SAFEGUARDING ADULTS & LEARNING DISABILITY

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1 SAFEGUARDING ADULTS & LEARNING DISABILITY Annual Report 2016/2017

2 CONTENTS Foreword... 3 Introduction... 4 Background Safeguarding Adults Team Structure Governance Structure... 6 Annual Workplan Safeguarding Adults Strategy Policies/Procedures... 8 Training Safeguarding Adults Activity Lessons Learnt Safeguarding Adult Review/Domestic Homicide Review Audits External Review Mental Capacity Act & Deprivation of Liberty Safeguards Learning Disability Domestic Violence..28 Dementia Local Authority & Partnership Working Key Risks & Mitigations in place Key Priorities for the Safeguarding Adults Team..32 Conclusion 33 References 33 Appendix 1 - Safeguarding Governance Structure...34 Page 2

3 FOREWORD Barking, Havering & Redbridge University Hospitals Trust has a long standing commitment to working to safeguard adults at risk. This annual report seeks to demonstrate the work undertaken to achieve this aim and to acknowledge the contributions from key partner agencies. The Trust s Safeguarding Adults Team is focused on supporting frontline staff in protecting adults at risk and promoting a positive learning culture within the organisation. There are established systems and processes in place to ensure there is a timely and proportionate response when concerns of abuse or neglect are raised. To address the increased activity and changing landscape of safeguarding the Trust s Executive Team fully supported a business case to invest in new posts within the safeguarding team during the reporting period. A focus on safeguarding in the Emergency Department and promoting the Harmful Practice agendas has been a priority. The Trust was delighted to end the year on a positive note; coming out of special measures was a huge achievement and the CQC inspection team recognised the contribution of our Learning Disability Team as outstanding. We would like to take this opportunity to acknowledge and thank members of the Safeguarding Adults Team who have continued to work hard to drive forward the adult safeguarding agenda and remain committed in working to safeguard our most vulnerable service users. Kathryn Halford Chief Nurse Gary Etheridge Deputy Chief Nurse, Safeguarding & Harm Free Care Page 3

4 1. INTRODUCTION Barking, Havering & Redbridge University Hospitals NHS Trust (BHRUT) provides acute services to a diverse population, from a wide range of social and ethnic groups, across three local boroughs (Havering, Redbridge and Barking & Dagenham). It is the responsibility of every NHS funded organisation and each individual healthcare professional working in the NHS to ensure the principles and duties of safeguarding adults are holistically and consistently applied, with the wellbeing of the adult at the heart of what we do. The Trust has a strong, ongoing commitment to providing safe and high quality care to our patients. The purpose of the Safeguarding Adults annual report is to inform the Trust s Board and Local Safeguarding Adult Boards of the work that has been undertaken during the year 1 st April 2016 to 31 st March 2017, and how the Trust remains responsive to national and local priorities. It also identifies key objectives for further development in the year to come. 2. BACKGROUND The Care Act (2014) defines adult safeguarding as working with adults with care and support needs to keep them safe from abuse and neglect. The statutory guidance states safeguarding is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adults wellbeing is promoted. This includes where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. The emphasis on working with adults at risk to have greater control in their lives to prevent harm from happening supports the ethos of Making Safeguarding Personal (MSP). MSP is a national initiative that provides an outcome focus to safeguarding work so that practice outcomes are person centred. Since its publication in 2015 the Care Act has provided the statutory footing for adult safeguarding. A revision of the statutory guidance was published in March 2016 which provided further information on self-neglect and highlighted the new offence of coercive and controlling behaviour in intimate and familial relationships which came into force at the end of Adult safeguarding is an important feature of the NHS quality agenda and vital for protecting people in society who might be at risk of abuse or neglect. Safeguarding Vulnerable People in the NHS: Accountability and Assurance Framework (2015) sets out the safeguarding roles, duties and responsibilities of all organisations in the NHS. It was developed by NHS England in partnership with colleagues from across the health and social care sector, the Department of Health and the Department for Education, particularly recognising the new responsibilities set out in the Care Act The Trust has a duty to ensure there are effective arrangements in place to safeguard adults at risk. This can be achieved through strong safeguarding leadership, robust safeguarding governance and appropriate training for all staff. The London Multi-Agency Adult Safeguarding Policy and Procedures (2015) are built on strong multi-agency partnerships working together with adults to prevent abuse and neglect to provide a consistent approach when responding to safeguarding concerns. The Trust s Protecting Adults at Risk - Safeguarding Adults Policy (2015) is aligned to these procedures. Page 4

5 The Mental Capacity Act (2005) provides the legal framework to empower and protect people who may lack capacity to make some decisions. The Trust s focus is to remain compliant with the legal requirements of the Mental Capacity Act and the CQC Key Lines of Enquiry (2016). The Cheshire West ruling 2014 has informed the criteria for when the Trust must raise a Deprivation of Liberty Safeguards (DoLS) whilst the recent judgement Ferreira v HM Senior Coroner for inner South London 2017 EWCA Civ 31 has altered the criteria for DOLS within the Intensive Care Setting and may have implications for treatment across the wider hospital setting. In March 2017 the Law Commission delivered its final recommendations on the House of Lords review of the Mental Capacity Act and Deprivation of Liberty Safeguards legislation. The new scheme proposed is called Liberty Protection Safeguards and will apply to any setting that might deprive an individual of their liberty and to individuals aged sixteen or over. The government is due to respond to this proposal by the end of The Government and NHS England have committed to reducing health inequalities for people with learning disabilities and have established national programmes to improve treatment and outcomes. The Government s Mandate to the NHS set an objective for the NHS to close the health gap between people with mental health problems, learning disabilities and autism and the population as a whole. In June 2015, NHS England commissioned the National Learning Disability Mortality Review Programme, to review and learn from deaths of people with a learning disability with the aim of improving services, care and support nationally. NHS England s Transforming Care programme intends to improve the quality of life of those with learning disabilities by substantially reducing the number of people place in hospital, reducing the length of time those admitted remain in hospital and enhancing the quality of both hospital and community settings. The Living well with dementia: A National Dementia Strategy (2009) was developed by the Department of Health to ensure that significant improvements are made to dementia services across three key areas: improved awareness, earlier diagnosis and intervention, and a higher quality of care. The Making a Difference in Dementia: Nursing Vision and Strategy, initially published in March 2013 and refreshed in 2016, sets out the government s vision of how nurses are fundamental in their contribution to high-quality, compassionate care and support for people with dementia and their carers/families. There are around 676,000 people with dementia in England and around 540,000 carers of people with dementia. These national drivers have provided the Trust s focus and shaped the work that the Trust has undertaken to safeguard adults at risk. 3. SAFEGUARDING ADULTS TEAM STRUCTURE The Safeguarding Adult Team comprises of: Named Nurse for Safeguarding Adults Named Doctor for Safeguarding Adults (2 PAs) - post currently vacant Learning Disability Liaison Nurse for Adults (LDLN) Page 5

6 Safeguarding Adults Advisor - Mental Capacity Act and Deprivation of Liberty Safeguards The Deputy Chief Nurse, Safeguarding and Harm Free Care line manages the Named Nurse, Safeguarding Adults on behalf of the Chief Nurse (Executive Lead for Safeguarding). In July 2016, following the completion and approval of a Safeguarding Business Case the Deputy Chief Nurse, Safeguarding and Harm Free Care has progressed the appointment into a number of new posts as follows: Emergency Department, Safeguarding Advisor (x 2) one at each hospital site; remit both children and adult safeguarding Safeguarding Advisor, Harmful Practices (FGM, CSE, Domestic Violence) Safeguarding Office Manager 4. SAFEGUARDING GOVERNANCE STRUCTURE The Safeguarding Governance Structure was updated in April 2016 and is attached in Appendix 1. The Chief Nurse is the Executive Lead for Safeguarding representing the Trust at Local Safeguarding Adult Boards. The Deputy Chief Nurse, Safeguarding & Harm Free Care is the Lead for the Safeguarding Team. Named Professionals within the team represent the Trust at the Local Safeguarding Adult Board sub-groups. The Safeguarding Strategic & Assurance Group meets quarterly and is chaired by the Trust s Chief Nurse. The purpose of the group is to obtain assurance that robust systems and processes are in place to safeguard children and adults and to ensure the Trust meets the statutory and legislative requirements of safeguarding children and adults. The Safeguarding Adults & Learning Disability Operational Group, chaired by the Deputy Chief Nurse, Safeguarding & Harm Free Care meets monthly. The purpose of the group is to ensure there is a multi-disciplinary approach to adult safeguarding within the Trust and that effective multi-agency partnership working is achieved. The Learning Disability Working Group met bi-monthly during 2016/17 and is chaired by the LDLN. The purpose of the group is to identify what is important for people with a learning disability who use hospital services and how the hospital can improve the services delivered. The group includes service users with a learning disability, carers and representation from our community health partners and voluntary agencies. Trust representation at the Learning Disability Partnership Boards, via the LDLN, continues for all three boroughs. 5. SAFEGUARDING ADULTS ANNUAL WORKPLAN The Safeguarding Adults Annual Work Plan 2016/17 was developed in April 2016 to identify the key priorities/actions for the Safeguarding Adults Team. The progress of the work plan was reviewed quarterly at the Safeguarding Strategic & Assurance Group. The majority of the actions were achieved; two on-going actions have been carried over to the 2017/18 workplan as follows: Page 6

7 To embed the Emergency Department Adult Safeguarding Trigger Checklist in practice the checklist was introduced in January 2016 for Emergency Department (ED) staff to complete for all attendances to ED. The checklist prompts staff to consider vulnerabilities, the potential impact this has on keeping the individual safe and whether escalation is required To support compliance of clinicians with MCA/DoLS in the clinical setting to increase the number and reporting of completed Mental Capacity Assessments. The number of capacity assessments undertaken/reported was not consistent with the significant increase noted for DoLS Due the reporting period, the priority to ensure staff received formal Safeguarding Adult Supervision proved difficult to embed in practice due to time constraints on the ward and the Safeguarding Adult Team. It is widely recognised that safeguarding work can be complex and stressful requiring staff to make urgent and sometimes difficult decisions. To ensure that adults are protected from harm requires sound professional judgements to be made and therefore it is good practice that staff involved have access to advice and support. Formal safeguarding supervision enables practitioners to assess and evaluate interventions in complex clinical circumstances. The Safeguarding Adult Team offer safeguarding supervision following a safeguarding incident or Safeguarding Adult Review/Domestic Homicide Review where learning has been identified. Going forward the Trust s Key Performance Indicator for Safeguarding Adult Supervision has been revised; it will be 85% of the Safeguarding Adult Team to have received supervision. Consequently, this priority was not carried over to the 2017/18 work plan. 6. SAFEGUARDING ADULTS & LD STRATEGY The safeguarding adult agenda remains a high priority within the Trust to ensure safe and effective care is provided to the patients that use our services. In September 2016, the Trust developed a three year Safeguarding Adults Strategy ( ) to identify how this will be implemented. Six monthly updates on the Trust s progress in meeting the Strategy s aims are reported to the Trust s Safeguarding Strategic & Assurance and Safeguarding Adults & LD Operational Groups. Key achievements are as follows: Achieved the Key Performance Indicators for Safeguarding Adults training as agreed by the Clinical Commissioning Group (85%) and Trust Board (90%) The delivery of Autism training to key staff e.g. Emergency Department and Security staff A significant increase to the number of DoLS raised during 2016/17 Sharing learning from safeguarding cases has been achieved through the development of monthly safeguarding bulletins and case presentations as Part 2 of the monthly Safeguarding Adult & Learning Disability Operational Group Page 7

8 The annual audit programme was maintained and results shared at the Safeguarding Adults & Learning Disability Operational Group, with exceptions reported quarterly to the Safeguarding Strategic & Assurance Group To work in partnership with statutory/non-statutory agencies to improve safeguarding outcomes BHRUT are represented at the local Safeguarding Adult Boards (SAB) and the SAB sub-groups 7. SAFEGUARDING ADULTS & LD POLICIES/PROCEDURES The Safeguarding Adults Team has contributed to updating the following Trust policies: Chaperone Policy (August, 2016). Visitors and VIP Policy (August 2016) in response to the Savile Investigations. Covert Administration of Medicines Policy (November, 2016). Rapid Tranquilisation Policy (not published as yet). In recognition of the valuable role carers play in patient care and to demonstrate the Trust s commitment to working in partnership with carers the LDLN produced a Carers Policy, which includes a Carers Support Plan, which was ratified in December The Trust s Missing & Absconded Adult Patient Policy was produced and ratified in March 2017 to provide staff with clear guidance on the process to be followed when a patient goes missing whilst in Trust care; particular attention is given to those patients considered to be vulnerable and at high risk of harm. 8. TRAINING The Trust s Safeguarding Adults & LD Training Strategy including a Training Needs Analysis 2016/2017 was produced utilising the Safeguarding Adults: Roles and Competences for Health Care Staff - Intercollegiate Document published by NHS England in February This links training with role, responsibility, competency, performance expectation and level of experience. 8.1 Safeguarding Adults Training Compliance As of end of March 2017, 97.92% of non-clinical staff were trained at Level 1; demonstrating a 5.5% increase to the percentage trained in the previous year. Whilst a further 95.53% of clinical staff were trained at Level 2; which is a significant 15% increase compared to the percentage trained in the previous year. The Safeguarding Adults Level 2 e-learning module which was developed and launched in June 2016, undoubtedly contributed to the monthly increase in compliance that was noted during 2016/17. Consequently, the Trust consistently achieved the CCG compliance target of 85% for Level 1 and Level 2 training and as of July 2016, compliance increased to above 90% for both levels meeting the Trust s local target of 90%. Table 1 below sets out the Safeguarding Training Compliance for 2016/17. Page 8

9 Table 1 Safeguarding Training Compliance 2016/17 (Trust KPI - 90%) Level 1 Level 2 KPI (Trust) KPI (CCG) Training is monitored at the Trust s Safeguarding Adults and Learning Disability Operational Group meeting, Safeguarding Strategic & Assurance Group and Divisional Performance Review meetings. Compliance is reported quarterly to the Local Safeguarding Adult Boards. The Safeguarding Adults Team continues to provide advice and support to frontline Trust staff regarding any aspect of the safeguarding agenda. 8.2 Prevent The Prevent Strategy, part of the Government s Counter Terrorism Strategy, plays an integral role in safeguarding adults and children from being radicalised or drawn into terrorism. Since the implementation of the statutory Prevent Duty in July 2015, the requirement under the Counter Terrorism and Security Act (2015) is for all levels of staff working in the health sector to receive Prevent training at the appropriate level (1-5). The training compliance target for Basic Prevent Awareness training should be in line with the national requirements for safeguarding training. All new starters to the Trust receive a Prevent Awareness leaflet. Clinical staff completing Safeguarding Adults & Children Level 2 training will have achieved the required competency for Basic Prevent Awareness. At the end of March 2017, training compliance was 95% as 5, out of a potential 5,907 staff headcount had received Basic Prevent Awareness. This is an increase to the figures reported for the same reporting period 2015/16 as the Prevent/radicalisation content within the safeguarding children and adults training modules was not being recognised. 8.3 Additional Training Safeguarding and Learning Disability Champion Workshop The Trust prides itself in having 80 Safeguarding Adult/Learning Disability Champions who work across the organisation. The role of the Champions is to provide advice and support in the clinical setting for colleagues and patient s alike. Page 9

10 The Trust s Named Nurse Safeguarding Adults and LDLN facilitated a one day study day in July The study day provided a good opportunity to enhance the champions knowledge base in the areas of safeguarding and learning disability including the latest national and local guidance. Key themes for training received included: A mother s perspective of caring for her son with a learning disability Living with Autism Mental Capacity Act & Deprivation of Liberty Safeguards Advocacy & Safeguarding Case study Makaton sign language The support and engagement of multi-agency partners was well received and positive feedback was received from those who attended. A similar one day event will be planned for Safeguarding & Learning Disability Champions are also invited to attend the Learning Disability Working Group chaired by the Trust s LDLN. This is to encourage the Champions to represent their clinical areas and contribute to the key issues and initiatives that are discussed at this group. All Champions receive a copy of the LD Working Group minutes if attendance is not possible due to clinical pressures. Learning Disabilities Awareness Learning Disability Awareness training is essential for all registered nurses, allied health professionals, healthcare assistants and midwifery staff working in the Trust. The Learning Disability session, incorporated in the Safeguarding Adult Level 2 training, focuses on defining a learning disability, health needs, communication and raising awareness of Trust resources and processes to improve the care and management of people with a Learning Disability accessing hospital services. This is aligned to the Learning Disability Core Skills Education and Training Framework launched in July The framework, commissioned by the Department of Health, sets out the essential skills and knowledge necessary for all staff involved in learning disability care. The LDLN has produced a 12 point Learning Disabilities information sheet which is distributed to staff during induction training. A monthly programme of additional 2 hour Learning Disability Awareness training sessions, copresented by people with a Learning Disability, has been provided by the LDLN throughout 2016/17 for reception staff and ward clerks across both hospital sites. Training has been extended to include clinical and non-clinical staff wishing to update and increase their knowledge; feedback from sessions is always very positive. A total of 41 staff attended the training. The LDLN and Paediatric LDLN have developed Learning Disability and Autism information leaflets respectively for Trust staff to aid understanding and these are distributed during training. The Paediatric LDLN has provided Autism Awareness training for staff attending Emergency Department kit days at King George Hospital, new staff on the children s wards and Security Staff at BHRUT across both sites. A total of 164 staff have received training. Page 10

11 Mental Capacity Act and Deprivation of Liberty Safeguards Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) are included within the Safeguarding Adults Level 2 training. The standalone MCA/DoLS e-learning package, available to all clinical staff that has contact with adults at risk, is mandatory for new starters. Going forward, to ensure all existing staff complete this training it will be included as Essential training from June The MCA/DoLS e-learning module has been revised with an emphasis on application of the law in practice providing clear guidance on the completion of documentation involved in mental capacity assessments and DoLS authorisations. Ward based training sessions have now been delivered in 13 clinical areas across both sites, with some of these sites having several sessions to ensure all relevant staff are included. A training session has been delivered to seven Health Care Assistants currently working for the Dementia Care Team with the aim of increasing identification of patients on 1:1 who need a DoLS. The Dementia Specialist Nurse will liaise with the MCA & DoLS Advisor for additional training as and when new recruits are appointed. Dementia The Dementia Team continued to deliver dementia awareness sessions across the Trust, which exceeded the baseline suggested by University College London Partners (UCLP- the allocated academic health science partners). Tier 1 - Raising awareness of dementia in terms of knowledge, skills and attitudes for all those working in health and social care settings. No baseline set Tier 2 - Knowledge, skills and attitudes for all those that have regular contact with people living with dementia. The ambition of UCLP for North, Central and East London was to train 5000 staff by 31 March It was determined that BHRUT would aim to train 300 staff as a percentage of this total. The Trust achieved 293; the shortfall attributed to staff shortages on the wards, which meant that staff were not released to attend training Tier 3 Enhancing the knowledge, skills and attitudes for key staff (experts) working with people living with dementia and designed to support them to play leadership roles. UCLP to roll out the programme from September SAFEGUARDING ADULTS ACTIVITY 9.1 Overview During 1 st April st March 2017 there were a total of 648 safeguarding adult referrals. This is a significant increase in comparison to the number of referrals (433) raised during the same reporting period 2015/16 and the number of referrals (435) in 2014/15. Of the 648 referrals a total of 584 referrals were raised internally by Trust staff with regard to concerns in the community. This is an increase of 201 referrals raised during the same reporting period 2015/16. An increase to safeguarding adult s activity is consistent with the national picture since the introduction of the Care Act (2015) and the inclusion of Domestic Abuse, Self-Neglect and Modern Slavery. Page 11

12 The remaining 64 referrals were raised by external agencies raising concerns within the Trust; this is an increase of ten compared to the number received during the same reporting period 2015/16. Table 2 sets out the number of Safeguarding Adult Referrals received during 2016/17. Table 2 A Safeguarding Adults dashboard was introduced in August 2016 to present the monthly safeguarding activity at the Safeguarding Adults & LD Operational Group meeting. This provides a divisional breakdown of the activity relating to adult safeguarding and visually represents noticeable improvements around safeguarding training targets and DoLS activity. 9.2 Referrals Number of Internal Referrals by Type/Borough (April March 2017) There were a total of 584 referrals made by Trust staff during 1 st April st March The highest number of referrals by the Trust relates to neglect/acts of omission (178). 106 referrals raised relate to pressure ulcers; this was a notable increase of 40 compared to the previous year. A Task and Finish group was established in July 2016, with the Commissioners, BHRUT and NELFT to review the available pressure ulcer data, in particular looking at where patients are admitted from and whether care providers are involved. An audit of 100 healthcare records was undertaken and this found that the majority of patients were in receipt of some kind of care input. This may have been formal or informal care and may have been provided by a care agency, relatives and/or community nurses. Of the 100 patients reviewed only 17 patients did not receive care of any kind. A plan is currently being developed with the CCG to help reduce these wounds. Since mid-november 2016 the CCG are sent copies of any safeguarding referrals raised for patients admitted with Grade 4 pressure damage. Page 12

13 During 2016/17 a significant increase to the number of self-neglect referrals (93) was noted across the local boroughs in comparison to the 31 raised in 2015/16. This demonstrates an increased awareness amongst staff with regard to this type of abuse. Given the Care Act legislation around domestic violence and the recognition of coercion and control it is unsurprising that referrals for domestic violence have increased by 15 in comparison to last year. Table 3 below provides the breakdown of Safeguarding Adult Referrals by Type of Abuse during 2016/17. Table 3 Number of External Referrals by Type/Borough (April March 2017) There were a total of 64 external referrals received by the Trust during 1 st April st March In comparison to the number of alerts received in the same reporting period for 2015/16 this demonstrates an increase of 12 alerts. Table 4 below sets out the number of External Adult Safeguarding Referrals received during 2016/17. Page 13

14 Table 4 A total of 46 allegations of neglect/acts of omission were reported. Of the 46 cases, the allegations included: discharge without District Nurse referral and/or appropriate support/equipment lack of discharge/transfer information to the care provider particularly comprehensive details with regard to pressure damage and its origin discharge without medication/medication error on ward discharge with cannula in-situ Enquiries, as per the duties under Section 42 of the Care Act, are undertaken to respond to the allegations raised and an action plan is developed for the ward area(s) involved if the allegations are substantiated. Examples of actions taken/changes made include: Drug chart revised - provision made for date stat dose of medication to be given in case different to date prescribed Facilitation of safeguarding adult supervision Ward huddles used to communicate reminders of the importance of safe discharge particularly the need for District Nurse referral 9.3 Outcomes The Trust s Named Nurse, Safeguarding Adults liaises with the borough Safeguarding Teams, the Trust s Joint Assessment & Discharge Team and Hospital Social Worker Team to ensure feedback from the Trust s enquiries is provided. Table 5 below provides the outcomes for the 64 hospital cases. Page 14

15 Table 5 Safeguarding Adult Referral - Outcomes On-going/no outcome 15% Inconclusive 6% Substantiated 21% Partially substantiated 6% Unsubstantiated 52% * 1 alert was for notification only - shared with clinical area 1 alert was dealt with via Complaints as quality of care issues rather than safeguarding It is extremely positive that out of the 14 allegations relating to discharge from hospital with pressure damage only one was substantiated. The hospital acquired pressure damage had already been investigated by the Trust as a serious incident and deemed avoidable by the Tissue Viability Steering Panel, which is chaired by the Trust s Chief Nurse. The 13 substantiated cases all had a discharge related theme: poor discharge planning lack of discharge information no District Nurse referral cannula in-situ on discharge no medication on discharge The areas for improvement are shared with staff during ward huddles, ward meetings, training opportunities, safeguarding supervision and published as lessons learnt. 10. LEARNING LESSONS Since August 2016, Safeguarding Cases are presented for discussion at the Trust s monthly Safeguarding Adults and Learning Disability Operational Group meeting. This is followed by the Trust wide circulation of a Safeguarding Bulletin which shares the lessons learnt and good practice of safeguarding cases/incidents. Safeguarding Adult Supervision is facilitated by a member of the Safeguarding Adults Team following a Section 42 enquiry where omissions are evident. The Safeguarding Team are currently producing in-house Vodcasts as an alternative method of sharing learning from safeguarding cases. These are short videos that provide a summary of a case and present the lessons learnt. Page 15

16 Going forward, methods to evaluate learning are currently being explored; a questionnaire to establish the views of staff has been developed. 11. SAFEGUARDING ADULT REVIEWS/DOMESTIC HOMICIDE REVIEW A Safeguarding Adult Review (SAR) will be commissioned by the borough s Safeguarding Adult Board (SAB) when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult at risk. The SAB also arrange a SAR if the same circumstances apply where an adult is still alive but has experienced serious neglect or abuse. Other circumstances when a SAR would be considered is when a case can provide useful insights into the way organisations are working together to prevent and reduce abuse and neglect of adults, and can include exploring examples of good practice. The Trust has contributed to two Barking & Dagenham SARs in the last 12 months and one Domestic Homicide Review. Areas of learning for BHRUT included: For staff to notify next of kin, with the patient s consent, when they are being discharged from the Emergency Department and record this in the documentation Action taken: a prompt is present on the newly designed discharge checklist on the Emergency Department casualty card Robust documentation of mental capacity is required when a patient is declining for staff to notify other agencies of their discharge Action taken: the MCA/DoLS Advisor continues to work closely with clinical staff, inpatient and outpatient settings, to raise awareness relating to capacity assessment and when it is required. The MCA/DoLS e-learning module has been updated to focus on the practical components of capacity assessment Additional considerations to be made when an adult at risk does not attend outpatient appointments Action taken: Patient Access Policy strengthened to include a flowchart identifying the actions to take if an adult at risk has already failed to attend three follow-up appointments. All the above cases have been presented for discussion at the Safeguarding Adults & LD Operational Group meeting and circulated in the Trust s Safeguarding Bulletins. A Learning Event relating to the two SARs was arranged by Barking & Dagenham Safeguarding Adults Board which BHRUT staff attended. Page 16

17 A further non-statutory SAR was undertaken for a Havering service user which focused on the transition from Children to Adult Services. No actions were specifically required of BHRUT however this case has prompted a review of how Trust staff manage frequent attenders. The Named Safeguarding Nurses for Children and Adults and senior members of the Emergency Department staff are working together to develop a Standard Operating Procedure guiding staff on the considerations and actions that are required when reviewing frequent attenders in the department who will usually present with complex health and/or social needs. The main focus will be to assess the individual s vulnerability, any risks posed to them, their level of engagement with other services and to consider whether a multi-agency approach is required to ensure the individual requires the correct level of support in the Community. 12. SAFEGUARDING ADULTS & LD AUDITS Audits are an important way of assuring the Trust and the teams on the quality of the process and practices used when implementing safeguarding adult processes. The Trust produced a Safeguarding Adult audit framework for 2016/17. During the reporting period the following audits were undertaken: Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) The purpose of this audit was to assess staff knowledge with regard to both MCA and DoLS. Reaudits were carried out in May 2016 and February 2017 to identify whether the MCA/DoLS training and support via ward visits from the Trust s MCA/DoLS Advisor had enhanced the level of knowledge amongst staff. Staff demonstrated much improved knowledge of how to access advice for themselves and advocacy for their patients. There was increased knowledge of the criteria for assessing capacity and some of the issues relating to capacity. Although the percentage identifying all the criteria for a DoLS was low, high numbers of staff correctly identified some of the factors triggering a DoLS. There was an increase in awareness of the Independent Mental Capacity Advocate role which is important progress in upholding the rights of patients without capacity who do not have the support of family or friends whilst in hospital. The MCA/DoLS continues to be visible in the clinical areas to provide support and guidance and has provided training to specific clinic areas as needed/requested. Reasonable Adjustments Reasonable adjustment audits were completed by the Learning Disability Liaison Nurse (LDLN) in 2014 and 2015 to ascertain whether staff were making adjustments to care delivery, e.g. double appointment times, quieter waiter area, to account for patient s learning disability. The audit results indicated the need for learning disability awareness training for outpatient staff and a named link worker for learning disabilities in each outpatient team. These recommendations were subsequently implemented. A re-audit to assess the knowledge of outpatient staff with regards to reasonable adjustments to care provision for people with learning disabilities was completed in July 2016 to determine whether outpatient staff knowledge regarding reasonable adjustments has been maintained. Page 17

18 The audit analysis provided a snapshot view of the knowledge outpatient staff had relating to what constitutes a reasonable adjustment and what resources are available to support them. It should be noted that a variety of nursing staff completed the audits demonstrating the level of awareness amongst all grades of staff. Results of the audit show improvements in three key areas regarding reasonable adjustments. These include use of easy read documentation, advice sheets and information about services for which 100% of respondents indicated they were able to access this information, with narrative providing evidence of where this could be found in each department; the availability of double appointment times with supporting narrative indicating extra time is automatically given during appointments for patients requiring this adjustment; the availability of easy read appointment outcome information sheet increased from 44% to 79.3% following recommendations from the previous audit. Overall knowledge base was sound in all areas for most respondents of the audit. There were no specific subject areas or teams where knowledge was demonstrably low. In addition the LDLN continues to receive positive responses from outpatient staff to requests made for reasonable adjustments for both adult and child patients alike in all outpatient areas. Learning Disability Care Pathway A learning disability care pathway documentation audit completed in 2015 demonstrated the need to review existing learning disability (LD) documentation and promote its use during mandatory staff training and ward visits. The LDLN subsequently reviewed and amalgamated the LD Good Practice Checklist and LD Discharge Pathway to produce one document combining the key aspects of each original document to avoid duplication and ensuring the format was user friendly in line with current nursing documentation utilised within the Trust. The new care pathway is known as the LD Good Practice Care Pathway. Its use is monitored during ward visits by the LDLN who maintains a LD database to reflect the level of patient contact the LDLN has within the Trust. The audit results clearly demonstrated a significant increase in the use of LD specific documentation across the Trust in the past year. There was good evidence that Trust staff are notifying the LDLN when a patient with a LD is admitted and that staff are proactive in the provision and utilisation of hospital passports. The LDLN will continue to raise awareness and promote the use of the learning disability care pathways, electronic learning disability alert system and hospital passport during mandatory staff training and visits to clinical areas. Since April 2016 the LDLN has produced a monthly dashboard which is presented at the Safeguarding Adult & Learning Disability Operational Group and demonstrates the use of LD documentation across the Trust. In light of the positive audit results and the production of the monthly dashboard there is no requirement for further LD Care Pathway Documentation audits to be completed. Page 18

19 Making Safeguarding Personal Making Safeguarding Personal (MSP) is a national programme, led by the Association of Directors of Adults Social Services (ADASS) and the Local Government Association (LGA) and funded by the Department of Health. MSP is integral to everything that we do in safeguarding adults; it means adult safeguarding: Is person-led Is outcome focused Enhances involvement, choice and control Improves quality of life, well-being and safety With the above in mind, consent is a fundamental part of the first stage of the safeguarding process. Consent should be gained from the individual involved unless there are mitigating circumstances that override the need for consent. The Trust s Safeguarding Adult referral form includes a section on consent; reminding staff that in some cases intervention may be limited without consent. The referral form prompts staff to consider the circumstances when consent can be overridden e.g. lacks capacity, children involved or a risk posed to others and includes the following statement to support MSP: Safeguarding should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, well-being and safety (Care Act, 2014). Overall the results of the audit were positive. The audit demonstrated that of those patients that did not consent a large percentage of those patients were either deemed to lack capacity to provide consent or another valid reason for lack of consent was identified. The numbers were small for those patients that were not consented at the start of the process without a valid reason for this lack of consent. The forms that were left blank, again is a small number, and the auditor felt it was likely these patient were not consented. For the patients that were consented it indicates that the conversation engaging the person at the start of the process is occurring so the principles behind MSP are being considered and adhered to. The Safeguarding Adults Team will continue to discuss MSP, consent and mental capacity assessment during training, advice calls and during feedback to referrers. Staff will also be reminded of the importance of completing safeguarding adult referral forms in their entirety. The results of the audit were shared with the Divisional Teams. This audit will be repeated in August Safeguarding Adults Screening Tool A review of the three mandatory safeguarding children screening questions on the Emergency Department (ED) casualty card was undertaken in January The recommendations of the review were to strengthen the existing safeguarding screening process for children and introduce a mandatory safeguarding screening tool for adults at risk. Page 19

20 Since the introduction of the screening tool in February 2016 monthly auditing has been undertaken. Compliance for the completion of the Adult Safeguarding Trigger checklist has been variable across site. Since its introduction the completion of the checklist at King George Hospital was initially achieved at 92% and has steadily increased each month reaching 97-99% compliance during Quarter 4. At Queen s Hospital compliance for the first six months was low (67-77%). Consequently, the auditors have been careful to identify the ED stream and disregard those patients that did not go through the triage process. This included those patients streamed to urgent care or admitted direct to Resus, for urgent medical attention, as completion of the Adult Safeguarding Trigger Checklist understandably will be omitted. As of October 2016, a marked improvement was noted in compliance achieving 98% in January In February and March 2017, discounting patients streamed to urgent care and Resus, compliance was achieved at 86% and 94% respectively. The remaining patients were streamed to Majors so completion of the safeguarding trigger checklist would have been expected. Non-compliance for the completion of the clinician s assessment has been apparent across both sites since its introduction. Education and training by the Specialty Lead, Emergency Medicine has been provided to staff to ensure they understand the tool and since October 2016 has undertaken spot checks of compliance whilst in the department. A noticeable improvement has been recorded across both sites since October 2016 with Queen s achieving 26-42% and 36-55% at King George. Completion electronically of the discharge safeguarding tool has been % across both sites. This provides the assurance that before a service user has been discharged from the department a final review of safeguarding concerns has been undertaken and where necessary addressed. The Safeguarding Advisors for the Emergency Department are now both in post and will assist in supporting staff to understand the tool and embed it in practice. 13. EXTERNAL REVIEWS 13.1 RMS Risk Assurance Limited In August 2016, the Trust commissioned an internal audit by RMS UK, to review the systems and processes in place for safeguarding to ensure that the Trust can deliver high quality care. Sample testing specifically focussed on two areas; the adult Emergency Department and the paediatric Emergency Department. The review assessed the processes in place with regards to the safeguarding referrals, including the completion of trigger checklists, referral forms, the guidance and policies in place and the monitoring and reporting arrangements in place with regards to safeguarding. Following the review, an action plan was developed which identified the actions required in response to the audit findings. Progress on delivering the actions was reported to the respective Safeguarding Children and Adult Operational Groups and any exceptions to the Safeguarding Strategic & Assurance Group. Following this review a Safeguarding Poster was developed so Page 20

21 patients and visitors were aware of how to raise a safeguarding concern and CQC and Borough contacts are also on display Care Quality Commission The Trust was inspected by the Care Quality Commission (CQC) in 2013, and due to concerns around the quality of patient care and the ability of the Leadership Team, the Trust Development Authority (TDA) recommended that the Trust be placed in special measures. The CQC returned to inspect the Trust in March Overall, the CQC found that improvements had been made, however it was evident that more needed to be done to ensure that the Trust could deliver safe, quality care across all core services. The CQC carried out an unannounced inspection in the Trust in September and October 2016, to review the progress of the improvements that had been implemented, to apply ratings, and also to make recommendation on the status of special measures. Summary of CQC findings relating to Safeguarding Adults and Children included: In line with statutory guidance the Trust had named nurses and named doctors, and safeguarding teams for child protection and safeguarding vulnerable adults The safeguarding adult and children policies were available on the Trust intranet and were up to date. Safeguarding was part of the Trust s annual mandatory training Staff we spoke to were aware of their responsibilities in relation to safeguarding adults and children. Staff were able to give us examples of what would constitute a safeguarding concern and told us they would seek advice from senior staff members and the Trust safeguarding team if they had any concerns All staff we spoke with knew the safeguarding team and could identify where to find the contact details if required There was a monthly safeguarding and learning disability operations group, where any issues around safeguarding or staff awareness of processes were shared Staff had a good understanding of female genital mutilation (FGM) and knew they could access the safeguarding lead for any support In the Emergency Department at the King George Hospital completion of safeguarding training by doctors was low. Compliance with safeguarding adults level 2 was 73% and safeguarding children level 3 was 60% Consent, Mental Capacity Act and Deprivation of Liberty Safeguards Staff we spoke with had mixed knowledge of the principles of consent and mental capacity, including the treatment of patients with Deprivation of Liberty Safeguards (DoLS) orders and were not familiar with the term mental capacity There was a Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) Advisor, who provided support and training to staff as necessary. We saw evidence that they regularly ed senior staff to remind them of the key issues surrounding capacity, Page 21

22 and provided additional training around topics such as independent mental capacity advocacy and the MCA itself. Training in relation to the Mental Capacity Act 2005 was incorporated into safeguarding training Outstanding Practice A dedicated paediatric learning disability nurse had introduced support resources for patients, including a children s hospital passport and visual communication tools. This helped staff to build a relationship with patients who found it challenging to make themselves understood. This had been positively evaluated and received a high standard of feedback from parents and patients Child to adult transition services were comprehensive and conducted with the full involvement of the patient and their parents. This included individualised stages of empowering the person to gradually increase their independence, the opportunity to spend time with paediatric and adult nurses together and facilities for parents to spend the night in adult wards when the young person first transitioned Areas identified for improvement have been incorporated in an action plan and feature in the Safeguarding Adult Annual workplan. 14. MENTAL CAPACITY ACT & DEPRIVATION OF LIBERTY SAFEGUARDS 14.1 MCA/DoLS Activity The Safeguarding Adults Team maintains a database which captures the number of Mental Capacity Act assessments (MCAA) that are completed by clinical staff and DoLS applications made to provide the Trust with quarterly data and to identify any emerging themes. Table 6 below records the number of MCAA toolkit forms completed and sent to the Safeguarding Office per quarter throughout 2016/17. The total of 153 is similar to the total recorded in the same reporting period 2015/16 (145). Despite reminders to send MCAA forms to Safeguarding and prompts during training, forms are found in files which have not been forwarded. Additionally, many patients who lack capacity to agree to surgery have a Form 4 (for adults unable to consent) but no MCAA toolkit form completed. This has been explored with staff and usually the resistance to completing the toolkit form is because they are too long. They are however comparable to documentation used nationally by other Trusts and organisations e.g. the Royal College of General Practitioners. Table 6 Page 22

23 Number of patients Number of patients 35 Mental Capacity Assessments: 2016/ /2017 Trend 5 0 Decisions regarding discharge destination (64) and consent to surgery (63) generated the highest number of mental capacity assessments. Going forward, ways to capture the routine MCAA s completed electronically by the Trust s Joint Assessment & Discharge Team is currently being explored to provide a more accurate picture of the Trust wide capacity assessment activity. Table 7 below records the total number of DoLS applications made per quarter throughout 2016/17. The total of 700 compares very favourably to the 135 applications during 2015/16. This demonstrates an improved knowledge base amongst staff which coincides with the provision of training and support provided by the MCA/DoLS Advisor. Within these numbers, in the last two quarters an increase to the number of DoLS raised unprompted is evident. Table Deprivation of Liberty (DoLS) 2016/ /2017 Trend Table 8 below provides a breakdown of the number of DoLS raised by division. Acute Medicine raised the most DoLS (350) followed by Specialist Medicine (225). The main reason for the DoLS being authorised was for close supervision. Page 23

24 Table Deprivation of Liberty (DoLS) 2016/2017 Quarter 1 Quarter 2 Quarter 3 Quarter 4 All DoLS applications are screened by a member of the safeguarding team before being sent to the Local Authority. Feedback is provided to referrers as part of learning and embedding the DoLS process. The increased number of DoLS and quality of narrative provided within the applications demonstrates an increased understanding of the circumstances in which DoLS are required. In October 2016, a modified version of the nationally used DoLS Authorisation Form was circulated to the Senior Sisters/Charge Nurses for comment. The aim was to make the form more straightforward and time efficient for staff to complete. The sections that detail care interventions, deprivations of liberty and risk factors were made into tick boxes against listed criteria. This was piloted across the Trust and amendments made following feedback from staff. The Local Authorities have accepted the modified version without raising any issues. This was presented for approval at the March 2017, Safeguarding Adult & LD Operational Meeting and subsequently received Chair s approval. A national benchmark for the number of DoLS applications made by Acute NHS Trusts does not exist MCA and DoLS information leaflet for patients and families An information leaflet on MCA and DoLS for patients and families has been drafted and a consultation has taken place. This was presented at the Safeguarding Adults & Learning Disability Operational Group meeting in January 2017 and has subsequently received Chair s Approval. The first opportunity to present the leaflet to the Patient Information Group was in June 2017; this delay was due to the capacity of the group. Once available this will ensure compliance with the MCA Code of Practice requirement that patients under a DoLS are given information about what this means and their right to appeal. It is hoped that this leaflet will also be a useful resource for Page 24

25 ward staff when explaining DoLS to family/friends and enhancing their own understanding of the key facts around capacity and DoLS. An easy read version of the leaflet has also been drafted. This has been circulated to staff for comment and was presented at the Learning Disability Working Group meeting in February The leaflet will be presented to the Patient Information Group meeting in June Given the cognitive impairment all patients under DoLS will be experiencing, this leaflet is likely to be helpful to share key information with a wider audience than learning disabled patients alone Advocacy Service VoiceAbility is the national advocacy service that provides people who are vulnerable or marginalised to raise their voices and have their rights respected. The service is for those patients who do not have capacity to make certain decisions or may not have family members to support them in the decision making process. The service continues to work with the Trust providing independent support and unbiased advice to those patients that require a best interest decision to be made. Throughout 2016/17 the Trust made a total of 40 referrals to VoiceAbility; this is a decrease in comparison to the 68 referrals made in 2015/16. This is disappointing given the attention that has been given to raising awareness of the advocacy services available. Promotional materials relating to advocacy will be re-circulated during the coming months. VoiceAbility were guest speakers at the Safeguarding Adults & Learning Disability Champions Study Day in July 2016 to promote awareness of the advocacy service. IMCA Service Leads are working collaboratively with the Trust s MCA/DoLS Advisor to look at ways to improve implementation of MCA/DoLS. A representative from VoiceAbility regularly attends the Trust s Safeguarding Adult & LD Operational Group meetings which provides an appropriate forum to raise any concerns relating to patients they are supporting in hospital. 15. LEARNING DISABILITY 15.1 Overview BHRUT continues to strive to improve the experience patients with Learning Disabilities receive whilst in our care. Equality in accessing healthcare is the central principle in the delivery of care within the NHS. The Trust is signed up to the Mencap Charter to demonstrate its commitment to improving the experience of people with a Learning Disability accessing hospital services and is compliant in all key principles of the Charter. The Trust has a Learning Disability Liaison Nurse Team which is available from Monday to Friday, The team has a Learning Disability Liaison Nurse (LDLN) for adults and a Paediatric Learning Disability Liaison Nurse (PLDLN) for children Learning Disability Patient Activity Page 25

26 The LDLN undertakes daily ward visits across Queen s and King George hospital sites for both inpatient and outpatient support. This activity is captured via an electronic database; the number of referrals per month to the LDLN has increased year on year as per table 9 below: Table LD Patient Activity April May June July Aug Sept Oct Nov Dec Jan Feb Mar 2014/ / /17 Going forward, to address the increase in activity the Chief Nurse and the Deputy Chief Nurse are supporting a business case for a substantive Band 6 Staff Nurse to work alongside the LDLN Learning Disability Working Group The Learning Disability Working Group is chaired by the LDLN and meets every other month on alternating sites between Queen s and King George hospitals to explore issues pertaining to the safe delivery of hospital services for people with a Learning Disability. All work streams in relation to the Learning Disability agenda are discussed at this group. This group is attended by people with Learning Disabilities, family and carers, local Advocacy Services, members of community Learning Disability teams, BHRUT staff including LD Champions, representatives from Healthwatch and Clinical Commissioning Groups. A local Hospital Group for people with Learning Disabilities is also chaired bi-monthly by the LDLN as a sub group of the Learning Disability Working Group. This group aims to capture the views of a wider Learning Disabled population which can be fed back into the LD Working Group. The Group also focuses on the need to de-mystify what happens in a hospital environment and regular social visits to different parts of the hospital have commenced, with positive feedback received from participants. Minutes from the Trust Learning Disability Working Group are displayed on the external Learning Disability web page. The Group have been instrumental in developing learning disability initiatives outlined in section 15.4 below. Page 26

27 15.4 LD Initiatives Implemented All Trust LD initiatives have been developed and implemented in consultation with members of the LD Working Group to ensure the voice of the patient with a LD is heard. Key initiatives implemented during the reporting period include: LD Information Boards are displayed in patient areas Easy Read Appointment Letters have been produced More Time Please stickers for use in outpatients to alert the staff for the need to make reasonable adjustments for patients with a learning disability Carer s Policy and Carer Support Plan have been produced Patient Partner Representative - a local person with a learning disability has been recruited I will statements to give people with a learning disability a voice when they attend healthcare appointments across the borough Z cards - this is a credit card sized card that concertinas out and is designed for people with a learning disability to keep in their purse or wallet for use during health care appointments. The Z-card contains the top 5 I will statements on one side and on the reverse has tips for healthcare professionals regarding reasonable adjustments 15.5 Learning Disability Awareness Week Learning Disability Awareness Week took place during week commencing 20 th June Information stalls were available at King George Hospital on the 21st June 2016 and on the 22 nd and 23rd June 2016 at Queen s Hospital. The stalls were manned by the LDLN Team and the Autism Ambassadors from the Sycamore Trust. The stalls promoted the resources the Trust has introduced to improve the experiences of people with a learning disability accessing hospital services. Resources include the use of the Hospital Passport, easy read information sheets, the hospital communication book and the introduction of the More Time Please headboard magnets and stickers. Stalls also promoted local learning disability and autism services, including carers groups available in the community. The feedback from members of the public, people with learning disabilities and hospital staff visiting the stands indicated the information available was well received and relevant Learning Disability (LD) Action Plan In April 2015 the Trust signed up to the implementation of the Guidelines and Audit Network (GAIN): guidelines for caring for people with learning disabilities in general hospital settings. The guidelines acknowledge that going into hospital for any reason is a time of anxiety and stress for any of us. People can find that they are in an unfamiliar environment, with unfamiliar people using unfamiliar language. Alongside this unfamiliarity the person may be suffering significant illness and/or pain and consequently, it is a time when people often feel vulnerable. These guidelines are intended to enhance safe and effective care throughout the journey within the general hospital setting for people with a learning disability. The LD Action Plan for 2016 / 2017 reflects the GAIN guidelines. There are no red areas for action. Page 27

28 15.7 Transition The Trust has a Transition Policy (Transfer from Children Services to Adult Services) which provides guidance to staff on the process for ensuring that young people with complex and chronic health needs have a smooth handover of care to adult services within the Trust. The Trust s Learning Disability Nurses are working closely together to identify those patients that require that support and have initiated two transition meetings for young people with a learning disability transferring to adult hospital services. This has proved particularly successful for one young lady and her family as she has required several hospital attendances since the transition meeting was held. Her parents have reported the smooth handover of care from children s to adult care has made the process far less stressful for both them and their daughter. 16. DOMESTIC VIOLENCE The Trust has the services of an Independent Domestic Violence Advisor (IDVA), funded by MOPAC (Mayor s Office for Policing and Crime) in a co-located post between Victim Support and the Trust. The IDVA has regular inputs into DV training, takes direct referrals from staff, makes initial contact with the person affected within 24 hours and can respond immediately in cases of acute need when required. The IDVA is supported by a Senior Manager in Victim Support and by members of the Safeguarding Team. During 2016 IDVA contact business cards, provided by Victim Support, have been distributed to staff in key areas to allow easy access to IDVA support contact details and DV pathway flowcharts and posters circulated. The role of the IDVA and awareness of the availability of the DV and Abuse Policy and the DV Intranet site were cascaded to all Trust staff via the LINK. A total of 53 IDVA referrals were made during The Trust has not previously received data relating to the number of referrals made to Victim Support or the outcomes. Going forward, more robust data collection will be a priority for the Safeguarding Team and the IDVA to work together to achieve this. The Trust supported White Ribbon Awareness week in November 2016 during which members of the Safeguarding Team and Victim Support manned a stall in the atrium of Queen s Hospital. This generated interest from both staff and members of the public. Seven nurses from the Emergency Department have been identified to act as link nurses for DV and have met with the IDVA/Named Midwife to agree optimal means of raising awareness and supporting staff in responding to DV issues. Five of these have attended the stand-alone DV training. The newly appointed Safeguarding Advisor, Harmful Practices will work collaboratively with the IDVA to drive forward the Domestic Abuse agenda in the coming year. Page 28

29 17. DEMENTIA 17.1 Overview The Trust s Dementia Team continues to adapt and evolve to ensure that the Trust effectively provides consistently excellent dementia care to our patients with dementia. The aim is to improve the health and well- being of our community affected by dementia through the provision of high quality, patient centred healthcare. This will be achieved in partnership working with our colleagues across the three local boroughs. The Clinical Nurse Specialist for Dementia works alongside a Dementia Practitioner who are supported by 11 Healthcare Assistances with a special interest in Dementia and an administrator. The team has consistently achieved the dementia CQUIN (all patients aged 75+ who have been admitted to our hospital are screened in order to identify those with dementia and/or other causes of cognitive impairments alongside their other medical conditions and to prompt appropriate referral and follow up after they leave hospital). The average performance for the last quarter was 97.15% against a compliance target of 90% Dementia Initiatives Key initiatives implemented during the reporting period include: Successful recruitment of 11 dementia Healthcare Assistance to provide 1:1 care for patients with dementia that need extra support A Welcome Pack is available for people with dementia and their carers at the start of their hospital journey. The pack contains important factsheets on Coming into hospital, What is dementia? The dementia Guide and initiates conversations with patients and carers on the care and treatment of patients with dementia at BHRUT, including the butterfly scheme and where to get support during and after their hospital stay Stimulation bags - containing activities for patients including, playing cards, dominos, jigsaw puzzles, aquarium gel pads, twiddle muffs and MP3 player. The bags are being used on the care of the elderly wards, mostly by the dementia HCA S, to provide stimulation and distraction therapy for patients with dementia Coffee afternoons for carers and patients with dementia - this is in partnership with Tapestry and Memory Services on a monthly basis at both hospitals to offer support and advice to patients and relatives / carers on dementia and signpost them to appropriate services in the community. #Dementia United - relaunched the Dementia Strategy on 21 st September 2016 (World Alzheimer s Day) in partnership with NELFT to create a more dementia friendly Trust. It included: Re-launch of the Butterfly Scheme Promote the This is me booklet John s Campaign Joint twitter chat with NELFT and BHRUT Page 29

30 Delirium clinic facilitated every other Friday for patients who require follow-up Monthly spot check audits commenced in January 2017 to monitor and improve ward compliance with the Butterfly Scheme, This is Me document and the Dementia/Delirium care plans 18. LOCAL AUTHORITY & PARTNERSHIP WORKING BHRUT is a member of two Local Safeguarding Adult Boards, which are the London Boroughs of Havering and Redbridge. The Chief Nurse and Deputy Chief Nurse represent the Trust at these meetings. The Named Nurse Safeguarding Adults represents the Trust at the Safeguarding Adult Board subgroups hosted by all three boroughs. The LDLN attends the Learning Disability Partnership Boards for Barking & Dagenham, Havering and Redbridge. The LDLN maintains a link between the local Community Learning Disability Teams and the Trust and with advocacy and carer groups within the three Boroughs the Trust serves. The Deputy Chief Nurse also attends the Havering LD Partnership Board and chairs the Health Pathway sub-group of the same board. The LDLN and the PLDLN also attend the Havering Health Pathway Group. The LDLN has been instrumental in the development of the I will campaign which includes use of a z-card, posters and information leaflets to improve the health care experience for people with a learning disability living in Havering. The campaign was launched at the local Town Hall in November The LDLN presented externally on behalf of the Trust to raise awareness of the resources BHRUT has in place for adults and children with a learning disability. Presentations were made at the following events: St Francis Hospice End of Life one day workshop in June 2016 Page 30

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