SAFEGUARDING ANNUAL REPORT 2015/16

Transcription

1 SAFEGUARDING ANNUAL REPORT 2015/16 This paper is for: Information Recommendation: FOR INFORMATION For further information or for any enquiries relating to this report please contact: Alison Brett, Acting Chief Nurse Date: 29 th November 2016 Reporting Officer: Alison Brett, Acting Chief Nurse Agenda Item: 221/16 Lead Director: Alison Brett, Acting Chief Nurse Version: Final This report provides the NHS West Kent Clinical Commissioning Group s (The CCG) Governing Body (GB) with an overview of safeguarding across health services within West Kent during The report reviews the work from 1st April 2015 until 31st March 2016, giving assurance that the CCGs have discharged their statutory responsibility to safeguard the welfare of adults & children across the health services that they commission. The Governing Body is asked to note the report. FOI status: This paper is disclosable under the FOI Act Strategic objectives links: D. Service quality and patient safety Service providers commissioned, and performance managed, to promote and support the highest standards of care, patient safety and patient experience. Board Assurance Framework links: Identified risks & risk management actions: Resource implications: Equality and Diversity assessment D. Failures of clinical governance in the system could lead to - less safe services - or failure to deliver high quality care for patients resulting in poorer health outcomes for local people or actual patient harm. N/A N/A Has an equality analysis been undertaken? West Kent CCG Front Sheet

2 Not applicable report for information only Legal Implications Report history: N/A Annual report to Governing Body Appendices Safeguarding Annual Report 2015/16 Next steps: N/A West Kent CCG Front Sheet

3 Patient focused, providing quality, improving outcomes West Kent CCG Annual Safeguarding Report DATE: April 2015 March 2016

4 Contents NHS West Kent Safeguarding Annual Report 2015/16. Page 1.0 Introduction Local Context West Kent CCG Summary of Progress and Achievement 2015/ Other Key Achievements Governance and Accountability Arrangements National Legislation and Guidance Safeguarding Children Working Together to Safeguard Children Intercollegiate Document Female Genital Mutilation Safeguarding Adults The Care Act (2014) Supreme Court Ruling Draft Intercollegiate Document Multi-agency Safeguarding Assurance Arrangements Safeguarding Children Section 11 Audit Kent Safeguarding Children s Board KENT SAFEGUARDING CHILDRENS BOARD sub-groups Child Sexual Exploitation Child Death Overview Panel Annual Report Safeguarding Adults 15 2 P age

5 6.2.1 Kent and Medway Safeguarding Adult Board Kent & Medway Safeguarding Adults Board Sub Groups Kent Adult Social Services Quality in Care Homes Central Referral Unit Domestic Abuse Domestic Homicide Review The Mental Capacity Act (2005) & Deprivation of Liberty Safeguards Other Multi-agency quality assurance mechanisms Care Quality Commission Goddard Enquiry Scope Key West Kent Health Provider Assurance Maidstone & Tunbridge Wells NHS Trust Kent Community Health Foundation Trust Kent & Medway NHS & Social Care Partnership Trust Sussex Partnership Foundation Trust (SPFT) 24 9 Areas for Development in 2016/ Appendix 1a,b &c 3 P age

6 1. Introduction This report provides the NHS West Kent Clinical Commissioning Group s (The CCG) Governing Body (GB) with an overview of safeguarding across health services within West Kent during The report reviews the work from 1st April 2015 until 31st March 2016, giving assurance that the CCGs have discharged their statutory responsibility to safeguard the welfare of adults & children across the health services that they commission. This annual report will focus on safeguarding adults & children. The Child Death Services annual report is available on request for information. The Looked after Children s report will be submitted separate to the Safeguarding annual report by the Designated Nurse for Looked after Children. CCGs are statutorily responsible for ensuring that the organisations from which they commission services have safe and effective systems that safeguards adults and children at risk of abuse, neglect or exploitation. This includes specific responsibilities for looked after children (LAC) and for supporting the Child Death Overview process including sudden unexpected death in childhood. Each CCG is a statutory organisation with safeguarding accountabilities discharged at Governing Body level by the Chief Nurse (CNO). Safeguarding accountability is via the designated professionals to the CNO. The Designated Nurses are line managed by the CNO and work collaboratively with other designated professionals to achieve consistency in safeguarding across Kent & Medway as set out in the memorandum of understanding (MOU). Monitoring of the safeguarding arrangements is via the Safeguarding Partnership Board attended by the five CNOs. The WKCCG safeguarding team consists of a Designated Nurse for Children and a Designated Nurse for Adults, there is also a Safeguarding Advisor (adults) who provides 0.4WTE per week service providing operational support to providers and the local authority when required. In addition there is input from the Designated Nurse for Looked after Children and the Specialist Nurse for Child Death. 2. Local Context NHS West Kent CCG represents over 250 GPs, working in 61 practices; the area is split into 4 geographical areas: Tunbridge Wells, Tonbridge & Malling, Sevenoaks and Maidstone. There are 481,548 residents within West Kent CCG s boundaries equating to 31.5% of the total population of Kent (1,524,700). The total population of Kent has increased by 1% (14,400 4 P age

7 residents) from last year with Kent s population growing faster than the national average; Maidstone has the fastest growing population (164,000) in Kent. Immigration accounts for 83% of the West Kent increase with the remaining 17% due to natural balance i.e. births / deaths. The increase in the migrant population will have an impact predominantly on the Looked after Children s Service and to a lesser degree on the adults and children s Safeguarding services. The projected population growth for West Kent by 2020 is: o 0-19 years = 3.9% increase. o years = 3.4% increase o years = 8.7% increase o 85yrs + = 22.4% increase Life expectancy in Kent is higher than the national average; male children born in West Kent between are expected to live to 80.1 years, the national average is 79.5 yrs; female children born in West Kent are expected to live to 83.6 yrs with a national average of 83.2 yrs. Male residents over the age of 65 years are expected to live for a further 19 yrs and females are expected to live for a further 21.4 yrs. The increase in the aging population will impact on adult safeguarding services due to the increase in the population of adults at risk of harm. 3. Summary of Progress and achievement 2015/16: The 2014/15 West Kent CCG Annual Safeguarding Report (November 2015) identified safeguarding priorities for achievement in 2015/16, below is a summary of progress against those priorities: o Ensure achievement against actions identified in response to NHS England s safeguarding assurance tool: Action plan submitted and assurance gained. o Engage with and support NHS England s four work streams; Mental Capacity Act, Looked after Children, Child Sexual Exploitation & Female Genital Mutilation: Fully engaged and work ongoing. o Implement and monitor service level agreements, job plans and job descriptions for the named doctor for West Kent: Job descriptions and job plan completed, recruitment to begin in next finical year. 5 P age

8 o Assist in the recruitment to the named GP for West Kent CCG and develop measures for collaborative working to deliver the safeguarding agenda within West Kent: As above. o Review policies, strategies and guidance in line with recent key national documents, national and local Serious Case Review/ Domestic Homicide Review/Case reviews, legislation and case law: All policies associated with adult safeguarding have been amended to reflect the Care Act (2014), Supreme Court Ruling related to deprivation of liberty (2014) and uploaded onto CCG s internet. o Build on work already completed to develop robust arrangements and relationships with providers and partner agencies: Established bi - monthly safeguarding meetings with Maidstone & Tunbridge Well NHS Trust, Kent Community Health Foundation Trust & Kent & Medway Partnership Trust, implementation of a quarterly Safeguarding Adults Health Leads, West Kent Quality in Care Homes multi-agency quarterly meeting and development of the Care Home Collaborative Workshops; all in place and on-going. o Attend and influence the Kent Safeguarding Children s Board & Kent & Medway Safeguarding Adults Board and their sub groups: Achieved, the Designated Nurses for adults attends the Kent & Medway Safeguarding Adults Board as does the Chief Nurse and contribute to and influence the sub groups as per MOU. The Designated Nurse for Children attends the sub groups of the Kent Safeguarding Children s Board as per MOU with the Chief Nurse attending the Health Safeguarding Group. o Continue to develop standardised assurance and data collection: Maidstone & Tunbridge Well NHS Trust, Kent Community Health Foundation Trust & Kent & Medway Partnership Trust have the safeguarding metrics within Schedule 4 of their contracts and report against the metric at their performance and quality meetings, some also report additionally through their safeguarding assurance / committee meetings. Draft metrics have been presented to independent providers for discussion and aiming to be included in the 2017/18 contracts. o To continue to develop communications pathways for dissemination of safeguarding lessons learnt / issues from Serious Case Reviews, Safeguarding Adults Reviews & Domestic Homicide Reviews to local health providers: Completed with full engagement of Designated Nurses with partner agencies to develop and deliver workshops, seminars and guidance documents. 6 P age

9 o To continue to develop systems to assure that safeguarding practice across the CCGs reflect learning from Serious Case Reviews, Safeguarding Adults Reviews & Domestic Homicide Reviews: Work on going. o To ensure that the CCGs are sighted on emerging adult safeguarding risks, including compliance with the Mental Capacity Act (2005) following the House of Lords Select Committee report and the implications of the Supreme Court judgement in relation to deprivation of liberty safeguards: Completed via the bi-monthly safeguarding report to the Quality Committee and escalation to the Governing Body via the Quality Committee s report. o Continue to develop GP awareness and response to adult safeguarding concerns, including their training levels and contribution to adult protection processes, working in partnership with NHS England: Work ongoing, GPs supported to provide Independent Management Reviews for Serious Case Reviews, Safeguarding Adults Reviews & Domestic Homicide Reviews & safeguarding training provided for practices as appropriate whilst awaiting the appointment of Named GP who will provide GP training where appropriate. o Implementing safeguarding and Mental Capacity Act provider metrics to capture meaningful safeguarding data and measurable outcomes from provider organisations: completed, metric embedded into schedule 4 of provider contracts and reported on at Quality & Performance meetings. o Continue to ensure that the CCGs are fully compliant with the NHS England Safeguarding Adults Accountability and Assurance Framework with key areas of work being; Aligning designated nurse duties with the Designated Adult Safeguarding Managers roles, amending awareness, Levels 1 and 2 Safeguarding Adults training to comply with the revised Multi-Agency Policy and procedures, all other relevant legislation and the proposed intercollegiate document (adult): Safeguarding Adults Accountability and Assurance Framework completed, Designated Adult Safeguarding Managers role deleted by Department of Health, adult safeguarding training remains under review by the Safeguarding Adults Board Learning & Development subgroup until Intercollegiate Document agreed with Royal Colleges and published by NHS England. o Ensuring both CCGs and provider organisations are focussed to meet the Making Safeguarding Personal agenda: Work ongoing Kent & Medway Safeguarding Adults Board policy, procedures and guidance amended and published. 7 P age

10 o Discharge of the duties of the House of Lords Mental Capacity Act (2005) Implementation Programme: Monies used to support the delivery of bespoke training for Practice staff (8 workshops over 4 days by Capsticks Solicitors), Mental Capacity Act Quality Improvement Nurse (6 month contract) to support identified Practices to self-audit Mental Capacity Act practice and develop associated skills resulting in legacy documents to support providers in quality assuring their practice against Mental Capacity Act requirements. o Ensuring that health organisations remain compliant with current statutory requirements and respond effectively to changes in legislation and best practice: Work ongoing individual provider s compliance discussed at bi-monthly safeguarding meeting, adult Health Leads Meeting and Care Home Collaborative. 3.1 Other Key achievements: o Safeguarding metrics are providing meaningful data on which to gain assurance. o Providing timely and concise safeguarding reports to the Quality Committee briefing the members on risks, threats and opportunities related to safeguarding across the West Kent health economy. o Consistent presence at the Safeguarding Adults Board & its subgroups. o The Governing Body has received both adult & children s safeguarding training. o Embedding legislation and recommendations form the Care Act (2014) & Counter Terrorism & Security Bill (2015) into all the CCG s safeguarding adult s policies. o Supporting local networks to promote safeguarding with providers and the public. o Contribution to two Domestic Homicide reviews. o Supporting the development of WKCCG s Care Plan Management System to ensure vulnerable patients rights are respected. o Supporting multi agency risk management groups (Multi Agency Public Protection Arrangements & Multi- Agency Risk Assessment Conference) to protect adults at risk and the public. 8 P age

11 o Working with the Community Safety Partnerships to promote proactive safeguarding in the community. o Contributed to the development of Kent & Medway s protocols for Human Trafficking and Modern Slavery. 4. Governance and Accountability Arrangements The Accountability and Assurance Framework: Safeguarding Vulnerable People in the Reformed NHS (2013) sets out the safeguarding accountabilities for CCGs, which include: o Staff being competent in recognising and reporting safeguarding issues; o A clear line of accountability reflected in the CCG governance arrangements; o Co-operation with the safeguarding adult and children Boards o Securing the expertise of a designated professionals for safeguarding adults, children and looked after children and a designated paediatrician for unexpected deaths in childhood; o Have a safeguarding adult lead and a lead for the Mental Capacity Act, supported by the relevant policies and training. The framework clearly advocates multiagency working to support and safeguard the most vulnerable in society. Safeguarding accountability sits within the portfolio of the Chief Nurse, who provides strategic direction on child and adult safeguarding, including Looked after Children, and has direct or delegated representation on the local Safeguarding Children s Board and the Adult Safeguarding Board for Kent. NHS West Kent CCG achieves governance through the Quality Committee, which is established in accordance with the CCGs Constitution, Standing Orders and Scheme of Delegation and directly reports to the Governing Body. NHS West Kent CCG has fulfilled its requirement to secure the expertise of designated professionals, who provide strategic guidance and advice in their respective roles for safeguarding adults, children, looked after children and child death. The incumbent professionals have relevant and appropriate skills and knowledge to support the CCG in commissioning and assuring safe and effective services for WKCCG residents. As alluded to previously the Named GP role has yet to be appointed to. 9 P age

12 5. National legislation and Guidance. 5.1 Safeguarding Children Working together to safeguard Children 2015 The government has updated the current statutory guidance Working Together to safeguard Children These revisions include changes to: o The referral of allegations against those who work with children; o Increased clarity and guidance around notifiable incidents involving the care of a child; and o The definition of serious harm for the purposes of serious case reviews Safeguarding Children and Young people: roles and competencies for health care staff: Intercollegiate Document The latest version of intercollegiate document, jointly published by the Royal Colleges and professional bodies, was updated in April 2014 to emphasise the Central Referral Unitcial role of the Executive Team and Board members of both CCG s and Trusts, whilst also taking into account the structural changes which have occurred across the NHS. The framework is applicable across all four countries of the UK and sets the standards and requirements expected of all health staff. While the responsibility of ensuring staff have access to appropriate safeguarding training and learning opportunities rests with healthcare organisations, the emphasis in the framework continues to be upon maximising flexible learning opportunities to acquire and maintain knowledge and skills, drawing upon lessons from research, case studies and serious case reviews. The Framework will be reviewed again in Female Genital Mutilation (FGM): Provision for confirming suspected FGM in children. The female genital mutilation mandatory reporting duty that requires regulated health and social care professionals and teachers in England and Wales to report known cases of female genital mutilation in under 18 years old were introduced from 31st October Known cases are those where either a girl informed the person that an act of female genital mutilation, however described, has been carried out on her, or where the person observes physical signs on a girl appearing to show an act of female genital mutilation has 10 P age

13 been carried out (DOH). Female genital mutilation is now to be included in any safeguarding children training and provider assurance given to the CCG with training statistics 5.2 Safeguarding Adults The Care Act (2014). On 1 st April 2015 the Care Act (2014) came into force, the impact of the Act on Health & Social Care has been significant in that the threshold for those at risk has been widened resulting in an increase in the population of adults at risk of harm and therefore potential referrals. Our colleagues in Kent Adult Social Services have seen a tenfold increase in referrals to the Central Referral Unit for both adults and children which has stretched the resources of all the multi-agency partners. Key points from the Act are: o Provision of a legal framework so statutory partners can identify how to support the Local Authority in keeping those at risk safe from abuse. o Statutory duty for the Local Authority to set up a Safeguarding Adults Board. o Identifies statutory partners of which the CCG is one. o Publish shared plans for safeguarding work. o Report to the public annually re progress against the plan. o Section 42 enquiries & the statutory duty to cooperate where a case is to be investigated led by the Local Authority. o Independent Advocates supporting the alleged victim through the safeguarding process. o Making safeguarding personal, an emphasis on person centeredness, moves away from process driven response The Supreme Court Ruling (Cheshire West). The Supreme Court ruling in March 2014 saw an overhaul of the then current Deprivation of Liberty Safeguards the ruling refined the definition of the deprivation of liberty to: 11 P age

14 Is the person subject to continuous supervision and control? (All three aspects are necessary) And Is the person free to leave? (The person may not be asking / trying to leave the issue is if he did would staff let him?). These two questions are now commonly known as the acid test. The Court also ruled that the safeguards were applicable to those living in domestic setting where their care was at the instigation of the state, i.e. care commissioned by the CCG. The impact for the CCG is: o Review of Continuing Health Care funded individuals lacking capacity to consent to their care requirements who are cared for within their own home and the possibility applying for authorisations to safeguard their rights. o Review of care packages within supported living placements and potential need to apply to the Court of Protection for authorisation where a deprivation of liberty has been identified; this will incur a cost to the CCG. Continuing Health Care were tasked with identifying all care packages delivered in supported living arrangements and domestic settings where the individual lacked capacity and where deprivation of liberty may have occurred. These were asked to be prioritised into those with greatest need and then considered if the care plan could be modified to be less restrictive or whether an authorisation was required. This is an ongoing piece of work Adult Safeguarding Intercollegiate Document. The Adult Safeguarding Intercollegiate Document has yet to be finalised, whilst the final draft has been circulated it was identified that it had not been seen by the Royal Colleges, a date for publication has yet to be publicised. The CCG s Safeguarding Training Strategy has been agreed with the proviso that there may need to be adaptions made once the intercollegiate document is published. 12 P age

15 6 Multi-Agency Safeguarding Assurance Arrangements. 6.1 Safeguarding Children Section 11 Audit CCGs have a statutory duty to be members of the Local Safeguarding Children s Board working in partnership with local authorities to fulfil their safeguarding responsibilities. These statutory duties fall under Section 11 of the Children Act 2004 and apply to a range of organisations as well as the health economy. All health organisations in Kent and Medway, including providers and CCGs, have been required to submit an s.11 self-assessment with final submissions to Kent Safeguarding Children s Board in March The designated nurse for safeguarding children has submitted assessments on behalf West Kent CCG during this year. The next S11 is audit due in Scrutiny of all self-assessment submissions has been undertaken by Kent Safeguarding Children s Board with professional support from the designated nurses. All requirements have been met with the exception of a Named GP for West Kent CCG. The funding has now been secured and recruitment can commence Kent Safeguarding Children Board The Kent Safeguarding Children s Board is the key statutory body overseeing multi agency child safeguarding arrangements across Kent. Governed by the statutory guidance in Working Together to Safeguard Children 2015 and the Local Safeguarding Children Regulations 2006, the Kent Safeguarding Children s Board is comprised of senior leaders from a range of different organisations. It has two basic objectives defined within the Children Act 2004; o To co-ordinate the safeguarding work of agencies and o To ensure that this work is effective. Children subject to a child protection plan for west Kent- Rate is per 10, 000 population under 18. o Sevenoaks o Maidstone o Tonbridge & Malling o Tunbridge Wells This compares favourably to the rest of Kent, with a rate of per (Kent Safeguarding Children s Board Annual report.) The variance for the mean rates for England 13 P age

16 metropolitan boroughs is 53 per children up to 31st march 2016, an increase from 35 per in 2010 ( Kent Safeguarding Children s Board sub-groups The Safeguarding Children Boards are required to have sub-groups to carry out the business of the Board. They are made up of all organisations that provide a service to children locally. The Designated nurses for safeguarding children are active members of the sub-groups and offer their expertise on all issues relating to the whole health economy. The sub groups are: o Policy and Procedures Sub-group o Risk, threats and vulnerabilities sub group which includes, trafficking & modern Slavery, missing children and unaccompanied asylum seeking children. o Serious Case Review Sub-group o Learning & Development Sub-group o Child Death Overview Panels (CDOP) o Quality & Effectiveness Sub-group o Health Safeguarding Group o Health Reference Group o Education & early help safeguarding group o Local Children s partnership group o Multi-Agency Sexual Exploitation Child Sexual Exploitation. At a national level, the government produced its strategy Tackling Sexual Exploitation (March 15). It responds to the numerous reports and subsequent enquiry in sexual exploitation by the Office of Children s Commissioner. The document is available at: Dealing with child sexual exploitation and should be read in conjunction with Information Sharing Letter Kent multi agency partners have developed a Multiagency Sexual Exploitation team which co-ordinates soft intelligence, data and safeguarding responses to victims of child sexual exploitation. A child sexual exploitation action plan has been devised by Kent Safeguarding Children s Board and all multi-agency providers will provide assurance and organisational action plans where gaps are identified. This agenda will be delivered via the Multiagency Sexual Exploitation. 14 P age

17 The child sexual exploitation Toolkit is regularly being utilised by agencies in regard to identification of children at risk of child sexual exploitation and used by the child sexual exploitation team in Kent police to identify and prioritise work streams. Child sexual exploitation champion s forum has been running since December This gives a county overview of child sexual exploitation and information exchange The Child Death Review Service Kent The Child Death Review Service works in partnership with the Kent s Health Economy to ensure that the statutory requirements of regulation 6 of the Local Safeguarding Children Board Regulations, 2006, made under section 14(2) of the Children Act 2004 are met. Health commissioners have a duty to employ, or have arrangements in place for Consultant Paediatricians with designated responsibilities (Health and Social Care Act 2012) to provide expertise and advice on commissioning services. These Paediatricians undertake enquiries into unexpected deaths in childhood, medical investigative services and the organisation of the CDOP process. 6.2 Safeguarding Adults Kent & Medway Safeguarding Adults Board The CCG is represented on the Kent & Medway Safeguarding Adults Board by the Chief Nurse and the Designated Nurse. The Board appointed an independent chair who commenced in January In February 2015 the Chair advised the Board of recommendations, all of which were accepted, to strengthen the work of the Board, the main recommendations were: o To improvement of Kent & Medway Safeguarding Adults Board s governance; assurance; structure and reporting. o To develop and maintain a Risk Register with quarterly reports to the Board. o To review the current Adult Safeguarding Strategy ensuring the 2017 Strategy reflects, aims, objectives, and desirable outcomes, which ultimately informs the feeds the 2017 Annual Business Plan, which in turn will be defined by metrics and measureable, SMART outcomes. o To ensure Carer and Service User voices are heard and that a Citizen s Panel be developed to inform Kent & Medway Safeguarding Adults Board decision making, strategy and planning. 15 P age

18 o To invite the Local Government Association to conduct a peer challenge to assess Kent & Medway Safeguarding Adults Board effectiveness and outline an improvement pathway. o To accept that a Safeguarding Adults Review Decision Making Group needs to be in place in order to make effective multi agency decisions with regard to the consideration of whether or not serious safeguarding concerns move into the Safeguarding Adults Review Framework Kent & Medway Safeguarding Adults Board Sub Groups. o Policy, Protocol & Guidance Group: The group continues to review the Kent & Medway Multi-Agency policy, however the frequency has changed from six monthly to annually. A task and finish group was convened to produce guidance on Modern Slavery & Human Trafficking, this guidance is now available on the Kent County Council web site. The PPG has been tasked with considering the safeguarding thresholds for alerting. Analysis of referrals to the Central Referral Unit has evidenced that providers require further guidance, this is work on going. o Quality Assurance Working Group: This group is currently looking for a new Chair. The group provides assurance to the Safeguarding Adults Board that providers have effective safeguarding arrangements; this is achieved through the provision of a Dashboard discussed at each SAB meeting and review of the annual Self-Assessment Framework returns. The 2016/17 framework is being devised to reflect current safeguarding issues such as preparedness for the Independent Inquiry into Child sexual Abuse in relation to record retention where these victims have transitioned into adult services. o Learning & Development Subgroup: This group has spent much of the last year focusing on aligning safeguarding training between Health & Social Care. There has been much consideration given to how the SAB can provide training to partner organisations and how to disseminate learning from Serious Care Reviews within the current financial envelope Kent Adult Social Services The Designated Nurse continues to work closely with Kent Adult Social Care to promote the safeguarding message and to support investigations into alleged abuse where there are identified complex health issues. 16 P age

19 There were six nursing homes within our locality that had significant safeguarding and quality concerns over the reporting period with sanctions in place precluding admissions. The Designated Nurse has worked closely with social care colleagues, the local hospices and the home s management to address their issues resulting in five of the homes being able to reach a standard of safe practice where they were able to open to admission again. The remaining home still has an embargo on health & social care admissions in place; the feedback from the Home s management is that they intend to de-register as a nursing home and focus on residential care. Kent Adult Social Care provides the CCG with a weekly sanctions list to identify homes where there are either safeguarding or practice concerns, this data is triangulated against Care Quality Commission reports and CCG quality visits to identify homes requiring support and to guide placements by CHC. The Designated Nurse meets bi monthly with the Safeguarding Adults Coordinators from Kent Adult Social Care and the Safeguarding Leads for Maidstone & Tunbridge Wells Trust and Kent Community Health Foundation Trust. These meetings allow for quality assurance / external scrutiny of provider investigations into alleged abuse, the resultant actions and learning identification. Both organisations have reported timely closures of alerts with feedback that can be shared with the Trusts and their partners within a meaningful timeframe. Kent & Medway Partnership Trust have been offered the opportunity for bi monthly meetings, they have agreed in principle and will commence in the near future Quality in Care Homes. The CCG hosts a quarterly Quality in Care Homes meeting with representatives from Kent Adult Social Care (safeguarding and commissioning teams), Healthwatch, the Hospices and the South East Commissioning Support Unit. The remit of the group is to improve and monitor the quality of care within care homes by, sharing quality data on care homes, identifying current quality themes and resolving issues locally and identify and share best practice. To support the latter the CCG s practitioners contribute to and present at the Provider Collaborative quarterly workshops with the aim of sharing current best practice and guidance Central Referral Unit. The CCG commissions Kent Community Health Foundation Trust to provide the health element within the Central Referral Unit, the current contract is due for renewal and will need to reflect the changes within Central Referral Unit brought about by the reorganisation 17 P age

20 of resources Kent Adult Social Services has to deliver the Central Referral Unit function. Kent Adult Social Care, the lead agency for Central Referral Unit, has reported a considerable increase in referrals to the Central Referral Unit, one contributing factor to the increase is in response to the changes in the adults at risk population brought about by the implementation of the Care Act (2014) and the second factor is the increase in allegations of child neglect / abuse which is prioritised within Central Referral Unit above adult allegations. The use of the health representatives within Central Referral Unit should be to provide demographic data and contribute to adult & child strategy meetings. The Chief Nurse and Designated Nurses for both adults & children have visited to understand the Central Referral Unit pathways to inform commissioning of the next contract, however Kent Adult Social Care have announced that Adults and Children s services within Central Referral Unit are to split which will also impact on the renewal of the contract. West Kent s Chief Nurse, representing all 7 CCGs, is working with Kent Community Health Foundation Trust to develop the contract Domestic Abuse The Kent & Medway Domestic Abuse Strategy Group drafted a strategy for for consultation with partners; the current version (V5) reflects the Government s Domestic Abuse Strategy s key objectives as: o Preventing violence and abuse challenging attitudes and behaviours at the earliest opportunity. o Provision of services good quality interventions for victims and families. o Partnership working improves links to safeguarding, risk mitigation & needs led interventions, including support through commissioning frameworks. o Pursing Perpetrators effective sanctions against perpetrators and support of sustainable behaviour changes. The prevalence of domestic abuse in Kent is rising with 32,000 incidents reported to Kent police in 2015/16; Medway had the highest number of reported cases (6,117) and Sevenoaks the lowest (1,355); within West Kent the prevalence is as follows: o Maidstone = 2,400 o Tonbridge & Malling = 1,700 o Tunbridge Wells = 1, P age

21 o Sevenoaks = 1,355. The majority of violence was perpetrated by intimate partners (76%) or family members (24%), females were more likely to be victim (74%) than men (26%) The majority of victims were white (85%) with Asians (3%) as the second largest ethnic group. The ages of victims pan Kent are: o yrs = 6% o yrs = 23% o yrs = 28% o yrs = 21% o 46 55yrs = 14% o yrs = 5% o 66 yrs + = 3% Domestic Homicide Review. There have been two Domestic Homicide Reviews within the CCG locality in this reporting period. Domestic Homicide Review 14 relating to hierarchy issues within a family is complete and the review has been agreed by the Home Office and is waiting uploading to KCC s web site. The identified learning from this review for sharing pan Kent was identified as: o Health professionals must consider domestic abuse when patients disclose violence within the home environment and make referrals where appropriate to do so; additional slides have been added to the CCGs Safeguarding Adults training to reflect this lesson, it is already incorporated into the on line training. o Organisations have a responsibility to ensure their staff have sufficient training to identify and respond to incidents of domestic abuse; domestic abuse training sits under adult safeguarding which is a mandatory training subject, on line training is available to all staff. The anticipated NHSE Intercollegiate Document for Adult Safeguarding also promotes Domestic Abuse training at all levels. o Organisations must ensure staff are aware of their responsibilities to record contacts accurately with patients; This lesson was disseminated through presentation at the Domestic Homicide Review workshops. 19 P age

22 The second Domestic Homicide Review (16) is related to a homicide of a female by her husband, this complex review has been completed and the final draft is awaiting submission to the Home Office for agreement. The review determined that organisations supporting this family had not missed any indicators that this homicide would be committed. Learning from this review, for health, identified that: o Professionals from Health and Social Care fail to identify the need for and offer carers assessments, a statutory duty under the Care Act (2014) where Carers are believed to be struggling with the carer s role; this issue has been highlighted at the Health Safeguarding Leads meeting & has been escalated to the Kent & Medway Safeguarding Adults Board. o Health and Social Care staff s knowledge of how a Lasting Power of Attorney (LPA) operates was poor; this has been addressed through the CCG s Mental Capacity Act (2005) training and has been escalated to the Kent & Medway Safeguarding Adults Board. o GP practices have a domestic abuse policy in place to support the identification of victims and how to support and sign post them; this is a requirement of the provider contracts under Schedule 4. o GPs to consider a flagging system to identify patients at risk of domestic abuse; the current Care Plan management System (CPMS) allows for this Mental Capacity Act (2005) & Deprivation of Liberty Safeguards. The Supreme Court ruling of 2014 continues to impact on the Local Authorities ability to respond to applications for standard authorisations to deprive a person of their liberty. At the end of 2015/16 there were approximately 1,500 individuals who were derived of their liberty without assessment and authorisation. The lack of authorisations suggests that there is a possibility that residents in homes and hospitals are not receiving the oversight and scrutiny that their situation requires with the potential for article 8 (right to respect of family and private life) breeches. The CCG has been clear in its direction to providers that any person awaiting application for or assessment of a deprivation must have regular reviews of their situation to ensure that: o The deprivation remains in their best interest. o There is no lesser restrictive option available in which to provide care and treatment. 20 P age

23 o They have access to advocacy / representation. The Kent Deprivation of Liberty Safeguards Office have increased the number of Best Interest Assessors available to assess people deprived of their liberty, the office have introduced a prioritisation system to identify those at most risk and the Department of Health have provided the Local Authorities with nonrecurring money to support them to reduce the number of outstanding assessments. The Law commission have reviewed the Mental Capacity Act (2005) and the accompanying Deprivation of Liberty Safeguards framework and propose a change to legislation to reduce the number of people who will meet the acid test. The formal outcome of the review has been delayed until spring 2017; providers are encouraged to continue close monitoring of unassessed deprivations and keep clear and concise records of decisions made. The Law Commission has consulted on the Mental Capacity Act s fitness for purpose and has drafted recommendations; the Department of Health has raised concerns about the way in which the new recommendations will work within Health and have asked the Law Commission to redraft their report. This re draft has been deferred to spring Other Multi-agency quality assurance mechanisms 7.1 Care Quality Commission The CCG works closely with Care Quality Commission, local inspectors will liaise with the Designated Nurse where there have been safeguarding concerns raised with Care Quality Commission anonymously and where a joint response from health and social care is required. The CCG shares soft intelligence with the Care Quality Commission when requested to do so prior to the Care Quality Commission visits so that a focused review can take place where needed. The Care Quality Commission and CCG also work with Kent Adult Social Care when an establishment fails to improve and where an organisational summit is required to escalate concerns to the organisations senior management team. Care Quality Commission provides the CCG with a weekly spread sheet detailing all the Care Quality Commission inspections published that week. Review of the reports identifies establishments where there is a need to improve or where a sanction has been applied by Care Quality Commission, these reports support the CCG to identify local care homes that need quality visits against their Care Quality Commission action plan so that compliance and sustainability of the actions implemented can be monitored. 21 P age

24 7.2 Goddard Enquiry Record retention. Providers have been encouraged to prepare for the possibility that the inquiry may arrive at their organisation requesting patient records. Goddard expects organisations to be prepared for her team s visit and to have considered, before they destroy patient records, if they feel that the patient may have been subject to sexual abuse as a child or young person and if so to retain the patient records. Two of the three main providers have completed a gap analysis, Kent Community Health Foundation Trust is confident that they will be able to produce records when required. Maidstone & Tunbridge Wells NHS Trust are less confident as there may be some historic records lost / destroyed during the archiving off site project. Kent & Medway Partnership Trust have yet to submit a position statement; the CCG will work with them to ensure that they are prepared and compliant. 8.0 Key West Kent Health Providers. 8.1 Maidstone and Tunbridge Wells NHS Trust Maidstone & Tunbridge Wells NHS Trust (the Trust) have good levels of safeguarding governance; the Trust s Chief Nurse is the safeguarding executive lead for the Trust, the Deputy Chief Nurse provides representation on the Safeguarding Boards. The Trust s Chief Nurse delegates safeguarding duties to the Matron of Adult Safeguarding and the Named Nurse for Children s Safeguarding, in turn the Matrons support the Named Nurse and the Safeguarding Matron to discharge the day to day safeguarding activity within the Trust. Adult safeguarding assurance is achieved & monitored through triangulation of data from: o The Trust s Safeguarding Adults Committee; this multi-agency committee scrutinises the Trust s compliance against the CCG safeguarding metric, training requirements and operational safeguarding practice within the Trust. o The Serious Incident closure meetings; the Trust presents investigatory information on incidents (including those that meet the safeguarding threshold) to the CCG, including learning outcomes and service development to improve the safety of the hospital population including adults at risk. o The intelligence gathered at the Provider Safeguarding Reviews with the Trust and the Safeguarding Coordinator from the Local Authority. The Safeguarding Matron is also the nominated lead for the Mental Capacity Act (2005), Deprivation of Liberty safeguards (2008), Domestic Abuse and Prevent. 22 P age

25 The Trust do have a significant gap in services related to the needs of patients with a Learning Disability in that they do not have a Learning Disability Liaison Nurse. The CCG have worked with the Trust to develop a business case for this role however due to fiscal pressures all new posts have been frozen. The CCG considers the risk mitigation to be weak in that the Trust relies on the Safeguarding Matron, a Registered Learning Disability Nurse to provide learning disability advice to Trust staff in management of people with a learning disability and behaviours that challenge. The Matron s role is such that she has very limited resources to fulfil this addition to her role. 8.2 Kent Community Health Foundation Trust Kent Community Health Foundation Trust has a very robust safeguarding governance. The Trust s Chief Nurse is the executive lead for both adult & children s safeguarding and sits on both Safeguarding Boards. The Head of Safeguarding providing the adult and children s strategic lead for the Trust and the Named Nurses providing operational leadership and advice to the staff of Kent Community Health Foundation Trust. Adult Safeguarding assurance is achieved & monitored through triangulation of data from: o Kent Community Health Foundation Trust s Safeguarding Assurance meeting, this meeting is held monthly and covers both adults and children s safeguarding. Compliance against the safeguarding metric is discussed at the meeting, as is training, operation safeguarding issues, audits and gap analysis related to current and emerging safeguarding themes. The weakness of the meeting is that it is not multi-agency with the CCG as the only external agency represented at the meeting. o The Serious Incident closure meetings; Kent Community Health Foundation Trust presents investigatory information on incidents (including those that meet the safeguarding threshold) to the CCG, including learning outcomes and service development to improve the safety of the hospital population including adults at risk. o The intelligence gathered at the Provider Safeguarding Reviews with the Kent Community Health Foundation Trust and the Safeguarding Coordinator from the Local Authority. 8.3 Kent & Medway NHS and Social Care Partnership Trust The CCG is partially assured of Kent & Medway Partnership Trust s safeguarding governance; the organisation appears inward facing with no external safeguarding scrutiny, 23 P age

26 the Kent & Medway Partnership Trust does not invite CCG representatives to their Safeguarding Committee despite requests for them to do so. The Chief Nurse is assumed to be the executive lead for safeguarding as the safeguarding policy is not clear as to who holds this role. The Head of Safeguarding leads Kent & Medway Partnership Trusts Safeguarding Strategy with support from the Mental Capacity Act / Deprivation of Liberty Safeguards Leads and members of the safeguarding team attending the governance and safety forums of each service line within the organisation; each service line has a trained safeguarding champion. Representation on the Kent & Medway Safeguarding Adults Board is by either the Executive lead or the Head of Safeguarding. Quality data supplied to the CCG does not reflect the 2014/15 safeguarding metric which had been agreed by the Head of Safeguarding, the Designated Nurses have met with the Head of Safeguarding to discuss this issue, the data is reported internally however but appears not to be shared externally, the Head of Safeguarding will explore why this is. Information from Serious incident investigation is shared with the CCG and this goes some way to assuring the CCG that the organisation is learning from incidents involving adults at risk. Training compliance is above the agreed 85% and the submission of their training materials demonstrates a high quality of the training provision which reflects best practice and case law. 8.4 Sussex Partnership Foundation Trust. The Trust currently provides Tier 2-3 services for children and young people (CAMHStargeted and specialist support) which are commissioned by West Kent CCG on behalf of the other 7 CCGs The Executive Lead for Safeguarding is the Executive Director of Nursing and Quality and there is a full time Named Nurse for Kent and Medway. The West Kent CCG Designated nurse for Safeguarding works with her CCG colleagues, through the safeguarding network arrangement, to gain assurance around safeguarding activity. The Designated Nurse Safeguarding Children for West Kent is due to meet with the Named Nurse for Sussex Partnership Foundation Trust in November. Sussex Partnership Foundation Trust have submitted their s.11 self-assessment as requested by Kent Safeguarding Children s Board. They have self-assessed that they are compliant in all areas. Safeguarding children training level 2 & 3 is reported as being 77% up to end March P age

27 The contract to provide mental health services to children and young people will go out to tender early 2016, with West Kent CCG as the lead health commissioner working with Kent Social Care to procure a new contract / provider. 9.0 Safeguarding areas for Development in 2016/ Support & influence the development of the new contract for the Central Referral Unit to ensure adult safeguarding has parity with children s safeguarding 2. Further embed the use of the Mental Capacity Act within Primary Care i.e. improve Mental Capacity Act compliance in Do Not Attempt Cardio Pulmonary Resuscitation forms. 3. Ensure learning and recommendations from Domestic Homicide Reviews, Safeguarding Adults Review s, Serious Case Review s & Multi agency audits are shared within the West Kent Health Economy. 4. Promoting Carer s assessments where carer s are facing challenging times. 5. Recruit to the West Kent CCG Named GP for Safeguarding. 6. Influence the evolving models of health provision to take into account the needs of adults at risk of harm and those with protected characteristics. 7. To continue to support provider organisations to reach their potential for good quality, safe and personalised care. 8. Review the Safeguarding metric to reflect changing practice and legislation. 9. To support NHS Kent, Surrey & Sussex to deliver its work streams for the coming year i.e. Independent Inquiry into Child Sexual Abuse, Modern Slavery & Human Trafficking, Child Sexual Exploitation, Unaccompanied Asylum Seeking Children & Violence against women and girls. 10. To support the local health economy to deliver against gangs, the toxic trio, FGM, Prevent, Early help, children in need, quality assurance models and safeguarding leadership & governance. 11. Review the CCG s safeguarding training when the Adults Intercollegiate Document is published. 12. Respond to the impact of the new proposed Mental Capacity Act / Deprivation of Liberty Safeguards legislation and what that will look like for health. 25 P age