Looked After Children (LAC) Sexually Active Young People Safeguarding Children Significant Incidents (SGC SI) Case Reviews Child Sexual Exploitation Female Genital Mutilation Safeguarding Adults Introduction Strategic Context The Kent Picture Adult Safeguarding Mental Capacity Act (MCA), including Deprivation of Liberty Safeguards (DoLS) Modern Slavery and Human Trafficking Safeguarding Adults Significant Incidents (SGA SI) Domestic Homicide Reviews (DHRs) Prevent Domestic Violence and Abuse Safeguarding Inspections Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 2

3 10 Safeguarding Training Safeguarding Supervision Safer Recruitment Safeguarding Audit Monitoring and Assurance Arrangements Safeguarding Policies and Procedures Risk Management Equality and Diversity (E&D) Safeguarding Work Plan 2017/ Conclusion Recommendations References APPENDIX ONE Safeguarding Declaration APPENDIX TWO Slavery and Human Trafficking Statement APPENDIX THREE Adult Safeguarding Alerts Equality and Diversity Information Glossary and Abbreviations Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 3

4 Executive Summary The Board of Kent Community Health NHS Foundation Trust (KCHFT) is assured that, during 2016/17, the following arrangements were in place to safeguard and protect our service users/patients, whether they were children, young people or adults at risk. We had lead safeguarding children professionals, who fulfilled the statutory requirements of Working Together to Safeguard Children (2015). We had lead safeguarding adults professionals, who ensured the requirements of the Mental Capacity Act 2005, the Care Act 2014 and Prevent Duty Guidance: for England and Wales (2015) were delivered. The Board level Executive Lead with the responsibility for safeguarding was the Chief Nurse, who is a standing member of the Kent Safeguarding Children Board and the Kent and Medway Safeguarding Adults Board. A Safeguarding Governance Framework was in place, including a Safeguarding Assurance Group, which was chaired by the Chief Nurse. The Board regularly received and responded to information about safeguarding incidents and investigations, including monthly exception reports from operational directorates, quarterly reports via the Quality Committee and annually, in the form of an annual report on Safeguarding. The Board was routinely informed of all significant safeguarding concerns, which provided opportunity for them to review the effectiveness of the organisation s response, whilst providing clear safeguarding leadership. We were actively involved in the Local Safeguarding Boards, which has helped us set our organisation s priorities and ability to protect vulnerable people from harm and abuse. Included within this multi-agency working were whole system reviews of safeguarding procedure and partnership, both of which evidenced good practice in place at frontline and corporate levels. We were continually concerned about the safety of vulnerable adults and children under our care and demonstrated that interventions to identify and protect vulnerable people are in place, to reduce the risk of actual harm, including the identification of and appropriate referrals to social care; incident reporting/investigations that provided opportunity for us to learn from significant events and change practice; early assessment and provision of early interventions; access to specialist support and advice around emerging safeguarding themes, eg, child sexual exploitation, Female Genital Mutilation, counter-terrorism, Modern Slavery and Human Trafficking, from clinicians who are highly experienced in working with young people and adults at risk. Whilst the level of Adult Safeguarding referrals implicating the Trust during 2016/17 saw an improvement against last year, work with our frontline services to reinforce the importance of the holistic, compassionate care that our service users need and should expect to receive from all of our practitioners remains a priority, particularly work within the Community hospitals. Within this pledge, we included further reduction of incidents of avoidable harm to patients receiving our care and achieved our aspirations from last year that no future cases of adult neglect be attributed to our care. Decisions being made by professionals were in the best interests of the service users/patients, including robust application of Mental Capacity Act/Deprivation of Liberty Safeguards (MCA/DoLS) legislation. The service has developed and published a Friends and Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 4

5 Family leaflet for DoLS to assist staff to support families to have a better understanding of the Deprivation of Liberty. There is continuing work to ensure Trust s compliance with DoLS legislation, by keeping abreast of changes as they occur and translating the legislative developments into practical guidance for frontline staff, specifically in light of the Law Commissions proposed Liberty Protection Safeguards. All Case Reviews and Domestic Homicide Reviews were investigated, lessons were identified and improvements implemented in a timely way. We routinely shared the lessons identified nationally and locally through safeguarding supervision, training and assurance reporting, to strengthen embedding of learning into frontline practice. We provided access to robust health assessments for Looked After Children, including the provision of initial health assessments to Unaccompanied Asylum Seeking Children (UASC) placed in independent living within Kent and the UASC Receiving Centre in Appledore. All eligible staff groups had access to regular safeguarding supervision, with additional arrangements in place to support staff seeking ad hoc advice or guidance on specific issues or cases. All eligible staff within Kent Community Health NHS Foundation Trust were supported in accessing their mandatory and essential-to-role safeguarding training. Compliance was monitored centrally and reported to the Board. - 95% of staff were compliant with safeguarding children training - 93% of staff were compliant with safeguarding adults training - 93% of staff were compliant with MCA training - 92% of staff were compliant with Prevent training Our internal safeguarding systems, processes and procedures to provide controls for identifying and responding to vulnerability and risk were in place. This was included in the Safeguarding Operational Strategy, training and supervision policies, Safeguarding Operational Manual and supporting procedures that meet the requirements of section 11 of the Children Act 2004, Working Together to Safeguard Children (2015), Mental Capacity Act 2005, MCA Deprivation of Liberty Safeguards (2007), Safeguarding Adults: The Role of Health Service Managers and their Boards (2011), Care Act 2014 and Care and Support Statutory Guidance (2014). We met our statutory requirements in relation to pre-employment clearance of all new staff, including enhanced Disclosure and Barring Service checks. Compliance was monitored centrally. We continually questioned the extent to which Safeguarding is embedded into our organisation, including access to training; internal assurance visits; audits to demonstrate safeguarding procedures were appropriately used to identify, escalate and respond to safeguarding concerns. A safeguarding audit programme was in place, which provided the Board (and the Trust s Audit Committee) with assurance that safeguarding systems and processes were working effectively. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 5

6 1 Introduction Kent Community Health NHS Foundation Trust (KCHFT) is committed to working in partnership with key stakeholders, to ensure that the children and adults at risk in Kent (excluding Medway) 1 are identified early and protected from harm. The purpose of this report is to: Provide an overview of the Trust s safeguarding activity during 2016/17, Provide assurance that the organisation is compliant with its safeguarding duties and, Outline the safeguarding priorities for the forthcoming year. The report deals collectively with children s and adult SG where sensible to do so and also provides separate information on both adult and children SG issues, achievements and on-going work 2. Whilst the report focuses mainly on the activities of Kent Local Children and Adult Safeguarding Boards (LSCB and LSAB), the Trust is mindful that its services based outside Kent are required to work to the safeguarding frameworks of their local LSCB and LSABs, of which Kent Community Health NHS Foundation Trust does not currently have standing membership. 1 The exceptions to this are our Health Visiting service in Swale and our Sexual Health services, both of which provided services into parts of Medway and had some contact with Medway safeguarding services. 2 Within the services provided by KCHFT during 2016/17, a number of services were based outside, or extended beyond the geographical boundaries of Kent: Newham Community Dental services Dental screening and fluoride application programmes in Tower Hamlets Dental screening, fluoride application and oral health promotion programmes in Redbridge Harmondsworth Immigration Removal Centre dental services Colnbrook Immigration Removal Centre dental services Kent & Medway Sexual Health Outreach services East Sussex Children s Integrated Therapy services East Sussex Children s Equipment Service East Sussex School Nursing services Looked After Children and medical adoption services in East Sussex Oral Health Service in Hackney Hillingdon Chronic Pain Service HWLH Lymphoedema Service Medway MSK Physiotherapy Service Medway Podiatry Medway GUM/Sexual Health Service NHSE Public Health Kent, Medway and East Sussex Children s Immunisation Services NHSE Specialised Commissioning AAC Hub services Kent &Medway (Augmentative & Assistive Communication technologies) NHSE - HIV services Kent and Medway NHSE Offender Health Children s SARC services (Sexual Referral Centre linked to police and we provide paediatrician) Whilst all of these services are expected to work to the Trust s safeguarding policies and procedures and apply the same level of safeguarding standards as those based within Kent, they are obliged to apply the multi-agency safeguarding guidelines of their respective Local Safeguarding Boards. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 6

7 2 Safeguarding Infrastructure Within the Trust, the SG specialist resources during 2015/16 consisted of 1.00wte Safeguarding Assurance Lead 3.00wte Named Nurses for Safeguarding Children (SGC) 2.00wte Named Nurse for Safeguarding Adults (SGA) 8.34wte Safeguarding Specialist Advisors (5.34wte SGC and 3.00wte SGA) 1.00wte Mental Capacity Act (MCA) Co-ordinator 1.00wte Specialist Central Referral Unit (CRU) Health Lead, Named Nurse 1.00wte CRU Safeguarding Specialist Advisor 4.45wte Administrative support staff 1.00wte Business Admin Apprentice (from March 2016) and, 0.20wte Community Paediatricians providing Named Doctors for Safeguarding Children (plus 0.6wte Named Doctor support provided by East Kent Hospitals University NHS Foundation Trust) During 2016/17, SG services made their 5% contribution to the Trust s Cost Improvement Programme for 2016/17. In response to this action, the service reviewed it s priorities to ensure business continuity and the capacity required to support frontline services. The skill mix of SG services was routinely reviewed to provide the required capacity across the service and its (3) locality based teams. Our internal SG duty rota continued to provide timely advice and support to frontline practitioners, who made contact with the service for a consultation about any SG concern they may have had. This arrangement has proven very successful in improving/enhancing timely safeguarding decision-making and practice within key operational services. The SG service facilitated a rolling programme of SG training and supervision, to ensure Trust employees had the necessary skills, knowledge and competencies to safeguard adults and children in their care. The SG service was supported by identified resources and links with: Quality Finance Corporate Management Informatics Governance and Risk Contract Management Human Resources Due to the nature of safeguarding there were key relationships with Children and Young People (CYP) and Adult services. 3.1 Children The Named Nurses for Safeguarding Children (SGC) have statutory responsibilities, as laid out in Working Together to Safeguard Children (2015), to support other professionals in their agency to Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 7

8 recognise the needs of children, including responding to possible abuse or neglect. Their key roles and competencies are outlined in the Royal College of Paediatricians and Child Health Intercollegiate document, Safeguarding children and young people: roles and competencies for health care staff (2014). Named Professionals need to be of sufficient standing and seniority within the organisation and have expertise in child health and development, child maltreatment and local arrangements for safeguarding and promoting the welfare of children. The Named Nurses for SGC work closely with the Trust s Named Doctors for SGC, who function at Consultant Paediatrician level within the organisation s Community Paediatrics service and one of the local acute Trusts (East Kent Hospitals University Foundation NHS Trust), and the Kent CCGs Designated Professionals. 3.2 Adults The Care Act 2014 and its supporting guidance, provides the statutory framework that makes provision to care and support adults and provide support for carers, including making provision to safeguarding adults from abuse or neglect. Publication of the NHS England s Safeguarding adults: roles and competencies for health care staff Intercollegiate Document which will describe the key roles and competencies of Safeguarding adult practitioners continued to be delayed throughout 2016/17. As with Named Professionals for SGC, those working within the field of SGA need to be of sufficient standing and seniority within the organisation, have expertise in the care of adults and be practised in the field of safeguarding adults. 3.3 Mental Capacity The Mental Capacity Act (MCA) 2005 provides the legal framework for acting and making decisions on behalf of people who lack capacity. The Trust sought to provide assurance that they comply with the Act and have patients best interests at the heart of decision-making processes, through a dedicated MCA Co-ordinator, who supported further embedding of MCA/DoLS in frontline practice. This post reported to one of the Named Nurses for SGA, with the strategic overview for MCA being led by a number of senior positions within the organisation, including the Chief Nurse, Assistant Director of Safeguarding, SG Named Nurses, Medical Director and Trust Solicitor. This arrangement has proven very successful in improving/enhancing MCA understanding, practice and decision-making across key operational services. 3.4 Governance and Assurance Arrangements Whilst the Chief Executive of KCHFT is the accountable officer for safeguarding, the Chief Nurse is the Executive lead for both safeguarding children and adults. The responsible officer for safeguarding is the Assistant Director of Safeguarding, who reports to the Executive lead and, provides strategic oversight and operational management to the Trust s SG service and oversees internal safeguarding arrangements, to ensure that they are appropriately structured and resourced to meet both statutory and operational requirements. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 8

9 As a sub-group of the Quality Committee, the Safeguarding Assurance Group took a strategic overview of the SG arrangements within the Trust. Local Commissioners (within Kent) representatives attended this meeting (CCG Designated Nurses and KCC Public Health Officer), to provide external scrutiny and feedback assurance to their respective organisations. The Head of Safeguarding met on a monthly basis with the Trust s Named Practitioners for Safeguarding and Safeguarding Assurance Lead, to provide protected time for senior staff within the services to plan SG priorities and delivery. The key actions agreed at each meeting were recorded formally and distributed to standing members of the group and the Executive lead. 3 Inter-agency Collaboration The Trust s SG service worked closely with local provider services throughout the Kent health and social care community, including Darent Valley Hospital NHS Trust (DVH), Maidstone and Tunbridge Wells NHS Trust (MTW), East Kent Hospitals University NHS Foundation Trust (EKHUFT), Kent and Medway NHS and Social Care Partnership Trust (KMPT), Kent and Medway CCGs, NHS England Area Team, Kent County Council (KCC) and Independent Contractors, eg, General Practitioners, to drive forward the standards and quality of safeguarding. Examples of work with local provider services include: Influencing and contributing to multi-agency SG policies and procedures Development and delivery of multi-agency training Support to individual complex cases, including attendance at multi-agency complex case planning/strategy meetings Involvement in and contributing to multi-agency audit, case reviews and domestic homicide reviews 4.1 Kent Safeguarding Children Board (KSCB) In line with the KSCB constitution, the KSCB Health Safeguarding Group nominated one of its Executive members (Director of Nursing for Maidstone & Tunbridge Wells NHS Trust) to represent local acute and community provider units on the KSCB Board. Lead officers within the Trust were identified for each KSCB sub-group, where the organisation had standing membership, including: Quality and Effectiveness Group Learning and Development Health Safeguarding Group Policy and Procedure Group Multi-agency Sexual Exploitation Group Risks, Threats and Emerging Vulnerabilities Group (joint with the KMSAB) Female Genital Mutilation Group Health Reference Group 4.2 Kent Corporate Parenting Group (KCPG) Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 9

10 The KCPG has statutory responsibility for the development and delivery of services to Kent Looked After Children (LAC). The Trust had standing membership of the KCPG, where we are represented by the Named Nurse for LAC. 4.3 Kent and Medway Safeguarding Adults Board (KMSAB) The Trust had standing membership of the KMSAB Board, where we were represented by the Executive Lead for Safeguarding. Lead officers within the Trust were identified for each KMSAB sub-group, where the organisation has standing membership, including: Learning and Development Group Policy and Procedure Group Quality Assurance Working Group MCA Group (Local Implementation Network) Risks, Threats and Emerging Vulnerabilities Group (joint with the KSCB) 4.4 KCC Central Referral Unit (CRU) 2016/17 has proved to be a very challenging year for the CRU Health team with a continued increase in both safeguarding children and adults work, whilst a new service model is still awaited. With its limited resources, the health team has worked with other agencies to best utilise health knowledge and skills. The workload has not always been predictable and it has been necessary to constantly monitor demand and take appropriate action, in order to provide a specialist resource that compliments partners and improves outcomes for children, their families and adults. As partner agencies review and develop their service within CRU to meet the increased demand and new ways of working, it is vital that health too move forward, as an equal and proactive member of the multi-agency team, with a planned review of the health service model. Key achievements in 2016/17 The CRU health team has met with Kent CCGs to discuss and explain the changing needs and increasing demands being placed upon the service to inform the review of the service model CRU health has been flexible, proactive and resilient in a constantly changing environment, to ensure optimum use of resources and improved outcomes CRU health has worked hard to ensure that their knowledge and skills are updated, to provide a specialist resource to professionals and agencies during interactions within CRU and with external agencies/providers Key challenges in 2016/17 CRU health has worked with agencies to ensure that optimum use is made of health resources, which have not increased since 2014 despite increased demand Maintaining the credibility and profile of a very small team that has not expanded in line with partner agencies, has required a heavy focus on networking and promoting the service CRU health has been required to employ strategies to meet the additional demand placed on the service by the increase in activity, such as over 50% of the county workload for adult Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 10

11 safeguarding being undertaken within CRU and a rise of 57% in the provision of personal data by health Key actions for 2017/18 KCHFT will continue to work closely with commissioners and stakeholders to review the CRU health model and ensure it meets the increasing demands placed upon the service. CRU health will continue to work in partnership with key agencies, as they introduce new structures and processes within CRU and across Kent, sharing resources, knowledge and expertise to provide a seamless service. Impact on the child/young person/adult The primary aim of the service is to ensure vulnerable children and adults are protected and kept safe, by ensuring that effective safeguarding practice, in line with statutory, national and local guidance, is in place across the multi-agency arrangements that have been established to support the delivery of the CRU. The input of health to the CRU has ensured consistency in the application of Child in Need and Adult Protection thresholds, provided timely professional challenge where deemed necessary, reduced the risks and improved the experience and outcomes for children and adults. 4 Safeguarding Children 5.1 Introduction This section of the report provides an overview of children s safeguarding, outlining both the national and local positions and an update on the current work programmes for KCHFT. 5.2 Strategic Context The Children Act 1989 provides the core legislative framework for safeguarding children, which is supported by the statutory duty on agencies to co-operate in making arrangements to safeguard and promote the welfare of children, under sections 10 and 11 of the Children Act During 2016/17, Working Together to Safeguard Children (2015) remained the key, statutory safeguarding children guidance that drove local policy and procedure, in terms of how organisations and individuals should work together to safeguard and promote the welfare of children and young people, in accordance with the Children Act 1989 and the Children Act At local level, the LSCB is the key statutory mechanism for agreeing how organisations/ agencies within its geographical location will co-operate to safeguard and promote the welfare of children and for ensuring the effectiveness of what they do 3. In support of their role, each LSCB maintains local safeguarding children procedures, which are accessible to all local agencies and practitioners via their respective website. In addition, the KCHFT s Safeguarding Operational Manual, which sits on its intranet, provides a link to relevant LSCB policies and procedures. Together, these resources underpin Working Together to 3 For services provided by the Trust that sit outside Kent, their respective LSCB provides the statutory, accountability framework for safeguarding children (currently London, East Sussex and Medway). Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 11

12 Safeguard Children and provide explicit instructions for all Trust staff in undertaking work that is associated with children s protection from harm and neglect. 5.3 The Kent (and beyond) Picture There were approximately 330,400 children and young people residing within Kent (excluding Medway), with 1,185 subject to a Child Protection Plan (Source: KCC Management Information Department, March 2017). Within East Sussex there were approximately 116,773 children who were eligible to access our School Nursing and Children s Integrated Therapy services. Kent County Council had 1,892 looked after children and young people placed within the county and 181 placed out of Kent (March 2017), with a further 1,325 looked after children and young people from other authorities placed within Kent (Source: KCC Management information Department, March 2017). The figures above give a brief indication of the level of safeguarding need and resource across the county and beyond. 5.4 Child Protection Throughout 2016/17, the Trust s frontline practitioners made child protection work a high priority within their case management, with attendance at child protection case conferences (CPCC) reaching 96.1% for Health Visitors and 98.4% for School Nurses. During the year, work was undertaken within the Trust s Children and Young People (CYP) services to develop a robust process to capture accurately our safeguarding information. Work, to link the capture of this information with the Trust s electronic patient records system (CIS), has continued throughout 2016/17. Through its internal duty system, the Trust s SG Service provided 929 episodes of immediate support and guidance in managing various cases involving children throughout the year. Frontline practitioners made 281 referrals into Children s Social Care. Kent s Inter-Agency Threshold Criteria for Children and Young People document provides guidance on referral and decision-making which is routinely applied, with staff being supported with the process and escalation of concerns as needed, by their line manager and/or SG service. SG services have worked with the legal department to develop a process, with safeguarding supporting frontline practitioners with expert opinion and the legal department supporting front line practitioners with the legal aspects when producing court reports. Early Help Notifications (EHN) initiated in line with the Kent Family Support Framework (KFSF) have continued during the year, with staff feeling confident with the framework. A total of 648 EHNs were submitted over the year by Trust practitioners, with a further 463 KFSF submitted by other agencies, e.g. schools, being contributed to by KCHFT practitioners. A Child Protection Plan (CPP) is put in place following a local authority led multi-agency Child Protection Case Conference (CPCC). In a large number of cases, there may be one or more health professional working in partnership with the child, family and partner agencies, to ensure that the child s needs are being addressed appropriately through their plan. Statistics held by KCC indicated that, in March 2017, there were 1,185 children subject to CPP with East Kent having the highest number (399) and North Kent having the lowest (185). Overall, Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 12

13 this showed a year end increase of 13 % against March The number of children subject to CPP over 18 months was recorded as 68 in March 2017, compared to 73 in March For children subject to CPP over 24 months, this was 16 in March 2017, compared to 9 in March The consultation Trust s SG database was reviewed and developed to capture consultations in relation to Female Genital Mutilation (FGM) and Child Sexual Exploitation (CSE). During 2016/17 there were no consultations relating to FGM and 11 consultations relating to CSE to the safeguarding service. The Trust s Chaperone policy has been reviewed and chaperone posters have been disseminated across the Trust, reminding staff that chaperones should be offered routinely to service users receiving intimate examinations. CSE training, including use of the KSCB CSE toolkit, was delivered to 328 targeted staff members, including the Trust s LAC service, Minor Injury Units, School Nursing, Health Visitors service and Sexual Health practitioners. The national Signs of Safety framework, through which Safeguarding Children (SGC) key work streams are managed, including CPCC and Early Help interventions, was introduced by Kent Children s Social Services. This has been embedded throughout children and young people s services throughout 2016/17. Key achievements in 2016/17 CSE training has been delivered across targeted services including Health Visiting Safeguarding training has been reviewed and emerging areas of safeguarding children (CSE and FGM) have been incorporated into the Trust training programmes KCHFT participated in the KSCB section 11 of the Children Act 2004, self-assessment audit, to demonstrate the Trust s engagement with children and young people Timely involvement of Health Visitors and School Nurses in CPCC case management Key challenges in 2016/17 CIS has continued to be rolled out to children and young people s services across the Trust, this has provided initial challenges regarding the storage of highly sensitive safeguarding information, eg, storage of safeguarding minutes from case conferences Support and encouragement to staff to escalate their concerns/professional disagreements, if child protection referrals are not accepted by Children s Social Services against the agreed multi-agency thresholds To support staff with learning and embedding the learning from Serious Case Reviews Key actions for 2017/18 Continue to develop and monitor the robust confidential process within CIS that allows safeguarding concerns to be held confidentially and confidently To support CYP services with the development of the peer review process, which is designed to support learning from Serious Case Reviews Impact on the child/young person Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 13

14 Staff are continually developing their SG knowledge and skills through SG training and supervision, which ensures appropriate child protection referrals are being made and cases followed through by the Trust s practitioners, supported by escalation where professional disagreements may occur Frontline practitioners attendance at CPCC ensures their timely support and contribution to safeguarding of children and young people. Moreover, it enables good outcomes for the health and wellbeing of the child/young person Continued partnership working with KCC enables appropriate interventions to meet best outcomes for children and young people The assessments completed by CYP staff capture the Voice of the Child, ensuring that care planning is child focussed and child led. 5.5 Specialist Community Public Health Nursing (SCPHN) KCC continues to commission public health nursing services with both health visiting and school nursing working to the national service specifications with some additions included to reflect and meet the local population s needs. Both services are subject to competitive tender processes and since the School Nursing Service has been with KCC since September 2012, it went out to tender first with the commissioners dividing service delivery into two distinct services - Primary School Public Health Service and Adolescent Health and Targeted Emotional Wellbeing Service. Kent Community Health NHS Foundation Trust bid for and were awarded the new contract which commenced on 1 April 2017 with our exciting model that ensures a seamless approach to all aspects of the specification. This will be achieved by: continuing to offer universal assessments of health needs for the school health population offering evidence and outcome based targeted interventions including strategies to improve emotional health and wellbeing as required working in partnership with other providers for children, young people and the families who require additional support and or referral to specialist provision This approach supports the The Way Ahead: Kent s Emotional Wellbeing strategy as published by KCC. 2016/17 has been a very eventful year and we are proud of what we have been able to achieve and will continue to work closely with all our partners to ensure that we continue to safeguard children and young peoples needs at any opportunity. Key achievements in 2016/17 Award of new school health contract Sign of Safety framework embedded into public health nursing practice Roll out of the Solihull Approach to parenting to all Community Nursery Nurses Transition to parenthood rolling programme across children centres in all districts UNICEF Baby Friendly Initiative Stage 1 accreditation Development and access to a Certificate in Public Health in Canterbury Christ Church University for non- Specialist Community Public Health Nurses Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 14

15 Early assessment and identification of needs continues to be embedded in frontline practice, within the Trust s Public Health services Improvement in key performance indicators across all five mandated Health Visitor contacts Age appropriate Ages and Stages Questionnaires 4 (ASQ) use now embedded in the health visiting service (Service has access to questionnaires spanning the 0-72 months age range and which can be used in support of families as required) The Generalised Anxiety Disorder Assessment Tool (GAD7) in conjunction with the Wholley questions 5 to assess maternal mood embedded in practice. Key challenges in 2016/17 Reduction in the public health grant and the impact on resources Embedding the new school health model into practice Systematic access to antenatal notifications from Midwifery Services Preparation of health visiting services for impending competitive tender (commissioners intend to test the market in preparation of a new contract by April 2018) Key actions for 2017/18 Progress a strategy to obtain client feedback that will better inform our ongoing service development and delivery Introduce reflective practice within 1:1 clinical supervision Work closely with SG services, to review case conference attendance pathways, to enable the Trust to contribute effectively, as required Increase the number of frontline staff attending key SG training, eg, CSE, FGM, Prevent, Signs of Safety Trial new ways of working that will enable the Trust to work closely with children and families, who may require additional support between the ages of 2.5 and 8 years Impact on the child/young person Our service is as accessible as possible to all families, at all stages in their child s early years of development The 5 face-to-face contacts offered through the Healthy Child Programme provide us with general access to all families, in a non-stigmatic way. The programme provides early opportunity to complete a family health needs assessment that will identify concerns/needs and provide appropriate early interventions The Ages and Stages questionnaire process is less about health surveillance and more about working partnership with parents, to ensure the best outcomes for their children. 5.6 Looked After Children (LAC) A child or young person is 'looked after' if they are in the care of the Local Authority for more than 24 hours. Legally, this could be when they are, living in accommodation provided by the Local Authority with the parents' agreement or if they are subject to an interim or full care order. 4 Ages and Stages Questionnaires are completed by parents and help with identifying key areas where their child has particular strengths and where there may be areas that require intervention or further assistance. 5 Generalised Anxiety Disorder Assessment Tool and Wholley questions are standardised tools that are used to ascertain whether new mothers are experiencing any symptoms of post natal depression. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 15

16 When a child is accommodated the Local Authority is responsible for making sure an initial health assessment (IHA) is undertaken. The Trust s Community Paediatric service is contracted to deliver IHAs across the Dartford/Gravesham/Swanley, Swale and West Kent localities. The statutory guidance is that the IHA is completed within 28 days of the child or young person entering care, which includes the report being available in time for the first statutory review by the Local Authority Independent Reviewing Officer. This service also undertakes Initial and Review Adoption Medicals and, when required, attending Adoption panels. Review Health Assessments (RHA) are undertaken by the LAC nursing team every six months for children under 5 years and annually for children up to the age of 18, or until they leave care. During the year, the Trust s dedicated LAC nursing team was contracted to undertake RHAs across all Kent Districts. Key achievements in 2016/17 90% of looked after children received an annual dental health check in 9 out of 12 months Patient experience 213 surveys were submitted during and service user satisfaction averaged 97.6% LAC team successfully went live on the Trust s CIS system on 1 April 2016 Following an administration review, the LAC administration team were relocated from various KCC and KCHFT sites into one central administration hub in March 2017 and now administer the whole LAC IHA and RHA pathway, from processing the initial referral, appointing the child or young person directly into a Paediatrician or LAC nurse clinic, typing and distribution of reports to KCC and updating CIS A review of roles and responsibilities within the Community Paediatrics service, including demand and capacity of clinicians, has resulted in all substantive Community Paediatricians being trained to undertake IHAs. This has increased capacity within our existing medical establishment. A recent successful recruitment of Community Paediatricians has supplemented the pool of doctors able to undertake IHAs, ensuring the service can flex capacity to meet demand As a result of a demand and capacity review, the LAC nurse team has been restructured: geographically the nurses have been divided into 4 locality teams and each team has a B7 nurse and B6 nurses. B7 nurses undertake a leadership role within their team including service development and audit Introduction of digital dictation which has released LAC nurse time to undertake more direct clinical care All LAC nurses undertook Child Sexual Exploitation (CSE) training. CSE guidelines have been adopted, all children aged 11 years and over are screened for CSE risk factors and robust links with made with the Trust s SG service and multi-agency partners. Key challenges in 2015/16 Over 2016/17 the transformation work with the community paediatric service has seen an upward trend in our IHA compliance. In December 2016 it peaked at 75%. However in February we identified a drop in IHA compliance - an immediate review of administration processes was undertaken which identified where the blockages were in the system We underestimated the impact of relocating and co-locating our admin team at Whitstable Health Centre. The newly created LAC Admin Team had its establishment increased by 2.0 WTE to enable them to absorb the IHA admin process which had previously been undertaken Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 16

17 by the Community Paediatric service. This required the newly created team to not only learn about LAC, but to develop and implement the complete IHA administration process It is anticipated that the revised administration processes will continue to be embedded and that IHA compliance will improve in 2017 early data review for March 2017 indicated 86% compliance for IHA Despite a business case being submitted to the CCGs in August 2017, requesting funding for additional LAC nurses (x3) to meet the demand for RHA pathways of care, the LAC nursing team continues to be under-resourced. Our current capacity will only ever be able to achieve a 66% RHA compliance Key actions for 2017/18 Continue to embed new LAC administration systems and processes Maximise use of CIS as complete child health record Fully utilising the LAC nursing skill set with the introduction of packages of care for Looked After Children and Young People To work with the CCGs to develop a commissioned service to meet health needs of looked after children placed in Kent from other Local Authority areas Impact on the child/young person The aim of the Looked After Children s service is to ensure that all systems and processes to track and focus on individual children and young people are in place, to promote and contribute to the achievement of the best health and wellbeing outcomes for children/young people, without making them feel any different from their peers. To achieve this, all children and young people in care are listened to and account is taken of their views, according to age and understanding, in identifying and meeting their physical, emotional and mental health needs. 5.7 Sexually Active Young People Following the successful award to KCHFT for the delivery of Sexual Health Services in Medway during 2016/1017, KCHFT now delivers a range of Sexual Health services across Kent and Medway which includes the delivery of: Universal sexual health clinics providing contraception and sexual health (CASH), genitourinary medicine (GUM), and adult outpatient HIV services, and includes the provision of selfmanaged care Sexual health outreach services and community based HIV screening Psychosexual Therapy Services Chlamydia screening programme co-ordination and deliver Long-Acting Reversible Contraception (LARC) fitting and removal in primary care Co-ordination of the delivery of sexual health services from community pharmacies Key achievements in 2016/17 The service has taken a proactive approach in progressing work to safeguard vulnerable individuals and groups identified at risk of poor sexual health across Kent and Medway which includes: Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 17

18 With the support of the Trust s safeguarding service, further developing our model of safeguarding supervision to ensure that all clinical staff in Kent and Medway have access to protected time for safeguarding supervision with a trained facilitator Re-launching the outreach referral system to enable access to support for individuals and groups at risk of poor sexual health. This year the service has had contact with 1,086 young people via 1-1 and 10,651 young people via group contacts across Kent and Medway Reviewing the electronic system used within community pharmacies so women who are repeat users of Emergency Oral Contraception (EOC) are identified and care pathways are in place to provide them with swift access to universal sexual health services Ensuring that safeguarding is a standing agenda item during contract review meetings for all sub-contractors Implementing a care pathway to ensure that all young people under the age of 16 years, identified as at risk using safeguarding risk assessments, are appropriately followed up by the Sexual Health service Establishing an additional Medway Public Advisory Group (PAG) in addition to the Kent PAG to increase public participation and engagement in our sexual health services Strengthening the pathway for patients displaying high risk taking behaviours, eg, chemsex, within universal sexual health services, to offer an opportunity to engage with Psychosexual Therapy Services Key challenges in 2016/17 There has been an increase in the number of information requests received from external agencies, eg, LSCB, LSAB and Community Safety Partnerships, in relation to potential safeguarding concerns and sexual health services this year compared to previous years Key actions for 2017/18 Audit the provision of safeguarding supervision within sexual health services in order to determine effectiveness and outcomes for staff Audit the use of the care pathway which was designed to ensure that all young people under the age of 16 years, identified as at risk using safeguarding risk assessments, are appropriately followed up by the Sexual Health Service Develop an improved mechanism for service user involvement in the specialist HIV service. Review and invigorate pathways with Termination of Pregnancy providers in Kent and Medway to enable the swift referral into Sexual Health Services Develop pathways with Drug and Alcohol providers in Kent and Medway to support patients who require substance misuse services Review pathways between Sexual Health Services and Early Help services in order to facilitate access to services for patients who require additional support To work with community pharmacy providers to undertake enhanced safeguarding training equivalent to Safeguarding Children Intercollegiate guidance level 2 To work with community pharmacy providers to ensure that each pharmacy has a dedicated safeguarding lead working within their setting Impact on the child/young person/adults Those accessing Sexual Health Services will have their care provided by highly trained and competent practitioners with up to date safeguarding knowledge Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 18

19 All vulnerable, at risk young people under the age of 16 years will be followed up appropriately and proactively by the Sexual Health Service Those patients under the care of the specialist HIV service will have more involvement in decisions around the development of the service to ensure that their needs are met All vulnerable young people and adults accessing Termination of Pregnancy Services in Kent and Medway will have swift and easy access to universal Sexual Health Services if required Those accessing Sexual Health Services will have seamless pathways in order to support any substance misuse issues which they may be experiencing Those accessing Sexual Health Services have pathways which support access to Early Help services in Kent and Medway in order to meet their wider health and social care needs Women accessing emergency oral contraception through community pharmacies will have their treatment delivered by pharmacists who are well trained in safeguarding 5.8 Safeguarding Children Significant Incidents (SGC SI) During 2016/17 there were two serious incidents relating to children/young people declared and investigated through the Trust s investigation framework. One of the incidents related to a case where safeguarding advice was not sought or a timely referral to specialist children s service was not made. One case related to unmet needs in the growth and development of a child. Some of the key lessons identified related to, Regular and effective one to one supervision of practitioners Effective case allocation Appropriate challenge by practitioners Holistic assessment and review Following of the No Access policy Lack of timely referral to safeguarding and other partners The Trust conducted a number of gap analyses against the findings and recommendations of a number of in-year local and national investigations, reviews and cases, including: The Report of the Independent Review of Children s Cardiac Services in Bristol Review of health services for Children Looked After and Safeguarding in Medway Overview of Serious Case Review in Sutton CQC Not Seen, Not Heard Kent Safeguarding Children Board Multi-Agency Deep Dive Child in Need The overview report into a Multi-Agency Review of the Services provided to Victims of Child Sexual exploitation in Kent (KSCB) CQC Time to listen a joined up response to child sexual exploitation and missing children KSCB Child in Care Child J Lambeth based child Where gaps or opportunities to strengthen our internal safeguarding working arrangements were identified, supporting action plans were developed and completed, including: Reviewing and updating the Trust s Chaperone Policy Opportunities to capture the Voice of the Child and to be able to demonstrate this within documentation Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 19

20 Targeting areas for further delivery of Child Sexual Exploitation training Raising awareness of the importance of professional curiosity with staff Key achievements in 2016/17 The Trust s SG service completed reports and investigations and supported staff with complex cases within a timely manner throughout the year The Trust has been responsive to identified internal and external reports and recommendations, addressing identified gaps with immediate effect The Trust s SG service has developed a Steering group to review reports and address any gaps. Key challenges in 2016/17 To continue to support staff with complex cases as they arise throughout the year To respond in a timely manner to internal and external investigations and reports, to ensure timely best practice and robust processes are in place To ensure training is developed and learning embedded, to improve outcomes for children under our care Key actions for 2017/18 Continue to maintain established assurance databases, reporting cases and assurance to various forum Ensure learning from (local and national) inspections, reviews and cases is shared across the Trust and is embedded into practice Oversee outstanding actions from the Trust s gap analysis reports Impact on the child/young person Staff are confident in their knowledge to support children, young people and their families and provides timely, responsive and robust support to children and their families, which is based on national best practice Frontline practitioners are supported with complex cases, safeguarding consultations and training 5.9 Case Reviews There were 4 Serious Case Reviews (SCRs) and 5 Case Reviews (CR) during 2016/17 Serious Case Reviews A 2 week old child who suffered a cardiac arrest and had unexplained bruising. Lessons learnt included: The importance of capturing the Voice of the Child Documentation of injuries and escalation of concerns The importance of bringing cases to safeguarding supervision Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 20

21 A 6 week old child who died following parents limited access to health, resulting in death, due to pneumonia. Lessons learnt included: Documentation of assessments and chronology, showing history of review The importance of bringing cases to safeguarding supervision Review of the process of ante-natal notification Involvement of health partners in child protection strategy meetings and in sharing the outcomes of assessments by children s social care 7 year old child who was exposed to significant issues of Neglect, as well as parental substance misuse, and domestic abuse. There was no School Health Service involvement. Child did not receive vision and hearing screening in her reception year. Lessons learnt included: Review of the process for identifying and signposting pupils who require health assessments A 3 week old child who suffered sudden death with unexplained bruising. Lessons learnt included: The importance of clear documentation The use of professional curiosity Accurate record keeping in relation to weighing and measuring children Deeper understanding of concerns when different histories are given Accurate recording of areas of concern to determine deterioration or improvement in injuries etc. Case reviews The Trust has been involved in 5 case reviews during 2016/17. Learning from Case Reviews included: The importance of robust documentation The importance of comprehensive completion of risk assessments Attendance at assessments Understanding of parental issues eg, any health issues they have or childhood experiences that may affect their ability to parent Understanding of MCA on parental capability Understanding of family dynamics Awareness of national and local guidance to inform practice Voice of the child heard, documented and responded to Relevant information from partner organisations is received and recorded in child s record Recognition of domestic abuse and disclosure of it Demonstrating professional curiosity Clear understanding of the normal development of the child Three other case review information requests were responded to during the year, for which we had limited/unremarkable involvement. The Trust will consider the learning opportunities from these cases, once the over-arching reports are published Child Sexual Exploitation (CSE) Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 21

22 Emerging areas of safeguarding children with respect to CSE required the timely development of robust training programmes, guidance and risk assessments, to support and develop staff awareness, knowledge and delivery of care to young people. Key achievements in 2016/17 Almost 300 staff from the Health Visiting service and Family Nurse Partnership received CSE Risk Assessment training between January and March 2017, in line with recommendations from Kent Safeguarding Children Board (KSCB) Operation Lakeland Case Review 2015 LAC Service supported to develop information sharing data base in regard to Young people at Risk of CSE and to record CSE risk assessments undertaken and actions completed. This has also enabled timely information sharing within the Trust s LAC service and with the CSE Lead Development of information database within the SG service, to ensure robust and timely information sharing both within the organisation and to relevant external partner organisations Key challenges in 2016/17 Rolling out CSE training programme to key frontline services to raise awareness of the key indicators regarding CSE and to enable robust CSE risk assessments to be undertaken Supporting LAC services in the development of a robust information database of those young people at risk of CSE and the recording of CSE risk assessments undertaken Developing clear pathways for information gathering and sharing both internally and externally regarding those young people at risk of CSE Key actions for 2017/18 Embed CSE awareness for all Trust employees within training programmes and via the Trust Intranet Complete CSE risk assessment training to the remaining 70 staff in Children s services Ensure any new guidance and legislation is shared in a timely manner within training presentations and via the Trust s intranet Review within the KSCB MASE current and proposed provision of services to victims of CSE as this is the next work stream being reviewed at strategic level. This information can then be disseminated to relevant services within the organisation Impact on the child/young person Staff to feel confident in using recognised CSE Risk assessment toolkit to identify the level of risk to the young person. As such there will be an early identification of those children and young people at risk of CSE, enabling multi agency early intervention to prevent those identified becoming victims of abuse Female Genital Mutilation Emerging areas of safeguarding children, including FGM, required the timely development of robust training programmes, guidance and risk assessments, to support and develop staff awareness, knowledge and delivery of care to young people and adults at risk. Key achievements in 2016/17 Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 22

23 Local and national FGM guidance has been embedded within the Trust s training and practice Development of FGM guidance regarding mandatory reporting for Practitioners made available on the Trust s intranet Attendance at Kent and Medway Multi-Agency FGM Steering Group and the development of a local multi-agency FGM work plan Key challenges in 2016/17 Developing a routine enquiry FGM question that practitioners feel knowledgeable and confident to ask The absence of a local or national FGM work plan to inform the Trust s internal FGM priorities FGM not currently being part of the risk assessment toolkit for KSCB Sexually Active young people Key actions for 2017/18 To ensure a routine enquiry question for FGM is embedded into patients first contact records or risk/vulnerability assessment Contribute to development of a local FGM work plan and implement key areas in the Trust s SG operational working Develop an FGM Workshop for Operational staff to attend as part of their Safeguarding Children Level 3 training, to ensure staff have the knowledge base and confidence to support anyone who has undergone FGM (utilising agreed DH pathways) Impact on the child/young person Operational staff are able to respond appropriately to any service user that has undergone FGM and provide protection to those at risk of potential and illegal FGM 5 Safeguarding Adults 6.1 Introduction This section of the report provides an overview of adult safeguarding, outlining both the national and local positions and updating on the current programmes of work for the Trust. 6.2 Strategic Context The Care Act 2014 provides the core legislative framework for safeguarding adults, which is supported by the Human Rights Act During 2016/17, the Care and Support Statutory Guidance (2014) was the key, statutory safeguarding adults guidance that drove local policy and procedure, in terms of how organisations and individuals should work together to safeguard and protect adults at risk. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 23

24 At local level, the LSAB is the key statutory mechanism for agreeing how organisations/ agencies within its geographical location will co-operate to safeguard and protect adults at risk and for ensuring the effectiveness of what they do 6. The Mental Capacity Act 2005 provides a framework to empower and protect people who may lack capacity to make personal decisions. The MCA Deprivation of Liberty Safeguards (DoLS) 2007 provides a legal framework to ensure that adults in care homes, hospitals and hospices, who lack capacity to make or be involved in decisions regarding their care or treatment, are protected from unlawful deprivation of their liberty. Safeguarding Adults: The Role of Health Services Managers and their Boards (2011) sets out six guiding principles that shape how staff and their organisations should safeguard those in their care, which all local agencies including the Trust are bound to work to. In support of their role, each LSAB maintains local safeguarding adult procedures, which are accessible to all local agencies and practitioners via their respective website. In addition, the KCHFT s Safeguarding Operational Manual, which sits on its intranet, provides a link to relevant LSAB policies and procedures. Together, these resources underpin the Care and Support Statutory Guidance and provide explicit instructions for all Trust staff in undertaking work that is associated with adults protection from harm and neglect. 6.3 The Kent Picture Significant work continued within KMSAB, to understand and further develop local arrangements around safeguarding adults and to align them with the legislative changes introduced by the Care Act Whilst the number of referrals made in 2016/17 into the local safeguarding process was lower than 2015/16, triangulation of supporting activity and incidents (reduction in falls and pressure ulcers) and opportunities to learn lessons from local cases of potential or significant harm have been embedded across the Trust and contributed to this improved position. 6.4 Adult Safeguarding Prevention, early identification/intervention and promoting the welfare of adults accessing our services are fundamental factors in safeguarding. The Trust s ultimate goal is to ensure that all patients receive care that reflects and responds to their specific needs and wishes, which includes keeping them safe from harm at all times, particularly when they may not be able to make decisions for themselves. During 2016/17, a total of 250 adult protection referrals were received by the Trust s SG service, see table one below. 201 were raised by KCHFT implicating others, compared to 225 raised within the same time period for 2015/16 49 were raised implicating KCHFT (of which 33 were raised by KCHFT staff against KCHFT and 15 by other organisations against KCHFT), compared to 61 raised within the same time period for 2015/16 6 For services provided by the Trust that sit outside Kent, their respective LSAB provides the statutory, accountability framework for safeguarding adults (currently London, East Sussex and Medway). Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 24

25 Table 1: showing total referrals received 2016/17 The highest area of abuse raised by KCHFT against KCHFT and raised by others against KCHFT was neglect, see table two below. Table 2: showing types of abuse raised against KCHFT Throughout the year, the Trust consistently raised referrals against other organisations, see table three below. Table 3: showing referrals raised by KCHFT against other organisations Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 25

26 Within these referrals, neglect was the largest area of abuse (111). The remaining categories of abuse were self-neglect (24), physical abuse (24), psychological abuse (14), domestic violence (11), financial abuse (8), sexual abuse (4), organisational abuse (3) and other (3) see table four below. Table 4: showing Referrals raised by KCHFT implicating other agencies, by type of abuse Following referrals that were raised implicating the Trust with possible abuse, internal processes were followed that included thorough investigation of the referral and recommendations made to support staff, such as training and supervision. As at 31 March 2017, 16 cases remained open with KCC (the investigating authority), of which 13 are under on-going investigation within KCHFT. The remaining 3 are awaiting outcome from KCC. Of the cases closed, the Trust had 8 cases in which abuse was substantiated or partially substantiated by KCC, 5 of these cases were tissue viability, 2 cases were failure to act and failure to give medicines and 1 case was financial misuse/theft of money. Within this financial year, the Trust was notified of the outcome of 3 previous cases of possible abuse from 2015/16, where abuse by the Trust was substantiated. All cases were of neglect - 1of tissue viability and 2 cases of failure to act. The Trust s internal investigation and incident management processes were followed at the time the referrals were raised. The Trust s SG service supported frontline staff through the provision of safeguarding consultations throughout the year - a total of 337 adult consultations were completed over the year. Key achievements in 2016/17 Although neglect remains the largest area of abuse within the Trust, there were 20 cases less reported compared to 2015/16 The Trust s SG service developed closer working relationships with its Community Hospitals and operational services, to raise awareness of practice that could constitute potential abuse and encourage staff to identify and avoid potential safeguarding concerns resulting in less adult protection referrals being raised during 2016/17 compared to 2015/16 The Trust s SG service provided staff with support (reflective and restorative) and SG supervision following any referrals received implicating the Trust The Trust participated in the KMSAB self-assessment audit, to evidence that it met its statutory obligations to safeguarding adults accessing its services Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 26

27 Key challenges in 2016/17 To reduce the number of cases of neglect affecting patients across the Trust To ensure services work collaboratively with internal and external partners to reduce patient harms To encourage services to Think Family and consider the wider family as a whole when delivering care to individual clients Key actions for 2017/18 SG service to continue to work with internal and external partners to strengthen collaborative and co-ordinated working that will further reduce avoidable patient harms Continue to develop existing electronic systems, to collate and enhance timely reporting of safeguarding activity and performance data Continue to support services within the Trust, including supporting KCHFT services based outside, or extended beyond the geographical boundaries of Kent Impact on the service user The number of cases of neglect cases was reduced and the overall numbers of abuse cases across the Trust was reduced over this financial year. In achieving this the Trust s SG service strengthened its links with operational services, raised staff awareness and improved their knowledge and confidence around all aspects of safeguarding This supported frontline practitioners recognition of safeguarding concerns and ensured prompt action to safeguard the service users, as well as the ability to recognise their own roles and responsibilities to protect service users The Voice of the Adult is routinely heard, which means that the service users needs are being taken into account, and are central and paramount in the delivery of their care The partnership working with KMSAB and other agencies continues to strengthen, enabling joint working and decision-making to meet the wider needs of service users. 6.5 Mental Capacity Act (MCA), including Deprivation of Liberty Safeguards (DoLS) Delivering the MCA agenda within the health setting continues to be an exciting but challenging arena in which to work. In March this year the Law Commission completed their review of the Mental Capacity Act and the Deprivation of Liberty Safeguards legislation and Draft the Bill is now waiting for a Government decision. The proposed Liberty Protection Safeguards will mean considerable change to the current law but in the meantime we continue to work to the existing legislation. Further to this a change to our existing law, for a death under DoLS, was introduced through the Policing and Crime Act 2017 where such a death is no longer considered a death under state detention and therefore negating the need for the Coroner to carry out an inquest on all such deaths. The Adult Safeguarding Team with the support of the Trust s MCA Coordinator remain committed to keeping abreast of these changes as they are introduced to ensure frontline staff work within the law. Key achievements in 2016/17 Providing frontline staff with practical support to assist their implementation of the Mental Capacity legislation Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 27

28 The development and publishing of the Friends and Family leaflet for DoLS for assisting staff to support families to have a better understanding of the Deprivation of Liberty Safeguards. The MCA booklet is now available online to ensure wider distribution within the Trust Further development of the MCA Champions network including the development of the MCA workspace MCA and DoLS training compliance exceeded the Trust target of 85% for the second year running, specifically MCA Level 1 training has reached 88% and MCA Level 3 training has reached 91%. Maintaining a robust monitoring system for patients meeting the threshold for Deprivation of Liberty Safeguards to ensure no service user is unlawfully deprived of their liberty Key challenges in 2016/17 A continued challenge is that MCA is a fluctuating area of law. The impact of the Supreme Court ruling in 2014 continues to play out in the identification, application and management of DoLS patients. While case law is slowly assisting with the implementation of the ruling we currently do not have clear national guidance or a definition of what specifically constitutes a Deprivation of Liberty Capturing and evidencing all frontline work associated with the Mental Capacity Act is an ongoing challenge particularly in light of the move to electronic records. The service has specifically worked on capturing Independent Mental Capacity Advocates (IMCA) referrals with the Trust s CIS team Key actions for 2017/18 The Trust s SG service will continue to support the Trust s compliance with DoLS legislation, by keeping abreast of changes as they occur and translating the legislative developments into practical guidance for frontline staff, specifically in light of the Law Commissions proposed Liberty Protection Safeguards. To explore extending the MCA Level 3 training package to additional staff cohorts namely band 5 and 6 s staff, to provide them with an enhanced understanding of DoLS Further development of the MCA Champion network which is a key platform to impart specialist knowledge and updates to frontline staff who act as additional resources for their respective teams. Impact on the service user Successful implementation of MCA and DoLS theory into practice/service delivery both empowers and promotes autonomy for the young person and adult, whilst protecting their basic human rights. Embedding MCA into all areas of practice throughout the Trust ensures that those service users (16 years and above) who may lack capacity are afforded the same choice and rights as those who do not lack capacity. 6.6 Modern Slavery and Human Trafficking Modern Slavery Act 2015 is the first legislative framework to specifically address slavery and trafficking in the 21st Century. The Home Office estimates there are 13,000 victims and survivors of modern slavery in the UK; 55% of these are female and 35% of all victims are trafficked for sexual exploitation. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 28

29 Every day, NHS staff come into contact with people from across the globe. With more than one million people accessing NHS funded services every 36 hours, the 1.5million staff who work in the NHS, not just in hospitals, but in places where people live their lives, will come into contact with modern slaves. Previously the Department of Health funded a three year research project, PROTECT (Provider Responses, Treatment and Care for Trafficked People), looking at Healthcare and Modern Slavery. PROTECT reported that 86% of NHS professionals lacked the knowledge to identify victims of modern slavery and 71% were not confident to make referrals for victims to receive additional support. With greater legal footing and introduction of Modern Slavery as a category of adult abuse through the Care Act 2014, the Trust s SG service has been committed to ensure Modern Slavery is included on its safeguarding agenda. This means Modern slavery awareness has been incorporated in all levels of in-house Safeguarding training, our SG practitioners have attended local Modern Slavery training and a Slavery and Human Trafficking Statement has been produced in line with section 54 of the Modern Slavery Act This is a form of declaration and commitment that sets out what steps the organisation has taken to ensure modern slavery is not taking place in their business or supply chains. The statement, which is attached at appendix two, is reviewed annually. Key achievements in 2016/17 The SG service is committed to ensuring that Modern Slavery and Human trafficking is recognised by all employees and is seen under the umbrella of Safeguarding is everyone s responsibility Trust SG practitioners have attended Modern Slavery training to gain a greater understanding of the national picture and challenges that Modern Slaver/Human Trafficking brings to Safeguarding arena The Trust has a Slavery and Human Trafficking Statement in line with section 54 of the Modern Slavery Act This is reviewed annually and accessible to public through KCHFT public webpage Modern Slavery awareness is included in all levels of the Trust s safeguarding training Key challenges in 2016/17 Modern Slavery and Human trafficking is a new and challenging priority both nationally and locally with only a few areas of best practice to tackle this hidden crime The national and local data in relation to the scale of the problem remains limited Local anti-slavery forums are still at its infant stages to enable sharing of local intelligence at multiagency level and to support coordinated multi-agency responds to victims of Modern slavery and Human Trafficking Key actions for 2017/18 To review PROTECT research, its findings and its recommendations to understand the implication of Modern Slavery and Human Trafficking on health organisations. This will enable the Trust to map key services that may require targeted training in relation to identifying victims of Modern Slavery and Human trafficking Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 29

30 To ensure Trust staff have access to training and resources in relation to Modern Slavery and Human trafficking to enable them to identify victims and respond appropriately in healthcare setting SG practitioners to engage with local anti-slavery multi-agency forums and local training. This will enable KCHFT to keep abreast of national and local guidance and best practice. Further it will enable us to understand the local picture, have access to intelligence and, as a result, explore the possible impact on local victims and implication for us as a health provider Impact on the service user Exploitation of Modern slavery and human trafficking victims inevitably occurs everywhere around us; within or around properties and therefore frontline NHS staff can play a vital role in identifying victims as they may be the only point of contact with those who are vulnerable. Understanding of Modern Slavery legislation, how to identify victims and know what support is available will enable staff to respond sensitively and with confidence to those in greatest need at most the vulnerable times of their lives. Contact with a health care practitioner may be the only real opportunity for someone to be identified as a victim and to explore support available. 6.6 Safeguarding Adults Significant Incidents (SGA SI) The Trust s SG service reviewed all reported serious incidents of a safeguarding nature and was routinely involved in supporting Root Cause Analysis (RCA) investigations. Serious incidents of a safeguarding nature were reported at the Trust s Safeguarding Assurance Group, including discussion around embedding the lessons learnt. They also formed part of the SG Performance Dashboard monitoring that was regularly reported to the Kent CCGs. In total, there were 18 serious incidents of safeguarding nature during 2016/17. Out of the 18 cases, 4 remained open at the end of the year with the respective commissioner, 5 cases were awaiting an outcome from the respective commissioner and the rest were closed. Within the closed cases, there were 5 cases where abuse was substantiated, see table six below. For all SIs where a safeguarding concern was identified, a referral was raised to KCC. Table 5: showing Open/Closed Serious incident cases, April 2015 March 2016 Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 30

31 Table 6: showing Open/Closed Safeguarding Serious Incidents April 2016-March 2017 As with adult protection referrals, the key themes identified through Serious Incidents related, in the main, to neglect associated with tissue viability (10), this theme remains the same as last year and the numbers have remained at 15 cases across both years. The Trust s SG practitioners were linked to each of the Community Hospitals, to support safeguarding practice. SG Champions have been in place within identified operational services since April 2015 and met regularly with the MCA Co-ordinator, who supported them by providing specialist advice and sharing local/national safeguarding information for dissemination across their service areas. The Trust s SG service worked closely with operational services and incident teams, through their involvement in RCA meetings and providing support to local teams to address lessons learnt. Some of the key lessons identified related to: Lack of regular review of pressure ulcers Lack of equipment exploration Communication between staff and clients and their families Lack of awareness of the deteriorating patient and responding to their needs Ensuring staff are up to date with NEWS (National Early Warning Screening) training Completion of capacity assessments when patients are non-capacious Lack of holistic assessment and review Lack of onward referral Lack of incident reporting Poor record keeping In 2016/17, the Trust developed a Pressure Ulcer Task Force led by the Tissue Viability Team (TVN). An overarching Trust wide action plan was developed to provide assurance that the SSKIN (Surface, Skin, Keep moving, Incontinence, Nutrition) bundles have been implemented across the services to support reduction of pressure ulcers across the Trust. This framework is supported by operational services completing a monthly report which is shared with service managers and the TVN team. Falls were also high on the agenda for the Trust and the Multi Factorial Risk Assessment (MFRA) tool has been reviewed alongside the development of an online video tutorial placed on the staff intranet and providing staff support and guidance in relation to falls and understanding of the Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 31

32 MFRA. A new falls leaflet has been developed for patients and carers and disseminated across the Trust. Key achievements in 2016/17 The SG service s daily duty rota for providing safeguarding advice to staff for adults and children s services ensured timely advice and support to staff who had safeguarding concerns, including advice on incident reporting (Datix) completion and referral into Social Services The reduction of serious incidents of a safeguarding concern from 24 last year to 18 this year demonstrates improvement towards reducing avoidable harm to patients SG practitioners have developed strong working relationships with the Serious Incident Team supporting triangulation of information and supporting/improving lessons learnt across the Trust SG service s routine involvement in initial SI conference calls, attendance at RCA meetings and embedding SG into action plans of the SIs Key challenges in 2016/17 Continued work towards reducing the reported incidents of avoidable harm to patients Developing processes to support staff with embedding the learning into practice Continued work with Datix, to support accurate and timely completion of the incident reporting information, that ensures safeguarding input is easily visible to the wider organisation and supports accurate and timely reporting Key actions for 2017/18 Continue to develop processes that support embedding lessons learnt into practice Supporting staff to develop awareness of the subtle and complex areas that are related to care developing understanding of the bigger picture when they are delivering care. Impact on service user It is not acceptable for patients to experience avoidable harm when they are in our care. The reduction in the number of serious incidents of a safeguarding concern from 24 last year to 18 this year demonstrates that the Trust is reducing cases of avoidable harm, which is of significant benefit to the patient. The Trust recognised that early identification of abuse and investigation is imperative to identify lessons to prevent re-occurrence and ensured appropriate support was put in place for the patient. The continued strengthening of internal partnership working between the Trust s SG service, Serious Incidents Team and operational services has enabled safeguarding concerns to be identified and appropriate actions to reduce avoidable harm to patients put in place. 6.7 Domestic Homicide Reviews (DHRs) Kent and Medway s DHR Protocol was published in May 2015 and has been followed by the Trust when overseeing any newly commissioned Domestic Homicide Reviews Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 32

33 During 2016/17 there were 3 DHRs commissioned by the Kent Community Safety Partnership (CSP), to which the Trust confirmed involvement with the perpetrators or victims and was subsequently required to produce an Independent Management Review. Key learning from these cases include: Holistic Assessments to be reviewed to ensure routine enquiry in relation to physical, mental and social wellbeing including domestic abuse Sharing the learning from domestic abuse cases through staff training Raising staff awareness in relation to domestic abuse Previous DHR action plans were completed in relation to the outstanding actions of producing a Domestic Violence and Abuse (DVA) policy and the introduction of essential-to-role DVA training. The Trust provides DVA training through a number of existing safeguarding and SCPHN training packages, resulting in approximately 90% of identified staff having received a level of DVA awareness training. Key achievements in 2016/17 Timely response to newly commissioned Domestic Homicide Reviews Trust review against recent NICE DVA quality standards (2016) and training guidance for health and social care professionals was undertaken in 2016/17 and the Trust reported full compliance A co-ordinated approach for the delivery of DVA training which reflects current NICE guidance and supports the training needs across the organisation Raising awareness of staff during the safeguarding awareness week in October 2016 Key challenges in 2016/17 A co-ordinated approach for the delivery of DVA training which meets the training needs across the organisation To develop a domestic abuse safeguarding workspace on the Trusts intranet To support all services to ask routinely about domestic abuse Key actions for 2017/18 A co-ordinated approach for the delivery of DVA training which reflects current NICE guidance and supports the training needs across the organisation Develop Domestic Abuse workspace on the Trust intranet Work with the electronic patient record systems to include a question about abuse that can be asked to all clients Impact on service user With robust systems, processes, tools and policy in place that increase staff knowledge and ability to support their client groups, support early identification and interventions, service users can be confident that their safety and wellbeing will be considered at all stages of the health care provided by KCHFT. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 33

34 Serious Adult Reviews (SARs) During 2016/17 there were 3 SARs commissioned by the Kent and Medway Safeguarding Adults Board. Key learning for the Trust from these cases includes: Team leader should have overarching responsibility of the case load Communication to all team members should be improved Regular and effective one to ones with staff Clear documentation that is completed contemporaneously, stored appropriately and removed from patients home promptly when care is completed and archived as per policy Assessments completed and care plans developed that are SMART, including assessment of mental capacity within a timely manner Consent to be gained prior to treatment and recorded clearly within the case records Competencies of staff to be reviewed and completed In Handover, transfer information and safeguarding issues and actions to be actively discussed and documented Liaison with other agencies as appropriate Review of training to include learning from SARs The Trust had involvement in 1 case that resulted in a round table discussion, but did not progress to a SAR, Trust involvement was reviewed and an action plan developed, which is currently being completed. Lessons learnt include: Considerations of the person s capacity and wishes in respect of a Do Not Attempt to Resuscitate (DNAR) should be considered at every review. People in receipt of adult social care and health services should have an equivalent to a grab pack Policies should be consistent across organisations to ensure policies don t conflict Agencies should make contact with the other agencies involved when there is a serious incident Personalised hospital discharge letter to be developed The Trust responded to 1 request for involvement in relation to a potential SAR. Key achievements in 2016/17 Timely response to newly commissioned SARs Trust review and gap analysis completion of the round table discussion Raising awareness of staff about the newly commissioned SARs Key challenges in 2016/17 Review of the adults training to incorporate learning from the SARs Sharing of the learning to services who moved to another provider To support all Trust s services who are involved in a SAR Key actions for 2017/18 Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 34

35 Development of the training packages to incorporate learning from SARs Development of a peer review audit tool to support learning from SARs Work with the electronic patient record systems to include a question about abuse that can be asked to all clients Impact on service user With robust systems, processes, tools and policy in place that increase staff knowledge and ability to support their client groups, support early identification and interventions, service users can be confident that their safety and wellbeing will be considered at all stages of the health care provided by KCHFT. 6 Prevent The Prevent Duty Guidance for England and Wales was published in the summer of This document gives clear statutory guidance on what specified authorities, such the Local Authority and the NHS need to do to prevent people (including patients, service users, communities and colleagues) from being drawn into terrorism. In terms of the Trust, we have a responsibility to: Embed Prevent into our Policies and Procedures Deliver Prevent training to identified staff groups within the organisation. The staff groups were identified with reference to the NHS England Training and Competencies Framework (2015). This Framework is also linked in to NHS England s draft Safeguarding Adults: Roles and competencies for health care staff Intercollegiate Document Ensure staff are aware of how to recognise and refer those considered at risk of being drawn into terrorism to the Trust s SG service, who may then advise an onward referral to Channel 7 Key achievements in 2016/17 A Prevent workspace was created to bring together all the information and up-to-date news on Counter Terrorism, so that all Trust staff can be kept abreast of the same In addition to SG practitioners being trained as WRAP 8 trainers, a further 4 staff from Operational services were also trained as WRAP trainers The Guidance from NHS England on Prevent Freedom of Information (FoI) requests was successfully incorporated into the KCHFT FoI Policy There were two Channel referrals made by KCHFT staff between April 2016 and March 2017, one of which was adopted as a Channel case Key challenges in 2016/17 To maintain WRAP training compliance of 85% by 31 March To continue to raise awareness on Prevent so that staff will continue to raise Channel referrals appropriately and in a timely manner To promote the WRAP Train the Trainer programme to other services, so that they may be trained and deliver the WRAP training to their local teams 7 Channel is a programme that uses a multi-agency approach that focuses on the provision of support to people who are identified as being vulnerable to being drawn into terrorism. 8 Workshop to Raise Awareness of Prevent 9 This new training was introduced by NHS England in February 2015 and requires the Trust to achieve 85% compliance by 31 March Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 35

36 Key actions for 2017/18 To maintain WRAP training compliance of 85% by 31 March 2018 To continue to raise awareness on Prevent so that staff will continue to raise Channel referrals appropriately and in a timely manner To promote the WRAP Train the Trainer programme to other services, so that they may be trained and deliver the WRAP training to their local teams Impact on children/young people/adults Early identification and timely Channel referrals enables the child, young person or adult to receive timely intervention and support, which could prevent them from being caught up in the subsequent criminal stage of the counter-terrorism process. 7 Domestic Violence and Abuse Health services have a pivotal role to play in the identification, assessment and response to domestic abuse not only because of the impact of domestic abuse on health, but more importantly victims may access KCHFT services. A Domestic Violence and Abuse policy for Service Users has been compiled for all KCHFT staff to follow to ensure they are able to respond effectively to disclosure of Domestic Abuse. KCHFT staff who have concerns about a child, young person or adult who is suffering abuse seek advice from the KCHFT Safeguarding Service. Staff must consider the danger the victim may be in following a disclosure from or discussion with the victim. KCHFT staff may need to contact the police/social Services as a matter of urgency if they believe a child, young person or adult is at risk of assault or abuse. It an essential part of KCHFT staff safeguarding work to ensure they embed Think Family as part of any Domestic Abuse situation or disclosure, in any situation both adult and children need to be considered within the family. Therefore this has been embedded within both Safeguarding Adult and Children training. Key achievements in 2016/17 Development of abuse line of enquiry onto first contact forms on CIS to include Domestic Abuse Continued delivery of Think Family into training packages especially for Adult services Ensuring Domestic Abuse is embedded into training packages following the addition of the abuse category of DVA within the Care Act 2014 Key challenges in 2016/17 Reviewing of current Domestic Abuse Training that has been delivered to SCPHN services delivered by the service s Domestic Abuse Leads Involvement in Kent Multi-Agency meetings with regards to DVA. Delivery of bespoke DVA training to staff groups not included in key Safeguarding Children/Adults training target audiences, eg, TB services, who are not required to access Safeguarding Children training that includes DVA Key actions for 2017/18 Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 36

37 Embed MARAC attendance into the SG team and ensure feedback to operational staff Deliver y of DVA training to KCHFT staff including MIU s and other identified operational staff Development of DVA workshop for Safeguarding Children Level 3 training, ensuring the NICE guidance is embedded into training packages Attendance on the Kent Multi-Agency Executive Board for DVA Impact on children/young people/adults Frontline practitioners have the knowledge required to respond effectively to DVA and be able to signpost and protect adults and children from abuse The Trust s SG service will be expanding its responsibilities to include attendance at Multi- Agency Risk Assessment Committees (MARAC) meetings across Kent and the provision of DVA training to SCPHN services 9 Safeguarding Inspections The Trust is registered with the CQC, without conditions. (A condition of registration can be imposed upon a provider where there is evidence that they are not compliant, to limit or restrict what they can do.) As at 31 March 2017, the Trust had 31 locations registered with the CQC. The Trust s existing standards assurance process required services and subject matter experts, including SG services, to self-assess compliance against the five domains of the CQC s fundamental standards regulations that came into force in April Safeguarding Training Training in safeguarding children and adults is a mandatory requirement of all staff employed by the Trust, including the Board. The compliance levels for the Trust s mandatory and essential-torole SG training were set 85%, to take into account staff who may be on planned/unplanned or extended leave. Overall, safeguarding training corporate compliance levels for 2016/17 were: Safeguarding Children 95% Safeguarding Adults 93% Mental Capacity Act 93% Prevent 92% Within this performance, where shortfalls against compliance were identified for local teams or services, local improvement plans, risk assessment and supporting mitigations were put in place. Key achievements in 2016/17 All training packages were updated to include learning from Serious Case Reviews and lessons learnt and to accommodate changes in legislation and/or policy and procedures. Evaluations by attendees were consistently positive about the content and quality of the training provided The SG training leads collaborated with the Trust s Learning & Development service, the KSCB and KMSAB, to ensure that all locally provided training materials were relevant and that the correct number of sessions were available to accommodate identified staff needing to access training Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 37

38 Prevent training packages were included in the Trust s Corporate Induction programme for all new starters, with essential-to-role sessions publicised through the Trust s Training Prospectus, resulting in a high level of compliance Child Sexual Exploitation and Trafficking Training was delivered to key staff groups across the Trust, including Health Visiting, Family Nurse Partnerships and Minor Injury Units Robust response by SG service in providing bespoke training sessions and identifying new methods of assessment of learning Peer review of SG service delivery of training, to provide quality assurance Key challenges in 2016/17 Competing clinical priorities to allow the timely release of frontline staff to complete SG training Assessment of training needs and delivery of training to newly acquired contracts that are based outside of Kent Development of webinars and other forms of training to increase accessibility for staff Key actions for 2017/18 SGC, SGA and MCA training packages, including e-learning will be reviewed to ensure that the contents are up-to-date and enough sessions provided throughout 2017/18 to support the training needs of staff who need to update their mandatory training All updated SG training to be recorded with the Trust s Clinical Excellence and Standards Validation Panel New/innovative ways of delivering training will be considered, to meet the needs of service users and staff providing their care Operational managers will continue to risk assess services where compliance levels may be low, to ensure on-going patient safety Training needs and delivery of training to be developed in line with the Safeguarding Adults Intercollegiate Document, when published Impact on children/young people/adults The overall training compliance levels increased significantly over the year. Staff knowledge and competence with safeguarding has increased, ensuring staff feel supported and empowered to seek advice, make decisions and act appropriately when there may be safeguarding concerns. 11 Safeguarding Supervision Throughout 2016/17 the provision of SG supervision has ensured that the Trust fulfils its commitment and responsibilities as a safeguarding organisation. Following SCR Lakeland in 2015, the model of safeguarding supervision for Sexual Health services was reviewed and a new group supervision model was developed. The new model was implemented in May 2016 and positive feedback has been received. The model of safeguarding supervision for Sexual Health services will be audited in SG supervision post SI and as requested/identified has significantly increased within Adult Services and this again is to be audited in Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 38

39 Achieving and maintaining SG supervision compliance of 85% for mandatory provision for identified staff within CYP Services - the year to date figure (across the year) was 84% against a compliance level of 85%. The SG service did experience staff vacancies and an unusual level of long term sickness during this time. It should be noted that Feb 2017 showed compliance at 86% and March 2017 at 94% and with additional, proposed changes within the Trust s SG supervision model, the compliance level should be maintained in the coming year. The SG supervision policy was also updated during this period to include the Signs of Safety model within the safeguarding supervision paperwork. Key achievements in 2016/17 Successful implementation of the SG supervision model in Sexual Health services Provision of group safeguarding supervision within adult services post SI, ad-hoc or by team request has increased and positive feedback has been received Review of current SG supervision arrangements within CYP Service to ensure future SG supervision compliance Key challenges in 2016/17 The introduction of an alternate model of safeguarding supervision within CYP services involving both 1-to-1 and group safeguarding supervision, the development of SG supervision within the Minor Injury Units and the provision of group supervision to East Sussex CITS team The need to audit the new model of safeguarding supervision in Sexual Health services and to develop/complete an audit of current SG supervision with Adult Services To ensure that 1-to-1 SG supervision is offered when the need may be identified via the SG consultation line or when requested by the practitioner Key actions for 2017/18 Achieve and maintain SG supervision compliance of mandatory SG supervision to Health Visitors and School Nurses and embed a revised model of safeguarding supervision Develop and undertake an evaluation of SG supervision provided within Sexual Health and Adult services Review SG Supervision Policy and Pathway (due October 2017), to incorporate any recommendations resulting from the planned supervision audits Impact on the child/young person/adult Through the provision of regular, planned SG supervision, respective roles, responsibilities and expectations of the organisation, managers, supervisors and supervisees can be clearly understood. Through monitoring of attendance at SG supervision, evaluation and audit organisational risk may be identified. 12 Safer Recruitment There has been little change in legislation or national policy with regards to safer recruitment in the past year. The Trust s safer recruitment arrangements have, therefore, been maintained in line with existing policies Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 39

40 Key achievements in 2016/17 The DBS policy has been re issued for a further 3 years, with no change to the content Key challenges in 2016/17 Embedding of the DBS Update service for bank staff, both new starters and existing workers has proved challenging and will roll forward as an action for next year Key actions for 2017/18 Embed the DBS Update service for bank staff, both new starters and existing workers Impact on child, young person, adult The Trust s Safer Recruitment arrangements provide assurance that any workers that patients may come into contact with are safe to practice and mitigates the risks that staff may cause avoidable harm 13 Safeguarding Audit There were five single-agency audits completed by the Trust in 2016/17 that focused on Safeguarding, with safeguarding specific lines of enquiry included in a number of mainstream operational audits. Safeguarding Supervision Re-audit This re-audit was undertaken to evaluate the safeguarding supervision service given to practitioners working with children and young people and to ensure decisions and actions are appropriate in meeting health requirements for safeguarding children and young people. The re -audit shows improvement in all areas identified as potential concerns from the audit undertaken in Amalgamated Audit An Integrated Audit including; Consent, MCA, Safeguarding, DoLS, personalised care planning, end of life care and venous thromboembolism was completed. The results of this audit were not available at the time of publishing this annual report. Domestic Abuse Audit The Trust s Domestic Abuse Leads within CYP services completed an internal audit, to audit the level of compliance with the NICE guidelines PH50 Domestic violence and abuse: multi-agency working. The audit showed significant assurance. Safeguarding Peer Review Audit This audit was developed following analysis of common themes and trends from Serious Case Reviews (SCRs) and Case Reviews (CRs) that Kent Community Health NHS Foundation Trust s practitioners had involvement with. Records of children seen by the health visiting and school nursing service were peer reviewed. The results of this audit were not available at the time of publishing the annual report as the audit was in the pilot stage. Follow up Audit for children under 16 who attend sexual health clinics The purpose of this audit is to clarify that the DNA flowchart for follow-up appointments for young people within Sexual Health Services is adhered to appropriately and consistently. The results of Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 40

41 this audit were not available at the time of publishing the annual report as the audit report was being written. Six multi-agency audits were completed by the KSCB, namely Child in Care Audit This was a multi-agency deep dive focussing on practice in Child in Care cases where harmful sexual behaviour had been identified as a factor. Child in Need (CIN) Audit This was a multi-agency deep dive focussing on planning within child in need cases that have been open for 4 months or longer, and remained child in need for the duration open. Early Help Audit A multi-agency audit focussing on practice where a child is open to an Early Help Unit, with identified poor school attendance and one or more partner agencies are actively involved with the child / family. Emotional Health and Wellbeing Audit A case file audit into children and young people who present to Accident and Emergency Departments with [serious] self-harm and/or suicidal ideation. Repeat Missing Episodes Audit A multi-agency audit focussing on practice where a child has had 3 or more missing from home or care, episodes within a 3 month period. Toxic Trio Audit A multi-agency audit focussing on practice where one or more elements of the Toxic Trio were identified at the assessment stage following referral. ( Toxic Trio - Domestic Abuse; Substance Misuse; and Parental Mental Ill-Health). The recommendations from these audits have been reviewed by the Trust and have been or are being shared with and benchmarked against CYP services. KCC also completed an audit into the Toxic Trio, the Trust completed this audit and developed an action plan addressing any gaps. The Trust also participated in 3 multi-agency Self Assessments, as required by the KMSAB and KSCB. A SGA Self-Assessment Frameworks (SAF) was led by KMSAB, which required partner organisations to review a SAF previously completed in 2016 to measure the quality of safeguarding that the organisation provides to adults in their care. This repeat SAF submission, which was peer reviewed, provided assurance that there had been improvement against the previous self-assessment, with the previously identified actions having been successfully completed. A CSE SAF was led by KSCB, which required partner organisations to review themselves against a self-assessment tool that aimed to assess the effectiveness of the arrangements for safeguarding children against Child Sexual Exploitation. This SAF showed compliance for the Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 41

42 Trust in most of the areas. Where compliance was not demonstrated, a supporting action plan was developed. Section 11 of the Children Act 2004 Voice of the Child SAF was led by KSCB, a full response audit was completed and submitted in February The SAF showed significant evidence and case studies, to demonstrate how the Trust routinely involves children and young people in the development and delivery of children s services, ensuring that care planning is child focussed and child led. Key achievements in 2016/17 Audits for 2016/17 provided assurance and evidence of good practice and identified areas for further service development Timely completion of multi-agency audits and SAFs, with positive levels of assurance Strong cross-organisational working to complete external SAFs Development of a safeguarding audit checklist for the Trust s operational services to consider when developing local audits Key challenges in 2016/17 Difficulties influencing change where gaps were identified within other agencies Competing timeframes for completing internal and external audits/deep dive exercises Completion of supporting action plans within specified timeframes Key actions for 2017/18 Oversee the completion of outstanding audit action plans Take forward an agreed audit programme for 2017/18 Further develop the peer review audit tool for services to use across children s and adult services Impact on child, young person, adult The audits findings provided assurance and identified both areas of good practice and areas that required development, that will equally support the development and improvement of meeting the needs of service users, strengthen partnership working and ensure appropriate interventions are afforded in a timely manner. Multi-agency audits and SAFs ensure the Trust does not work in isolation, but rather in a joined-up manner with partners in the Kent health and social care economy. 14 Monitoring and Assurance Arrangements KCHFT SG arrangements were monitored in various ways and at different levels: A monthly SG Planning Meeting provided the oversight of monitoring and assurance progress and supports, including strengthening and escalating associated assurance frameworks A bi-monthly Safeguarding Assurance Group considered the Trust s progress and performance against a Safeguarding Assurance Dashboard, where the Trust s safeguarding activities, functions and outputs were scrutinised. Local CCG Designated Nurse and KCC Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 42

43 Public Health representatives attended this meeting and fed back to their respective organisations Quarterly Assurance Reports were presented to the Quality Committee, which provided progress on safeguarding activities and performance, both internally and externally A quarterly exception report was produced by the Trust s SG service for the Adult, Children s and Specialist Service Directorates, respectively providing updates on SG activities and highlighting areas for attention/development. This model enabled closer collaboration and partnership working between SG services and Heads of Services and supported the continuity of quality service delivery A SG Annual Report provided assurance to the Trust Board, Board of Governors and external organisations, e.g., CCGs and CQC, of the Trust s compliance against its statutory responsibilities Quarterly SG service development days, where all of the Trust s SG staff come together, to discuss key developments for the service and to discuss safeguarding cases that were suitable to support SG practitioners professional revalidation process The external monitoring and assurance arrangements were executed through the provision of a SG Performance Dashboard to commissioners, on a monthly basis Safeguarding staff were invited to contribute to RCAs as required internally Attendance at the LSCB, LSAB and CRU Board meetings and a wide range of multi-agency meetings to represent the Trust External assurance reporting to LSAB and LSCB which included: Quarterly completion of the SGA KPI dashboard (KMSAB) KCHFT contributes to the KSCB and KMSAB Annual reports Completion of the KMSAB Self-Assessment Framework (SAF) and peer review of the same, that assessed the quality of safeguarding that the organisation provides to adults under their care. This self-assessment process provided assurance that there had been continued improvement against previous self-assessments Completion of a Child Sexual Exploitation SAF, which was led by the KSCB, required partner organisations to review themselves against an agreed self-assessment tool that aimed to assess the effectiveness of the arrangements for safeguarding children against Child Sexual Exploitation. This SAF showed compliance in most of the areas and, where compliance was not demonstrated, a supporting action plan was introduced and completed Completion of a section 11 of the Children Act 2004 Voice of the Child SAF, which was led by the KSCB, required partner agencies to review themselves against an agreed selfassessment tool and peer review of the same. Review of KCHFT involvement and reports for Serious Case Reviews, Case Reviews, Domestic Homicide Reviews and Serious Adult Reviews with the development and completion of supporting actions required as needed Gap analysis and development /completion of action plans, in response to key local and national cases, eg, Joint Targeted Area Inspections (JTAI), Review of health services for Children Looked After and Safeguarding in Medway, Overview of Serious Case Review in Sutton, CQC Not Seen, Not Heard, deep dives completed by KSCB, CQC Time to listen a joined up response to child sexual exploitation and missing children Whilst the Trust s SG service has established a strong reporting process model, the service has also developed a triangulation model of monitoring, reviewing and benchmarking with operational, quality and patient experience services. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 43

44 Key Achievements in 2016/17 The Trust continued to maintain, sustain and build upon existing safeguarding monitoring and assurance arrangements and there was a sustained improvement in the assurance demonstrated across the organisation over the past year Continued promotion of safeguarding within the Trust and support to operational services, to address identified gaps within their areas Continued engagement and working in partnership with partner agencies and completion of reporting requirements in a timely manner, with Kent CCGs and out of area CCGs Development of a Trust Steering group to co-ordinate the gap analyses that the Trust undertakes Key Challenges in 2016/17 The frequency and level of reporting both internally and externally represented a number of challenges in meeting deadlines Demonstrating that learning has been embedded and practice had changed following identification of gaps Key Actions for 2017/18 Continue to maintain, sustain and build upon the Trust s safeguarding monitoring and assurance arrangements Continue to promote safeguarding within the Trust and support operational services to address identified gaps within their areas Continue to engage and work in partnership with other agencies within Kent and with agencies that are linked with out of Kent contracts Impact on service users The overall monitoring and assurance framework provided assurance that a robust system is in place to support staff identify, protect and promote the welfare of all service users accessing services across the Trust. Furthermore, the process provided good information sharing and communication from and to all levels of staff across the Trust, through which safeguarding forms part of the forefront of service delivery and features highly on the Trust s business agenda. 15 Safeguarding Policies and Procedures During 2016/17, all Trust safeguarding policies and procedures were reviewed and updated accordingly. These are all available to Trust staff on its intranet. To support Trust staff access and apply Local Safeguarding Board procedures, the Trust s SG service provided and maintained an internal Safeguarding Operational Manual. This electronic guidance also provided links to relevant LSCB and LSAB procedures and key national documentation. 16 Risk Management Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 44

45 The risks to delivering the Trust s SG agenda have been reviewed on a regular basis and high risk issues reported to the Board, via the organisation s risk assurance framework. The risks identified and addressed during 2016/17 included, Vacancies and planned absences within SG services that may impact upon the Trust maintaining compliance against key performance indicators and responsibilities UASC may not be adequately safeguarded (risk assessment, Voice of the Child, timely interventions), which could find the Trust in breach of its statutory responsibilities under the Children Act 2004, to safeguard and protect young children Inappropriate inclusion of highly sensitive SG information on CIS held patient records, which could constitute an information governance breach Lack of clarity regarding the specialist health model within the CRU, resulting in reduced opportunity or evidence to support multi-agency decision making Key actions put in place to support these risks included, Daily availability of SG support/advice, through the service s duty rota Development of a Restrictive Interventions training matrix has been produced Recruited to existing vacancies within SG services Provision of ad hoc SG supervision Appointment of appropriately trained/experienced locum paediatricians to complete backlog of >900 Initial Health Assessments (that did not distract substantive paediatricians away from supporting health needs of other children in care) Trust Code of Confidentiality signed by all KCHFT employees Development of operational protocol to support the storage of highly sensitive SG information at local team level Situation escalated to CRU Strategic Board to brief key partners of the challenges for health partners and lack of multi-agency decision-making Lead CCG (West Kent) identified to co-ordinate service model review 17 Equality and Diversity (E&D) The Trust is committed to safeguarding and protecting its most vulnerable service users, within which there may be specific sub-groups who are more vulnerable than others. An overview of the E&D information available for all adult alerts raised by the Trust during 2016/17 is included in appendix three. 18 Safeguarding Work Plan 2017/18 The key themes for 2017/18 include On-going review of SG service resources and skill mix, to support the organisation s programme of SG transformation, with particular focus on the development of enhanced safeguarding practice and decision-making at frontline. Work with partner agencies, to review the existing CRU health model, to respond to the changing needs and increasing demands on the CRU. Ensure all local policies, procedures and guidelines reflect legislative changes. Continue working with the Trust s frontline services and our partner agencies, to ensure that professional decisions to make referrals to children and adult social care are in line with local Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 45

46 thresholds, that the information provided by individual referrers is of sufficient quality to reflect the risks, needs and required/expressed outcomes of the vulnerable person. Work with partner agencies, to influence the on-going review and development of multiagency SG thresholds, policy and procedure. To continue to work with internal and external partners to strengthen collaborative and coordinated working that will further reduce avoidable patient harms. Continue to develop and monitor the robust confidential process within CIS that allows safeguarding concerns to be held confidentially and confidently. To support CYP services with the development of the peer review process, this is designed to support learning from Serious Case Reviews. Ensure timely involvement in and sharing of learning from SIs, SCRs, SARs and DHRs. Work closely with SG services, to review case conference attendance pathways, to enable the Trust to contribute effectively, as required and to trial new ways of working that will enable the Trust to work closely with children and families, who may require additional support. Fully utilising the LAC nursing skill set with the introduction of packages of care for Looked After Children and Young People and work with the CCGs to develop a commissioned service to meet health needs of looked after children placed in Kent from other Local Authority areas. Develop sexual health services, clinics and resources including developing an improved mechanism for service user involvement in the specialist HIV service, review pathways between Sexual Health Services and Early Help services in order to facilitate access to services for patients who require additional support and work with community pharmacy providers to ensure that each pharmacy has a dedicated safeguarding lead working within their setting. Progress existing working relationships between our SG and operational services, in relation to MCA and DoLS assurance, competencies, best interests decision-making, identifying where additional specialist resource may be required to support/advise on emerging changes to the DoLS framework. Structured SG training programme to be in place, to ensure sustained compliance against mandatory and essential-to-role training, supplemented by bespoke training to support local team learning from incidents, Prevent (WRAP), domestic abuse awareness, FGM, child sexual exploitation and trafficking, modern slavery and continued learning from SIs, SCRs, SARs and DHRs. To enable staff to identify victims and respond appropriately in healthcare setting. New/innovative ways of delivering training will be considered, to meet the needs of service users and staff providing their care, in line with the SG Intercollegiate Documents. Continued engagement in local, multi-agency investigations and reviews, providing timely evidence to demonstrate the Trust s compliance. Provide mandatory SG supervision in line with the Trust s SG supervision policy and seek opportunity to strengthen existing SG supervision arrangements and/or expand to additional staff groups. A (single and multi-agency) SG audit programme that reflects current SG assurance priorities, identifying good practice and developing strategies to address areas that require development. Continue to maintain, sustain and build upon the Trust s safeguarding monitoring and assurance arrangements Continued review and development of safer recruitment arrangements within the Trust, to reflect future policy change at national level. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 46

47 19 Conclusion The safeguarding agenda within the Trust continued to be very busy during 2016/17, in terms of clinical services roles and responsibilities, changes in Safeguarding legislation and the on-going development of the Trust s safeguarding assurance work. Areas of strength for 2016/17 included robust management and monitoring of our DoLS applications and the development of the Friends and Family leaflet for DoLS. Although neglect remains the largest area of abuse within the Trust, there was a reduction in the number of cases reported compared to 2015/16. Significant improvement in SG training compliance and an appetite to benchmark ourselves against key national and local reports and initiatives, in an effort to identify areas of learning that may be of benefit to the Trust and its service users. Overall, safeguarding training corporate compliance levels for 2016/17 were all over 90%. CRU health has been flexible, proactive and resilient in a constantly changing environment, to ensure optimum use of resources and improved outcomes and has worked hard to ensure that their knowledge and skills are updated, to provide a specialist resource to professionals and agencies during interactions within CRU and with external agencies/providers. Safeguarding training has been reviewed and emerging areas of safeguarding (CSE and Trafficking, FGM and Prevent) have been incorporated into the Trust training programmes, DVA has also been embedded into training packages following the addition of the abuse category of DVA within the Care Act Early assessment and identification of needs continues to be embedded in frontline practice, within the Trust s Public Health services. Following the successful award to KCHFT for the delivery of Sexual Health Services in Medway during 2016/1017, KCHFT now delivers a range of Sexual Health services across Kent and Medway. A review of roles and responsibilities within the Community Paediatrics service, including demand and capacity of clinicians, has resulted in all substantive Community Paediatricians being trained to undertake IHAs. This has increased capacity within our existing medical establishment and with successful recruitment this has ensured the service can flex capacity to meet demand. LAC Service supported to develop information sharing data base in regard to Young people at Risk of CSE and to record CSE risk assessments undertaken and actions completed. This has also enabled timely information sharing within the Trust s LAC service and with the CSE Lead. The SG service is committed to ensuring that Modern Slavery and human trafficking is recognised by all employees and is seen under the umbrella of Safeguarding is everyone s responsibility. Trust SG practitioners have attended Modern Slavery training to gain a greater understanding of the national picture and challenges that Modern Slaver/Human Trafficking brings to the Safeguarding arena; ensuring Modern Slavery awareness is included in all levels of the Trust s safeguarding training. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 47

48 The reduction of serious incidents of a safeguarding concern from 24 last year to 18 this year demonstrates improvement towards reducing avoidable harm to patients. SG practitioners have developed strong working relationships with the Serious Incident Team supporting triangulation of information and supporting/improving lessons learnt across the Trust. A Prevent workspace was created to bring together all the information and up-to-date news on Counter Terrorism, so that all Trust staff can be kept abreast of the same. The Guidance from NHS England on Prevent Freedom of Information (FoI) requests was successfully incorporated into the KCHFT FoI Policy. Successful implementation of the SG supervision model in Sexual Health services and provision of group safeguarding supervision within adult services post SI, ad-hoc or by team request has increased and positive feedback has been received. The Trust continued to maintain, sustain and build upon existing safeguarding monitoring and assurance arrangements and there was a sustained improvement in the assurance demonstrated across the organisation over the past year. The Trust has continued involvement in audits and self-assessment frameworks with our multi-agency colleagues to peer review our performance against a number of self-assessment frameworks to evidence the Trust s compliance against its statutory safeguarding responsibilities ensuring the Trust does not work in isolation, but rather in a joined-up manner with partners in the Kent health and social care economy. Partnership working across the local health and social care community continues to be strong and can be evidenced by the Trust s on-going work with the KSCB and KMSAB partners. 20 Recommendations That in receiving this report, the Quality Committee notes the successes for 2016/17, the key actions for 2017/18 and recommends the report to the Trust Board That the Quality Committee receives and reports to the Trust Board, future safeguarding assurance updates as agreed/requested Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 48

49 References Children Act 2004 Children Act 2004 (Joint Area Reviews) Regulations 2015 Mental Capacity Act 2005 Mental Capacity Act Deprivation of Liberty Safeguards (MCA DOLS) (2007) Care Act 2014 Modern Slavery Act 2015 CQC (2015). The Fundamental Standards. cited at cited on 5 January 2106 DH (2014). Care and Support Statutory Guidance. Department of Health. DH (2011). Health Visitor Implementation Plan. A Call to Action. London: COI. DH (2009). Healthy Child Programme - Pregnancy and the First 5 Years of Life. London: COI. DH (2011). Safeguarding Adults: The Role of Health Service Managers and their Boards. London: The Stationary Office. DH (2015). Working Together to Safeguard Children. London: The Stationary Office. HM Government (2015). Prevent Duty Guidance: for England and Wales. Guidance for specified authorities in England and Wales on the duty in the Counter-Terrorism and Security Act 2015 to have due regard to the need to prevent people from being drawn into terrorism. Home Office (2016). Mandatory Reporting of Female Genital Mutilation procedural information. HM Government (2014). Tackling Child Sexual Exploitation. Hon. Dame Lowell Goddard DNZM (2015). Opening Statement. cited at cited on 29 September KCHFT (2015). Safeguarding Operational Manual. Kent Community Heath NHS Foundation Trust. KCHFT (2016). Security Management Policy. Kent Community Heath NHS Foundation Trust. KSCB (2015). Safeguarding Children at risk of Sexual Exploitation. Risk Assessment Toolkit, version 4. KSCB (2015). Inter-Agency Threshold Criteria for Children and Young People. Kent Safeguarding Children Board. NICE (2014). Domestic violence and abuse: multi-agency working. NICE guideline PH50. London: NICE. NICE (2016). Domestic violence and abuse. Quality standard. NICE guideline QS116. RCPCH. Safeguarding Children and Young People: roles and competences for healthcare staff. Intercollegiate Document. 3 rd edition. London: The Royal College of Paediatrics and Child Health. NHS England (2015). Prevent Training and Competencies Framework. NHS England. NHS England (2016) Safeguarding adults: roles and competencies for health care staff Intercollegiate Document. (Final draft). NHS England. L. Scott-Moncrieff and B. Morris (2015). Independent investigation into governance arrangements in the paediatric haematology and oncology service at Cambridge University Hospitals NHS Foundation Trust following the Myles Bradbury case. A report for Cambridge University Hospitals NHS Foundation Trust. London: Verita. RCN and RCPCH (2015). Looked after children: Knowledge, skills and competences of health care staff. INTERCOLLEGIATE ROLE FRAMEWORK. London. The Royal College of Nursing and The Royal College of Paediatrics and Child Health. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 49

50 Kent Community Health NHS Foundation Trust APPENDIX ONE Safeguarding Declaration The Board of Kent Community Health NHS Foundation Trust (KCHFT) is assured that the following arrangements are in place, in line with the recommendations of the Care Quality Commission, to ensure that systems and processes are in place to safeguard all our patients whether they are children, young people or adults. Kent Community Health NHS Foundation Trust meets its statutory requirements in relation to Disclosure and Barring Service (DBS) checks for all new employees. Compliance is monitored centrally and there is an escalation process, including referrals to the DBS. Kent Community Health NHS Foundation Trust has a Safeguarding Operational Strategy and supporting policies and systems in place, that meet the requirements of Working Together to Safeguard Children (2015), Care Act 2014, Care and Support Statutory Guidance (2014), Mental Capacity Act 2005 and Local Safeguarding Board, multi-agency safeguarding procedures. Safeguarding training, which includes the requirements of the Mental Capacity Act/DoLS, the Children Act 2004, the Care Act 2014 and Prevent, is mandatory within the organisation induction programme for all new employees and refreshed at 3 yearly essential-to-role updates for eligible staff. Kent Community Health NHS Foundation Trust is committed to ensuring that the application of the Mental Capacity Act 2005 is embedded in service delivery. This includes the Deprivation of Liberty Safeguards amendment in 2007 and the Supreme Court ruling of KCHFT is proactive in assessing all potential DoLS cases and making the relevant applications and, where upheld, notifying the CQC of such authorisations. The Board level Executive Lead with the responsibility for safeguarding in Kent Community Health NHS Foundation Trust is the Chief Nurse, who is a standing member of the Kent Safeguarding Children and Adults Boards. Kent Community Health NHS Foundation Trust has lead safeguarding professionals - Named Doctors and Nurses for Safeguarding Children and Safeguarding Specialist Advisers, to fulfil the statutory requirements of Working Together to Safeguard Children (2015). Kent Community Health NHS Foundation Trust has lead safeguarding professionals Named Nurses for Safeguarding Adults and Safeguarding Specialist Advisers, to fulfil the statutory requirements of the Mental Capacity Act 2005, the Care Act 2014 and the Care and Support Statutory Guidance Kent Community Health NHS Foundation Trust has a Safeguarding Assurance Group, which is chaired by the Chief Nurse. There are effective processes for following up children who miss outpatient appointments and for flagging children for whom there are safeguarding concerns. The Board reviews Safeguarding, via the Quality Committee, on a monthly exception reporting basis by operational services, which is supported by a quarterly organisation-wide Safeguarding Assurance Report and annually, when the Trust Board will receive a Safeguarding Annual Report. In addition, a rolling programme of internal assurance visits take place across the organisation and local compliance reports are produced to feedback on key findings and recommendations. Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 50

51 Kent Community Health NHS Foundation Trust has a safeguarding audit programme in place, which provides the Board (and the Trust s Audit Committee) with assurance that safeguarding systems and processes are working effectively. In addition to single agency audits the Trust takes part in multi-agency audits with partner agencies. Kent Community Health NHS Foundation Trust is actively involved in partnership working with Kent County Council and other local agencies, in relation to the development and provision of multi-agency arrangements to safeguard and protect adults and children. 1 April 2017 Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 51

52 Our organisation Kent Community Health NHS Foundation Trust APPENDIX TWO Slavery and Human Trafficking Statement We are one of the largest NHS community health providers in England, serving a population of about 1.4 million. We employ 5,000 staff, including doctors, community nurses, physiotherapists, dieticians and many other healthcare professionals. We became a foundation trust on 1 March We were formed on 1 April 2011 from the merger of Eastern and Coastal Kent Community Services NHS Trust and West Kent Community Health. Our budget is around 234millon. We procure goods and services from a range of providers. Contracts vary from small one-off purchases to large service contracts. Arrangements to prevent slavery and human trafficking We are committed to ensuring there is no modern slavery or human trafficking in our supply chains or any part of our business activity. Our commitment to social and environmental responsibility is covered by our approach to modern slavery and human trafficking, which is part of our safeguarding strategy and arrangements. Our arrangements Safeguarding Our commitment to ensure no modern slavery is reflected in a number of our policies and procedures. These include our adults and children Safeguarding Operational Strategy and Safeguarding Operational Manual, which have been developed and maintained within the national and local safeguarding children governance and accountabilities frameworks. It includes guidance on initial contact with a suspected human trafficking victim and the National Referral Mechanism. Training and promotion Our safeguarding training includes role relevant modern slavery awareness and understanding to reflect the Department of Health s project around Provider Responses, Treatment and Care for Trafficked People (PROTECT). Suppliers/tenders The trust complies with the Public Contracts Regulations 2015 and uses the mandatory Crown Commercial Services Pre-Qualification Questionnaire on procurements, which exceed the prescribed threshold. Bidders are required to confirm their compliance with the Modern Slavery Act. Sub-contracts Our procurement and contracting team is qualified and experienced in managing healthcare contracts and have receive appropriate briefing on the requirements of the Modern Slavery Act 2015, which includes: requesting evidence of their plans and arrangements to prevent slavery in their activities and supply chain using our routine contract management meetings with our providers, to address any issues around modern slavery implementing any relevant clauses contained within the Standard NHS Contract. This statement is made pursuant to section 54(1) of the Modern Slavery Act 2015 and constitutes our slavery and human trafficking statement for the financial year ending 31 March Paul Bentley Chief Executive Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 52

53 APPENDIX THREE Adult Safeguarding Alerts Equality and Diversity Information April 2016 March 2017 Groups at Risk Referrals raised against KCHFT (49 cases) Referrals raised by KCHFT against others (201 cases) Vulnerable Groups Age Groups Gender Groups Ethnic Groups Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 53

54 Religious Groups Kent Community Health NHS Foundation Trust Safeguarding Annual Report, 2016/17 54