Annual Safeguarding Children and Adults at Risk Report

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1 Annual Children and Adults at Risk Report Authors; Paula Adams, Deborah Wallwork, Nicola Mitchell, Karen Charlton and Susan Wallace May 2017

2 Contents Chapter Title Page Introduction and Overview 1 1. Mainstreaming safeguarding children, young people and adults 3 at risk into everyday business 1.1 Operational business units Children Champions Children Links Adult Links Partnership working 4 2. Effective safeguarding structures and governance arrangements Locala Committee Locala Board Named Doctor Policies and Procedures Section 11 Self-audits KSAB Challenge Event Mandatory Training Supervision Performance Data 11 3 Learning through experience and continuous improvement Serious Case Reviews Domestic Homicide Reviews Adult Reviews Incidents Allegations against Locala 16 4 Development of Knowledge and Skills of Locala Colleagues In house face to face learning team contacts Training Needs Analysis Children Supervisor Development 18 5 Engaging with Service Users Making Personal Voice of the Child 20 6 Risks and Challenges 21 7 Key Priorities for

3 Introduction and Overview This annual safeguarding report provides an account of safeguarding activity within Locala from 1 April 2016 to 31 March It summarises information about the efficiency and effectiveness of our internal safeguarding systems and processes, in order to demonstrate progress and the status of compliance with our statutory safeguarding obligations during 2016/2017. The report also highlights on-going work and developments and outlines our engagement with Local Boards, partner agencies and other multi-agency commitments. This year has seen a number of significant challenges. Management arrangements for the safeguarding team have been predominantly interim arrangements due to the unexpected long term sickness and subsequent retirement of the Director of Quality, who was the direct line manager of the team and Head of. A named nurse has been in the role of Acting Lead since September, with executive leadership provided by the Acting Director of Quality until longer term management solutions have been agreed. A longer term solution is a priority as the demands on the safeguarding children team have increased significantly over this year due to tender preparation and subsequent mobilisation of services and formal case reviews initiated by Kirklees Board. Adult safeguarding team resources were significantly depleted during the months of July and August, after a full time named nurse adult left the organisation, requiring cover to be provided by the children safeguarding named nurses signaling a move towards a more integrated team. The first named professional for safeguarding adults from a non-nursing background joined the team at the end of August. The amalgamation of adult and children safeguarding into one safeguarding team needs to be further developed to create a resilient, experienced and knowledgeable integrated team. There has also been a recognition and acknowledgement of the need to introduce skill mix within the safeguarding team to facilitate leadership, establish clear lines of accountability, support safeguarding development and succession planning and ensure appropriate use of expertise, skills and knowledge in relation to safeguarding team work. The 2016 Ofsted inspection rating of inadequate of Kirklees Children s Social Care and Kirklees Children Board has had a significant impact on frontline practitioners and the safeguarding team alike. The number of children in Kirklees subject to child protection processes (431 on 31/03/17) and taken into Local Authority care (698 on 31/03/17) has continued to rise throughout the year. Capacity within frontline services to meet the increased demands of child protection work has been, and continues to be, a significant challenge; particularly for the school nursing service. The challenges within Kirklees children s social care that resulted in the Ofsted rating has also had an impact on the effectiveness of multi-agency working and this year has seen a sustained increase in 1

4 incidents noted by Locala practitioners of non-adherence to safeguarding procedural expectations. Increased resource from the safeguarding children team has also been utilized to support development and improvement work to address these difficult issues, as we are committed to work in partnership to improve outcomes for children in the Local Authority areas where we provide services. The CQC inspection of four Locala services in October also highlighted areas for development in relation to safeguarding and resulted in a major review of our safeguarding governance arrangements and assurance processes. children and adults is an integral aspect of care, requiring all services to work effectively together to prevent harm and intervene only when harm, neglect, or abuse is suspected. Work is continuing across the organisation, both at an operational and strategic level, to ensure that safeguarding children and adults at risk becomes everybody s business as opposed to being seen as the remit and responsibility of the specialist practitioners within the safeguarding team. These changes and developments are underpinned by the first Locala Integrated Strategy and Implementation Plan that outlines our approach to ensuring the safety of all adults at risk, children and young people. It is a 3 year strategy that recognises the need to place safeguarding at the heart of everything we do and sets out how we will improve in five key areas. This report outlines the progress that has been made and the key challenges and developments for 2017/2018 in each of the five key areas. Mainstreaming safeguarding children, young people and adults at risk into everyday business Effective Structures and governance arrangements Learning Through Experience and continuous improvement Development of Knowledge and Skills of Locala colleagues. Engaging with Service Users 2

5 1. Mainstreaming safeguarding children, young people and adults at risk into everyday business We understand that good communication underpins the effective safeguarding and caring for vulnerable children and adults at risk. The development of clear unambiguous information for colleagues and service users is essential to achieve full engagement at all levels within Locala with the wider safeguarding agenda. This year has seen the introduction of a monthly safeguarding update in the electronic newsletter Locala Live and an integrated quarterly safeguarding team newsletter to relay key messages, news and updates. However, we understand that a variety of approaches to relay key messages is required to reach all colleagues. 1.1 Operational Business Units From November 2016 a member of the safeguarding team has presented an integrated safeguarding report at all monthly operational business unit management meetings. This has enabled the business unit managers to have direct knowledge of the safeguarding issues and challenges within their services and develop a collaborative approach to progress the safeguarding agenda within the services they manage. Attendance has also provided a means of cascading essential information throughout the business unit. Work to progress Undertake an audit of all operational team meeting minutes during a given timeframe to determine whether safeguarding is routinely considered and discussed during team meetings and the effectiveness of the current means of cascading information. 1.2 children champions children champions were recruited within the health visiting and school nursing services during to increase frontline practitioner knowledge about safeguarding processes and procedures and to promote standardisation and good practice across all teams. Quarterly meetings during have enabled the safeguarding children team to understand and appreciate the safeguarding challenges from a practitioner perspective and to disseminate current good practice directly to frontline practitioners. Work to progress in champions. review and evaluate the impact of safeguarding 1.3 Children Links The quarterly safeguarding children links skype meetings for Integrated Children s Services and Wellbeing Services (those accessed by young people) were reviewed and subsequently discontinued in December 2016 and February 2017 respectively due to falling attendance. Two way safeguarding communication of operational key messages and updates is now taking place during the monthly strategic leads meeting in Integrated Children s Services. 3

6 A safeguarding update and presentation was delivered at the Wellbeing Forum in November Work to progress updates during will relate to both safeguarding adults and children. A member of the safeguarding team will aim to attend either clinical forums or team meetings for all wellbeing and integrated adult services a minimum of once per quarter. 1.4 Adult Links adult links meetings were re-instigated this year with the first meeting taking place February 2017 where Terms of Reference and membership were agreed. Work to progress evaluation of impact, outcomes and achievements during Partnership working Locala has worked hard to develop strong and effective partnerships and working arrangements both at an operational and strategic level. We continue to engage with, and be active members of Kirklees Children Board (KSCB) and Kirklees Adults Board (KSAB) and their associated work streams/subgroups across Kirklees. There has been Locala representation at all KSCB and KSAB full board meetings this year. The safeguarding children leads are members of the KSCB Evaluation and Effectiveness, Child Sexual Exploitation (CSE) and Learning and Development workstreams. A named nurse is also a member of the KSCB Neglect task and finish group. The named nurses also contribute to the delivery of the KSCB multi-agency training programme. The operational manager for the school nursing service in Calderdale has represented Locala on the Quality and Performance subgroup of Calderdale Children Board in relation to the school nursing service. The safeguarding children team also attend the Kirklees monthly MACSE (multi-agency child sexual exploitation) meeting and provide information to the Calderdale weekly CSE hub meetings. This enables any relevant health information to be shared to inform risk assessments and for information to be recorded in health records to alert health professionals to CSE risks. There has also been safeguarding children representation at the Kirklees MARAC (multiagency risk assessment conference) at 22 of the 24 bi-monthly meetings. A full report of health information was sent on the 2 occasions when it was not possible for a team member to attend. Essential relevant key information and the MARAC action plan is 4

7 recorded into every child and pregnant women s record following a MARAC discussion to alert the relevant health professional to the current risks of domestic abuse. The safeguarding adult leads are members of the KSAB Training and Quality and Performance subgroups. A safeguarding adult lead is also member of the KSAB hoarding and self-neglect panel meetings to share relevant health information and inform assessments of risk to both the individual and other people. Key Challenges for The level of resource and representation required from the safeguarding team on two LSCBs and 7 associated workstreams following the successful bid for the provision of the Public Health Early Years Service in Calderdale from 01/07/17. Mitigation recruitment of a full time specialist safeguarding children nurse and an internal audit review of safeguarding team resource. 2 Effective safeguarding structures and governance arrangements This year Locala has strengthened governance arrangements in order to gain positive assurances that safe and effective processes and systems are in place to effectively safeguard all children, young people and adults at risk of abuse who access our services. Governance arrangements will be further strengthened during 2017/2018 to provide increased levels of assurances of meeting our statutory responsibilities. 2.1 Locala Committee Locala Committee meetings are held on a quarterly basis and were chaired by the current Executive Lead for at the time of each meeting. A 3 year Integrated Strategy that incorporates an annual work programme with agreed key safeguarding performance indicators was approved at the Quarter 3 meeting. As a provider of NHS Care, Locala is required to provide assurance of compliance with safeguarding standards to the Designated Nurse/Professional for Children and Adults on behalf of the CCG. The self assessment audit tool was initially completed in September 2016 with several standards not fully met. The work programme undertaken by the safeguarding team enabled all actions to be completed by the end of the year with sign off at the Quarter 4 safeguarding committee. Revised terms of reference, placing a significantly increased emphasis on assurance and on criteria for evaluating the effectiveness of the committee, were approved at the Quarter 4 committee meeting. This will ensure a more defined purpose and focus of the committee for

8 2.2 Locala Board The board began to have increased oversight of safeguarding risks and activity throughout this year via a status update report submitted via the Acting Lead in November 2016 and Committee KORS submitted to the monthly clinical quality group. A monthly quality update report, incorporating safeguarding, has been provided directly to the Board by the Acting Director of Quality since February Named Doctor As a provider of NHS funded services Locala has a statutory requirement to identify a named doctor for safeguarding children. In previous years this has been the Named GP appointed by the local CCG but this option is no longer available. This year a GP from one of Locala s GP practices was appointed to the role of Named Doctor. The role is still in the early stages and needs further development. Work to progress development of the Named Doctor role 2.4 Policies and Procedures The following safeguarding children and adult policies have all undergone a full review and update this year to ensure they reflect both local and national learning and also changes and updates to safeguarding agenda procedures and processes. Children and Young People Mental Capacity Act and Deprivation of Liberty Safeguards Adults at Risk Domestic Abuse Locala does not have an overarching set of safeguarding standard operating procedures (SOP). The safeguarding committee members accept that a SOP is not feasible due to the current pace of change and safeguarding procedural developments across the three Local Authority areas where we provide services that would require continual re-submission for ratification. However, all safeguarding adult and children policies incorporate direct links to multi-agency safeguarding procedures and there is also a direct link to multi-agency procedures from the Locala intranet site. This year guidance and procedural flowcharts relating to subject areas of the safeguarding adult and children agenda have been produced and are readily available to all colleagues on the safeguarding homepage on the intranet ELSIE e.g. child sexual exploitation, human trafficking, hoarding and self-neglect. For assurance purposes all future updated guidance and procedural flowcharts will require approval by the safeguarding committee. 6

9 2.5 Section 11 self-audits Locala is required to complete a Self-Assessment Audit in relation to statutory duties under Section 11 Children Act The self-audit is led and monitored by Local Children Boards and aims to assess the effectiveness of the arrangements for safeguarding children at a strategic level. KSCB Section 11 self- audit and challenge event is conducted on a 2 yearly basis. There was no audit this year, however, all the outstanding actions arising from the 2015 child sexual exploitation themed Section 11 challenge were completed with sign off at the Quarter 4 safeguarding committee meeting. CSCB requires a Section 11 self-audit to be undertaken by each individual service. Audits were submitted from community dental services and the school nursing service in Calderdale in June The action plans to achieve full compliance were completed this year with sign off at the Quarter 4 safeguarding committee meeting. BSCB section 11 self-audit was requested by Bradford Public Health Commissioners on behalf of BSCB for Bradford Integrated Sexual Health Services. There are two outstanding actions required to achieve full compliance. Progression will be monitored via the Wellbeing business unit meeting and reviewed at the Q safeguarding committee meeting. 2.6 KSAB Challenge Event The KSAB challenge is an annual event whereby representatives from each partner agency are challenged by a small panel of board members in relation to progress made with safeguarding adult arrangements with a focus on KSAB strategic priorities. The challenge event took place in September 2016 and areas of progression and those for further development were identified. There has been no formal monitoring of progression this year by the safeguarding committee. Work to progress - to develop an action plan for formal monitoring by the safeguarding committee for Mandatory Training A new approach to safeguarding children mandatory training was introduced in April 2016 based on adult learning theory. This approach offers learner choice to undertake bespoke tailored learning to meet their own individual needs to achieve the required level of competences as outlined in Children and Young People: Roles and Competences for health care staff. Intercollegiate Document (RCHCP, 2014). 7

10 The roll-out of this new approach was beset with issues from the outset, however, an intensive joint campaign by workforce and safeguarding children team members resulted in a significant increase in compliance by the end of the year. Children Learning Compliance as at 31/03/17 level Number completed Total number required to Percentage compliant self-declaration complete self-declaration % % % % Work will continue to support all colleagues to achieve compliance and is to be monitored via the business unit meetings and safeguarding committee. Work to progress continued support to increase compliance rates and undertake an audit of the quality of the evidence of learning activities undertaken by colleagues Adult Training All safeguarding adult mandatory training is via e-learning this year and the compliance rates as at 31/03/17 are shown in the table below. Course Mental Capacity Act Adults Part A Adults Part B Compliance rate 96% 99% 97% Volunteer Training Locala currently has 102 volunteers. All volunteers must either complete the e-learning modules Level 1 safeguarding children and Adults Part A or receive face to face safeguarding training before commencing active volunteering. For those volunteers who remain with Locala for more than one year it is mandatory to complete an annual face-to-face refresher safeguarding adults and children training with a member of the safeguarding team. There are currently 54 active volunteers that have remained with Locala for over one year (many leave within a year to take up paid employment or higher education). Number of active Number attended Number booked on Total volunteers >1 year refresher training refresher training (96%) 8

11 Compliance is monitored by the volunteer service manager who is attempting to make contact with the 2 volunteers who are not yet booked on refresher training. LCP Board training A bespoke face to face safeguarding children and adult update was delivered to 9 board members and 2 non-executive directors (NED) waiting to formally take up their posts. In November 2016 in accordance with the requirements of the Intercollegiate Document (2014). The update session incorporated an activity designed to consider how the board may be assured of safeguarding arrangements within Locala. 2.8 Supervision Supervision is acknowledged in child welfare to be one of the primary means of improving outcomes for children and for developing the safeguarding skills and knowledge of practitioners and is therefore mandated for certain roles. The specific requirements are set out in the Children and Child Protection Policy (2015). Business Unit Q1 Q2 Q3 Q4 Integrated Children Services 82% 93% 83% 93% Wellbeing 49% 65% 68% 70% Compliance rates are below policy requirements throughout all four quarters this year. A new system for recording attendance at safeguarding children supervision was introduced this year. Whilst the new approach is far more reliable, the change was implemented without consultation between performance team, the safeguarding team and operational leads and has consequently taken considerable time to communicate and embed in practice. In order to ensure compliance with policy requirements there needs to be a sufficient number of safeguarding children supervisors who are trained and supported to provide quality supervision to colleagues. A shortage of supervisors in some services has impacted on the availability of group supervision particularly in wellbeing services. The safeguarding children nurses have facilitated supervision sessions in services where there has been a shortage of supervisors and are working with service managers to develop action plans to improve compliance. Risks non-compliance with supervision policy requirements Shortage of trained safeguarding children supervisors in some services Mitigation safeguarding children team to work with operational managers and service leads to develop action plans to achieve the required 98% compliance with group supervision requirements by end of Q1 in 2017/

12 Rolling 3 year supervisor training and development programme to be accessed by all Band 6 and 7 clinical practitioners in children s 0-19 services. Work to progress - ongoing data cleansing to ensure data accuracy Individual Supervision The safeguarding team maintain records of colleagues who have accessed individual safeguarding supervision with a member of the team and safeguarding supervisors are required to provide quarterly information about their individual supervision activity. There is currently no means of triangulation to identify colleagues who have not accessed individual supervision in accordance with the Children and Child Protection Policy (2015) requirements. Risks lack of assurance about individual safeguarding children supervision compliance Mitigation - The safeguarding team are working with the performance team to establish robust mechanisms for recording and monitoring individual supervision compliance for 2017/2018. Children Supervisors A new requirement for all safeguarding children supervisors to attend a minimum of 2 group supervision sessions for supervisors facilitated by a member of the safeguarding team was introduced this year. All supervisors attended one session but only 74% attended the required 2 with geographical issues and capacity cited as reasons for non-compliance. Risks not all supervisors able to access supervision for supervisors to support development and quality assurance of supervision practice Mitigation increase availability of safeguarding supervisor supervision opportunities with wider geographical venues and options. Adult Supervision Adult safeguarding supervision is considered best practice but is not currently mandated in any service. There is currently no specific training for adult safeguarding supervision. Work to progress - Data will be collated during to determine the baseline level of adult safeguarding supervision taking place across Locala services. 10

13 2.9 Performance Data for The table below highlights safeguarding children and adults at risk performance data for this year to provide assurance that colleagues are engaged in statutory safeguarding procedures and processes. However, additional information and work is needed to provide a meaningful narrative. Number of Referrals to children s social care Kirklees 55 Calderdale 4 (YOT) Bradford 3 Initial child protection case conferences Kirklees 661 Calderdale 182 Review child protection conferences Kirklees 957 Calderdale 165 Core group attendance Kirklees 2636 Calderdale 529 Legal statements provided for child welfare (28) Kirklees 26 Calderdale 2 Child welfare court cases where colleagues 3 required to give evidence FGM mandatory reporting 0 Referrals to MARAC (Multi Agency Risk 10 Assessment Conference) Referrals to Pennine Domestic Violence 27 Group (PDVG) for outreach support Child Death Overview Panel returns 25 PREVENT enquiries 2 (only recorded since quarter 4) Early Indicators of Concerns forms 17 completed DoLS applications 1 There has been no mandatory reporting of FGM this year but it must be noted that routine screening is not currently mandated in health visiting and school nursing services. All the 11

14 referrals to MARAC and PDVG were from children s services this year. Adult safeguarding performance data has been derived from incident reports or data bases developed by the adult safeguarding leads as current safeguarding templates within adult services are not consistently or routinely used and data is likely to be unreliable and inaccurate. Risks Locala requires assurances from across all the new 0-19 Thriving Kirklees partnership service next year. The impact of the reduction in the number of nursing registered colleagues in the new model to be able to meet the safeguarding work demands. Mitigation introduction of an operational safeguarding group meeting within integrated children s services where safeguarding performance will be monitored and analysed. Ongoing work with public health commissioners in Kirklees to understand the capacity and resource issues in relation to safeguarding children work. Exploration of appropriate use of skill mix within safeguarding and child protection work Work to progress - Quality assurance and monitoring of the outcomes of all referrals to children s social care. (This will not only develop practitioner skill and assessment of levels of need but will also help to support children s social care to reduce the number of inappropriate referrals.) Introduction of a standard adult safeguarding template to support adult safeguarding assessments and record keeping and also to facilitate data reporting to gain an overview of adult safeguarding activity and practice across Locala services. 3 Learning through experience and continuous improvement We are continuing to develop effective systems for prevention, reporting, responding and learning in respect of safeguarding and be reactive to changes in the safeguarding landscape. Learning from safeguarding reviews and incidents is disseminated widely and included on the monthly safeguarding report for all business unit meetings, discussed at clinical forums and team meetings and reported in Locala Live and the safeguarding newsletter. All action plans based on recommendations and learning from multi-agency safeguarding children or adult reviews are formally monitored by the safeguarding committee. 3.1 Serious Case Reviews (SCR) A KSCB SCR involving Locala service provision was completed this year. The specific learning for Locala was to ensure that the voice of the child is captured within health visiting and school nursing assessments to inform analysis and interventions. The learning has been cascaded and introduced into health visiting and school nursing services. 12

15 This year one SCR and two learning lesson reviews with involvement of Locala services were initiated and are still ongoing at the end of this year. Work to progress Additional work with other children s services and wellbeing services to ensure the voice of the child is consistently captured within clinical assessments in all services accessed by children and young people. Undertake a clinical record audit to provide assurances that the learning has become embedded in practice BSCB initiated a SCR with involvement of Locala Sexual Health Services whilst under a previous provider. A joint action plan between the previous provider and Locala has been agreed but all actions are not yet complete. The learning is specific to CSE and sexual health services. Groups and Relationships Re-Audit An initial audit into completion of the groups and relationships section of children s records was initiated in response to learning from a serious case review where no agency knew the details of or the level of involvement of a child s biological father was undertake in This year a repeat audit of completion of the Groups and Relationships section within the electronic health record of children on active caseloads in children s services highlighted significant improvements in completion across the services audited. Completion of groups and relationships will now be incorporated into the audits of clinical record keeping undertaken in all children s services. 3.2 Domestic Homicide Reviews (DHR) Locala has had no service involvement with any domestic homicide reviews initiated in any of the Local Authority Areas in which we provide services this year. A Kirklees DHR action plan developed for a service whilst under a previous provider was became no longer appropriate due to the redesign of the new service provided by Locala. An amended action plan was accepted by the DHR panel and approved and signed off at Q4 safeguarding committee. A DHR concluded in Calderdale this year where there had been involvement of the school nursing service whilst under the previous provider. There is no specific learning for Locala colleagues but the generic learning around risks of domestic abuse has been communicated and incorporated into domestic abuse in house learning opportunities. 13

16 Routine domestic abuse enquiry An initial audit of health visitor records following a domestic homicide review identified that the routine enquiry using recommended domestic abuse screening questions, when appropriate to do so, was not consistently or robustly captured in clinical records. Prompts were then added within SystmOne and the results now demonstrate that routine screening takes place when safe to do so and that the reason for not asking screening questions is now clearly documented. Key Challenges Contributing to safeguarding reviews when we were not the provider of the service at the time of involvement. Assuming responsibility for progression of multi-agency safeguarding review incomplete action plans when Locala becomes the new provider of an existing service. 3.3 Adult Reviews There have been no safeguarding adult reviews initiated during the timeframe of this report. 3.4 Incidents The table below illustrates the number of incidents reported this year indicating potential safeguarding adult or children concerns. All incidents submitted with safeguarding children or adult concerns indicated are now reviewed directly by a member of the safeguarding team. There is no consistency or standard category of reporting safeguarding children or adult at risk incidents across all business units and in many cases it was deemed not appropriate for safeguarding children or adult concerns to have been indicated. Business Unit Number of potential safeguarding children incidents Number of potential adult safeguarding incidents Number of alerts made to Gateway to Care Integrated adults Integrated children Wellbeing Total Potential Children Incidents The graph overleaf illustrates the safeguarding children incidents by category. Communication is by far the most common category accounting for 66% of all potential safeguarding children incidents submitted this year. Of these 61 (63%) relate to communication issues with children s social care including lack of receipt of minutes from core groups and child in need meetings, health colleagues not being informed when social care led meetings 14

17 cancelled or rearranged, no allocated social worker for children subject to child protection plans and no social worker attending for pre-arranged core groups. A further 10 incident forms relating to social care practice were submitted under the category of referrals or clinical records. The issues were raised directly with the Assistant Director for Children s social care and the service manager for assessment and intervention. Plans to address these issues and work together more collaboratively were agreed in February 2017 but due to ongoing social worker retention issues within social care the challenges remain ongoing, plans have not progressed and incident forms continue to be submitted. The concerns re the ongoing impact of children s social care on children and on multi-agency work have also been highlighted to Kirklees Children Board SAFEGUARDING CHILDREN INCIDENTS BY CATEGORY incidents relate to breakdown in communication from midwifery services but only 1 had actual safeguarding children implications. Only 2 of the incidents reported under the category of violence and abuse related to aggression (verbal) towards colleagues. One of these resulted in awareness raising of the need to consider child welfare when aggression is experienced towards a colleague in the presence of a child. Learning from potential safeguarding children incidents has resulted in Escalation of concerns to senior children s social care managers in Kirklees a full review of Locala MARAC information guidelines 15

18 liaison with midwifery services to review discharge documentation highlighting the need to be alert to the potential of disguised compliance review of internal admin processes for management of child protection information Potential Adult Incidents 47 safeguarding adult concern incidents resulted in an alert being made to adult social care in Kirklees. There are a variety of reasons why alerts were not raised in the other incidents ranging from work with care homes to improve on infection control and medicines management, completion of early indicator of concern forms as an alternative and listening to the wishes of the adult at risk, however, the reason is often not recorded. A prompt has been added for 2017/2018 in the Datix reporting system for colleagues to record the rationale behind a decision not to raise an adult at risk safeguarding concern with Gateway to Care. A full review of safeguarding adult incidents this year has been undertaken to identify patterns and trends and will be presented at Q1 safeguarding committee. Work to progress Guidance is to be developed to indicate what should and should not be reported as a potential safeguarding adult or child incident. 3.5 Allegations against Locala This year 17 safeguarding concerns were raised with Gateway to Care with Locala named as the alleged perpetrator (7 of these were raised by Locala colleagues against Locala services). The breakdown of allegations per service is shown in the graph below. Breakdown by service Home care District nursing Individual Intermediate care Rapid response Podiatry Three of the concerns raised against Locala have proceeded to case conference with the following outcomes 1 case of neglect substantiated against all the agencies involved 16

19 1 inconclusive 1 abuse not substantiated. The other cases are still ongoing and two of the ongoing cases have been held up in the safeguarding process due to police investigations. Learning taken forward from the case conferences have included ensuring improved communication between district nurses and care homes, more detailed explanation of the risks in regards to pressure care and the development of action plans to reduce insulin incidents. A new policy Managing Allegations against Staff was developed in response to learning from one of the allegations which is being investigated as a serious incident. Work to progress develop a combined single safeguarding report for all monthly business unit meetings to facilitate safeguarding learning to be shared across all business units. 4 Development of knowledge and skills of Locala colleagues There has been a shift away from a sole reliance on training this year to achieve safeguarding learning. Locala recognises that colleagues learn in different ways and have differing learning styles. In house learning opportunities have been developed and delivered in response to identified knowledge gaps or learning needs. Multi-agency adult and children safeguarding training is available to all colleagues via the LSCB/LSABs. All colleagues required to achieve Level 3 safeguarding children competences are required to attend one multi-agency learning event in every three year period in order to self-declare and will be monitored via appraisals. 4.1 In house face to face learning This year has seen an increased focus on embedding the principles of the Mental Capacity Act (MCA) in clinical practice. A rolling programme of MCA briefings has been available and clinical colleagues have been encouraged to attend. Number of MCA briefings Total Number of attendees Work to progress MCA principles application in clinical practice is to be reviewed via an audit of clinical records Face to face themed sessions were developed and delivered to support colleagues in adult services to achieve Level 2 safeguarding children competences. 17

20 Course Total Number of sessions Total number of attendees Level 2 FGM themed 5 29 Level 2 Domestic Abuse themed 6 66 Domestic Abuse Risk Assessment briefings Total number of briefings Total number of attendees Team contacts Activity Q1 Q2 Q3 Q4 Total children planned supervision children supervision unplanned children telephone advice adults telephone advice Not recorded 9 (Sept only) The drive towards planned safeguarding children supervision that requires preparation work to be completed by the supervisee has been successful with more planned than unplanned supervision taking place every quarter this year. The use of the planned supervision template is improving the quality of supervision and focus on outcomes for children. 4.3 Training Needs Analysis The first comprehensive safeguarding training needs analysis (TNA) survey was conducted via Survey Monkey between 16/02/17 05/03/17 and presented at the Q4 Committee meeting. The aims were to provide an initial baseline of safeguarding adult and children awareness and knowledge of all colleagues and to identify any knowledge gaps and learning needs. The findings were overall extremely positive and provide assurances of colleague safeguarding knowledge and competences as appropriate to role and level assigned; particularly in relation to the Mental Capacity Act, when and how to report concerns about colleague behaviour and a basic awareness of domestic abuse relating to both users of our services and colleagues. Some knowledge gaps and learning needs were identified at all levels. This knowledge will enable the safeguarding team to develop more focused and targeted learning opportunities for The key areas of knowledge gaps and learning needs include; 18

21 Agendas linked to safeguarding adults and children, including Human Trafficking and Modern Slavery, Female Genital Mutilation, Forced Marriage, Radicalisation and Honour Based Violence (knowledge levels significantly higher in Level 3 respondents). Clarity around the principles of appropriate information sharing for children and adults and the 7 Golden Rules of Information Sharing. MARAC and DASH risk assessments within adult services. Legal processes and procedures, including the provision of legal statements for clinical colleagues in adult and children s services. Effective contribution to adult safeguarding investigations and writing reports for adult case conferences. Colleagues reported a variety of learning styles to be useful but face to face is the most preferred. This information will be used to inform a blended safeguarding learning opportunities offer for 2017/2018. Work to progress - develop a programme of learning opportunities to meet identified learning needs and knowledge gaps 4.4 Children Supervisor Development A programme of safeguarding children supervisor development has been introduced during The initial focus of development has been around practical issues relating to safeguarding supervision e.g. documentation and management of group dynamics. The development programme needs to incorporate more structure and focus this year to ensure the availability of high caliber safeguarding children supervision across all services where safeguarding supervision is mandated. The programme will focus on the findings of a peer audit of safeguarding children documentation that will be completed during Q1 of Work to progress focus the supervisor development programme on the findings of the peer audit of supervision documentation 5 Engaging with service users Effective safeguarding practice requires communication with people and children who use our services at both an individual and community level. Engagement is central to the development of new Locala services or when changes are being made to existing services. The customer engagement manager reports to the monthly business unit meetings provide robust 19

22 evidence of engagement with communities and groups e.g. Locala s young people s network and feedback from Friends and Family and Patient Opinion. On National Dignity Day in February Eddercliffe s Jubilee Rehab Team held an event asking patients to share their thoughts about what dignity meant to them on a dignity tree to inform the delivery of their service. 5.1 Making personal Making Personal (MSP) is a person centred and outcomes focussed approach to safeguarding adults at risk. The principles of the Mental Capacity Act and Making Personal are central to Locala s safeguarding culture, and are reflected in the 2017 Adults at risk policy, to ensure that there is a timely and proportionate response when abuse or neglect has occurred and individuals are supported to have choice, or best interest decisions are made that are clearly documented within the health record. Work to progress; Development of MCA and best interest decision making template within SystmOne to support clinical record keeping. 5.2 Voice of the child On an individual level is essential that the voice of the child is considered so that we can see their experience, from their point of view, and don t make assumptions about individual children s health and welfare. The voice of the child is not merely verbal communication but involves actively looking at the behaviour and interaction of the child with his/her carers. Capturing the voice of the child within health assessments in integrated children s health visiting and school nursing services during quarter 4 of this year. There has never been any work undertaken to specifically understand the perceptions and views of Locala colleague involvement and interventions provided for children, young people and families who experience safeguarding or child protection processes. Though this is a challenging area there is now the potential means to sensitively progress this work to inform service development. Work to progress; A clinical record audit within children s services to determine whether the voice of the child is routinely captured and considered in health assessments. Joint work with the children s business unit customer engagement manager to develop a Children Engagement Plan. 20

23 6 Key risks and challenges Risks Mitigating actions 98% compliance rate for safeguarding children not achieved Monthly reports to be produced by Workforce to enable service managers and safeguarding team to monitor compliance and identify colleagues who are not compliant to identify barriers to non-compliance team to target and offer additional support to colleagues not yet compliant children group supervision policy requirements not some services team to work with service managers to develop action plans to improve compliance rates Supervision compliance to be monitored in monthly business unit meetings and Stand Up Tuesdays Rolling programme of safeguarding children supervisor training All band 6 and 7 colleagues in a clinical role to become trained supervisors over the next three years Lack of assurance of individual safeguarding children supervision compliance team to work with performance team to develop robust systems to record individual supervision access Not all safeguarding children supervisors able to access supervision for supervisors Locala requires safeguarding assurances from all partner agencies in the Thriving Kirklees 0-19 partnership Ability to meet safeguarding work demands due Impact of the reduction of registered colleagues in the new 0-19 Thriving Kirklees partnership. Increase availability and access to safeguarding supervisor supervision opportunities Introduction of an operational safeguarding group to monitor and scrutinise safeguarding performance data Introduction of an operational safeguarding group to monitor and scrutinise safeguarding performance data Conduct Quality Impact Assessment 21

24 Provide robust safeguarding capacity and demand data and work with commissioners and children s social care senior managers to identify potential solutions Explore appropriate use of skill mix i.e. assistant practitioners and nursery nurses within Calderdale Framework Ensure impact of current children s social care workforce is communicated with improvement board and senior social care managers. Challenges Level of resource and representation required to meet KSCB and CSCB and their associated workstreams requirements Undertaking a review and analysis of service provision for formal multi-agency safeguarding reviews whilst the service was under a former provider Locala assuming responsibility for incomplete multi-agency actions plans agreed whilst under a different provider Mitigating Actions Recruitment of a full time safeguarding children specialist nurse Undertake review jointly with safeguarding leads in former provider organisation where possible Agree all actions plans developed for new service provider before submission Identify any outstanding actions plans as early as possible after securing new contracts Discuss and agree amendments with review panel to action plans if no longer appropriate or applicable to delivery of new service model 22

25 7 Key priorities for We will continue to develop awareness around the safeguarding agenda and promote good practice in all the services we provide. Area of work Lead Expected outcome Timescale Audits Audit of team meeting minutes during a given timeframe Audit of learning activity undertaken to achieve compliance with safeguarding children learning requirements Audit of all referrals to children s social care using an agreed audit tool Clinical record audit for all services within Integrated Adults Business Unit Clinical record audit of all services within Integrated Children s Services Supervision Work with performance and service managers to ensure that team lists of colleagues required to access safeguarding children supervision are reviewed and updated on a minimum quarterly basis kept up to date Named Nurse Children Acting Lead children nurses Named Adult Professional & Quality Manager Named Nurse children and Quality manager children nurses Identify whether safeguarding is a standing agenda item on all team meetings Identify whether current safeguarding information sharing arrangements are effective Assurances gained that adult learning theory approach is enabling colleagues to achieve the required safeguarding children competences Quality assurance of referrals to improve colleague skill and knowledge Support Local authority to reduce number of inappropriate referrals to social care Review of application of Mental Capacity Act principles in clinical practice Establish whether the voice of the child is captured within health assessments Data cleansing to ensure accuracy of supervision data Complete by 30 th September 2017 Complete by 30 th June 2017 Ongoing through the year. Reports to be p[produced for each safeguarding committee meeting Complete by 31 st December 2018 Complete by 30 th June 2017 Ongoing 23

26 Collate baseline data of adult safeguarding supervision Delivery of a more focused and structured safeguarding children supervisor development programme based on findings of peer audit Colleague development Develop the role of the Named Doctor Review and evaluate impact and outcomes of adult safeguarding links Review and evaluate impact and outcomes of safeguarding children champions Develop a programme of learning opportunities based on the findings of the Training Needs Analysis Guidance Development of a Mental Capacity Act and Best Interest Decision making template within SystmOne Development of Adult template to be introduced into all SystmOne units Guidance on reporting potential safeguarding adult at risk and children incidents Communication Performance Adult safeguarding leads children nurses Acting Director of Quality Named Nurse Adults children nurses Team SystmOne project lead and safeguarding adult leads SystmOne project lead and safeguarding adult leads Team Gain a baseline understanding of the level of adult safeguarding supervision taking place within Locala services Supervision skills and knowledge developed to provide high quality supervision to improve outcomes for children and support colleagues Clarity of expectations and fulfilment of statutory responsibilities Assurance that safeguarding adult link role is effective in progressing the safeguarding agenda and promoting best practice Assurance that safeguarding children champion role is effective in progressing the safeguarding children agenda and promoting best practice Colleagues able to address gaps in knowledge to be able to identify adults and children who may require safeguarding interventions and early help Colleagues supported in best practice for clinical record keeping and evidence of application of making safeguarding personal in practice Colleagues supported in best practice for safeguarding and data available to be generated to determine accurate level of safeguarding adult work taking place across services. Increased assurance of safeguarding practices Colleagues aware of what should and should not be reported as a safeguarding incident Consistent and standard reporting categories to identify patterns and trends more effective Ongoing To be reviewed at each safeguarding committee meeting Ongoing Report to be produced by 31 st March st January 2018 By 31 st March 2018 By 31 st March 2018 Programme to be developed and courses available to book on ESR by 15 th July Roll out of new template by 31 st March 2018 Template to be in place by 31 st July 2017 Guidance to be available by 31 st July

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