Safeguarding Vulnerable Adults Annual Report

Transcription

1 Safeguarding Vulnerable Adults Annual Report Author: Margaret Jolley, Head of Adult Safegaurding & Vulnerable Adults 1

2 Contents Executive Summary 3 Introduction 3 Responsibilities 3 Reporting 3 National Context / Care Act Wigan Safeguarding Adults Board 4 Safeguarding Referrals/ concerns 5/6 Mental Capacity Act/Deprivation of Liberty Safeguards 6/7 Learning Disabilities 7 Dementia 7/8 Training 8 Key Priorities/Challenges 205/16 9 Summary 10 2

3 Executive Summary Safeguarding Vulnerable Adults at risk is everybody s business and everyone working in health care has a responsibility to help prevent abuse and to act quickly and proportionately to protect vulnerable adults where abuse is suspected. The safeguarding of all our patients remains a priority for the Trust and safeguarding is a fundamental component of all care provided. Introduction The purpose of this report is to update the Board on the progress and developments made in addressing the needs of Vulnerable Adults at risk within Wrightington, Wigan & Leigh NHS Foundation Trust within the period April 14 to March 15, with specific reference to. Responsibilities Reporting National Context / Care Act 2014 Wigan Safeguarding Adult Board (WSAB) Safeguarding Referrals Mental Capacity / Deprivation of Liberty Safeguards (MCA/DOLS) Learning Disabilities Dementia Training Responsibilities Safeguarding vulnerable adults at risk is wider than adult protection which predominately focuses on reacting to incidences of harm. WWL s approach to safeguarding is about addressing inequalities, creating an environment where patients feel safe and where their dignity is respected, and, whatever their circumstances are free from discrimination. WWL Adult safeguarding team currently comprises of: Head of adult Safeguarding & Vulnerable Adults: 1wte Senior Nurse for Adult Safeguard: 1wte Safeguarding is everyone s responsibility Reporting The Director of Nursing remains the identified Executive lead for Safeguarding and is therefore responsible for reporting to the Trust Quality & Safety Committee. The Trust Safeguarding Committee addresses both the adult and child/young person s safeguarding agenda s, the committee meets on a bi monthly basis and receives adult safeguarding update reports from the Head of Adult Safeguarding at each meeting. These reports identify the number and type of adult safeguarding concerns raised by staff across the organisation, highlighting any trends. Updates from Wigan Adult Safeguarding Board (WASB) are also presented together with training compliance figures and new training initiatives. 3

4 National context The Care Act 2014 The Care Act (2014) puts Adult Safeguarding on a statutory footing from April 2015, this was in response to the recognition that the law and practice around adult safeguarding had become complex and consumed. The Department of Health Guidance states: Adult safeguarding means protecting a person s right to live in safety, free from abuse (2014). WWL, under the guidance and direction of WASB, has been working with all partner agencies to ensure policies and procedures and the activity underlying these, are fit for purpose. The care act makes the following changes in regard to safeguarding adults: Safeguarding Adults Boards will become statutory Formal case reviews will be mandatory in the cases of where an adult dies in circumstances where abuse or neglect is known or suspected. Lessons learned following the review must be identified and apply to future cases. Relevant agencies will have a duty to cooperate with regard to supplying information There will be a duty of candour on providers regarding failings in hospital and care settings There will be new offences for providers- of supplying false or misleading information in the case of information that they are legally obliged to provide. Wigan Safeguarding Adult Board (WSAB) WWL is committed to and in full agreement with the WSAB vision for safeguarding: that residents of the Wigan Borough can live safely, free from harm, and abuse or the fear of abuse, in communities which: Have a culture that does not tolerate abuse Work together to prevent abuse Know what to do when abuse happens The Director of Nursing represents the Trust on the Wigan Safeguarding Adult Board, reporting back to the Trust Safeguarding Committee. Professor Paul Kingston continues in the position of independent chair of WSAB. The multi-agency borough wide Adult Safeguarding Policy and Procedures have been reviewed and revised with all partner agencies being involved and inputting to the final document, this is available on the trust adult safeguarding web page. There have been a total of 4 Domestic Homicide Reviews within the borough during the reporting period, Adult Safeguarding have been involved in one of the cases. The WASB Learning and improvement plan includes a comprehensive audit plan, following concerns raised around the discharge from WWL of a vulnerable lady with dementia and a learning disability, a case file audit was instructed to look into hospital discharge of patients discharged from WWL to nursing/ care homes. The audit took place in March

5 Safeguarding Referrals/Concerns The reporting period of 2014/15 has seen a further increase in of acute Trust referrals in relation to Adult Safeguarding. A total of 526 potential safeguarding referrals were made, In the same period 2013 /14 there were 271 referrals. The significant increase in concerns raised can, in part, be attributed to both an increase in application for Deprivation of Liberty Safeguards (DoLS) and in all pressure Ulcers grade 3 & 4 now being reported to Adult Safeguarding team. The following graphs illustrate the number of referrals received year on year,(graph 1), the types of abuse/concerns raised in the reporting period (graph 2), and the number of grade 3 & 4 Pressure Ulcer alerts raised also within the reporting period (graph 3). Graph 1 Number of Referrals to Adult Safeguarding 2010/15 Graph 2- Breakdown of Referrals 2014/15 Graph 3 - Number of Grade 3 & 4 Pressure Ulcer alerts 1014/15 5

6 There were a total of 100 grade 3 reported pressure ulcers and 66 grade 4 during this reporting period. The following is a breakdown of source: Source Grade 3 Grade 4 Hospital 2 2 Nursing /residential Home Own home Transfer from other Hospital 2 2 The Adult Safeguarding team continue to work closely with the hospital tissue viability nurses in ensuring the early identification and escalation of safeguarding concerns in respect of pressures ulcers, the 4 hospital acquired pressure ulcers were all referred for safeguarding enquiry. Mental capacity Act / Deprivation of Liberty Safeguards ( MCA/DoLS) The Mental Capacity Act (2005) (MCA), provides a statutory framework to empower and protect vulnerable adults who may not be able to make their own decisions. The MCA makes clear who can take decisions on an individual s behalf and how to go about this. It also enables people to plan ahead for a time when they may lose capacity. Previous arrangements regarding Power of Attorney have been reformed by the MCA and a new Public Guardian and Court of Protection has been provided concerned with financial, property, health and welfare matters relating to people who lack capacity. The Act introduces new criminal offences of willful neglect and willful ill treatment of a person who lacks capacity. The Deprivation of Liberty Safeguards (DoLS) was added to the act by government in 2008, the safeguards focus on the most vulnerable people in society, who, for their own safety and 6

7 in their own best interests need to be accommodated under care and treatment regimes. These regimes may have the effect of depriving them of their liberty. In March 2014, Judgment was passed by the Supreme Court on 3 cases which now has a significant impact on the criteria when determining a deprivation of liberty. Deprivation of Liberty Safeguards (DoLS) has not been without its challenges during 2014/ 2015 for the Trust as a result of the changes in national law and the threshold for referrals. The local picture reflects the wider national pressures in this arena. In April 2014, the new Cheshire West guidelines identified the acid test for making an application to deprive a patient of their liberty: The person is under continuous supervision and control The person is not free to leave, whether they are trying to or not The person lacks capacity to consent to these arrangements. Learning Disabilities The Trust continues to work collaboratively with its partner organisations via the following: Wigan Learning Disability Partnership Board Wigan Borough Clinical Commissioning Group The Trust is committed to integrated working with the hospital liaison team for learning disabilities and together delivers at monthly Trust Induction for all new starters to WWL. Tours of A&E and the Thomas Linacre outpatient department, for individuals with a learning disability continue, with ongoing dates for the forthcoming 12 months. The main aim of the tours is to show the individual with a learning disability, what they can expect should they ever have to attend hospital either in emergency (A&E), or at outpatients. The Trust will continues to, via the Head of Adult Safeguarding, contribute to the Annual Joint Health and Social Care assessment (Learning Disabilities). The outcome/ action plan from this self-assessment, when published will be included in the Trust Safeguarding Committee agenda. The Trust is also on plan to achieve the 2014/15 CQUIN for Learning Disabilities. Dementia The Trust is committed to improve the care and experience of patient s with Dementia and their family and carers. Dementia continues to be a significant challenge and a key priority for the Trust with an estimated 25% of acute beds occupied by people with dementia. Nationally there are around 800,000 people with Dementia in the UK, with the cost to the health economy of 23 billion / year. It is expected that by 2040, the number of people affected will double, with the cost expected to treble. Currently an estimated 25% of acute hospital beds are utilized by people with dementia. Figures released by the Department of Health in 2014 suggest that there are currently 3,500 people with Dementia in Wigan, however it is estimated that nearly 50% of people remain undiagnosed. 7

8 WWL key achievements to date: 150 Dementia Champions across the organisaton Further 65 staff attending champion training in staff have completed an NVQ in the Principles of Dementia Care 10 staff are currently undertaking a post graduate certificate in Advanced Dementia Care The Trust is 98% compliant with mandatory training A bespoke dementia aware training course has been devised for Dementia Volunteers Over 1000 staff have received Dementia Friends Training Senior Nurse represents the Trust, and is actively involved in the multi-agency Dementia Steering Group led by Wigan Clinical Commissioning Group. Information and reports from this group are delivered at the Trust Safeguarding Committee. Introduction and implementation of Forget me Not stickers on case notes Development of a Trust led carers group. The following highlights some the challenges for 2015/16 in respect of delivering the Dementia agenda: Availability of Information leaflets on wards/ departments Increase care involvement in the care planning process Addition of Delirium to the CQUIN. Training Safeguarding adult s awareness is delivered via a module on the Trust e-compulsory training site, and also face to face at the Trust induction sessions this includes junior doctors induction. Additional Adult safeguarding training is provided by the adult safeguarding team twice yearly to A&E doctors. Compliance for e-compulsory safeguarding vulnerable adults training, for the reporting period was 96% against a Trust target of 95%. The continued provision of multi professional training, provided by Wigan Council, is under review by Wigan Adult Safeguarding Board. The Head of Adult Safeguarding represents WWL on the WASB training sub group and informs the Trust of progress and changes via the Safeguarding Committee. Training for all clinicians and practitioners on the Mental Capacity Act / Deprivation of Liberty Safeguards has continued to be delivered on a monthly basis, with dates set for the coming 12 months. PREVENT is a work stream from the UK s counter terrorism strategy and aims to raise awareness of front line staff of the vulnerabilities and susceptibilities of vulnerable individuals that may be susceptible to radicalization. It has been mandated by the Department of Health/Home Office, that all health care staff undergo this workshop. The workshop is delivered by WWL trainers and the training commenced July WWL Head of Adult Safeguarding is responsible for informing Wigan CCG Quality, Safety & Safeguarding Committee on a bi-monthly basis. 8

9 Key Priorities/ Challenges for 2015/16 The following list outlines the main challenges and priorities for the Trust in respect of Adult Safeguarding for the coming year: Continued development of vulnerable adult senior nursing team: The increase in referrals together with the outcome of the Supreme Court Judgment has resulted in an increase in the workload for the team. Referrals have increased year on year and the coming year is expected to follow this trend. It is therefore necessary that the current establishment and skill mix is reviewed in order to meet the demand and progress the service in line with local and national directives. It is anticipated that the introduction of the care act will undoubtedly increase the number of multi-agency case reviews of which the WWL Safeguarding Team will be involved with. MCA/DoLS training: in addition to the current training provision, e-learning packages will be developed and will be mandatory for qualified clinicians and support staff to undertake this training. High risk conflict training: WWL is committed to delivering the highest standard of healthcare, and ensuring the safety and welfare of all patients, visitors and staff. Challenging behaviour is often a manifestation of a patient s distress and / or their only method of communicating. The Trust recognises that this behaviour can escalate to the point where restraint may be needed to protect the patient, staff and visitors to the Trust from injury or harm. The Trust has commissioned 12 half day training sessions for staff deemed to be working in high risk areas. This will be a pilot and after evaluation and review a decision will be made commission further sessions. PREVENT: this training will continue to be delivered throughout the coming year and will also be delivered at Trust Induction for all new staff to the organisation. Intra/Internet site: Development is required to update the site, ensuring the latest documents, policies and legislation is available for staff, patients and carers. Discharge Audit: Following the Discharge audit in March 15, the WASB have requested that this is repeated end of 2015/ beginning of MCA/DoLS Audit: A base line audit will be undertaken by the Adult Safeguarding Team, prior to the roll out of the e-learning modules and will be repeated in six months later to measure the impact and change following the introduction of the e- learning module. Dom Abuse training: This will include human trafficking & modern day slavery: working with multi agency partners to raise awareness. Clinical induction: In response to Cavendish, the Trust is in the process of developing clinical induction training for new starters to the organisation. The Adult safeguarding team will be involved in delivering training to bands 1-4 and 5-7 over the coming. 9

10 Summary In line with national and local trends, there has been an increase in adult safeguarding referrals within WWL. E mandatory training compliance has remained above the Trust Target of 95% throughout the reporting period. There is a robust reporting structure in place to give assurance to the Trust Board with regards adult safeguarding. The Care Act (2014) has at last put Adult Safeguarding on a statutory footing. The Safeguarding of Vulnerable Adults remains a key agenda item on the WWL Quality Safety & Safeguarding Group (CCG). Multi agency case note discharge audit carried out March 2015, key findings of which when published will for action plans for the divisions. The Committee are asked to receive this report for information and discussion. Margaret Jolley Head of Adult Safeguarding 28 August