NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST TRUST BOARD 28 JUNE Safeguarding Annual Report. Bella Dorman- Head of Safeguarding

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1 NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST TRUST BOARD 28 JUNE 2018 Title of Paper Safeguarding Annual Report Reference Number NUH 4482 Author & Sponsor Mandie Sunderland- Chief Nurse Bella Dorman- Head of Safeguarding Contributions from; Elizabeth Byrne - Named Nurse Safeguarding Children Philip Millott- Adult Safeguarding Lead Bev Nield- Named Midwife Safeguarding Children Joy Moran- Child Death Nurse Purpose of Submitting to the Board The Outcome which I am seeking from submitting this to the Board What happens after this meeting and why? Performance issue off track No Progress report on key Initiative Yes Planned item on regular meeting cycle Yes Strategic / horizon scanning Issue No Other No To receive and note the attached report and the progress to date Continue to progress safeguarding work plan 2018/19 Relevant Corporate Strategic Aims Risk Issues (financial, patient impact, operational, strategic, reputational, legal) Patient People Performance Harm to children, young people and adults (more notably if demand exceeds capacity to deliver expert intervention/advice/training) Reputational damage to NUH Threat to CQC registration Litigation Overall Risk Score Consequence = (4) x Likelihood = (3) = Overall Risk = (12) Overall Level of Assurance to the Meeting (a) Now a) Sufficient (b) Upon implementation of the requested outcome b) Significant once the mandatory training improvements are consolidated. 1

2 Executive Summary 1. Safeguarding the health and wellbeing of all our patients remains a high priority for the Trust. 2. NUH is recognised as a key multi-agency partner on, and a valuable contributor to, local adult and children s safeguarding boards. 3. During 2017/18, local commissioners completed a safeguarding quality visit. The visiting team gained significant assurance that the Trust was prioritising the safety and welfare of children and adults and meeting its contractual safeguarding responsibilities. Significant areas of good practice were identified, most notably a proactive and supportive safeguarding team who were valued for their expertise and experience; and safeguarding being demonstrated as core business by healthcare professionals. Staff interviewed demonstrated an awareness of relevant safeguarding policies and procedures and how to make a referral. The application of Think Family principles were exemplified by staff. 4. The Trust s Safeguarding Adults Assurance Framework (SAAF) was submitted to commissioners in March Of the 22 areas of assessment relevant to providers, NUH is compliant in all areas and is excelling in 14 of these, especially in relation to workforce. 5. In the safeguarding vulnerable patient essence of care benchmark 95% of all areas scored Green/Gold. 6. In October 2017 a follow up report was received by the executive lead for safeguarding which confirmed that all actions identified in the internal audit review of safeguarding carried out in October and November 2016 were complete. 7. NUH is CP-IS ready using the summary care record in the Emergency Department (ED) as directed by NHS England - this was completed by the end of March Safeguarding training has proved a challenge this year and unfortunately the NHS England target of 85% for mandatory Prevent training was not achieved by the end of quarter four. NHS England has agreed that all acute trusts can have until the end of Q2 2018/19 to meet this target and there are plans in place to achieve this. 9. Referrals to both the children s and adult safeguarding teams have more than doubled over the past year. The teams have been strengthened to manage this workload and technological support is also being explored as part of the NerveCentre development. 10. Of note during the year were 22 allegations against staff. These have been managed by the named professionals for safeguarding and the HR Head of Operations. Ten of these staff were substantive NUH employees, the rest agency staff or students. Four of these were referred to the Local Authority Designated Officer and one was referred to the Disclosure and Barring Service. 11. Between1 April 31 March 2018, NUH has been the subject of 58 safeguarding adult referrals. This has doubled since 2016/17. All the allegations were investigated by the departmental manager along with a member of the safeguarding team and reported back to the allocated social worker. Only one of these allegations of abuse was substantiated. 2

3 Safeguarding Annual Report May Introduction 1.1 The safeguarding of all our patients; both adults and children remains a high priority for the Trust. Safeguarding is a fundamental component of all care provided. The purpose of this annual report is to provide an update of safeguarding activity across the Trust in the last 12 months (April March 2018) This report sets out the work carried out by Nottingham University Hospitals NHS Trust adults and children s safeguarding teams. In addition this report will provide assurance that the Trust meets its statutory responsibilities in relation to safeguarding. 2.0 Background 2.1 Safeguarding means protecting people s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect. Recent events have shown us that the definition may be straight forward but issues surrounding safeguarding are challenging and complex. In 2017 we witnessed a number of terror attacks in the UK, Manchester was devastated by the Manchester Arena bombing and we will never forget the young lives taken so tragically early. London saw a number of attacks designed to spread fear across communities reaffirming why the Prevent agenda is so important. In 2017 we also heard about cases of historical abuse in sport and, after decades of torment, survivors of sexual abuse have been able to tell their stories. At the end of the year social media helped to illuminate sexual exploitation in the entertainment industry. Protecting those at risk requires constant vigilance and willingness to act whenever and wherever we suspect abuse exploitation or neglect. Safeguarding is everyone s business. 2.2 All health providers are required to demonstrate that they have safeguarding leadership and commitment at all levels of their organisation and that they are fully engaged and in support of local accountability and assurance structures, in particular via the local safeguarding boards. As of October 2017 the Head of Safeguarding represents NUH at the Local Safeguarding Children s and Adult s Boards (LSCB & LSAB). Health providers must ensure that a culture exists where safeguarding is everybody s business and poor practice is identified and tackled. They are required to have effective arrangements in place to safeguard adults and children and to assure themselves, regulators and their commissioners that these are working. These arrangements include: Safe recruitment Effective training of all staff Effective supervision arrangements Working in partnership with other agencies Identification of named professionals for safeguarding 3

4 Named professionals have a key role in; promoting good professional practice in their organisation supporting the local safeguarding system and processes providing advice and expertise for fellow professionals; and ensuring safeguarding training is in place 2.3 All health providers must be registered with the Care Quality Commission (CQC) and are expected to be compliant with the fundamental standards of quality and safety. Two of these standards have particular relevance in safeguarding regulation 11(consent to care and treatment) regulation 13 (safeguarding vulnerable people from abuse). The Head of Safeguarding is working on the safeguarding requirements of the provider information return in preparation for the next CQC inspection. 2.4 The most important duty imposed on health and social care organisations is to recognise and respond to any suspected or alleged abuse. 3. Progress against key national and regulatory requirements 3.1 Safe recruitment and managing allegations against staff NUH continues to operate a safe system of recruitment which is in line with the NHS employment check standards. There have been 22 allegations against staff in the past 12 months managed by the named professionals for safeguarding and the HR Head of Operations. Ten of these staff were substantive NUH employees, the rest were agency staff or students. Four of these were referred to the Local Authority Designated Officer and one was referred to the Disclosure and Barring Service. 3.2 Effective staff training The approach to delivering mandatory training in changed. All staff view pod casts (in their birthday month) with clinical staff receiving additional safeguarding training. In April 2017 June 2017, high priority staff (level 3 staff, plus other identified teams) attended a Workshop to Raise Awareness of Prevent (WRAP); level 2 Prevent training was an e-learning package. However due to issues with its compatibility with Moodle, the trust were unable to capture who had completed this training. The safeguarding teams in combination with Learning and Organisational Development agreed that all level 2 and 3 staff should receive the WRAP training. This change commenced July Additional training capacity was provided. Feedback was given to NHS England regarding the incompatibility of the e-learning package with NUH systems (not restricted to NUH as an issue). Compliance with mandatory training attendance has been reported to both safeguarding committees. Mandatory training compliance is reported to the Trust Board and is also part of the Divisional Performance meetings. Direct Care to Children and Adults staff (Level 2 and 3) are currently at 66.6% training compliance for All Other Staff (Level 1) are 76% compliant. The safeguarding teams in combination with Learning and Organisational Development (L&OD) have agreed to continue WRAP training into the next financial year in order for the trust to reach 85% compliance rate expected by NHS England. NHS England has acknowledged problems faced by many acute Trusts and have therefore agreed that Trusts have until end of Q to reach the 85% target. NHS England is working towards the 4

5 e learning packages being SCORM compliant so that they are compatible with Trust platforms for recording. Individual practitioners are being reminded by L&OD of the need to complete their mandatory training. Management teams will also be informed. Mandatory training compliance very much relies on staff being released from Divisions to attend training in their birthday month. L&OD arrange mandatory training sessions and Divisions are responsible for release of staff and to follow-up nonattendance. The safeguarding teams have previously written to Divisional management teams on the importance of staff attending their mandatory WRAP training. In addition to mandatory training the safeguarding team deliver tailored training on a variety of topics as required, for example: domestic abuse, mental capacity act, deprivation of liberty safeguarding. The teams also support training programmes for student nurses/midwives and foundation doctors and work closely with the University of Nottingham. 3.3 Effective supervision arrangements The safeguarding children supervision policy forms part of the NUH generic clinical supervision policy. Safeguarding supervision is provided on an ad-hoc basis to members of staff when requested and as formal debrief after a complex case. Some specialist teams receive regular safeguarding supervision e.g. cleft lip and palate, burns and plastics and CASH. Currently where staff require specialist input 100% of the requests are being met. Paediatrician supervision is available via safeguarding peer review sessions that occur three times per month. The named doctors also provide ad hoc supervision and advice as required. The Adult Safeguarding Lead provides supervision for the learning disability liaison team and adult safeguarding specialist nurses The Named Nurse for Children provides supervision to the Children s safeguarding specialist nurses and ED domestic abuse nurse The Head of Safeguarding provides supervision for the adult lead and named nurse as well as the adult safeguarding specialist practitioner within the Nottingham City Clinical Commissioning Group and Adult Safeguarding Lead from University Hospitals of Leicester NHS Trust Supervision is provided on request to members of staff following a safeguarding incident or complex case in the form of a formal debrief. Q3 and Q4 have seen some particularly distressing safeguarding children s cases and the team have acknowledged the impact these have had on clinical teams. The Safeguarding Children s Team will be providing group safeguarding supervision to the Children s Hospital and the Emergency Department in via mentor group days. This is new pilot and will be evaluated by the team. 3.4 Working in partnership with other agencies The Trust continues to be represented on Nottingham City Safeguarding Children s and Adults Boards and their relevant sub-groups by the Head of Safeguarding (HOS) Named Doctors, Named Nurse Children and Young people, Named Midwife and Adult Safeguarding Lead. 5

6 The Trust continues to contribute to multi-agency safeguarding audits/reviews in Multi-agency risk assessment conferences (MARAC) MARAC s are risk assessment conferences for high- risk survivors of domestic abuse. NUH is currently represented on weekly MARACs by the domestic abuse specialist s nurses; these are held on alternate weeks in Nottingham City and Nottinghamshire County. Currently the meetings each week last approximately eight hours and require at least six hours preparation time in the week prior to the meeting to research cases and complete case logs. Usually the top 20 high-risk cases are discussed, recently in Nottingham City the number of high-risk cases referred to MARAC fortnightly have exceeded 30 cases. Since November 2017 this has required an additional MARAC day every fortnight. There was also an identified need to increase the number of MARAC Chairs, the Head of Safeguarding continues to support this chairing a full day meeting every eight weeks. 4. Performance monitoring responsibilities 4.1 NUH provides CQC, Ofsted, local safeguarding board with evidence that it is discharging its safeguarding and Child Death reporting duties In April 2017 an update of progress against the outstanding actions of the selfassessment Markers of Good Practice submitted in May 2016 was reported to the local safeguarding children s board and all but one were assessed as green. The amber score and progress is described below; 1) Can NUH evidence the impact of SCR recommendations on current practice? Learning from SCR s is a standing agenda item of the Safeguarding Children and Young Peoples Committee. This area would still be rated as amber due to learning from SCR s being an ongoing process The Safeguarding Adults Assurance Framework (SAAF) has been submitted to Commissioners and will shortly be requested by the safeguarding adults boards. There are 22 areas of assessment relevant to providers and NUH is compliant in all areas and is excelling in 14 of these areas, especially in relation to workforce. 4.2 Safety of Vulnerable Patient Benchmark. The benchmark was required to be scored in all patient areas. Nuclear Medicine (City campus) and Physio Outpatients (QMC) did not submit scores (7 th February 2018). Results 185 areas scored: 98 (52.9%) scored GOLD 78 (42.1%) scored GREEN 9 (4.8%) scored RED 6

7 95% of ALL areas scored Green/Gold Comparisons to previous year s results are outlined below (Table 1). Table 1: Comparison of scores Gold 110 (65%) 94 (50%) 112 (59.6%) 98 (52.9%) Green 61 (32%) 84 (45%) 70 (37.2%) 78 (42.1%) Red 5 (3%) 8 (4%) 6 (3.2%) 9 (4.8%) Total % of areas scoring Green/Gold 97% 95% 96.6% 95% Summary In the Adult areas, six of ten indicators of best practice were achieved by at least 90% of departments. In the Children s areas, nine of the indicators were achieved in 90% of all areas. Red Scores The following 9 areas scored red for this benchmark, none of these areas scored red last year: MRI QMC Renal Home Therapies Obstetric and Paediatric theatres Eye Theatres B49 Fletcher (rescored Gold) Haywood House E14 Harvey 1 (rescored Green) Red scores indicated a level of inconsistency in the knowledge of staff across different areas of adult safeguarding within these clinical areas. All areas were rescored within two months and all areas demonstrated improvements. Themes for Action The following adult indicators scored lower than 90% Indicator 3: Staff are aware of the NUH restraint policy and have an understanding of what constitutes proportional restraint. Trust wide work continues on restraint, enhanced supervision and mental health pathways. The benchmark measured this knowledge specifically in line with mental capacity assessments and best interest decisions. Indicator 6: Staff know: What age group the Mental Capacity Act covers How to perform a mental capacity assessment 7

8 Under what circumstances they should perform one The adult safeguarding team delivered mandatory training on MCA and it continues to be covered at Trust induction. Up to date guidance is available on the adult safeguarding website and from the team. MCA will be audited by 360 Assurance in April 2018 and reported to the Trust Audit Committee at the end of May. Indicator 8: Staff are aware of the role of an independent mental capacity advocate (IMCA), when it is needed and who to contact for advice or how to make a referral. During mandatory training in the safeguarding adults team delivered training on the Mental Capacity Act. This specifically discussed when an IMCA is required. The safeguarding team advise accordingly and the intranet page has the current guidance on when an IMCA is required, as well as referral documentation. Indicator 10: Staff are documenting whether the patient has any caring responsibilities. This benchmark measure was developed as a result of actions from safeguarding adults reviews, domestic homicide reviews and coroners cases. It remains essential that staff assess and document any specific caring responsibilities that patients have for others specifically the importance of building up a picture of who is involved in a patient s life. This continues to be addressed through mandatory training until 31 st March The following children s indicators scored lower than 90%: Indicator 7: Staff awareness and acknowledgment of importance of asking and documenting: who has parental responsibility? how this can be determined if adult is unsure? Despite the importance of this being raised at face to face mandatory training ( ), this continues to be a low scoring indicator. The importance of this has been identified as a result of recommendations from serious case reviews and coroners cases. Education of staff to raise awareness and knowledge of requirements continue through mandatory training Safeguarding Adult Internal Audit- Follow up report In October 2017 a follow up report was received by the executive lead for Safeguarding which confirmed that all actions identified in the Internal Audit carried out in October and November 2016 were complete. 4.4 Clinical Commissioning Group Annual Safeguarding Visit- October 2017 In October 2017 representatives from Nottinghamshire County and Nottingham City CCG visited NUH. They were accompanied by the Chair of the Nottinghamshire Safeguarding Adults Board. This visit was positive. The feedback from the CCG s is attached as Appendix Child Sexual Exploitation (CSE) NUH has an identified CSE lead as per the NHS Quality Standard Contract supported by a newly formed NUH steering group. The CSE risk assessment tool for staff has been fully implemented and is well established within the Emergency Department. 8

9 4.5 Child protection Information-Sharing Systems (CP- IS) Project - This system allows staff working in unscheduled health care settings, for example ED, to access information as to whether a child is cared for by the Local Authority or is subject to a Child Protection Plan. CP-IS is included in the NHS standard contract 2017/18 which is mandated by NHS England. NUH is CP-IS ready using the summary care record in the Emergency Department (ED) as directed by NHS England this was completed end of March Within Nottingham and Nottinghamshire the local Authorities are not yet live with CP-IS and are not predicted to be until May/ June Therefore ED staff will only be checking CP-IS for children (under 18) attending from out of area. Unscheduled maternity services and Eye Casualty will be live by end of May Work is ongoing within NUH and System C as to the compatibility of the ED Medway system and CP-IS which is part of a wider national problem between these two systems. 5 Serious Case Review (SCR) and Safeguarding Adults Review (SAR) The children s safeguarding team have provided one report for a newly commissioned county SCR. NUH however are not actively involved with this SCR going forward. The team have also responded to seven requests for information regarding children known to NUH. This is to assist with the decision about whether the criteria for a SCR has been met. The adult team have provided summaries for three requests for information under the statutory Safeguarding Adults Review process. 5.1 Domestic Homicide reviews (DHR) Within Nottingham and Nottinghamshire there are currently 11 Domestic Homicides in progress. NUH is currently involved in four Domestic Homicide Reviews. Chronologies and Individual Management reports are being written for all four. These reviews impact on the capacity of the team and often include interviews with front line staff. 6 Safeguarding activity in support of local Safeguarding systems and processes 6.1 Children and Young People Activity Data This is now reported quarterly to commissioners via the Quality Scrutiny Panel. Data presented in this report will be on for Q1-Q (see appendix 2) Self-harm Self-harm remains a significant problem for the under 18s and this reflects the national picture in this challenging area. 9

10 In there were 439 cases of self-harm recorded with 35 of these being children under 10 years of age and 8 being under 11 years (the recording has changed in 2018) and means that 43 children were under 11 years of age. The Trust has initiated a range of actions to assist in managing self-harm presentations including pathway work, risk assessment tools, safe ward areas, and working with senior child and adolescent mental health service (CAMHS) staff to plan pathways of care and prevention. The Children s Hospital is now using a validated risk assessment tool for children with self-harm in the ward environment. Recording of under 18 s activity is now routine and reported to the Family Health and Safeguarding Teams. There is on-going work and liaison with the Local Authority to reduce delayed discharges and ensure safe discharge planning. As part of this there is on-going work with the local authority, CCG and CAMHs to produce a pathway for children and young people with mental health needs admitted to hospital. Going forward the plan is that CAMHs will be located within the QMC and the hope is that this should improve the access to assessment and support for these children and young people Section 47 Enquiries and Medicals Section 47 (s47) enquiries are embedded within the Children Act 1989 and are led by Children s Services Social Care. Medical - Non accidental Report (see appendix 1) Medical Child sexual abuse (see appendix 1) Female Genital Mutilation (FGM) FGM prevalence standards have been established and this data now forms part of the quarterly data collection and submission to commissioners and national sources. Activity data for this service is presented in Appendix Domestic Violence (Emergency Department (ED) Specialist Nurse Update) The role and function of the Domestic Violence (DV) Nurse is being maintained. The commissioning function has been transferred from Local Authority Public Health team to the Crime and Drugs Partnership (CDP) (Nottingham City). The safeguarding team has met with the CDP to agree data requirements and reporting and the CDP was assured with the planned systems and processes. The service review held in November 2017 was positive. There have been changes within the CDP and the service review planned for April 2018 was unfortunately cancelled. Presentations in ED continue to reflect established patterns (stab wounds, alcohol misuse, self-harm). Much of the work includes ongoing liaison with housing and mental health services. The role continues to deliver DV training to ED staff, which is well received and approaches 100% uptake. Recent training has developed a Think Family approach, also well received, for all new starters in ED. There has been a noticeable improvement in the quality of risk assessments leaving the organisation. The risk assessment forms are now completed electronically. This work has been done in partnership with ICT and has been very successful and welcomed by front line ED staff. This enables all referral forms to be quality assured by the ED Domestic Abuse nurse. 10

11 6.2 Safeguarding Midwifery Update April 2017 to March There are 811 completed (delivered and discharged from hospital) midwifery cases that the safeguarding team were involved with from the beginning of April 2017 to the end of March This is an increase of just over 9% for the year which reflects the local and national position. There continues to be approximately 150 ongoing (women still pregnant in maternity services) cases. It is important to note that this is not the total number of safeguarding cases managed by midwifery, as some cases are managed by midwives without the need for discussion with the safeguarding team. Most cases consist of multiple risk factors, the most frequent being domestic violence followed by mental health, drug misuse and alcohol misuse. The number of referrals to social care has increased Midwifery safeguarding supervision continues to be high on the agenda and has been provided as outlined in the provision set out at the beginning of the year. The expectation is that every community midwife attends one session per quarter. Staff group Type Annual sessions Annual hours Generic Midwives Group Supervision 16 x 2 hours 32 hours Maternity Support Workers Group Supervision 4 x 2 hours 8 hours Specialist Midwives Teenage Pregnancy Substance & Alcohol Misuse Domestic Abuse/Homeless Mental Health Hospital Maternity Staff Individual Supervision Individual Supervision Individual Supervision Individual Supervision As required Total number of supervision hours provided 9 x 3 hours 27 hours 9 x 3 hours 27 hours 9 x 2 hours 18 hours 4 x 2 hours 8 hours 242 hours 11

12 Preparation and documentation for supervision sessions Overall Total 56 hours 298 hours At these sessions we have taken the opportunity to share learning from case reviews and events that happen throughout the year. The midwifery safeguarding team continues to support staff that are requested to write statements for court, which is a more frequent occurrence, and have supported staff attending court in respect of child protection cases. We have also provided debriefing sessions for staff when the need has arisen. Further safeguarding training is provided on the maternity forum for midwives and midwifery support workers. This is interactive and designed to bring professionals focus back to the voice of the unborn/baby and refresh knowledge on day to day safeguarding. It also includes working with complex cases and learning from serious case reviews. These sessions have evaluated well throughout the year. The maternity safeguarding team also contributes to delivering the Trust wide Level 3 mandatory safeguarding training. 6.3 Child Deaths NUH is commissioned to provide the local Child Death Review process. This process provides rapid response and information-gathering after an unexpected child death - as well as information gathering for expected child deaths - in Nottingham City or Nottinghamshire County. Information about deaths of children who reside out of area is also gathered and shared with the neighbouring Child Death Overview Panels (CDOPs). Hospitals in other areas provide information about City and County deaths in a reciprocal arrangement. For the year ending 31 st March 2018 there were 75 child deaths at NUH; 20 were children from out of area. There were safeguarding concerns in 13 cases. In three cases these concerns were neither current or related to death; one who was a care leaver and died by hanging following an argument and two where there were concerns in the past about domestic violence and mothers mental health. Out of the remaining 10, nine were unexpected deaths and one was expected due to complications of prematurity. In this case there had been a plan for a pre-birth conference due to concerns about mother s alcohol use and domestic violence in the relationship. Summary of Safeguarding Concerns: Parental Alcohol and substance abuse Domestic violence Neglect Parental Mental health issues Parental personality disorders Parental Chaotic lifestyles 12

13 Sexual exploitation Victims of crime stabbing, head injury Victim substance misuse Several cases are subject to ongoing police investigations and 2 are subject to a serious case review Key Safeguarding Messages Children who were not brought for appointments may be subject to medical neglect and suffer harm. A safe sleeping working group has been actively ensuring that the safer sleeping message is widely disseminated. Further questionnaires have been completed by health visitors at the 6-8 week check in both the City and the County. Multi-agency training sessions have been arranged to raise the awareness amongst other professionals in the community such as social workers, family support workers and housing managers. The sessions will also provide an opportunity to launch an assessment tool for use by professionals undertaking targeted work with vulnerable families where there are maternal mental health problems, substance misuse issues, domestic abuse and housing problems to give a few examples Key National Documents The Children and Social Work Act was passed in 2017.This includes that child death review will come under the remit of the Department of Health as of It also describes the arrangements once the LSCBs are disbanded and replaced by local arrangements. Child death review function will come under the remit of Clinical Commissioning Groups (CCGs) and Local authorities. The contract for providing the national database has been awarded, but the name of the successful consortium has not yet been released. The Consultation period on both the revised Chapter 5 of Working Together (relating to child deaths) and also the accompanying statutory guidance on Child Death Review is in the process of having final draft before being signed off by Parliament. The statutory guidance provides clarity of the review of all deaths in childhood with less emphasis on the differences between the management of expected and unexpected deaths. There is more emphasis on the review of in - hospitals deaths and an attempt to strengthen and streamline all the reviews including perinatal reviews, Serious Incident investigations, and investigations by root cause analysis, internal reviews such as Morbidity and Mortality meetings etc. There will be closure links with the Child Death Overview Panel and the requirement for information to be inputted into the new national database. Changes are expected to be in place in June Rapid Response arrangements will remain for traumatic and unexplained sudden deaths based on the Sudden Unexpected Death in Infancy and Childhood (2 nd edition) produced by working group of the Royal College of Pathologists and Child Health chaired by Baroness Kennedy (2016). 6.4 Adults- appendix Referrals to Local Authority: NUH has made 240 referrals to the local authorities 1 st April 31 st March The safeguarding team are core members of the Nottingham City safeguarding Board Quality Assurance group. Quality of referrals and abuse trends are monitored. 13

14 Nottinghamshire County have been able to break this down and of the 95 referrals made by NUH to the County in 2017/18, 61 (64.2%) led to section 42 enquiries. This is 2% lower than last year but it is above the target set by the Nottinghamshire Safeguarding Adults Board as 55%. The safeguarding team hope to increase this to 70% in the next financial year. NUH made an additional 145 referrals. 124 of these were to Nottingham City and the remaining 21 were to other local authorities. Nottingham City local authority are not able to break down further their data as they do not record specially which hospital with the City has made the referral. This has been raised at the Quality Assurance group by health partners across the city and is being reviewed. Referrals from NUH to the local authorities have remained consistent in numbers however it is important to note that the number of safeguarding advice calls to the team has more than doubled in the last 12 months. In 2016/17 the team recorded 1124 advice calls and in 2017/18 this increased to (see appendix 2) Referrals against NUH 1 April 31 March 2018, NUH has been the subject of 58 safeguarding adult s referrals. This has doubled since 2016/17. All were investigated by the departmental manager and a member of the safeguarding team and reported back to the allocated social worker. One of these allegations of abuse has been substantiated. The adult safeguarding lead has been working closely with the complaints team as many of these are also received as complaints to the organisation or should be investigated as a complaint rather than an accusation of abuse or neglect Deprivation of Liberty Safeguards The Trust is a managing authority with respect to the DOL Safeguards by virtue of being an organisation providing care. The local authorities are the supervising authorities. DOLs remain a challenge for the adult safeguarding team due to the demands on the capacity of the team. Between 1 April March urgent deprivations of liberty authorisations were submitted to the supervisory body. Nottinghamshire County received 94 of these referrals; no referral resulted in a standard authorisation. One of the referrals had an assessment. The other referrals were not assessed as their condition changed or they were discharged from hospital before a Best Interest Assessor was allocated. The Local Authority follows the guidance issued by ADASS in the prioritising of allocation of BIA s. The Local Authority is in contact with wards to assess whether the patient s condition has changed. We have not been able to get this level of data from Nottingham City. In January 2017 the court of appeal Ferreira vs Senior Coroner for Inner South London ruled that a person receiving life sustaining emergency treatment in an intensive care or high dependency unit was not deprived of their liberty. They were unable to leave due to the complexity of their condition, not actions undertaken by the hospital. With effect from March 2017 following this case law ruling, DOLs were no longer required from all three intensive care units and E12 at QMC, except in extenuating circumstances. The team predicted a reduction in DOLS for the year 2017/18 due to this change however the number of DOLS referred to the local authority has remained static. 14

15 6.5 Learning Disabilities NUH has a team of acute learning disabilities nurses who are employed by Nottinghamshire Healthcare Trust and funded by the Clinical Commissioning groups. This team provide support to patients with a learning disability. They help with planning admissions and respond to acute admissions. They support NUH staff to make reasonable adjustments and provide training. The nurse led team are involved in the Learning Disability Mortality Review process (LeDeR) process (commenced October 2017). In addition to this all learning disability deaths are subject to structured judgement case reviews which are completed by the team and the Named Doctor, Safeguarding Adults. These are all presented to the Safeguarding Adults Committee. There has been good practice identified which includes early involvement of the acute liaison nurses. Please see appendix 4 for a summary of their activity. 7. Prevent The Trust has developed a process for referring cases of vulnerable people who we suspect may have been radicalised by extremists to the appropriate agency within the local police force. In the last year the safeguarding team have received four Prevent referrals from NUH staff one of these was referred into the Chanel process. The compulsory Department of Health (DH) training on Prevent is delivered at NUH as mandatory training for members of NUH staff are accredited trainers following completion of the DH/Home Office train the trainers course. 8 Mental Health Act In 2017/18 15 patients were sectioned to NUH under the Mental Health Act. This figures does not include Section 5:2 s NUH has been working in partnership with Nottinghamshire Healthcare Trust to agree a service level agreement to ensure that NUH meets its legal responsibilities. Currently this is provided on a good will basis due to the good working relationships built up over the years. To ensure compliance with CQC this needs to be formalised. The Head of Safeguarding is leading on the development of a Trust Mental Health Policy and also working with colleagues in IT and the Deputy Chief Nurse, Corporate, to explore the use of Nerve Centre to collect data. 9. Providing advice and expertise for fellow professionals The Trust has 70 safeguarding champions, with coverage in each Division, including community services. Their role is to: a) give advice and support around mental capacity and safeguarding adults, children and young people to staff in their respective directorates; b) to assist with the embedding of the Mental Capacity Act 2005 within the specialties in which they are based; 15

16 c) to drive forward the awareness of domestic and sexual abuse and the implementation of the use of the domestic violence, stalking and harassment risk assessment tool (DASHRIC). Each safeguarding champion can be identified by their safeguarding champion lanyard. The safeguarding champions have clear objectives. The last 12 months have been challenging and it has not been possible to invest time in developing the champions further due to cancellation of non-mandatory training at the beginning of the year and capacity of the safeguarding team to deliver champions training days. The champions have been supported at their Divisional meetings and clinically in their ward areas by the safeguarding team. The safeguarding champions in midwifery and within the Children s Hospital have continued to meet regularly with the Named Midwife and Safeguarding Children s Nurse respectively. A Champions forum has been arranged for Q Progress on priority areas/ challenges identified from 2016/17 annual report 10.1 Children, Young People and Midwifery Maintain compliance and assurance for all Safeguarding standards Completed markers of good practice and section 11 self-assessment tool. All actions identified are complete Continue to improve and develop training methods and compliance There remains a challenge in this area. As described above mandatory training compliance did not meet the required NHS England directive of 85% or Trust target of 90%. The safeguarding team has continued to work with Learning and Organisational Development to further offer additional training sessions into 2018 to try to meet this target. (12 sessions arranged for Q1) We need to train 1500 additional clinical staff in health wrap to achieve 87.7% compliance; 2000 more staff to achieve the NUH target of 90%. We remain reliant on staff being released to training to achieve these targets. We have offered the option of e learning but the take up of this has been very poor. As the systems are not compatible it would mean that the staff member prints off a certificate and send it to the safeguarding administrator to be inputted onto Moodle training focuses on modern slavery, child sexual exploitation and coercion and control and this a face to face session. We have had verbally positive feedback from staff who value the face to face element of the mandatory training Work towards NUH implementation of CP-IS NUH is CP-IS ready in ED and the CP-IS working group Chaired by the Head of Safeguarding will continue until an integrated system into Medway PAS has been implemented. This working group reports to the Safeguarding Children and Young Peoples Committee SCR sub-group establishment In view of proposed service re-design a decision has been made that the dissemination and impact on practice will be the responsibility of the safeguarding committees. 16

17 Continue to improve data collection including new quarterly reporting process Quarterly reporting continues within NUH and to the commissioners and data quality improvements have been well received by commissioners Work on self-harm with partners As described in Section Recruitment All posts have been recruited to and the safeguarding team is now up to establishment Adults Deprivation of Liberty Safeguards and changes to legislation and case law From 3 rd April 2017, deaths under a standard authorisation DOLS do not need to be routinely referred to the coroner (Police and Crime Act 2017) Safeguarding referrals to the Local Authority A shorter more concise referral form was introduced in August 2017 to assist staff in making safeguarding referrals. The safeguarding team quality assures all referrals to the local authority. As a result of the work the team has done with this over 64.9% of referrals from NUH move on to further assessment this is above the local safeguarding adult s board target of 55%, Staff allegations All allegations against staff will need to be addressed with consistency and discussed where appropriate with the Named Nurse for Adults or Children in conjunction with the Human Resources safeguarding lead currently the Assistant Director of HR. A new flow chart has been developed and included in the revised Safeguarding Allegations Policy (HRP&C013) The adult safeguarding lead will be providing some training to HR managers in Q1 of Recruitment Recruitment is complete and the team is now up to establishment 11 Priorities for Adults and Children 11.1 Achieve the NHS England target of 85% for Prevent training Plans are in place to achieve this as described above Embed learning from serious case reviews, safeguarding adult s reviews and domestic homicide reviews This is currently delivered within the mandatory training programme

18 11.3 Work on improving the quality of Children s safeguarding referrals to the Local Authority This will include a review of the referral process and forms used and is being led by the Named Nurse for Children and Young People Child Protection Information System (CP-IS) Continue with roll out of CP-IS in line with the local authorities going live Ensure that all safeguarding information is uploaded directed to DHR 11.6 Work with the Nerve Centre team to further improve data collection especially in relation to patients detained under the Mental Health Act Achieve Trust Mandatory training compliance of 90% for To hold two safeguarding champions development days Maternity 11.7 Improve Maternity safeguarding data collection 11.8 Implement a safeguarding specific workflow in Maternity Medway to improve sharing of safeguarding information and plans Undertake an audit to assess the quality of safeguarding documentation within maternity services Repeat the audit to ensure continued compliance of performing routine enquiry during the pregnancy pathway. 12. Summary The last year has seen continued high safeguarding levels of activity within NUH. This in part reflects high levels of safeguarding activity in Nottingham and Nottinghamshire. The increased demand due to mental health presentations (including self-harm) at NUH is reported above. This continues to emphasise the vital importance of integrated pathways with CAMHS and the Local Authority regarding safe discharge. The restructure of the safeguarding team is complete the new structure is working well and is complimenting the Think Family agenda. The teams are working more closely, sharing knowledge and experience but still maintaining their adults and children s specialities. The safeguarding adults and children s agenda is continually evolving and includes the application of the Mental Health Act, domestic and sexual abuse, FGM, CSE, Modern Slavery and Prevent in addition to the day to day strategic and operational safeguarding activity. Our safeguarding structure within NUH functions well and this is reinforced as a view from external scrutiny. Bella Dorman, Head of Safeguarding April

19 Appendix 1 Mandie Sunderland, Chief Nurse Nottingham University Hospitals NHS Trust Trust HQ, 3 rd Floor City Hospital Campus Hucknall Road NG5 1PB Dear Mandie Newark & Sherwood NHS Clinical Commissioning Group Balderton Primary Care Centre Lowfield Lane Balderton Nottinghamshire NG24 3HJ Re Safeguarding Quality Assurance Visit Many thanks for the opportunity for myself, Sandra Morrell, Designated Nurse Nottingham City CCG Alison Robinson Associate Designated Nurse (observing) Dr Nadya James Designated Dr Notts CCGs, Rhonda Christian and Jean Gregory Safeguarding Adult Leads and Allan Breeton Independent Chair of Nottinghamshire Safeguarding Adult Board to meet with your representative Daljit Athwal and Trust Safeguarding and Governance leads to discuss safeguarding arrangements in relation to the Emergency Department, the Labour Suite and Ward C29 at NUH. The objectives of the visit were To observe operational implementation of strategic safeguarding priorities To speak to frontline practitioners to capture their understanding and experiences of safeguarding arrangements and hear how they have implemented strategic safeguarding priorities in practice. NUH Strategic Safeguarding Evidence The CCG visitors had had previously had the opportunity to review the evidence submitted in relation to the NUH S11 and Safeguarding Adults Self-assessment tools, annual reports and update on progress of implementation of the Child Protection Information Sharing Project. Further assurance was offered on the day in response to questions in relation to: - Mental health admissions and co-ordination of multi-agency responses to enable safe prompt care and discharge planning. Implementation of the Learning Disability Review process The use of Red bags in relation to admissions from care homes Safe care planning and discharge of patients who are homeless or without recourse to public funds Chaperone policy and implementation Safeguarding training, components and operational delivery arrangements We visited the adult ED department, the Labour Suite, and Maternity Ward C29, observed the environments and spoke to a range of staff to gain an overview of safeguarding arrangements in practice. Findings from the visit Leadership and Organisational Accountability a) Staff were able to identify who the safeguarding leads were within the organisation and how they could contact them. Out of hours they stated that they would use the site matrons, duty nurse manager and silver on call as appropriate. b) Staff reported a proactive and supportive safeguarding team. They knew where to access advice and support around complex cases, and valued the team expertise and experience. The prompt response and personal approach to resolving issues was appreciated and appeared to increase staff confidence and competences. 19

20 c) There is an established system for distributing news and updates in relation to safeguarding through the Daily Rollcall and the Chief Nurses Bulletin d) Staff knew who to report concerns to and escalate issues if concerns were not resolved. e) Safeguarding was demonstrated to be seen as core business and this was evidenced by observing documentation and discussions with staff. f) The Trust is represented on both the City and County MARAC groups g) NUH have a clear policy for escalating concerns in relation to the availability of mental health beds. They have developed strong working relationships with NHCT and they work closely together to ensure patients are identified and supported within the hospital. h) Silver & Gold on call are aware of the challenges faced in relation to Mental Health beds particularly as the focus is now to allocate beds to people who are waiting in community settings as the risk is perceived to be higher for them. i) LeDER NUH have representation on the LeDER Steering Group and have already begun reviewing deaths internally. The currently have one death that needs to be notified. j) Roll Call is carried out daily in ED, and the Safeguarding Team were described by the Matron as being the most engaged team within the hospital. They frequently send updates but are more likely to attend themselves to deliver key messages and learning. Safer Working Practices a) Staff described what they would do if they had concerns about the behaviour of another employee and were aware of the whistleblowing Policy and the Allegations Against Staff Policies. They were confident in how to escalate concerns about unsafe practices or oppressive cultures. b) Staff were aware of the incident reporting policies and procedures and described the process of reporting an incident on STEIS Training a) Staff reported positive views of the Trust safeguarding training opportunities both through mandatory training on induction and on-going through annual updates and briefings which include the daily roll call and Chief Nurses Briefing. b) Staff were aware of current issues in relation to FGM, Modern Slavery and Domestic Abuse c) ED staff will be receiving PREVENT training between FEB MARCH 2018 but all new starters have the safeguarding mandatory training which is now level 3 for all clinical staff. Supervision a) Supervision is provided ad-hoc by senior staff, safeguarding leads, and the midwifery forum. (Staff reported they felt happy and confident to access even very senior members of staff as well as safeguarding leads. b) The Domestic Abuse Midwifery lead described how they received monthly safeguarding supervision from the Named Midwife. This is highly beneficial in light of the complex and high risk families with whom she works. c) Other staff, described how they access individual planned supervision and ad-hoc advice from the safeguarding team. This service was valued to enable reflection and joint decision making around complex and risky situations. Policies and Procedures a) Staff demonstrated an awareness of relevant safeguarding policies and procedures, and were able to access them through the Trust Intranet. Some staff had difficulty 20

21 locating some policies. b) Staff new how to make a safeguarding referral, what forms to use and where to send it. c) There had been a recent issue in relation to DASH RIC forms that needed to be faxed to a LA but this has now been resolved and forms are now scanned over to the LA. d) The Whistleblowing Policy highlighted by an individual on the Intranet was out of date. It was subsequently ascertained that an older version came up in a search result in error and this has now been rectified by ICT. The Policy had been reviewed and approved at Trust Board in June 2017 and is now on the intranet under Policies and procedures, Midwifery staff shared the Safe Discharge Plan for Babies Subject to a Child Protection Plan which has prominence in midwifery records and prompts safe discharge planning and communication e) There is a Chaperone and Dignity Policy available which appears to be well received. f) All staff questioned about the MCA demonstrated a good level of understanding of the legislation appropriate to their role. When a best interest decision was required the consultant was clear that this was a collaborative decision between the nurses and doctors and also involving relatives carers were they could and that it was clearly documented in the medical notes. Think Family Approach a) Midwives described how their assessments considered family and environmental factors and how vulnerable groups are prioritised for home visits. Increased maternity support is offered for these individuals at 34 wks. b) Staff demonstrated a good awareness of domestic abuse and the Trust Safeguarding and Domestic Abuse Leads have a high profile in the ED department, Midwifery Ward and Labour Suite. Staff appeared confident in clinical questioning around domestic abuse and completing DASH risk assessment forms and making safeguarding referrals to children s social care where necessary. Junior staff knew who to seek advice from if they had concerns or needed support. c) Homelessness - Staff in both ED and Midwifery services highlighted the increasing issues in relation to challenges around safe discharge of patients who were homeless or had no recourse to public funds. The Specialist Midwife for substance Misuse also has Homelessness within her portfolio and is proactive in working with partner agencies to ensure appropriate responses to this increasing issue. These issues are particularly prominent in the City, and the City Safeguarding Children Board has received a paper in relation to this and this issue continues to be an issue for the Multi Agency Partnerships. d) Staff gave examples of where they apply Think Family principles and consider dependent children or carers, referring to social care or other services as required. e) Staff raised concerns that the Mother and Baby (psychiatric) unit is due to move across town. This is a concern as it means the ward no longer will have rapid access to appropriate psychiatric support on-site, and the ability for rapid or regular review of an emerging case on the wards will not be so possible. The staff mentioned they feel (on reflection) that they have at times 'soldiered on' managing unwell women. It was discussed that there has been a feeling in the past that maternity is somehow separate to the rest of the hospital, and that they have been coping without realising they can activate the same levels of support as any other service. Examples include when there is a mentally unwell mother but the psychiatric unit is full, or when they have no beds for the influx of patients. They are now aware they can call bed managers and silver on call etc., which has really helped them. Voice of service users a) Staff worked hard to ensure that service users who were non-english Speakers were able to access translation services from within the Trust. Where in-house interpreters could not be found alternative provision was secured by an external interpreting service. 21

22 Environment k) The clinical areas were clean and tidy with no patient identifiable information on display. Issues Identified Recording Systems Staff commented on the complexities of recording systems which pose significant challenges to ensure safeguarding information follows patients from GP primary care, through community midwifery and hospital services and out as safe discharge information to GPs and 0-19 services. The risks are that safeguarding information may be lost in translation from one system to another. These challenges have been exacerbated by the removal of GP practice based midwifery services and changes to the 0-19 service provision meaning staff have to go the extra mile to share relevant information. Some staff on maternity wards have no access to SystmOne, so cannot see protection plans or alerts placed on that system. Community Midwives may be able to look this up for them if they are in the Hub (which staff found helpful), but they relied heavily on information being handed over from labour suite. Hospital-based systems (e.g. Notis) can have alerts placed on them, but this again depends on information being handed over by the community. The new ICT system (Medway) allows safeguarding concerns to be entered into an electronic record, but staff explained these notes get lost amongst all the other electronic entries and can be hard to locate. Internally, the staff do have paperwork in the patient's file that they use to highlight concerns, using a mixture of codes (these do not appear to be official or standardised). The ward does however rely heavily on good handover from labour suite/neonates etc. They feel their communication is very good (and it appears to be so). A staff member in ED pointed out that the Domestic Abuse marker was not input onto the records out of hours, they wait until the DA nurse is in. When we asked the matron why this was she wasn t sure as all other markers are entered by the band 7 s. On asking the exec team they were able to clarify that this was because a marker was not entered onto the record until the case had been to MARAC and all facts established. And a MARAC action agreed for an alert to be placed on the records. Staff felt that they would value safeguarding link midwives attending morning handover in order to get 'heads up' on cases (as happens in paeds), or at least to have the ability to the links daily with cases. Staff on Maternity Wards are struggling with filling in safeguarding referral forms as they are not 'user friendly' and the boxes do not expand when filling with text. They also reported that they are faxing them. Advice was given to utilise nhs.net for secure ing and how to set this up, and how to download and amend templates to allow more text, and uploaded to the hospital electronic records system. Areas for development a) We would recommend The Trust monitor the quality and effectiveness for sharing safeguarding information and alerts in relation to adults and children at risk between GPs, community and hospital midwifery and 0-19 community services. This was an area of challenge which staff identified which potentially impacts on the safety of unborn babies and children. b) The Trust needs to gain assurance that staff have access to secure accounts to allow safe secure submission of safeguarding referrals, and ensure that staff understand that faxing of information should not be used for this purpose. c) The Trust may wish to develop plans (if not already underway) to ensure effective support and communication for staff in relation to Mothers experiencing mental illness in anticipation of the transfer of the Mother and Baby Unit to a separate location. The above information gave us significant assurance that the Trust is prioritising the safety and welfare of children and adults. It was a very positive visit which evidenced the Trust is 22

23 fulfilling their contractual safeguarding responsibilities. Many thanks for taking the time to meet with us. We will forward a copy of this letter to the NSCB and NCSCB for information Yours sincerely Val Simnett Designated Nurse Safeguarding Children Nottinghamshire CCGs CC. Elaine Moss Chief Nurse, Newark and Sherwood and Mansfield and Ashfield CCGs Nichola Bramhall Chief Nurse Nottingham North & East, Nottingham West & Rushcliffe CCGs Sally Seeley Director of Quality and Delivery, Nottingham City CCG Nadya James Designated Dr Safeguarding Children Mid-Notts Sandra Morrell Designated Nurse Safeguarding Children Notts City CCG Rhonda Christian Safeguarding Adult Lead City CCG Jean Gregory Safeguarding Adult Lead South Notts CCGs Sue Barnitt Safeguarding Adult Lead Mid Notts CCGs Allan Breeton Independent Chair Nottinghamshire Safeguarding Adult Board Steven Baumber, NSCB Board Manager 23

24 Appendix 2 Activity Data The information collated is a summary of the safeguarding nurse activity and statutory data collated for 2017/18 ACTIVITY Q1 APRIL JUNE Q2 JULY SEPT. Q3 OCT DEC. Q4 JAN - MARCH Referrals to Safeguarding Team from clinical areas (in patient activity ) Advice calls Messages left on team answer phone Referrals to Social Care from Emergency Department COMMENTS Information received via electronic SBAR Template Children where there are safeguarding concerns, complex needs, staff allegations, signposting and working with external agencies As above and case specific discussions, planning of SG Meetings Themes Self Harm(12-18 years ), Domestic Abuse, Non accidental injury and neglect (0-5 years ) Supervision sessions To Specialist Nurses within Family Health Follow up of appointments where child Was not brought Domestic Violence Nurse Safeguarding issues identified Referrals/DASH Specialist ED activity MARACs MARACs attended 24

25 MEETINGS Q1 Q2 Q3 Q4 COMMENTS 74 DPM 47 Strategy 20 RCPC 1 MDT 2 Child Death DPM- 49 Strategy -20 RCPC 1 Professional 2 MDT -2 Child Death DPM 38 Strategy- 17 MDT- 2 Professional DPM 31 Strategy 11 MDT-2 Professional-2 Safe Discharge Planning, professional, Strategy/Initial/review Child protection Conferences MEDICALS ACTIVITY Q1 Q2 Q3 Q4 COMMENTS Nonaccidental Injury 112 (plus 25 not seen but advice given) 88 (plus 26 not seen but advice given) 67 (plus 30 not seen) 48 (plus 23 not seen) Breakdown as follows:- SEEN City 78 County 25 Mansfield 1 Out of area 8 Total 112 Breakdown as follows:- SEEN City 65 County 18 Mansfield 0 Out of area 5 Total 88 Breakdown as follows:- SEEN City 45 County 20 Mansfield 0 Out of area 2 Total 67 Breakdown as follows:- SEEN City 35 County 11 Out of Area 2 Total 48 Medicals are completed as part of the Section 47 Child protection enquiries. The organisation has a duty to comply with requests by the Local Authority as per Children Act 2004 Child Sexual Abuse 49 (plus 15 not seen but advice given) 39 (plus 9 not seen but advice given) 40 (plus 19 not seen but advice given) 38 (plus 22 not seen) As above REPORTING 25

26 ACTIVITY Q1 Q2 Q3 Q4 COMMENTS FGM Data As per below Section 85 (children in hospital >3 months)statutory reporting to Local Authority Children with complex medical needs TRAINING ACTIVITY Q1 Q2 Q3 Q4 COMMENTS Level 1 - new starters non PODCAST PODCAST PODCAST PODCAST patient facing (30 mins) Nursing and Midwifery Induction (SG Families new starters) Level 2 (1 hr 45 minutes) 3 sessions 3 sessions 6 sessions ALL LEVEL 3 Level 3 (1hr 45) 5 sessions 9 sessions 0 sessions 5 sessions Prevent and safeguarding children level 3 ( 1 hr 15 minutes) Emergency Department Training New starter level 3 including DV and DASH form completion 2 sessions 4 sessions 0 sessions 19 sessions 2 sessions 4 sessions 39 sessions 7 sessions 0 sessions 29 sessions 4 sessions 0 sessions DV refresher (level 3) SERIOUS CASE REVIEWS/LEARNING EVENTS ACTIVITY TOTAL NUMBERS COMMENTS Q1 Q2 Q3 Q4 Serious Case Reviews Outstanding actions SILPs 0 0 0? 1 Learning review Requests for information Safeguarding Adults Annual Activity Summary Appendix 3 26

27 April 2017 to March 2018 Referral Activity Safeguarding Referrals to the team Safeguarding Advice Domestic Abuse MCA & Consent Urgent DOLS Referred Section 42 enquiries concerning NUH Quarter Quarter Quarter Quarter TOTAL Safeguarding Referrals: Adult Safeguarding at NUH is focused upon empowering staff to identify possible abuse and make referrals. The new safeguarding adult s referral form for the trust is now in use across the organisation. These are submitted to and processed by the adult safeguarding team. As well as monitoring and processing referrals, the team give safeguarding advice. This involves: Staff seeking advice about possible abusive situations and how to respond Requests for further advice on safeguarding processes Input request from outside agencies regarding information sharing The safeguarding data does not include multiple contacts regarding ongoing cases. Domestic Abuse: The majority of domestic abuse referrals are passed to the female safeguarding workers, with a small number assigned to the safeguarding adults lead (male worker). Deprivation of Liberty Safeguards (DOLS): The team approve and assist with all urgent DOLS requests, prior to submission to the local authority Mental Capacity Act (MCA): The team receive a number of varying referrals regarding mental capacity. These include: Advice regarding the mental capacity act Requests for independent mental capacity assessments Input and advice regarding Lasting Powers of Attorney Advanced decisions to refuse treatment (ADRT) The MCA referrals are often complex cases that require deeper input from the team. Annual Training: Session Title Time per Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total 27

28 Mandatory Training Corporate Induction Doctors Induction session 1 hour hours 45 minutes 30 minutes Multi-agency risk assessment conferences (MARAC) Domestic Abuse Title Time Total Sessions MARAC 6 hours 24 Research 5 hours 24 Safeguarding Adults Reviews (SAR) and Domestic Homicide reviews (DHR) meetings Title Quarter 1 Quarter 2 Quarter 3 Quarter 4 TOTAL SAR DHR Acute Liaison Learning Disability Nurse Team Annual Activity Summary April 2017 March 2018 Appendix 4 28

29 Referrals Total Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Referral source April March 2018 Alert NUH CLDT HF Other Paid Carer Unknown Family/Friends Self Not Recorded 2% 1% 0% 16% 4% 43% 6% 1% 6% 21% Alert: Flags on hospital systems (known Learning Disability) NUH: Staff CLDT: Community Learning Disability Team HF: Health Facilitator 29