Safeguarding Adults at Risk. Annual Report

Transcription

1 Safeguarding Adults at Risk Annual Report June

2 DOCUMENT CONTROL CHANGE HISTORY Version Author Date Change V0.1 Christine Dyson 12/06/2014 First draft Version Reviewer Role Date VO.1 Trust Safeguarding Adults Committee Review and suggest changes VO.2 Governance and Risk Management Review and suggest Committee changes VO.3 Trust Board For information and approval 2

3 Contents Page 1. Introduction 4 2. Safeguarding Adults at Risk National Policy Context 4 3. Local Context 5 4. Summary 8 5. Key Achievements 8 6. Self-Assessment Assurance Framework 9 7. Key Challenges 9 8. Infrastructure 9 9. Achievements of the Trust Safeguarding Adults Committee Training Quality Assurance Peer Reviews Multi Agency Case Reviews External Monitoring Safeguarding Adults in the Dementia and Cognitive Impairment Service Line Mental Capacity Act Domestic Violence and Abuse Learning Disability PREVENT Data Management Progress from Work Plan Priorities for Conclusion 25 References 26 Appendix 1 - Work plan

4 1. Introduction Safeguarding vulnerable adults from abuse and other types of exploitation is everybody s business and requires strong partnerships. The local authority, health and support organisations need to work together to ensure that services offered to people have safeguards against poor practice, harm, abuse and neglect. All patients using health care services should be supported to maintain control over their lives and to make informed choices about health care treatments and arrangements even when their ability to make decisions may be impaired. No Secrets (2000) will continue to underpin local interagency policy and practice until at least The guidance underpins the Pan London Safeguarding Adults procedures citing the local authorities as the lead agencies with responsibility for coordinating local multi-agency safeguarding arrangements in the London Boroughs of Barnet, Enfield and Haringey. Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) is committed to the principles and definitions set out in the Pan London Safeguarding Adults procedures to safeguard adults from abuse. Barnet, Enfield & Haringey Safeguarding Adults Boards (SAB) are the multi-agency partnership of senior managers from key local organisations responsible for developing and implementing the Board s strategy to safeguard vulnerable adults. This Annual Report will give an account of the work that has been carried out across the Trust to support the safeguarding of adults. The Annual Report will highlight national policy guidance and how this guidance has been transferred into practice. Furthermore, the Annual Report will conclude with the proposed work priorities for 2014/ Safeguarding Adults at Risk National Policy Context Over the past year there have been a number of changes within Health and Social Care which change the landscape in safeguarding adults. A principal change was the publication of the Health and Social Care Act One of the principles included in the Act is the responsibility for commissioning of health services. This now lies with Clinical Commissioning Groups (CCG). Equally, under the Health and Social Care Act 2012 the new National Commissioning Boards have responsibility for commissioning of primary care and some community and specialist health care services. Local authorities will retain the duty to improve the health of the people who live in their communities. Additionally, Health and Wellbeing Boards are established by law under the Health and Social Care Act. The role of the Health and Wellbeing Board is to formally consider matters affecting health and well being, including all changes to local health services. A further change has been the establishment of Healthwatch which was developed to represent the views of service users within health and social care and other members of the public. Local authorities were required to establish a local Healthwatch organisation to ensure local people are involved in the commissioning, scrutiny and provision of health and social care services. 4

5 A further development has been the draft Care and Support Bill which sets out the government s intention for the future of Adult Social Care. It is proposed that the Care and Support Bill will give clarity of entitlements to care and support, give people a better understanding of what is available, help them plan for their future and ensure they know where to go for help when they need it. The Bill provides a clearer legal framework for safeguarding adults with Safeguarding Adults Boards becoming statutory. Local authorities, the NHS and the police will be core members of Safeguarding Adults Boards. Safeguarding Adults Boards will carry out Serious Case Reviews in certain circumstances and will be required to publish annual plans which reflect the agreed local priorities. The department of Health published the final report Transforming care: A national response to Winterbourne View Hospital in December 2013, setting out actions to improve care and support of vulnerable people with learning disabilities. The report lays out clear milestones for health and local authority commissioners to work together to ensure that commissioned services are safe and there is evidence that the service users and their families have been included in the decision making process. To reduce the number of people who are cared for long term in inpatient services for assessment and treatment. Lessons learned from inquiries such as Mid Staffordshire Foundation Trust have highlighted the need to make safeguarding integral to care. Commissioners have responsibilities to address failures of care and have a key role in managing the impact of enforcement action taken by the Care Quality Commission (CQC) by ensuring that the impact on the local health economy is minimal. 3. Local Context 3.1 Winterbourne Review The Winterbourne view report was discussed at the Senior Management Group on 24 th January It had been previously discussed at the Dementia and Cognitive Impairment Operational Management Meeting on 10 th January 2013 and during February/March 2013 the Trust was self-assessed against the 14 recommendations from the Serious Case Review with this self-assessment being discussed at the Dementia and Cognitive Impairment, Severe and Complex Clinical Governance meeting on 13 March A RAG rating system was used to show how the Trust has self-assessed itself against the relevant recommendations. Our assessment showed that the Trust has a flagging system which is done through diagnosis on RiO in relation to service users with a Learning Disability who have been in contact with the Mental Health Service. The system of flagging people is to be further strengthened in order to cross reference with those people with Learning Disabilities who use local authority services. To date four policies have been converted into easy read format including infection control and complaints. Barnet, Enfield and Haringey Mental Health Trust Safeguarding Adult Booklet is in easy read format. There are Department of Health easy read materials for people with learning disability which are available on all the Wards and Teams. Additional policies will require 5

6 converting into easy read format and we all need to make them more visible within Teams. This is incorporated in our work plan for 2014/15. On 17th February 2013 there was an unannounced visit by The Mental Health Act Commissioners on behalf of the CQC to Mint Ward, North London Forensic Service. The ward was found to be compliant with the outcomes assessed. Learning Disabilities services cross four Service Lines: Child and Adolescent Mental Health Services, Dementia and Cognitive Impairment, Enfield Community Services and Forensic have reviewed their compliance. An action plan has been developed which gives a breakdown of the work to be undertaken to strengthen our practices. This will be monitored via the Dementia and Cognitive Impairment Clinical Governance Group and the Safeguarding Adults Committee. 3.2 Service Line Reports Crisis and Emergency Service Line Report All adult acute departments (wards and home treatment teams) have identified safeguarding leads and team managers have been trained to carry out strategy meetings / case conferences in a timely manner to support effective safeguarding processes. Trust staff have access to dedicated safeguarding training to enhance the skills in clinical teams and safeguarding is regularly discussed in individual staff supervision. Lessons learned and actions to be taken following safeguarding incidents are recorded through the Trust Datix system and these outcomes are shared across the service line. All staff have to attend mandatory training on safeguarding to enhance their skills and to be aware of the Trust position in relation to the management of adults at risk and the role of safeguarding processes in supporting this Enfield Community Service Report (ECS) The Multi-Disciplinary Care Home Assessment Team has been established for a year now working with residential and nursing homes across Enfield to improve quality of care and support residents and patients safely in the home environment, avoiding unnecessary admissions to hospital or A&E attendance. The emphasis is on education of staff in the homes to tackle issues such as excessive rates of falling, potential feeding and choking problems and pressure area damage. Where there are safeguarding concerns, these are raised by the team but there is a need to manage this sensitively with the homes to maintain their confidence and cooperation with the project. In some cases the basic care of patients was not optimum but education has demonstrated improvements - for example, the rate of falls in one home reduced by 50% over the year. The main wounds encountered are pressure sores though not all these develop within the homes, by education and intervention we aim to reduce incidence of home acquired pressure damage. Carers have had training in the management of patients with dementia and depression, the outcome of this has been a demonstrable improvement in staff 6

7 tolerance of such behaviours in those they are caring for within residential/care home settings, the need for a kinder, more understanding approach has been appreciated. ECS teams alert safeguarding concerns and fully cooperate with strategy meetings and investigations; we await guidance from North East London Commissioning Support Unit (NELCSU) regarding new processes for reporting pressure sores with a safeguarding element. ECS contribute to the safeguarding information panel and District Nurses highlighted particular issues with the care in one particular residential establishment. The Community Matron Team was commended for their work in investigating concerns in another home in the borough Forensic Service Report The Forensic Service employs a bespoke Social Work (SW) team through the London Borough of Enfield, with a Service Manager. He is the Safeguarding of Vulnerable Adults (SoVA) lead for the Unit. The SW team have all received training through Enfield, to various levels i.e. investigating, managing the process, chairing meetings, etc. The senior SWs and Service Managers chair the meetings. All Trust staff receive the mandatory training. In recognition of the challenges of implementing the SoVA process within a secure hospital we arranged half day bespoke training during the year and were able to get over a hundred senior clinical staff to attend. Although the social workers often take a lead in safeguarding there is now a clearer understanding that this is a shared/everyone s responsibility and there is noticeable increase in co-operation. We rely heavily on input from our MIND advocates to represent patients and to contribute to the process. 3.3 Multi Agency Public Protection Arrangements (MAPPA) MAPPA provide a national framework for the assessment and management of risks posed by serious and violent offenders, including individuals who are considered to pose a risk or potential risk or harm to children. Children who are at risk of danger due their own behaviour by not engaging with services are also discussed here. Meetings are attended by a representative from BEHMHT. 3.4 Multi Agency Risk Assessment Conference (MARAC) and domestic violence A large number of children who are subject to a Child Protection Plan have multiple difficulties including families with domestic violence, substance abuse and mental health problems. MARAC panels meet monthly to identify high-risk incidents and agree interagency plans to ensure that those affected receive appropriate support. Secure IT pathways have been established to share information. The liaison nurse from BEHMHT and a safeguarding adviser attend to share the information between health, social care and police. 3.5 London Borough of Enfield Report The Enfield Safeguarding Adults Board is a partnership of statutory and non-statutory organisations, including local people and those who use services and their carers, committed to preventing and responding to the abuse of adults at risk. BEHMHT and ECS are key partners in championing and supporting safe service delivery, 7

8 particularly those which aim to improve the health and well-being of local people. This provides a real opportunity for the Board to work with BEHMHT, to ensure that those who provide services are safe and do not cause harm. The Trust chairs the Training and Development sub group of the Safeguarding Adults Board and attends the Policy, Procedure and Practice sub group. The Trust were involved in the development of the Safeguarding Strategy and Action plan and provides detailed feedback to the Board on their progress of the implementation of the strategy actions. The Enfield Local Authority Safeguarding Lead attends the Trust s Safeguarding Adult Committee Meetings and Trust representatives attend the Local Authority 6 weekly Practice Forum; this promotes both partnership working and information sharing. 4. Summary Protecting adults at risk from abuse has continued during 2013/2014 by ensuring each allegation of abuse is managed under the Protecting Adults at Risk: London Multi-Agency Policy and procedures to Safeguard Adults from Abuse (Pan-London Procedures). The Trust can demonstrate this by the following achievements. 5. Key Achievements Key Achievements Development of safeguarding adults elearning refresher level 1 training, slides amended to include female genital mutilation, The Self-Assessment Assurance Framework (SAAF) was reviewed and signed off by the Enfield Safeguarding Adults Board in March Following which internally the SAAF will be reviewed by the Trust Safeguarding Adults Committee. Level I training has continued to be delivered in the Trust on mandatory training days Additional safeguarding adults level 1/2 training has been delivered to teams that were non compliant with the Trust Compliance inspections against the criteria in Outcome 7 (safeguarding) of the CQC s regulatory framework on all inpatient units and Community Teams. A Domestic Violence factsheet and flowchart have been developed for each borough in the Trust. Safeguarding Adult updated information on the new Trust Website and intranet site A Safeguarding Adults Poster has been developed for Enfield Community Services. These are given to staff on Mandatory Training days to continue to raise awareness of safeguarding adults and their responsibilities. Trust representatives have continued to represent the Trust at multi-agency groups such as Safeguarding Adults Board s sub-groups, attendance at MARAC, domestic violence forums. 8

9 Participation in the Barnet, Enfield and Haringey Safeguarding Adults Board peer challenge reviews. The Trust has contributed to multi-agency Serious Case Reviews. 6. The Self-Assessment Assurance Framework (SAAF) The Self-Assessment Assurance Framework was reviewed by the London Borough of Enfield Safeguarding Adults Service and Head of Safeguarding Adults NHS North Central London (Enfield Office), on behalf of the Safeguarding Adults Board. The Safeguarding Adult Assessment Framework was accepted and signed-off following their review. There are three areas that the review team has asked the Trust to consider for 2013/14 which will inform the basis for next review of the Safeguarding Adult Assessment Framework. The three areas identified were: embedding learning across the partnership addressing quality assurance of secure wards where appropriate referrals to Independent Safeguarding Authority are made 7. Key Challenges For the Trust as an NHS organisation to track and demonstrate how learning from recommendations from national and internal safeguarding cases are implemented across the Trust and the partnership. For the Trust to ensure that the relevant recommendations from the key strands including national inquiries, Serious Case Reviews and safeguarding investigations are implemented in a way that supports practice at clinical level. How the Trust engages with local initiatives such as Healthwatch to fulfil its role in partnership working. How the Trust ensures active participation in its 3 Safeguarding Adults Boards and their respective sub groups. 8. Infrastructure The Executive Director of Nursing, Quality and Governance is the Executive Lead for Safeguarding Adults in the Trust. The Safeguarding team was reviewed and three new roles were created. Head of Safeguarding People who has a strategic lead for safeguarding across the Trust. 9

10 Safeguarding Adults Lead Safeguarding Children's Lead Safeguarding Adult and Children & Young People administrator The management of safeguarding cases are co-ordinated by the Community Mental Health Team Managers and Team Managers within the integrated teams. This arrangement has been reached with Barnet and Enfield local authorities. The process for Enfield Community Services is different as all safeguarding alerts are referred to and managed by the London Borough of Enfield. The Board receives an Annual Report and work plan on the Trust s Safeguarding Adults activities. At each public Board meeting the Trust Board receives an update on the number of alerts, investigations and related activities. The Trust has a Safeguarding Adults Committee that meets on a quarterly basis which reports to the Trust s Governance and Risk Management Committee, a sub-committee of the Trust Board. The Safeguarding Adults Committee meeting is chaired by the Executive Director of Nursing, Quality and Governance. Other members of the committee are Assistant Directors from each Service line or their representative, Local Authority partners and commissioning colleagues. There is a bi monthly practice development group co-ordinated by the Enfield Safeguarding Adults Team of which the Trust is a member. This forum allows for sharing of best practice and learning across all agencies. 9. Achievements of the Trust Safeguarding Adults Committee The function of the Trust Safeguarding Adults Committee is to direct and ensure an overview of the safeguarding adult work programme and practice in the Trust. The Committee ensures that national and local practices are adhered to within the organisation. During 2013/14 this has been done through participation with service line management and representatives from partner agencies. The Safeguarding Adults Committee during the past year tabled work completed through case file audits, action work from the Safeguarding Adults Boards, national reports relating to safeguarding adults, and receiving updates on data regarding the safeguarding adult alerts/ referrals made. 10. Training The Trust training strategy is that each employee attends level 1 mandatory safeguarding adult training every three years. This is done via a face-to-face taught session on the mandatory training day. Refresher training is also offered via face-toface. Since Autumn 2011, the Trust have provided 24/7 access to e-learning courses on MCA and Deprivation of Liberty Safeguards (DoLS). Relevant staff are effectively trained in Mental Capacity Act and DoLS so that they understand the requirements placed upon them by the Act and the safeguards. 10

11 Level 1 safeguarding adult training continues to be offered as part of the Mandatory Training day. As of 3 rd June 2014, 86% of staff has been trained in level 1 training as seen in the table above. Total number of staff 2695 Total number of staff compliant 2210 The Safeguarding team has identified 150 key staff who will need to complete level 2/3 training in order for them to participate in the safeguarding process. Other safeguarding training related activity during the past year there has been sessions held at the local authorities including feedback to managers on external case file audit (Enfield). 11. Quality Assurance The Safeguarding Adults Assurance Framework was discussed at the Safeguarding Adults Committee. This gave an opportunity to make changes and update the SAAF in order to inform the work plan for 2014/15. The Safeguarding Adult Tool on Meridian went live in July Although some managers have completed the monthly audit, work is on-going to ensure the tool is embedded across all Trust services. 12. Peer Reviews During 2012/2013, the Practice Standards Leads carried out compliance inspections in the inpatient and community teams. The assessment consists of a series of questions for staff and service users as well as inspection of service user s records and of the ward/team environment. The results of the safeguarding (Outcome 7) Peer Service Reviews are discussed within service lines through their quarterly Deep Dive meetings. Teams are required to address any areas which scored below 100% in 11

12 their team action plans to support future compliance. Some themes that have come out of the service peer reviews carried out in 2013/2014 and have been acted upon are storage of safeguarding adult documentation on RiO, the need for staff in some community teams to complete the safeguarding investigators training, care planning and documentation. Further work continues to be done in those areas Audit Programme Audit Activity BEHMHT Safeguarding Adults Case File Audit from Meridian CQC Standard 7 Safeguarding Adults audit of clinical and community teams When Undertaken July March 2014 Bi-Monthly Practice Standards Leads Key Findings of Internal monitoring within the Trust 15 case files were audited. 5 in the Dementia and Cognitive Impairment service line, 3 in the Severe and Complex Care Service line, 5 in Psychosis Service Line and 2 from Crisis and Emergency. Areas for development: Recording on RIO Completing of Mental Capacity Act Assessment Management involvement and oversight of cases An example of which is: to improve training in safeguarding adults and Children in the inpatient unit. Both training are included in the Trust mandatory training and additional training is provided to some teams. Breakaway training is required in several community teams for their staff members. Team managers are to book necessary staff on the course (7E). Safeguarding leaflet to be made available in the inpatient unit. Safeguarding leaflets are now accessible in the inpatient unit. All staff to be made aware of what policies support them if they want to report areas of concern within their practice. Information about Whistle-blowing is included in the Safeguarding Adult training. Staffs are informed of list of people to contact if they have concerns in their areas of practice. The training also includes the support available to staff and contacts numbers. Staffs require Deprivation of Liberty Safeguards training which is provided through Workforce Development. Team / Ward Managers are to book their staff on the necessary training. Some inpatient staff are not aware who the Trust's leads for safeguarding children and safeguarding adults. This information is now available on the Trust s intranet and also on leaflets displays on each ward. Staff to the reminded of the need to upload completed safeguarding adult documentation onto RiO in a timely manner, in line with procedures. All managers are to ensure all documentation around safeguarding alerts is uploaded to RiO and a note added to the progress notes informing readers of the uploaded documentation. Audits are completed on a monthly basis by the Trust. The results of the audits are discussed with service lines. Service lines are expected to discuss the action plans which are discussed and monitored in their service lines. Conflict resolution training is required for some staff members in the community services of ECS (Enfield Community 12

13 Services). Team managers are to book their staff on the necessary training. BEHMHT Safeguarding Adults Case File Audit from Meridian 13

14 CQC Standard 7 Safeguarding Adults audit of clinical and community teams 13. Multi Agency Case Reviews A Board Level Inquiry has been completed following an incident that occurred in the Forensic service. The police have conducted their investigation. The safeguarding process is underway. 14

15 14. External Monitoring Month 8 May June June July 2013 External Agency CQC CQC CQC Area of Trust Enfield Community Services (District Nursing, Tissue Viability and Paediatric OT) Inpatient wards at Edgware Community Hospital Inpatient wards at St Ann s Hospital Type of inspection Unannounced Unannounced Unannounced Outcome Compliant with the requirements of Outcome 7 (Regulation 11) Compliant with the requirements of Outcome 7 (Regulation 11) Compliant with the requirements of Outcome 7 (Regulation 11) CQC Ken Porter Unannounced Compliant with the requirements of Outcome 7 (Regulation 11) 15. Safeguarding Alerts in the Dementia and Cognitive Impairment Service Line (DCI) During 2012 and 2013 there had been a number of safeguarding alerts raised and action plans were put in place to address the concerns. When further concerns were raised by a whistleblower in 2013 the CQC visited the ward. A decision was made to use the Provider Concerns Framework to address the concerns. An independent review was commissioned to provide assurance that the level of care was effective and safe. The aim of the report was to highlight areas of good practice whilst identifying areas for improvement Areas Identified for Improvement Care planning The environment The mix of patients on the ward was not therapeutic Staffing Leadership Support for Junior Doctors No falls protocol Physical Healthcare Communication, handover and risk management Capacity assessments not carried out A lack of activities 15

16 15.2 Progress Against the Action Plan Person Centred Care Planning training was delivered to the Multi Disciplinary Team (MDT) in November The quality of the care plans has improved and goal setting meetings are held on a regular basis to review the patients progress against the plan. The environment has undergone major refurbishment. The ward is now split into two units - one housing patients diagnosed with a functional disorder and the other housing patients with dementia. A full time Consultant Psychiatrist has been appointed who teaches, supervises and appraises the junior doctors. A band 8a Ward Manager is in post strengthening the ward leadership. A falls protocol has been developed and implemented. Registered general nurses have been recruited to work alongside their mental health nursing colleagues providing excellent nursing care. The MDT meet every morning for a white board review, each patient is discussed and a plan for the day is put in place. Those patients detained under the Mental Health Act are reviewed and capacity assessments are routinely undertaken. An Occupational Therapist and activity coordinators offer a range of therapeutic activities Organisational Learning from Safeguarding Alerts Following the investigation of the above cases in the Oaks, an action plan was drawn up which is being monitored by the operational management of the Dementia and Cognitive Impairment Service Line. The actions are as follows: Signage improved Staffing levels were reviewed Monitor compliance of monthly supervision and appraisal Review the mixture of functional and organic dementia patients on the Oaks and the number of beds in view of recommended standards of good practice CCTV cameras installed Consider and implement system of offering support to staff on a regular basis in dealing with stressful events during work Ward refurbishment creating two units with a staffed reception area 15.4 How Will the Above Organisational Learning be shared? Through supervision Through practice development meetings Ward meetings Team Business Meeting 16

17 Through Trust meetings i.e. Safeguarding Adult Committee, DCI Clinical Governance Deep Dive Meetings Quality Assurance meetings with commissioners External scrutiny from CQC Service users and carer feedback Since changes were made to the structure and staffing across older peoples inpatient wards we have not seen a repeat of the 2012 clusters of safeguarding incidents and complaints. A learning event will take place in July 2014 to review learning from a whole systems perspective. 16. Mental Capacity Act (2005) DoLS and MCA assessment policies are under review and will go out for consultation, with the final consultation / sign off planned for the October Mental Health Law Committee meeting before ratification at the policy group. The key messages of the P v Cheshire and Surrey case have already been disseminated to staff along with CQC guidance in this area pending the policy update and there have been an increase in DoLS applications as a result. MCA / DoLS training has already been updated to reflect the P v Cheshire and Surrey case and is being rolled out to staff Policy & Local Arrangements A number of key facts sheets are available for staff including one focussing on Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 Policy: A policy providing guidance to staff on the Act and what is required from them in practice and Deprivation of Liberty Safeguards Procedure: A policy document providing clarity to staff about responsibilities in regard to Deprivation of Liberty Safeguards, are both on the Trust intranet Training & Awareness It is expected that all clinical staff should understand the requirements of the wider Mental Capacity Act to ensure that people using services have their rights protected and supported. All inpatient staff are expected to be aware that imposing restrictions of movement on all patients may be a deprivation of liberty for informal patients who lack capacity. They are aware of the need to ensure that the way they care for informal patients does not amount to a deprivation of liberty without legal authority Working with the Mental Capacity Act It is expected that staff have a working knowledge of the Mental Capacity Act including the Deprivation of Liberty Safeguards; the principles on which the Act is based; the role of the Decision Maker and how to identify this person; how to make an Assessment of Capacity; the importance of recording that assessment; the meaning of and necessary factors in considering the Best Interest of an individual lacking in capacity; the concept of Decision Specific Capacity; and the concept of section 5 protection from liability. 17

18 The Supreme Court has now confirmed that to determine whether a person is objectively deprived of their liberty there are two key questions to ask. Is the person subject to continuous supervision and control? Is the person free to leave? The person may not be saying this or acting on it but the issue is about how staff would react if the person did try to leave. Patients in the Trust requiring DoLS assessment have been reviewed in the light of the P v Cheshire West and Surrey case Uses of the Deprivation of Liberty Safeguards by Borough during April st March 2014 Borough Number of applications Barnet 0 Enfield 4 Haringey Domestic Violence and Abuse A key action for 2014/15 is to disseminate the NICE guidelines published in March The guidelines support staff to identify domestic abuse, risk assess and make a referral to either the Safeguarding Team or MARAC. The Safeguarding Adults training materials have been reviewed. The MARAC coordinators have been attending the Safeguarding Leads and Champions meetings to inform staff of the process and how to use the assessment tools. Domestic Violence and Abuse is discussed in the Leads and Champions meetings. 18. Learning Disability BEHMHT is committed in meeting the needs of those patients who suffer from a learning disability. Following the review after the publication of the Winterbourne view report much work has taken place in the Trust to support the needs of those who suffer from a learning disability. One of the priority areas was to create a learning disability webpage. This has can be found at: Equally during 2012/2013, the Trust was assessed against the five criteria in the Learning Disability Access to Healthcare for All document (DH, 2008) namely: 18

19 Mechanism to flag patients Provide comprehensive information Protocols in place to support family carers Protocols in place to provide relevant staff training Protocols in place on representation Each service line was assessed to be either green or amber. An action plan has been devised for those areas that were found to be amber and will be monitored via the clinical governance groups of the service line. The Trust will participate in the annual stock take in September 2014, the exercise will allow the Trust to benchmark progress against the Winterbourne View report recommendations. 19. PREVENT PREVENT is part of CONTEST, which is the abbreviated name for the UK Government s counter terrorist strategy. The aim of PREVENT is to help identify vulnerable persons who are at risk of engaging in or supporting terrorism or terrorist activity. Approximately 30 areas of the UK have been identified as priority boroughs where, according to intelligence sources, there is a greater danger that radicalisers and extremists will operate. These priority boroughs include two boroughs where the Trust provides services, namely Enfield and Haringey. It should be noted that the list of priority boroughs does change from time to time to reflect the latest intelligence situation and world events. A dedicated PREVENT training session is not part of Trust induction / refresher training, however the health and safety information leaflet given to all attendees at induction training does contain information on PREVENT, and training courses on PREVENT can be booked through the Workforce Development Department s training diary. Since the start of May 2013 there have been 14 dedicated PREVENT training sessions delivered to staff with 187 employees attending. These training sessions tend to be to dedicated or specific groups of staff i.e. DASH, Crisis Resolution / Home Treatment teams, AMHPs and junior doctors. The PREVENT training course is approximately one hour long, and can therefore be included in an existing team meeting or similar team event. PREVENT training sessions are jointly delivered by the Trust Head of Non-Clinical Risk and Metropolitan Police officers from the PREVENT engagement team based in Haringey. There is no mandatory requirement to include police officers as part of the training delivery, however their expertise is very welcome and well received by attendees. The Trust has over the past eighteen months developed a successful and close working partnership with the local Metropolitan Police PREVENT engagement officers, which is an excellent example of multi-agency working and information sharing. Evaluation sheets completed by PREVENT course attendees overwhelmingly show that participants believed it be an interesting and valuable training session which gave them food for thought. The Head of Non-Clinical Risk attends sector and London wide PREVENT meetings and seminars hosted by NHS London, and he also attends meetings of the Haringey Borough PREVENT delivery team, chaired by Haringey Council and charged with ensuring delivery of the PREVENT strategy in Haringey (Haringey has been identified as a priority borough for the delivery of PREVENT). 19

20 Developments over the past couple of years in Syria, and more recently in Iraq have strengthened the case for continued delivery of the PREVENT strategy to healthcare workers who by definition will be working with vulnerable adults susceptible to radicalisation and exploitation by violent extremists. Information from Trust staff has resulted in vulnerable and susceptible individuals being referred to the Metropolitan Police PREVENT engagement officers, and there have also been a small number of referrals to the CHANNEL project where vulnerable individuals who could easily be exploited have been channelled' into activities and social networks designed to steer them away from radicalisers and extremists. 20. Data Management The table on the next page shows the number of alerts raised during 2013/2014. In each borough there has been an increase in the number of referrals. This data does not include alerts from Enfield Community Service. We are working with the team at Enfield local authority to ensure the data is made available to the Trust. Quarter 2,3 and 4 Data - Safeguarding Adults Types of Abuse Combination Financial Physical Sexual Neglect Psychological Other Not Confirmed Barnet Enfield Haringey No Safeguarding Issues Partially Substantiat Inconclusive Outcome of Cases Unsubstantiated Ongoing Substantiated Barnet Enfield Haringey

21 21

22 Outcome of cases 22

23 20.1 Allegations of Abuse by Staff in BEHMHT The table below gives a breakdown on the disciplinary cases from 2011 to Date April March 2012 April March 2013 April March 2014 No Case to Answer First written warning Final written warning Dismissal Ongoing Total

24 21. Progress from Work Plan 2013/2014 Level 1 training is delivered in Trust on mandatory training days. Domestic Violence and Abuse protocol has been developed and implemented, now needs to be updated to reflect changes in personnel. Compliance inspections against the criteria in Outcome 7 (safeguarding) of the CQC s new regulatory framework on all inpatient units and Community Teams. Case File Audits have been carried out as part of a quality assurance measure. Safeguarding Adult updated information on the new Trust Website and intranet site. 22. Priorities for Continue to raise awareness amongst staff in the practice of Safeguarding Adults. Create a safe, friendly and caring environment where people are treated with respect, courtesy and dignity. The needs and interest of adults at risk are always respected and upheld. Embedding learning across the partnership. Strengthening quality assurance of secure wards. Ensure appropriate referral is made to Independent Safeguarding Authority when criteria is met. Safeguard adults by ensuring that any case of abuse is reported and managed though the London Multi Agency Policy and Procedure. Have a continued programme of Level 1 Safeguarding Adult training with compliance achieved. With the increased activity in the number of referrals being reported by services to ensure that adequate resources are available to support and respond to alerts in a timely way. Staff to access domestic violence and abuse training to raise awareness and gain further understanding of the referral process. Raise awareness in the use of the Domestic Violence and Abuse protocol. 24

25 23. Conclusion This report outlines the work that has been carried out in respect of Safeguarding Adults in Barnet, Enfield and Haringey Mental Health NHS Trust and Enfield Community Services from 1 st April 2013 to 31 st March The report demonstrates the breadth of activity and the variation in safeguarding issues that may arise across the people who access our services. Safeguarding is everyone s responsibility. Re - alignment of the senior safeguarding team has enabled a close focus to be kept on the development of safeguarding in line with national changes in policy. During 2013/14 practice has been strengthened and further embedded so that Trust staff are equipped to both recognise and respond when concerns are raised and to support keeping individuals safe and free from harm. That the Trust has been successful is evidenced in two ways - by the positive outcomes of the CQC inspections, and the number of disciplinary cases against staff suspected of abuse. A work plan (Appendix 1) has been developed which details a number of actions to guide the practice of safeguarding adults in the Trust over the coming year. 25

26 References The Health and Social Care factsheet can be found at: A fact sheet on the draft Care and Support Bill Protecting adults from abuse or Neglect has been developed and can be found at: The draft bill can be found at: The Mid Staffordshire full inquiry report makes 290 recommendations and can be found at o A summary of the report can be found at The Winterbourne View Hospital: Department of Health review and response can be found at:. 26

27 Appendix 1 Work Plan Area Action Time Scale Lead Outcome measure 1 Multiagency Partnership Working Health System Leadership Continue to represent the Trust at the three Boroughs Safeguarding Partnership Boards March 2015 Executive Director of Nursing, Quality and Governance Ensure that the Trust is represented at the safeguarding adults subgroups. Assistant Directors for Service Line/Safeguarding Adults Lead Staff in each Borough identified to attend Multi-agency meetings and mechanism to feedback to the Adults Safeguarding Committee Ensure the Trust has representation at Multi Agency Risk Assessment conference (MARAC) March 2015 Executive Director of Nursing, Quality and Governance Trust represented at each MARAC To ensure that the Trust work plan is linked to the Safeguarding Adults Strategy of the three safeguarding Adults Boards Head of Safeguarding People Clear priorities and actions identified across all Trust services. 2 Working in partnership with the clinical commissioning group and the local authorities to developing a strategy to educate and inform staff, volunteers and carers about the Ensure the Trust works in partnership with the Clinical Commissioning Group and the local authorities in developing the work around DoLs. March 2015 Executive Director of Nursing, Quality and Governance, Mental Health Act Manager, Head of Safeguarding People, Safeguarding Adults Lead, Service line Management. Strengthening of DoLS practice with BEHMHT and across partners. Agree outcome measures with partners at the Safeguarding Adults Committee 27

28 Area Action Time Scale Lead Outcome measure MCA and DoLs and practice in care homes. August 2014 Mental Capacity Act DoLs policy to be reviewed following the Cheshire West and Surrey Supreme Court Judgement March 2014 Guidance from the Trust MCA lead has been circulated to staff 3 Safeguarding Information Panel Share information regarding areas of practice that appears not to be maintaining the safety of service users. 4 Privacy and Dignity Present progress reports on privacy and dignity at the Safeguarding Adults committee and the Safeguarding Adults Board. 5 Training Training in Domestic Violence to continue to be delivered to staff in BEHMHT to raise awareness and gain further understanding of the referral process. The delivery of the training to be both at the local authority and in-house March 2015 March 2015 March 2015 March 2015 Adults safeguarding Lead /Team Managers Audit Manager/ Adults Safeguarding Lead Adult Safeguarding Lead /Children/Domestic Violence Leads in the three Boroughs The safety of service users will be enhanced. Privacy and Dignity of service users is maintained while being cared for in the Trust Training is delivered and staff knowledge increased Ensure that 150 key members of staff receive level 2 and 3 safeguarding adult training in 2013/2014 March 2015 Adults Safeguarding Lead /Assistant Directors for Service Lines/ Ward That staff receive the appropriate training which is commensurate to their role 28

29 Area Action Time Scale Lead Outcome measure Link with Workforce Development to ensure the training needs of BEHMHT and ECS staff in safeguarding adults is achieved. and Team Managers That the Trust is Compliant with Safeguarding Adult Training 6 Audit and Monitoring to maintain quality standards regarding safeguarding adults in the Trust Team Managers to continue to audit 1 case file per month on Meridian as part of a quality monitoring. Attend Team/staff meetings and establish areas of concern they may have regarding the practice of safeguarding adults. Use team meetings to communicate key messages. Continue raising awareness checking that staff have an increased understanding of SoVA procedures. Complete internal case file audits and report to the Safeguarding Adult Committee on a quarterly basis. March 2015 Safeguarding Adults Lead/Assistant Directors for Service Lines/ Team Managers Adults Safeguarding Lead/ Nurse Consultant DCI. DATIX Manager/ Audit Manager Audit is fed into the quality assurance process of the Trust Develop Meridian Audits that capture Evidence that the Pan London Procedures have been adhered to Service users have been involved in the process and are happy with the outcome of any safeguarding process. How have we captured the voice of the service user? Privacy and dignity Restraint in care. Complete actions plans following evidence drawn from these audits. 29

30 Area Action Time Scale Lead Outcome measure Audit shows sustained improvement Any variation in audit is addressed at Deep Dive Meetings 7 Data Management Ensure the maintenance of the Safeguarding adult database Receive regular data updates from the Local Authority. March 2015 Adults Safeguarding Lead/Team Managers/ Local Authority staff Data quality is maintained. Regular data reports are developed and presented at the required committee meetings or Trust Board. Present a data update at the quarterly Safeguarding Adults Committee. 8 Use of the Learn to Care Competencies (Bournemouth Safeguarding Adult competences) to inform Safeguarding adult training and practice. As part of the implementation the Learn to Care Competencies (Bournemouth Competences) to ensure that the safeguarding adult training meets the competencies or each staff group. Work with the local authority training subgroup to ensure competences are linked to safeguarding adult training across the health economy. March 2015 Safeguarding Adults Lead / Team Managers/Local Authority Training subgroup System assessment to be reviewed Evaluation against practice standards to be monitored as training is rolled out across the organisation 30

31 Area Action Time Scale Lead Outcome measure 9 Use of the Safeguarding Adults Self-Assessment and Assurance Framework for Healthcare Services Review the outcomes on a six monthly basis to ensure that standards in practice are maintained. Link the actions from the Self- Assessment to the Trust work plan for 2014/2015. March 2015 Head of Safeguarding People/ Safeguarding Adults Lead/Assistant Directors in Service Line Actions link to Safeguarding Adults work plan. Gaps identified are communicated to relevant personnel 10 Learning Lessons from Safeguarding Investigations Ensure learning lessons from safeguarding cases are fed back into practice through clinical governance meetings, ward and team meetings and the partnership Ensure action plans from safeguarding cases are reviewed and acted upon March 2015 March 2015 Safeguarding Adults Lead /Ward and Team Managers Ward and Team Managers/ System to be developed to capture national and local lessons learned from Serious Case Reviews and Domestic Homicide Reviews 11 Trust assessment against Winterbourne view recommendations 12 Review Trust Safeguarding adults policy 13 Update Safeguarding Adult Flow chart To review the actions at the Clinical Governance meeting/safeguarding Adults Committee to ensure the actions are delivered Review policy and agree changes at the policy group To update the flow chart to reflect the recent changes to personal and contact March 2015 August 2016 September 2014 Safeguarding Adults Lead/ Director and Assistant Directors for the service lines/team managers Safeguarding Adults Lead /Team Managers, Service Line Management Assistant Director Safeguarding Adults, Safeguarding Adults Admin, Communications Participate in the 2014 stocktake Safeguarding Adult Policy updated 31

32 Area Action Time Scale Lead Outcome measure 14 Develop a Pressure Ulcer strategy with Partner organisations To participate in the Borough wide and Trust wide work stream. Mach 2015 Head of Safeguarding People / Local Authority / CCG 15 Care Bill Disseminate guidance to staff that relates to Safeguarding Adults Adults Safeguarding Committee to agree future reporting in relation to the Bill in order to assure Partners compliance. March 2015 Executive Director of Nursing Quality and Governance Head of Safeguarding/ Local Authority/ CCG Attendance of service user Attendance of Advocates Evidence of a person centred approach to Safeguarding Adults Strengthen partnerships with advocates Review the Terms of reference Review the membership of the committee To participate in the development of Adult MASH 16 Trust Leads and Champions meetings held in Haringey, Barnet and Enfield Terms of reference need to be agreed and signed off Minutes of the meetings will inform the adults safeguarding committee. February 2015 March 2015 Safeguarding Adults Lead New information is incorporated into local work streams Practice improves Complex cases will be reviewed 32