Safeguarding Annual Update (London Region) NHS England London Region Safeguarding Update 2016/17

Transcription

1 NHS England London Region Safeguarding Update 2016/17 1

2 NHS England London Region Safeguarding Update 2016/17 Version number: 1.0 First published: May 2017 Prepared by: Lorren Stainton with contributions from NHS England London Region Safeguarding Programme Team 2

3 Contents Foreword Introduction The London Region The Role of NHS England (London Region) Safeguarding Governance Providing our expertise Key Achievements Progress on Key Priorities in London Contribution to Regional Safeguarding Policy Development Commissioning Safeguarding Projects Conclusion References Appendices

4 Foreword This report covers and provides an update on the work undertaken by NHS England London region in 2016/17 in relation to the responsibilities of NHS England as well as the wider safeguarding system. Coming into post half way through the year has given me the opportunity to observe the work of the team and how this relates to the many visits I have undertaken across providers and CCGs as part of my induction. It is clear that safeguarding in London is challenging and complex but I have witnessed first-hand the dedication and passion of individuals and organisations to safeguard children, young people and vulnerable adults. I am proud to see how the programme has shown how values, such as care and systems leadership, translate into everyday practice. The programme has strengthened the culture of care by supporting our safeguarding leads across the region via forums, workshops and individualised support and advice. The programme has also showed real systems leadership by being proactively involved in the development of policies and strategies that will have tangible impacts across the region, including consulting on: the Mayors new Crime Plan; NICE guidance; NHS service specifications; and joint inspection frameworks. I am also particularly proud of our FGM Prevention Programme for being awarded with a National award for its contribution to Midwifery, Project of the Year for NELCSU and also for being nominated for an international award due to be announced shortly. The review of the safeguarding networks has been an important piece of work, I believe that strengthening the clinical networks provides the peer support, sharing of good practice and challenge we need to make a real difference and particularly note the chairs of these groups for their leadership. The networks provide an opportunity for true engagement and two way cascade to the region and the national leaders. There is always more to do and endorse the identifying priorities for the coming year. We have strengthened the regional team with some excellent new appointments and prepared for the changes in legislation that will require us to work collaboratively with our partners to ensure the system remains strong and resilient to safeguard Londoners. Professor Oliver Shanley OBE Regional Chief Nurse (London Region) NHS England NHS Improvement 4

5 1. Introduction NHS England London region is responsible for ensuring that the commissioning system in London is working effectively to safeguard children and adults at risk of abuse or neglect. There are several Acts that govern the ways in which NHS England safeguard and help to ensure the wellbeing of children, young people and adults at risk of harm (see Appendix ii: Relevant Legislation and Statutory Guidance). This role includes commissioning assurance as well as strategic leadership and influencing. Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework (NHS England, 2015a) clearly sets out the safeguarding responsibilities of NHS England. NHS England ensures that the health commissioning system as a whole is working effectively to safeguard adults and children at risk of abuse or neglect. NHS England is the policy lead for NHS safeguarding, working across health and social care, including leading and defining improvement in safeguarding practice and outcomes (NHS England, 2015a). Key roles include: Providing leadership support to safeguarding professionals Ensuring the implementation of effective safeguarding assurance arrangements and peer review processes Providing specialist safeguarding advice to the NHS Leading a system where there is a culture that supports staff in raising concerns regarding safeguarding issues Ensuring that robust processes are in place to learn lessons from cases where children or adults die or are seriously harmed and abuse or neglect is suspected Ensuring that locally NHS England teams are appropriately engaged in the Local Safeguarding Boards and any local arrangements for safeguarding both adults and children Over the past year, the London region Safeguarding Programme has delivered on several key pieces of work that reflect these commitments as listed in the Accountability and Assurance Framework. The Programme team has worked to ensure that safeguarding is continuously being embedded across the health care system. Especially as contemporary safeguarding trends come to light, we must have the leadership and direction, and also the flexibility to adapt to safeguarding changes across the region. Emerging trends such as: needing to have increased awareness of human trafficking, especially as we have seen unaccompanied asylum seeking children enter into the region via Croydon or Kent for example and the need to safeguard against exploitation; or the need to safeguard women and children from domestic violence as we see cases reported by the Police following an upward trend; or 5

6 supporting and reinforcing our regulated healthcare colleagues to consider their personal duty to mandatorily report FGM to the Police. Over the past year the team has worked to strengthen previous safeguarding work, while also adapting to regional trends and working with our Police, Social Care, Charity sector, and other colleagues, to ensure we are all working towards safeguarding together. Key pieces of work that the programme has continued to strengthen across the region have included: Female Genital Mutilation (FGM) Child Sexual Abuse (CSA), including Child Sexual Exploitation (CSE) Prevent Mental Capacity Act (MCA)/Deprivation of Liberty Safeguards (DoLS) Looked After Children (LAC), including Unaccompanied Asylum Seeking Children (UASC) Child Protection Information Sharing (CP-IS) Emerging pieces of work that the team has commenced work on include: Modern slavery Human trafficking Domestic violence Breast ironing While the Safeguarding Programme have specifically worked on several key projects as listed above, we have also provided support to the safeguarding leads in Trusts and CCGs across London. In addition, the programme team has consulted on strategic pan-london level policies/frameworks that will guide the future of safeguarding practices into the future. Our team in London is comprised of a skill mix of safeguarding experts with varying backgrounds. While the team possess a high level of skill and experience in their safeguarding specialisms, we know that it is absolutely vital that safeguarding leads working across the region in both CCG and Provider capacities are heard. In a recent review of the London safeguarding networks, leads were asked about what they would like to see as priorities for the next financial year into 2017/18. All those who were surveyed responded that they would like to see a continuation of the FGM, CSA (including CSE), Prevent, LAC (including UASC), MCA/DoLS, CP-IS work streams, they added that self-neglect and domestic violence were the two overwhelming majority areas that needed more focus. Given this, safeguarding against self-neglect will be a focus of our future work. Domestic violence will also form part of a new work stream in efforts to help safeguard both adults and children and young people from this type of abuse. 6

7 2. The London Region London is the largest city in England and one of the largest cities in Europe. It is home to a diverse population, totaling around 8.6 million people. London sees some of the greatest opportunities for its citizens, but also some of the most disadvantage. This section is to provide a quick snap shot 1 of the challenges the region faces, and why it is so critical for the London region safeguarding team to be aware of the trends, and have the adaptability to refocus our work accordingly. While many of the priorities for 2016/17 will be carried forward into the next year, much our future work will also rely on continuous working with our wide range of partners to gather intelligence and address safeguarding needs as they emerge. London, when compared to the national averages, has more children achieving a good level of development at the end of reception (71%) compared to the England average of 69.3%. When compared to the national average (20.8 per 1000), London sees a lower rate of conceptions for girls years (19.2 per 1000). However, for some London boroughs this figure is much higher, for example, in Barking and Dagenham (31.0), Greenwich (29.2), Lambeth (28.7). London has a higher rate of first time entrants into the youth justice system (416.5 per ) compared to the England average of per Almost one in four children under 16 years of age are part of low incomes families (compared to around one in five for the national average). London sees more A&E attendances (0 4 years) per 1000 compared to per Hounslow is the borough that sees the most A&E at a rate of per In London, family homelessness 2 is measured at an average rate of 4.1 per 1000 compared to 1.9 per 1000 nationally. For some boroughs however, this figure is as high as 10 per 1000 (Newham), 9.5 per 1000 (Barking and Dagenham) and 8.9 (Waltham Forest). Hospital admissions due to substance misuse for years is at a national average of 95.4 per In London some boroughs such as Bromley (158.1), Bexley (118.3) and Sutton (110.8) see far over this figure. Hospital admissions for children and young people 0 17 years with mental health conditions reached 82.1 per for London, just under the national average of 85.9 per Some London boroughs saw nearly double this amount: Barnet (150.9), Islington (144.4) Southwark (143.8) and Croydon (113.7) 3 1 Most figures were sourced from Public Health England s Public Health Profiles website unless otherwise referenced. (Public Health England, 2017a; Public Health England, 2017b). 2 Family Homelessness is defined as applicant households eligible for assistance who are unintentionally homeless and in priority need (under specific categories). Priority need of households includes dependent children or pregnant women. 3 One in ten children aged 5 16 has a clinically diagnosable mental health issues and, of adults with long-term mental health issues, half will have experienced their first symptoms before the age of 14. Self-harming and substance abuse are known to be much more common in children and young people with mental health issues 7

8 Number of children in care Safeguarding Annual Update (London Region) Children in Care per Area average per The most recent figures (Department for Education, 2017) for the numbers of children in care show how the London Region overall has less children in care than the national average of 60 per However, the City of London (92), Islington (88), and Croydon (86), all had the highest numbers of children in care in the region. The National Referral Mechanism (NRM) is a framework for identifying victims of human trafficking or modern slavery and ensuring they receive the appropriate support. Over the year there were a number of referrals that came through to the NRM. The majority of referrals were from Tower Hamlets and Hackney. Of all referrals from Tower Hamlets, 17 were relating to children. Out of Hackney s 17 referrals, 13 were relating to children and 4 to adults. Croydon (11) and Camden (12) were the second highest refers (National Crime Agency, 2017). While the number of referrals for children was overall higher than those for adults, this does not indicate that less adults are needing safeguarding from trafficking. The most recent figures by the Office for National Statistics (ONS, 2016) shows that out of all recorded crime, approximately 10% is related to domestic violence. The most recent data reported by the Metropolitan Police in May 2016, shows that over a one year period in London, domestic violence accounted for cases (nearly 200 cases per day) (Metropolitan Police, 2016). Croydon had the overwhelming majority of cases (22 per day), followed by Newham (18 per day), Lewisham (17 per day), and Tower Hamlets (17 per day) (Metropolitan Police, 2016). It is acknowledged that many victims do not report the abuse, so figures could be much higher. Nationally, between April and December 2016 there were women and girls who had their FGM information collected in the Enhanced Dataset for the first time. London accounted for of these new attendances (47% of the total number of attendances) (NHS Digital 2016a; 2016b; 2016c). with 10% of year olds having self-harmed. Failure to treat mental health problem in children can have a devastating impact on their future, resulting in reduced job and life expectancies (Public Health England, 2017b). 8

9 The most recent data shows that adult social care mental health clients (aged years) receiving home care across London (46.1 per ) is greater than the national average (42.2 per ). Camden was overwhelmingly the borough with most patients in this category (229.6), followed by Hammersmith and Fulham (136.9) and Westminster (133.2). In London, 70.1% of adults with a learning disability who are known by the local council live in stable and appropriate accommodation such as their home or their family s home. This is in comparison to the national figure of 75.4%. In both Bromley (41.9%) and Islington (48.5%) this figure was down to less than half. Out of all the boroughs, Redbridge reported having the most adult social care users feeling that they had sufficient social contact with others (51.5%). Those users in Hounslow (36.2%), Camden (36%) and Ealing (35.8%) reported the least social contact, and subsequently at greater risk of social isolation. Nationally, the most recent figures indicate that Deprivation of Liberty Safeguards (DoLS) applications were reported as having been received by councils over a twelve month period (NHS Digital, 2015a). This is the most since the DoLS were introduced in 2009 and represents 454 DoLS applications received per 100,000 adults in England. Whilst historic trends have shown an increase in applications every year since DoLS were introduced in 2009, the scale of the increases over the last two years, and the increased volume of applications not yet completed at the year-end are mostly attributed to the Supreme Court judgment 4 of March In London in 2015/16 there were DoLS granted, up from in 2014/15 (NHS Digital, 2015b). 4 P v Cheshire West and Chester Council and another and P and Q v Surrey County Council 9

10 3. The Role of NHS England (London Region) Safeguarding NHS England is a national organisation split into four regions. There is a regional safeguarding team that sits within the Nursing directorate in each of the four regions: North, Midlands and East, London and South. The London Region safeguarding team supports the teams working in NHS England in specialised commissioning, primary care contracting, Health in the Justice teams and the delivery commissioning operations teams. There is also close working with the national safeguarding team and strong engagement with the safeguarding networks internal and external to Health both regionally and nationally Supporting Sustainability and Transformation Plans The NHS and local councils have recently come together in 44 areas covering all of England to develop proposals and make improvements to health and care. These proposals, called sustainability and transformation plans (STPs), are place-based and built around the needs of the local population. In London there are five STP footprints. In 2016/17, the safeguarding team made a decision to work towards ways in which they can provide more local supports to our safeguarding leads in each of these five areas in the following year. This will be a major focus for the 2017/18 work plan and will involve cultivating and strengthening relationships between leads in these five footprint areas: STP footprint area STP footprint boroughs North Central London Barnet, Camden, Enfield, Haringey, Islington North East London Barking and Dagenham, City of London, Hackney, Havering, Newham, Redbridge, Tower Hamlets, Waltham Forest North West London Brent, Ealing, Harrow, Hammersmith and Fulham, Hillingdon, Hounslow, Kensington and Chelsea, Westminster South East London Bexley, Bromley, Greenwich, Lambeth, Lewisham, Southwark South West London Croydon, Kingston, Merton, Richmond, Sutton, Wandsworth 10

11 4. Governance All of the work carried out by the London Region team is reported up to the National team via annual update reports and on a quarterly basis at the National Safeguarding Steering Group (NSSG) meetings via the regional Safeguarding leads. The Chief Nursing Officer (CNO) is then assured by the NSSG that the health system is effectively safeguarding. All of the actions required by NHS England with regards to safeguarding are discharged through the CNO who has a national safeguarding leadership role. The CNO is the Lead Board Director for Safeguarding and has a number of forums through which to gain assurance and oversight, particularly through the NHS England NSSG (NHS England, 2015). This governance section demonstrates how the NHS England (London Region) Safeguarding programme: is delivered; operates across London; is assured across London; is ensuring adequate levels of safeguarding training; is undertaking children s Audits; is undertaking adults Audits; The London Region Safeguarding Team The London Region Safeguarding team is led by Regional Safeguarding Lead, Vanessa Lodge, and overseen by Oliver Shanley, London Region Chief Nurse. For each of the patches there is one quality manager: Shruthi Belvadi, North Central and East London; Sarah Green, North West London; and Jemma Sharples, South London. Quality managers take on a safeguarding portfolio and are responsible for ensuring their patches are supported and the health system is safeguarding effectively. Any safeguarding concerns will be raised with the patch safeguarding lead who will then escalate concerns to the Director of Nursing (DON) for their patch. There are two Safeguarding Programme Officers, Joey Buckley and Lorren Stainton, who solely support the various safeguarding work streams. There is one safeguarding business support professional, Debbie Gore, who supports the entire team to carry out administrative functions. There are two regional Prevent Co-ordinators, Misha Upadhyaya and Paul McCann, who work to the National Safeguarding Lead, Susan Warburton (see section 4.3 for reporting structure). 11

12 Making Safeguarding Personal Meet the London Region Team Shruthi Belavadi North East Central London Clinical Quality Manager Sarah Green North West London Clinical Quality Manager Jemma Sharples South London Quality Manager Vanessa Lodge London Safeguarding Lead National FGM Lead Debbie Gore Safeguarding Business Support Misha Upadhyaya & Paul McCann Regional Prevent Co-orindators 12 Joey Buckley & Lorren Stainton Safeguarding Programme Officers

13 4.2. Regional Accountability and Assurance In 2014/2015 NHS England (London Region) undertook a full review of its systems and processes to understand where improvements were needed. Since this review there has been the development of several key governance groups that oversee the work of the safeguarding programme in London: NHS England (London Region) Safeguarding Steering Group Nursing Accountability Group Quality and Clinical Governance Committee These groups ensure the safeguarding programme is assured by the safeguarding lead, Regional Chief Nurse and other senior members of the London Region. These groups assure whether the programme in continuously being effective by reflecting on whether the following points have been achieved: Underpin system accountability through peer review-based assurance to identify local improvement priorities Identify and share best practice across the local health system Lead and drive improvement in safeguarding practice across the local NHS system, working closely with the Local Safeguarding Children s Board (LSCB)/Local Safeguarding Adults Board (LSAB) as appropriate Consider in detail the health implications & learning from inspection and local incidents, and develop local action plans as appropriate Ensure the commissioning of appropriate education and development for Designated Professionals, through engagement with the education boards Maintain an up-to-date business/operations risk register and appropriate escalation mechanism Contribute to and oversee Section 11 5 audits (Children Act 2004) and Safeguarding Adults Assurance Tool audits on behalf of the local system Work plan and key milestones are being met Specialised Commissioning Specialised Commissioning is one of our directly commissioned services. We work closely with the Director of Nursing for Specialised Commissioning to ensure robust safeguarding processes are in place. The national Specialised Commissioning team held a two day conference for all Spec Com case managers where they received excellent presentations on safeguarding issues, the Mental Capacity Act, and case studies highlighting the complexity of some cases encountered by the team. This was well attended by London Specialised Commissioning case managers. A monthly telephone safeguarding clinic has been introduced to provide an advisory and escalation point for the case managers. Though in its infancy, this initiative is proving to be invaluable to staff in terms of the support they have received and the 'critical friend' aspect. Our group clinical supervision for all case managers remains a 5 Section 11 of the Children Act

14 key component of the support provided to the team. Safeguarding deep dives have taken place within some of the Providers and we particularly have provided support to our independent Providers. We held a safeguarding themed Quality Network meeting with our Independent Providers and were able to share not only updates to the relevant safeguarding policies, our assurance framework but also reiterated the contractual aspects which were particularly helpful. We will continue to strengthen our work over the coming year Safeguarding Forums/Meetings Attended 2016/17 The safeguarding team over the 2016/17 attended a total of 26 meetings, with an additional number of LSCB and LSAB meetings across the region (see Appendix iv for list of meetings attended) including: Pan-London meetings CSA/CSE meetings FGM meetings Modern slavery meeting Prevent meetings MCA meetings Homelessness meetings Learning disability meetings Several local safeguarding board meetings 4.3. National Accountability and Assurance The London Region safeguarding programme is accountable to the National team and must assure them of the points listed above, and that the 2016/17 work plan is being met. The National Safeguarding Steering Group (NSSG) is the mechanism to hold the region to account and to offer them assurance and oversight. The NSSG meets every quarter and is comprised of each of the regional safeguarding leads (from North, Midlands and East, London and the South regions). At each meeting the regional leads review their work plans and risk assess, via Red Amber Green RAG rating, whether tasks are on-track or at risk of not being met. Work plans are cross-checked by each of the Regional safeguarding leads and the National safeguarding lead. For specific work streams such as Prevent, the London Region Prevent Coordinators are accountable to the regional safeguarding lead, who reports to the national safeguarding lead, who then reports to the Department of Health Directors Oversight Group (see reporting structure below). 14

15 NHS England Board NHS England Board - Commissioning and Assurance Committee Chief Nursing Officer Senior Management Meeting National Safeguarding Steering Group Meeting Department of Health Directors Oversight Group North Region Safeguarding Forum Midlands and East Region Safeguarding London Region Safeguarding Forum South Region Safeguarding Forum Regional Quality Surveillance Groups x 3 Regional Prevent Co-Ordinator (RPC) Meeting RPC strategic objectives x 6 Local Safeguarding Children s and Adult s Boards Local Areas Safeguarding Networks x 32 Local Quality Surveillance Groups x 32 Reporting structure for the Prevent Programme The Safeguarding team has worked in partnership with a wide range of key stakeholders over the 2016/17 period. Notably they included: London Region Safeguarding Stakeholder List Internal All Directorates within NHS England London Region National Safeguarding Steering Group (NSSG) National Safeguarding Team 15

16 External Care Quality Commission Clinical Commissioning Groups (STP areas) Department of Health Foreign and Commonwealth Office Home Office Health Education England Home Office Independent providers, third sector organisations and charities (including NSPCC, Barnardo s, Save the Children) Local Authorities London and Home County Universities Metropolitan Police MOPAC NHS Provider Organisations, including Directly Commissioned Services Ofsted Public Health England 4.4. Self-Assessment Assurance Tool The 'Section 11 Audit' and the Safeguarding Adults Risk Assessment Tool are designed to allow the Local Safeguarding Children and Adults Boards to assure themselves that agencies placed under a duty to co-operate by this legislation, are fulfilling their responsibilities to safeguard children and adults to promote their welfare. NHS England London Region has undertaken a self-assessment audit based on these two tools to provide both internal and external assurance they we are fulfilling our responsibilities to safeguarding children and adults (see Appendix iv for the full audit). In summary the audit identified the following: Theme The culture of safeguarding within the organisation Self-assessed outcome Fully met Actions needed No action needed at this time 16

17 A safe organisation Partially met Although we can demonstrate >80% level 1 training for NHS England employees we are aware that within this there are individuals and groups of staff that require level 2 & 3 training and that we do not have a system to idenfify or capture this, A Safeguarding Training sub group is to be held on a quarterly basis to address this. Assurance and system leadership Partially met Need to continue the strengthen the linkage between CCGs, Local Authorities and NHS England London Region in relation to Primary Care assurance. Safeguarding Team to arrange bespoke Safeguarding Training for the GP validators to ensure that Safeguarding is considered during the primary care revalidation process. Continue to work with London Councils in relation to the Wood Review and implications for NHS England London Region In accordance with the Reformed NHS Accountability and Assurance Framework (2015) NHS England are committed to ensuring that all staff undertake mandatory safeguarding training in order to equip them to carry out their safeguarding responsibilities confidently and effectively. To support staff in doing this and improve upon current training completion rates, NHS England (London) has developed a Safeguarding Training Strategy. The strategy aims to provide staff with information about their responsibilities in relation to safeguarding children and vulnerable adults, the level of training they require and where they can access it. Overall, safeguarding training figures as of 31 March 2017 is 83%, up 3% against a regional target of 80%. 17

18 5. Providing our expertise 5.1. Hosting an international delegation to learn about NHS England s response to domestic violence in conjunction with the National team In September 2016, three members of the Georgian Ministry of Internal Affairs were guests of the Foreign and Commonwealth Office during their stay in Britain. The Visits Section of Protocol Directorate is arranged their programme. The delegation were in London from 19th 24th September visiting several different organisations, including NHS England. The purpose of the visit to the UK was to hold consultations with the Domestic Violence specialist departments, services and agencies on policies and guidelines in order to: 1. identify and share the best practices of addressing domestic violence, as well as gender based violence more broadly 2. promote gender equality in general Appointments were being sought from Home Office, Women and Government Equalities Office, Police, National Health Service and Specialist Domestic Violence Courts. NHS England National, with support from the London Region team, organised the agenda for the delegation visit. The safeguarding team in London hosted the National safeguarding lead with support from a regional programme officer, to discuss approaches to safeguarding against domestic violence within the NHS. Good practice within the NHS that was shared included: Routine enquiry in a GP for all women to screen for domestic violence, delivered by a GP in Leeds Awareness & Response to Domestic & Sexual Abuse (AR-DSA) delivered by Camden & Islington NHS Foundation Trust Identification and Referral to Improve Safety (IRIS), delivered by 43 General Practices in the Borough of Hackney Information Sharing to Tackle Violence (ISTV) A&E data is one of the datasets available on SafeStats used by the Homerton Hospital to collect statistics on the number of survivors of domestic violence Violence Reduction Nurses at the Emergency Department, The Royal London, Hospital Barts Health NHS Trust Redthread s Youth Violence Intervention Programme (YVIP), delivered out of London s four Major Trauma Centre hospitals. 18

19 5.2. Consulting on National Institute for Health and Care Excellence Guidance During February and March 2017, the safeguarding team began reviewing the draft National Institute for Health and Care Excellence (NICE) guidance on Child abuse and neglect (In development [GID-SCWAVE0708]). The proposed guidance will help professionals who work with children recognise and respond to any form of abuse and neglect. While the guidance will be for professionals working with children outside health settings, such as social workers, teachers and police officers, the safeguarding team felt that with their expertise, they could offer valuable feedback. The proposed guidance is also said to have a focus on how professionals can handle fors of abuse and neglect such as FGM, sexual exploitation, child trafficking and forced marriage. The guidance is expected to be published in September Consulted on the Mayors Policing and Crime Plan The NHS England (London Region) Safeguarding Programme welcomed the opportunity to provide feedback on the Mayor s Office for Policing and Crime (MOPAC) Draft Police and Crime Plan for London The team fed back on the three main strands that the Mayor will be focusing on over the next four years: 1. Keeping children and young people safe 2. Tackling violence against women and girls 3. Standing together against extremism, hatred and intolerance After the feedback was submitted to MOPAC on the draft plan, approximately a month after the final Crime Plan was released. The safeguarding team were in consensus that the plan had taken into account some of the feedback and recommendations made Consulted on Guidance for Joint Inspections of Protection for Children Living with Domestic Abuse In June 2016, the Social Care Policy Team in Ofsted contacted NHS England Safeguarding teams to review the content of the deep dive questions for joint targeted area inspections (JTAIs) September 2016 to March 2017 into Children living with Domestic abuse. Ofsted proposed scope and guidance for JTAIs of multiagency arrangements to protect children living with domestic abuse. Ofsted drafted the inspection criteria, which the London Region safeguarding team feedback on. The safeguarding teams overall comments were around: 19

20 clarifying the term domestic abuse as it is such a general term for very complex forms of violence and if this investigation is focusing on intimate partner violence and children experiencing this, then that needs to made clearer investigation into the preventative/early interventionist approaches to DV, such as exposure to healthy relationships education more emphasis on the role of primary care in screening for DV would also be interesting to investigate specifically in this context 5.5. Consulted on the London Perinatal Mental Health Service Specification In April 2016, the safeguarding team were approached by the Perinatal Mental Health team at NHS England (London Region) to review the London Service Specification. The team consulted on the document and recommended important safeguarding content be added to the document. Main safeguarding elements addressed were the need to highlight specific legislative requirements such as: o Disclosure Barring Scheme (HM Government, 2013) o Working Together (HM Government, 2015) o Female Genital Mutilation Risk and Safeguarding: Guidance for professionals (Department of Health, 2015) The importance of considering the role of fathers in perinatal mental health service provision was also suggested. Fathers can also experience mental health concerns that can influence the health and wellbeing of the women and unborn child. Critical analysis of statistical references was also recommended such as reflecting on potential linkages between mental health and domestic violence for example: around 10 15% of women experience depression during pregnancy and around 8% experience some form of domestic violence (keeping in mind that DV is underreported) (Taillieu & Brownridge, 2010). 20

21 6. Key Achievements 6.1. Review of Regional Safeguarding Networks/Forums NHS England (London region) Safeguarding undertook an exercise to map out the existing safeguarding networks across London at the end of 2016 and explore the perspectives of their members for improving connectivity, effectiveness and impact. There are currently eight existing safeguarding networks (health) and four prospective ones as per tables below: Existing Network / Forum Proposed Network / Forum 1 Named Midwives forum School Nurses network 2 Named GPs Safeguarding Children GP Adult Leads network forum 3 Provider Named Nurse meeting Provider Named Doctor meeting 4 Designated Professionals network Mental Health providers Safeguarding network 5 CDOP Chairs network 6 LAC 7 Provider Safeguarding Adult and Prevent Leads Forum 8 Commissioning Adult Safeguarding network The analysis provided the first systematic insight into all the existing (in health) safeguarding forums and networks in London. The analysis produced a series of mappings, showing the reach and borough/ccg/provider representation. All members were offered the opportunity to feed their views on how networks operate currently via surveys and the chairs participated at two workshops identifying where networks currently are and what is the vision for working better together across London. It is worth noting the rich variety in forms and operating models that were found, spanning from less to more structured. All existing networks were found to be essential to their members in their function in sharing practice, creating knowledge and standardising safeguarding approaches across the region. The Safeguarding team based on the findings highlight in the forums review would like to offer the following to the London Safeguarding Health forums: Creating a virtual safeguarding networks chairs meeting to improve visibility and connectivity between networks and NHS England 21

22 Providing meeting spaces at NHS England s offices for network meetings Offering tools to support administration of network meetings, such as templates and tips for running meetings and organising chair rotation Offering to attend or provide briefings as and when needed, as well as being a node for communicating information between networks through the chairs 6.2. Child Sexual Abuse Hubs and Child House Development During 2016/17 the Safeguarding team in the Nursing Directorate working closely with our colleagues in the Health in the Justice London Region team to deliver on the Child Sexual Abuse Hubs (CSA Hubs) and Child House (CH) programme of work. In the Review of pathway following sexual assault for children and young people in London (Goddard, Harewood & Brennan, 2015) commissioned by NHS England London, it was suggested that the development of CSA Hubs be a short term solution to the fragmented pathway, where the CHs would be a longer term option and eventually replace the CSA Hubs. The safeguarding team was valuable in testing current safeguarding pathways in light of the London Child Protection Procedures (London Council, 2017) with Health, Social Care and Police colleagues across the region to determine current processes and practices. This also assisted with making recommendations for clear safeguarding pathways into these new models of support for young survivors of sexual violence across London. Part of this work involved consulting with Multi- Agency Safeguarding Hub (MASH) managers across London. The Safeguarding team is currently in discussion with the wider Child House/CSA Hubs implementation team to see how it might be able to support ongoing work in this area over the next year, linking in with STP areas and helping to sustain this programme of work. 22

23 6.3. Local Authority Designated Officer and Performance of Independent Contractors We worked with the medical directorate on some concerns raised through safeguarding about the relationship between the local authority designated officer (LADO) and the performance teams at NHS England who manager any performer concerns in relation to general practitioners, dentists and pharmacists. Section 11 of the Children Act 2004 state that allegations against people who work with children should not be dealt with in isolation and that local authorities should be involved in the management and oversight of allegations against people that work with children. There are 32 LADOs across London, one for each borough. The role of the LADO was not well understood by the teams managing concerns about practitioner performance and the LADOs equally were not always aware of the current process for management of performer concerns at NHS England. A session was held in December 2016 to explore more about the respective roles and to agree how to strengthen the process. 20 people attended with the following recommendations/actions agreed: Circulation of contact details to the performance teams (completed) Standing item about safeguarding on Performers Lists Decision-making Panel(PLDP)/ Performance Advisory Group (PAG) agendas 6 (completed) Checklist to be developed for safeguarding to use in PLDP/PAG meetings (being tested) Safeguarding training to be strengthened for medical directorate (for 17/18) Supervision for teams to be put in place (under development) for reflection on cases. Audit of safeguarding cases (to be agreed following national safeguarding audit report publication) Escalation of issues to national team in relation to PLDP/PAG training to strengthen safeguarding input 6.4. Safeguarding Database NHS England (London Region) are committed to ensuring robust processes are in place to learn lessons from cases where children or adults die or are seriously harmed and abuse or neglect is suspected. NHS England (London Region) developed a database in order to collate learning and highlights key themes and trends for improvement from Safeguarding Adult Reviews and Serious Case Reviews. We are cognisant that this learning is vital to the health commissioning system as a whole, so that the NHS can work effectively to safeguard and improve the outcomes for children and adults at risk and their families NHS England (London Region) appreciates that LSABs and LSCBs are expected to maintain a local learning and improvement framework. Safeguarding Adult Reviews 6 Performers Lists Decision-making Panel(PLPD)/ Performance Advisory Group (PAG) are described in the Framework for Managing Performer Concerns (NHS England, 2014) 23

24 (SARs) and Serious Case Reviews (SCRs) provide a sound analysis of what happened in the case, and why, and what needs to happen in order to reduce the risk of recurrence, and that organisations are working together to safeguard and protect the welfare of adults and children. NHS England (London Region) are committed to working with safeguarding boards to ensure learning is embedded and communicated across the health care system. Key work over 17/18 will be: enhancing of the database of SARs/SCRs to ensure that it efficiently identifies themes from reviews including data from DHRs, MHHRs and PFDNs improving communications of themes to share learning across London, and support quality improvement promoting the logging of case reviews on the Strategic Executive Information System (STEIS) (NHS England, 2015) 6.5. GP Primary Care Toolkit The Quality Improvement (QI) in Safeguarding (Adults and Children) programme funded by NHS England (London region) aimed to build on the previous Royal College General Practitioners (RCGP) child safeguarding programme. The programme recruited a clinical lead with Safeguarding expertise and updated existing RCGP resources for safeguarding children, and developed educational resources for safeguarding vulnerable adults, including those with protected characteristics. Programme outputs were defined as: to work with other organisations to develop Intercollegiate Training Guidance for Safeguarding Adults to develop an Adult Safeguarding Toolkit similar to that for children already published on the RCGP website 7 to produce a 2017 Child Safeguarding update for inclusion in the RCGP/NSPCC Safeguarding Children Toolkit taking into account legislative and other changes since the toolkit s publication to develop and deliver standardised and RCGP accredited educational modules for GPs and practice staff in safeguarding vulnerable people of all ages to develop and deliver a certified and accredited Safeguarding conference with expert guest speakers. The programme recruited a steering group comprised of representatives from NHS England (London region) and Clinical Innovation and Research Centre (CIRC) (including CIRC s Medical Director), the National Mental Capacity Forum, the Safeguarding lead from Camden CCG, ADASS (the Association of Directors of Adult 7 Toolkit-2014/RCGP-NSPCC-Safeguarding-Children-Toolkit.ashx 24

25 Social Services), Care Quality Commission (CQC), and a named doctor for child safeguarding from Coventry and Rugby CCG. The steering group met four times over the course of the programme to review progress and outputs. The Adult Safeguarding online toolkit 8 and Child Safeguarding update were peer reviewed by the programme steering group. Adult Safeguarding elearning modules authored by an RCGP elearning Fellow with input from the Programme Clinical Lead were peer reviewed by the RCGP elearning team s network and by programme steering group members. The programme will evaluate the effectiveness of the one day training conference with an evaluation issued to delegates. Data from this, and available impact from the toolkit, Child Safeguarding update, and elearning modules will be included in a final programme report. 8 Safeguarding Adults at Risk of Harm toolkit: 25

26 7. Progress on Key Priorities in London 7.1. Child Sexual Exploitation (CSE) Child Sexual Exploitation (CSE) Awareness Week ran from Monday 13 th Sunday 19 th March 2017, with the National CSE Awareness Day being held on Saturday 18 th. NHS England (London region) asked all trusts and healthcare professionals to support, and take action, by raising the profile of CSE in their organisation. Health professionals are vital in helping to spot the signs of child abuse and help to safeguard against it. We know that of all disclosures made in childhood, only 58% are acted upon. We also know that children do disclose sexual abuse, but it takes on average 7.8 years for us to really hear what they are saying and support them (Allnock & Miller, 2013). Throughout the week healthcare professionals and our Designated and Named Safeguarding Professionals across London were asked to: Holding training sessions on CSE for all staff Hosting an CSE awareness event Including an CSE prevention message in your weekly newsletter/bulletin Reflecting and evaluating your current work on CSE prevention and share good practice Including an CSE agenda item in your weekly meeting/handovers Tweet using the #HelpingHand and #seenandheard hashtags Not only did the safeguarding team call our safeguarding leads across the region to action, we also partnered with other health colleagues and a charity organisation to hold a stall at Skipton House to raise awareness of CSE. On the 17 th March, the day prior to the National day, NHS England (London Region), Public Health England, Department of Health and the Children s Society joined up to hold a stall to raise awareness among our colleagues in Health with strategic roles who can really champion the CSE agenda and drive change in our region. People who approached the stall were asked to sign up to be CSE champions via the Department of Health commissioned Children s Society s Seen and Heard online campaign. The Safeguarding team from NHS England (London Region) who have been working on the Child House also spoke with people about the new Child House model for London and how it will help to safeguard and support survivors of CSE and their non-offending family members. PHE spoke with people about their new CSE framework and education in schools around CSE. The Department of Health and the Children s Society spoke to colleagues about the Seen and Heard campaign, and asked people to be CSE champions in their workplace. Everyone was tweeting #seenandheard and #helpinghand throughout the week. 26

27 NHS England London Region has worked with the CSE National Sub- Group over the last year to take forward actions from the 2015/16 work plan Pan London LSCB CSE sub-group Holding a stall with PHE, DH, and the Children s Society at Skipton House Based on the Review of pathway following sexual assault for children and young people in London: Joey Buckley, Shruthi Belavadi and Lorren Stainton at the CSE Stall raising CSE awareness among our Health colleagues. o Transforming the three London SARCs (or Havens in Camberwell, Paddington and Whitechapel) into places that are more child-friendly and appropriate for younger people following sexual abuse o Establishing two Child Sexual Abuse hubs in London (North Central and South West) to provide medical, psychological and advocacy support o Transforming the Child Sexual Abuse hubs into the Child House model in London (North Central and South West) to provide medical, psychological, advocacy, police, and social care supports Pan-London MASH review Consulting on the NICE Child Abuse and Neglect draft guidance (NICE, 2017) Working with the pan-london CSE task and finish group Working with the London Safeguarding Adolescent Steering Group 27

28 7.2. Female Genital Mutilation There have been a number of areas of progress within FGM nationally which is being led by the London region, these include: Training events run jointly with the Department of Health and that have included 2 mental health focused events in London. The LSA conference (see section 9.1.1) also gave an opportunity to update every maternity unit in London about FGM. Additionally HEE ran a series of health visitor and school nursing events which included a section on safeguarding and FGM. Contribution to FGM forums including World Health organisation in March 2017 and the health select committee in September 2016 Completion of the training strategy Engagement with clinicians and patients on the commissioning guidance Publication of the guidance for the identification of FGM in under 18 s FGM Awareness Raising at Skipton House during the Week of Action On Thursday 9 th February during the Week of Action, the FGM Prevention Programme team set up a stall at Skipton House, London, to raise awareness about FGM among our other Health colleagues in the building. Those from Public Health England, Department of Health, NHS England (London Region), NHS England (National), NHS Digital, and others passing by, came to visit the stall and hear about how the programme is safeguarding against FGM. Resources were handed out to colleagues such as: FGM Mandatory Reporting Duty flyer FGM Safeguarding Pathway flyer FGM Risk Assessment flyer Awareness raising resources such as the #EndFGM lanyards and #EndFGM stickers were also handed out to prompt discussions among professionals who visited our stall. The aim of the stall was to reach those within strategic positions within the various departments and ask them to think about what they could do within their roles to champion FGM prevention work. 28

29 Sir Bruce Edward Keogh, KBE, FRCS, FRCP, National Medical Director, with Vanessa Lodge taking a stand against FGM. Dr Jacqueline Cornish OBE, FRCP, National Clinical Director for Children, Young People and Transition to Adulthood shows her long time support for FGM prevention with Vanessa Lodge and Astrid Faircough at Skipton House, London.. London Region Chief Nurse Prof. Oliver Shanley shows his support to Care. Protect. Prevent. FGM Deputy London Region Chief Nurse Jane Clegg and Vanessa Lodge tweet this photo to pledge help #EndFGM Vinice Thomas (Head of Nursing, Specialised Commission) (far left) and her Specialised Commissioning team 29

30 In London there have been some specific pieces of work undertaken in conjunction with the London councils and London safeguarding children s board: FGM Enhanced Dataset The FGM enhanced dataset is published quarterly on NHS Digital website, the report is reviewed by the national task and finish group. Following the publication of the first annual report a workshop was held at Richmond House in London on the 28th July 2016 to review the data and implications to the health systems. A pilot in London was undertaken using the data from the enhanced dataset and using mapping software created visual maps of each of the 32 boroughs in London to display population prevalence, cases recorded by CCG and organisation, predicated prevalence and police reports. The data set slides were sent to each of the local safeguarding children s boards (LSCBs) with an accompanying letter from the Chair of the London safeguarding board asking local board to review the information, ensure local engagement from organisations and review local services. In addition the local boards were asked to nominate a lead social worker to attend a workshop in 2017 to work collectively to improve the social work response to safeguarding. NEL CSU that it received the Project of the Financial year 2016/2017 award by the CSU (meaning it was considered the best project of the year by our senior management team across the entire CSU)! 30

31 Mandatory duty to report to the Police The national Police chief council seminar was held on 1st November 2016 in London to mark the one year anniversary of the mandatory duty to report under 18 s to the police. The seminar aimed to provide knowledge and reflection over the past year and was well attended from all sectors across the country. As an outcome of some of the lessons learnt there was agreement to pilot a feedback mechanism to clinicians who report to update on the case which will be evaluated by the police in London London Assembly FGM conference Jennette Arnold OBE AM hosted a FGM conference on 24 January 2017 at City Hall. The event provided an opportunity for practitioners with a responsibility for responding to FGM in London to come together to share insight and best practice, this included health, social care, police and education as well as hearing from communities. A number of recommendations were made during the event including leadership, collaborative and partnership working, education and training, information sharing and finally resources and long term funding United States Senior Officials visit to London to learn about England s approach to FGM Eleven Senior United States government officials, including the FBI, joined a meeting hosted by the nursing directorate in London on 11th January The meeting discussed how health and the Met Police have worked together to support women and girls with FGM and to prevent the practice. The officials heard presentations from the Department of health on policy change, from NHS England on how the NHS has implemented government policy and how in London and locally we have worked to strengthen the relationship with the police and health professionals. The meeting finished with a personal account by a survivor who is involved in engaging local communities. The US officials were impressed with the progress made in London and how multi-agency working occurred through safeguarding. 31

32 7.3. Mental Capacity Act / Deprivation of Liberty Safeguards GP MCA Quality Improvement Project In their Mental Capacity Act (2005) post-legislative scrutiny the House of Lords Select Committee concluded that Mental Capacity Act (MCA) implementation has been poor and that more needs to be done to embed MCA principles within everyday practice. In 2016 London Purchasing Healthcare (LPH) supported by NHS England (London Region) delivered a project to support implementation of the MCA by Clinical Commissioning Groups (CCGs) across all services. Primary care was identified as a key area for MCA quality improvement. A follow-on project was launched, commissioned by NHS England (London Region) to develop a suite of best practice processes and supporting documentation for CCGs to gain assurance from GPs and to support GPs to improve MCA quality. The initial project focus was to produce resources for GPs to enhance compliance with the MCA, particularly with regard to assessing capacity and making Best Interests Decisions. However, early feedback from the Royal College of General Practitioners (RCGP) suggested that the project should focus on MCA quality improvement rather than compliance, and build on existing tools rather than develop new standalone documentation. The RCGP suggested developing templates to be implemented in existing GP software systems such as EMIS, System One, and Vision. The templates would support GPs to improve MCA quality and report to CCGs Existing guidance and templates developed by CCGs across the UK were reviewed. LPH identified a number of templates and pro forma guides for the assessment and best interest s decision process that had been uploaded to the SCIE website. The project delivered an agreed London-wide set of MCA templates for GP systems. The templates were developed with input from NHS England (London Region), RCGP, Care Quality Commission, Adult Safeguarding Lead GPs, MCA leads, and Safeguarding leads. The templates meet the MCA requirements for assessing capacity and making Best Interests Decisions and GP requirements for clear and user-friendly processes. The above graph shows potential reporting metrics however, this dashboard has not been validated by stakeholder and is still in draft format. 32

33 Best Interest Assessor Programme The 2014 House of Lords Post-Legislative Scrutiny report into the Mental Capacity Act 2005 (MCA 2005) was highly critical of some aspects of the way the legislation is being implemented across health and social care. One of the thirty nine recommendations was that training in the Act continues on an ongoing basis. We commissioned Bournemouth University to train 20 Best Interest Assessors across London. This programme explored the legislative frameworks, together with the accompanying principles and processes to further expand knowledge. Completion of the whole programme also prepared students to undertake the important statutory role of Best Interest Assessor. The completion of this programme will enable the attendees to have: 1. An applied knowledge of the Mental Capacity Act 2005 and related Codes of Practice 2. The ability to keep appropriate records and to provide clear and reasoned reports in accordance with legal requirements and good practice 3. The skills necessary to obtain, evaluate and analyse complex evidence and differing views and to weigh these appropriately in decision-making 4. The ability to work with vulnerable people in a manner consistent with the Key Capabilities for Best Interest Assessors 5. The ability to use reflection and critical analysis to examine their own practice with service users and families where issues of mental capacity and human rights are central to care-planning Challenges: A lot of people experienced difficulties in arranging to shadow a Best Interest Assessment either because of existing work pressures or lack of capacity within their Local Authority. Feedback from attendees: What it has helped with is: my ability to chair the CCGs most complex / high profile Best Interests meetings improve understanding within the Continuing Health Care service, wider CCG and with family members by being able to explain things better (as I am now clearer) it has improved my confidence to decision make on behalf of the CCG 33

34 7.4. Prevent The Prevent strategy continues to play an integral role in safeguarding vulnerable adults and children from being radicalised or drawn into terrorism. The threat of terrorism has significantly increased in recent years, and with attacks taking places across Europe and in the UK, the risk of vulnerable people being exploited is real and ever present. London continues to play a lead national role in Counter Terrorism policing, and the capital hosts a higher level of risk when it comes to most forms of criminal activity including the threat posed by terrorism and the radicalisation of vulnerable individuals. Since the implementation of the Prevent Duty in July 2015 the health sector has made significant progress in implementing and integrating Prevent within Children and Adults Safeguarding. This has mainly been achieved through three mediums:- 1. Accurate and proportional delivery of Prevent staff training. 2. Supportive policy and procedures detailing appropriate referral pathways. 3. The development of strong local relationships between health and key Prevent partners including Local Authorities and the Police. During 2016/17, there was a hiatus in terms of delivery when there was little or no regional Prevent support available for CCGs and Providers across London. However, in October 2016 two new NHS England Regional Prevent Coordinators were recruited to the London team. Since these appointments, London has been in a stronger position in terms of mainstreaming Prevent within health sector safeguarding practices. The RPCs have made it a priority from the outset to establish productive working relationships with all CCG Prevent leads, and also by helping to forge stronger links between CCG leads and their Local Authority Prevent Coordinator counterparts. In terms of Prevent, the RPCs identified that in some instances there was a lack of effective local partnership working, and the health sector was therefore not always contributing to optimum levels. In this initial relationship building exercise, the RPCs were able to resolve some of the key issues raised around the health sector s contribution to local Prevent action plans and attendance at relevant meetings. The RPCs have also been fully integrated into the London Prevent Network (LPN) to ensure that their local authority colleagues have a greater understanding of some of the complexities which exist within the health sector, and what local authorities can expect in terms of support for Prevent at borough level. Work was also undertaken to engage more closely with colleagues from SO15 Counter Terrorism Command (CTC). Introductory meetings were held with the Superintendent for Prevent in London and relevant Prevent Inspectors, and the RPCs are gradually enhancing the knowledge of their police partners to better understand some of the key challenges for the health sector around Prevent, particularly in relation to information sharing and patient confidentiality. 34

35 National Prevent strategic activity is now encompassed in five key thematic work streams which allows for NHS England, the Department of Health and Home Office to collectively align their efforts. These are national priorities but regional activity supports all national work Mental Health In London the RPCs have been working closely with the Prevent Liaison and Diversion Hub (PLaD) to ensure that there are strong collaborative working relationships with designated safeguarding leads in Mental Health Trusts. The PLaD includes NHS Mental Health clinicians embedded within the Counter Terrorism (CT) Prevent network to assess those who have been referred to the police because of Prevent concerns, but who may also require access to mental health support. The Hub operates on a consultative basis; identifies individuals who may have mental health needs, undertakes assessments where required, and works collaboratively with the relevant Mental Health Trusts to formulate support plans and access to care pathways. This fledgling work has had an extremely beneficial initial impact both for police in understanding mental health concerns, but also for vulnerable individuals accessing or being reconnected to services. The RPCs have facilitated access for the PLaD to all of the relevant Trust Prevent leads within London, South East and South Central, to ensure there is a dedicated single point of contact with whom they can liaise with directly regarding vulnerable clients. Over the last few months, the national NHS England Prevent team has also been extensively involved in the creation of the Mental Health Prevent Guidance and e.learning Prevent package for Mental Health professionals. The creation of these two products will help further mainstream Prevent within wider Mental Health Trust activity. To support this work in London, the RPCs have been liaising closely with the Prevent Leads from Mental Health Trusts to clearly articulate to clinicians and staff, the importance of considering any potential Prevent vulnerabilities that are identified when providing treatment or support to patients. These conversations are also helping mental health professionals to understand how Prevent interventions can complement ongoing care plans. The new guidance and elearning package will continue to reinforce this message and will be published in the financial year 2016/ Primary Care In the financial year 2015/16, over was allocated to CCGs to deliver Prevent training for Primary Care services. The training commenced in the year 2016/17, and has resulted in greater numbers of GPs across the London region being trained to a Level 3 standard in Prevent. The RPCs have also been encouraging the CCGs to liaise more closely with their respective Local Authority and Police counterparts to facilitate effective multi-agency conversations around Prevent. 35

36 The RPCs have attended the Designated Children GPs meeting and spoken about Prevent within a Primary Care context. The wider aim is to increase GP confidence in referring to Prevent and understanding that Prevent firmly sits within the safeguarding policy domain. As a result of this meeting, the RPCs have subsequently received requests to attend various GP conferences and meetings across London hosted by the Designate to further articulate this message. From a wider perspective RPCs have started to work collaboratively with the General Medical Council (GMC) to support the introduction of their revised Confidentiality Guidance (good practice in handling patient information). which comes into effect from 25 th April 2017 (GMC, 2017). This guidance document demonstrates to GPs the importance of sharing information in a timely fashion when it comes to safeguarding individuals and communities from harm. The RPCs are using this guidance to galvanise GP understanding of their professional responsibilities when it comes to supporting the Prevent aims Communications Prevent Conferences In March 2017, the RPCs secured funding from the NHS England London regional safeguarding budget to host two half-day Prevent conferences for CCG and Provider organisation Prevent leads to provide an update on current Prevent activity across government and the police, and to articulate the current levels of risk and threat from all forms of terrorism (see 9.1.2). Key note speakers were drawn from the Home Office Prevent Team, Department of Health, National Counter Terrorism Police HQ (NCTPHQ), SO15 Counter Terrorism Command (CTC), Prevent Liaison and Diversion Hub (PLaD) and NHS England. The two events were well attended and extremely positively received. (See Fig. 1 & 2 below). Fig.1 CCG Forum Fig.2 Provider Forum 36

37 National Prevent bulletin London produces a national Prevent bulletin which is circulated to all Prevent leads in CCGs and Provider organisations and seeks to better inform and engage health leads around current activity. This bulletin provides an update on the current national risk/threat/harm picture and also gives useful information on Prevent policy development, including access to the online resources which are available to support training and delivery Information Sharing and Assurance In London, Prevent is a standing agenda item at both the CCG and Provider quarterly Safeguarding fora, where RPCs host discussions regarding pertinent Prevent issues. Regular geographic Prevent updates are also delivered to the Quality and Clinical Governance Group and to all of the London Quality and Surveillance Groups regarding emerging trends, risk and threat levels, and recent Trust assurance data is also provided. This approach ensures that relevant stakeholders are aware of all Prevent activity taking place at any given time. These fora are also used as an opportunity to host discussions around information sharing and Prevent referral pathways. Nationally, an Information Governance and Sharing document has been developed by NHS England which describes the legal frameworks which exist for organisations to facilitate effective information sharing when Prevent concerns are identified. This document is due to published in the financial year 2016/17. From a performance perspective, NHS England has sought assurance from all provider organisations who are commissioned from priority areas. London receives 100% Prevent data return compliance from all Trusts regarding levels of training and referral data. This allows the RPCs to monitor their performance in mainstreaming the Prevent Duty within their organisations. In the quarterly analysis for 2016/7, two Trusts were identified as requiring further support to embed Prevent and requisite support is being provided through the RPCs to enhance their training capabilities and local Prevent policies Channel Panel Referrals Working with all the Local Authority Prevent Coordinators and Channel Panel chairs in London to ensure health is accurately represented at Channel panels has been an ongoing priority in London. In early November 2016, the RPCs undertook an audit to gauge levels of engagement and attendance from CCG Prevent leads and relevant Mental Health Trust Prevent Leads at Channel panel meetings, and found excellent levels of compliance. Where Channel Panels did not regularly convene there was inconsistent participation from health members in some instances, and this has since been addressed with the relevant Local Authorities and Prevent Leads. Attendance and participation in the bi-annual Channel Intervention Provider 37

38 Symposium 9 has also commenced with NHS England being represented by one of the London RPCs. At this forum, NHS England was given the opportunity to discuss the role of health within Prevent. Intervention Providers often have in-depth theological, ideological knowledge and commensurate mentoring skills to provide supportive interventions to Channel clients, but may not be aware of all relevant health treatment pathways. This was an opportunity to reassure and educate all Intervention Providers that health is well integrated into the Channel process and is able to coordinate access to support or treatment where required Key Achievements 1. Organised and delivered two successful Prevent conferences. 2. Built relationships with all CCG Prevent leads and Local Authority Prevent leads across London. 3. Contributed to the Prevent Task and Finish10 and London CONTEST Board11 ensuring the health sector is equally represented. 4. Built relationships with the National Counter Terrorism Policing HQ and organised professional development days for the National Prevent NHS England team. 5. Attended and participated at numerous local GP Exploitation conferences to discuss Prevent. 6. Created a London regional Prevent work-plan that feeds into the national work streams. 7. Liaised and supported the PLaD s activities by ensuring their access to Prevent leads in Mental Health Trusts across London. 8. Met with the SO15 CTC Prevent leads to establish effective working relationships between health and CT policing. 9. Engage the health sector in all Prevent related activity. 10. Commenced working with SO15 to ensure Health is involved in the Counter Terrorism Local Profile (CTLP) information collection cycle and dissemination process. 11. The Director of Nursing responsible for safeguarding attends the London Prevent Board to receive updates from all partners and provide a strategic health update. This has resulted in closer working relationships across central and local government. Since the implementation of the Prevent Duty in 2015, the health sector has played a significant role in raising awareness with staff members. Despite this productive ongoing work, some challenges still exist in mainstreaming Prevent across the health economy- not least in increasing understanding of how Prevent concerns should 9 The Channel Intervention Provider Symposium is the gathering of all the registered Intervention Providers by the Home Office. At this meeting the Intervention Providers are trained and updated on all Prevent activity to support their understanding when they work with individuals from the Channel Panels. 10 Prevent Task and Finish is a meeting hosted by London Councils which aims to bring together all key London partners to deliver on issues which may be occurring. 11 London CONTEST Board is a regional meeting which discusses all pillars of the UK s Counter Terrorism Strategy. NHS England are represented alongside all other statutory and non-statutory partners. 38

39 be addressed within the context of treating mental health conditions, and wider issues around patient confidentiality and information sharing- particular within the primary care milieu. These are all challenges which the regional and national RPC team will continue to address, however there has been significant progress in mainstreaming and embedding Prevent across the London region over the past year. 39

40 8. Contribution to Regional Safeguarding Policy Development 8.1. Supporting the development of a possible new chapter in the London Child Protection Procedures In 2016, the London Assistant Directors Network, Metropolitan Police Service, Mayor s Office for Policing and Crime, London Councils, NHS England (London Region), the London Heads of Community Safety, London Youth and a range of other associations joined together to form the London Safeguarding Adolescents Steering Group (LSASG). The group formed in response to evidence being generated by local site work and case reviews conducted by University of Bedfordshire and the MsUnderstood partnership which has suggested the need for improvements to London s approach to safeguarding young people aged The group will work together until May 2018, supported by the contextual safeguarding team at the University of Bedfordshire, and in consultation with London s practitioners and young people. The group is committed to developing a coherent London policy framework for supporting local practice, including the development of a supplementary chapter in the London Child Protection Procedures (LCPPs) on Safeguarding Adolescents. It has been suggested that the possible addition of a chapter in the LCPPs might help to guide professionals to safeguard adolescents more effectively. There are several key tasks that need to be undertaken before a decision on whether a new chapter on adolescents in the LCPPS can be written: Scan, map and analyse key policy documents/activities developed by LSASG members which impact the safety and welfare of adolescents in London. Feedback on London policy documents that are published for consultation during the LSASG delivery period Survey London members of the contextual safeguarding practitioners network to create opportunities for local professionals to inform the thinking and direction of the LSASG Send a survey out to safeguarding leads across the region, questions included: Do you feel as though you understand safeguarding in the context of keeping adolescents safe equal to, or greater than, safeguarding younger children? What are your experiences of trying to keep young people safe in London? What are some examples of good practice when keeping adolescents? Are there particular challenges you have experienced when trying to safeguard adolescents? 40

41 Where do you need further resources, guidance and support and what might this look like? Provide a thematic seminar/webinar/podcast series to develop understanding of contextual safeguarding and adolescent vulnerability Should the above activities suggest it would assist practice in London, LSASG members will work together to develop a chapter on safeguarding adolescents in the LCPPs Contributing to understanding the Health role in MASE panels Through the work of the Child Sexual Exploitation Task and Finish Group, Multi- Agency Sexual Exploitation (MASE) panels are being reviewed. A major piece of this work involves working with MASE analysis to understand how data is being collected and shared across different boroughs, and also understanding the Health roles in MASE panels. The safeguarding team helped to develop a survey for health professionals to determine: who within Health sits in the MASE, the effectiveness of information sharing, the Health information received at the MASE panels about the child/young person, confidence in processes to help identify vulnerabilities (ie. to sexual exploitation), the level of safeguarding training they have acquired to enable them to perform their roles Contributing to the guidance on Return Home Interviews for Children and Young People who go missing The safeguarding team represent NHS England (London Region) at the Child Sexual Exploitation Task and Finish Group meeting held at London Councils and provide an important Health input into multiagency discussions around CSE. The meeting is one of several task and finish groups that report up to the London Children s Safeguarding Board. One of the key tasks of this group is to review the guidance for independent interviewers conducting Return Home Interviews (RHIs) for children and young people who go missing. The safeguarding team assisted in the review of the draft guidance which is due to be published soon Child Protection-Information Sharing Child Protection Information Sharing (CP-IS) 12 is the national safeguarding alert system that gives immediate access to current safeguarding status of a child which aides clinical decision making, ensures information is held centrally and transferred securely and removes the cost, effort and time in managing child protection lists. 12 Child Protection Information Sharing (CP-IS) NHS Digital Project. 41

42 NHS Digital and NHS England have a team dedicated to progressing sites that become live with this system in London in July LA RAG rating: Green (G): Live Local authority areas Amber (A): Sites actively working to implement CP-IS Red (R): Those areas that are engaged in implementing CP-IS but there are key dependencies that agencies are working towards resolving to go live 42

43 In July 2016 a review of progress in across the country was presented at the National safeguarding steering group, the map above shows the position in London, in order to progress quicker with implementation we undertook a series of actions: Held a meeting with CCG and LAs who were rag rated red to better understand the issues Supported sites financially Engaged the London safeguarding chairs to By the end March 2016 there had been substantial shift in progress with more local authorities gone live or actively working to implement the system. A priority for 2017/18 will be to progress all Local authorities and urgent care providers to a live status. 43

44 9. Commissioning Safeguarding Projects For the financial year 2016/17, the Nursing Directorate in London was allocated Regional teams were asked to take into account the national safeguarding priorities when allocating the monies; Child Sexual Exploitation, Female Genital Mutilation, Looked after Children, Mental Capacity Act and Prevent. A number of regional priorities were also agreed with the rest of the allocation being offered to the health system to bid in to. A series of initiatives and projects were agreed and bids were received by providers and organisations within London throughout the year /17 Commissioned Safeguarding Projects Local Supervising Authority Conference On the 24 th February 2017 NHS England (London region) hosted the Final Local Supervising Authority (LSA) Conference. This was attended by over 200 supervisors of midwives with representation from every maternity unit in London with the theme- look what we have done and look what we can do now (see Appendix vii for the agenda). The changing face of midwifery supervision featured strongly during the conference- The section 60 order had started its journey through parliament and will be subject to a debate in both Houses before it is confirmed and becomes law later this spring. This legislative change occurred and on the 31 March 2017 the LSA function and statutory supervision of midwives ceased but had not happened at the time of the Conference and so this conference focused on the fact that although the Section 60 Order had not been debated it was anticipated that it would happen in the next couple of weeks. Professor Jacqueline Dunkley Bent presented The A-EQUIP framework which will replace statutory supervision. She reported that the pilot phase continues and the University of Sheffield had been commissioned to undertake the evaluation of this model and that Operational Guidance was in the process of being developed to implement it Professor Cathy Warwick presented on Better Births and how maternity will feature strongly in the Five Year Forward View. This will enable an improved collaborative way of working together in Local Maternity Systems with the wider multi-agency teams and shared governance pathways will be put in place. These considerations are of the upmost importance when ensuring that vulnerable mothers and their children are kept safe. It is thought that these changes will go a long way to improve continuity of care, a factor which is so important when caring for these families. Safeguarding presentations also featured strongly throughout the day and were received well by midwives who felt that they had gained a significant amount of new 44

45 information from both a Safeguarding of adults and children s perspective as a result. The headlines from the Safeguarding presentations were; Domestic Violence it was acknowledged that this was significant contributor featured in the last Maternal and Morbidity report and how important it is to ensure there is routine enquiry around domestic violence within midwifery services. The importance of the IDVA service within maternity services was discussed to ensure timely identification and risk assessment takes place. The need to consider domestic violence when women present with mental health concerns was also discussed. FGM the new risk assessment tool for FGM was discussed and the DOH guide to FGM and Safeguarding. Human Trafficking This presentation focused on the Health needs of women who had been trafficked into the UK -particularly with regard to the physical and mental health of survivors which continues to be ongoing work. The National Referral Mechanism (NRM) was also discussed and the importance of ensuring that women suspected of having been trafficked to be given the opportunity to be referred to the NRM which would enable them to access additional support. Breast Ironing Police from the Sexual Offences Exploitation Unit presented on this. This was an area that many midwives knew very little about and it was concluded that there was a lot more work needed to raise awareness within this area of Safeguarding. The need for an awareness raising package was acknowledged. 45

46 It was acknowledged that Safeguarding and providing care for vulnerable families within maternity services could be very challenging due to the seemingly increasing number of cases which demand a lot of time and compassion from staff in order to make a difference to these groups of women. It was acknowledged how important this area of work is as well as the importance of ensuring that there are adequate multi- agency pathways/ joint working and lines of communication in place. Instead of being a conference signifying the end of an era and feeling morose and sad, it was evident that the audience were uplifted by the content of the conference and left the day feeling positive and excited about the new era in the midwifery profession with the implementation of the A-EQUIP model NHS England (London) CCG Prevent Conference This was a conference for all London wide Prevent Leads within CCG s to attend a conference to engage in the wider Prevent narrative. The conference was held to bring all Leads knowledge base to an accurate level and reflective of the current changes within Prevent activity across the sectors. The objectives were to: To allow CCG Prevent Leads to engage in inputs from National Counter Terrorism Policing HQ, Home Office, Department of Health and NHS England. To update all CCG Prevent Leads on wider Prevent activity, including health specific changes and national Prevent changes To give CCG Prevent Leads an opportunity to network with one another and speak directly with the individual influencing Prevent policy making. We completed evaluation forms for the event and overall the feedback was as follows: 94% found event either very beneficial or beneficial 76% found the NHS England Input very beneficial 94% found the Question and Answer panel very beneficial or beneficial Outcomes wise, the conference has started to allow RPC s to understand where the gap in knowledge is with CCG Prevent Leads and what needs to be done in the future to bring multi agencies together to discuss Prevent related issues Healthy London Partnership Child Death Overview Panel Programme Child Death Overview Panels (CDOPs) are a statutory body delivering the review of child deaths function, identification of modifiable factors and sharing of lessons learned to help prevent avoidable deaths. They have a legal duty to publish annual reports. Currently there are 28 CDOPs in London with no way of collating their data to give a population based view of child deaths which would enable effective action to prevent future deaths for a population. In addition, their processes and data 46

47 collection methods show huge variability. The Healthy London Partnership (HLP) successfully requested funding to establish a programme of work to address some of these identified challenges. Funding was used to appoint a programme team to lead on a programme of development and support in The team comprises: a clinical lead (consultant paediatrician) a CDOP chair a programme manager The HLP team have liaised with the National CDOP Programme, NHS England (London Region) safeguarding, London Coroners, London Ambulance Service, and other vital stakeholders to ensure that the London CDOP system and external partners were fully aware of developments and programme outputs. The national CDOP programme team has throughout requested input from the HLP team to support the development of national policy and statutory guidance. The programme will be submitting a funding bid for a further year of support to enable the embedding of programme materials and realisation of programme benefits within the London CDOP system. This will ensure London is well placed to meet future system and legislative changes Identification, coding and recording of information relating to vulnerable children in Primary Care City & Hackney CCG are currently looking at how we might streamline the identification, coding and recording of information in relation to vulnerable children in Primary Care. We currently have: a variety of templates No clarity for GPs in relation to how information is recorded No obvious, easy pathway / process for recording A system that does not enable consistency, information that is recorded but not readily retrievable Disparity across individual GP practices City & Hackney CCG have streamlined this process, resulting in: A reduction of risk of information being unavailable to inform assessment of children Facilitation of work with HIE in relation to care plan sharing and IT road map A product which will be available on the EMIS library and can be replicated by other areas A clearer oversight of the vulnerability of the child population including those that sit below the statutory threshold A product that will work in tandem with our vulnerable children s contract 47

48 Barnet domestic violence and abuse support guidance for GPs London Borough of Barnet to be one of the partner agencies that have contributed financially to enable the commissioning of a specific service for GP practices and domestic violence and abuse support. This is called the Identification and Referral to Improve Safety (IRIS) project. IRIS is to support all staff within a practice to support, identify referrals and know how to deal with cases Enfield Pressure Ulcer Training Following the introduction of Section 42 of the Care Act 2014, Enfield Local Authority placed the responsibility to undertake any nursing investigations firmly on the Safeguarding nursing directorate of the CCG and Continuing Healthcare department. A training needs analysis following this decision highlighted potential gaps in knowledge and skill set for key teams that was required. The CCG sought funding to plug this gap and to increase the knowledge base of key staff in Pressure Ulcers, i.e. Formation, staging and grading, current dressings used and risk factors and preventable measures. The aim of the project was to: Increase in knowledge required regarding Pressure Ulcers to give appropriate decisions in reports Increase in knowledge required to manage safeguarding alerts for adults at risk with Pressure ulcers Safeguarding Adults Lead, Best Interest Assessors & Nurse Assessor (x4) to attend course in Pressure Ulcers which would enhance accurate decision making and report writing. University lecturer commissioned to undertake bespoke training with key Enfield staff. The key staff who manage safeguarding alerts from health organisations in relation to pressure ulcers require an increased level of knowledge. This increase in knowledge will ensure the staff meet the Section 42 investigation criteria and the correlation with pressure ulcers. Assistant Director for Safeguarding successfully completed Pressure Ulcer training course at Buckinghamshire University. Remaining staff due to undertake course in September & February, 2016/17. Feedback from key staff on the impact of the training on their decision making has been positive. Staff also reported they have been able to determine which safeguarding referrals meet the Section 42 criteria at an earlier stage. 48

49 Camden Safeguarding Children Board Annual Conference on Child Sexual Abuse Camden Safeguarding Children Board (CSCB) annual conference on Child Sexual Abuse - 9th February 2017 was funded by the safeguarding programme to support a full day conference. The conference was attended by over 100 professionals from various agencies. It was aimed to raise awareness and equip frontline professionals with the tools and confidence in addressing CSA. The conference included presentations from: keynote speaker Donald Findlater from Lucy Faithfull Foundation; The Children s Commissioner s Office; NHS England on Child House model; NSPCC on PANTS campaign; MET Child Abuse Investigation Team (CAIT) and from CSCB Health partners on model of treatment and intervention. 3 Stage evaluation process was used, which included, pre-course evaluation, immediate post-training evaluation and line manager evaluation 2 months later to reflect on if training is being implemented into practice. Evaluation from the workshop demonstrated positive feedback, with 100% of participants reporting the workshop met the identified aims and objectives. 100% said they had gained knowledge of this area through this event and 100% would recommend this conference to a colleague. 94% rated the conference as good/ excellent. Following training 100% stated that the feel fairly to very confident to support victims of CSA. As part of the CSCB s strategy to address CSA with its partner agencies, the following is planned: Delivery of whole school training programme to help professionals feel more confident to address CSA Camden schools are equipping children to understand healthy and safe relationships as part of PSHE curriculum with a focus on CSE. Aim is to encourage children to talk to appropriate adults within the school. Next identified school for training is Acland Burghley. In conjunction with NHS England (London Region) development of the Child House Model in Camden Greenland Place. 49

50 Health Champion Training for Looked After Children Nurses On 2 and 3 February 2017 NHS England (London region) hosted Looked After Children (LAC) Nurses (Designated, Named and Specialist). The one day course built on knowledge of the principles of health improvement, together with understanding how to influence behaviour change and successfully communicate important health messages. The training was ideal for those who were looking to inspire and motivate others to improve their health and wellbeing. On passing the short examination at the end of the workshop, delegates qualified as a RSPH certified Health and Wellbeing Champion. Health and Wellbeing Champions for Children Looked After and Care Leavers will: Champion the health and wellbeing Children Looked After and Care Leavers Act as an information hub for Children Looked After, Care Leavers and Professionals working with this client group Create mini marketing campaigns for each health topic / issue Organise inspiring live events Gather feedback to inform future initiatives Course Benefits include learning how to Inspire and support others to put their health and wellbeing back on track Recognise the TRUE aspects and influences of health and wellbeing Help overcome the challenges many people face in making behaviour changes Build rapport and trust with others as a respected champion of health Communicate and lead health campaigns that may potentially change lives Enfield Safeguarding Adults and Children Conference In early 2016, 80 Enfield primary care delegates attended the NHS Enfield CCG Primary Care Safeguarding Children and Adults at Risk Symposium in the Lee Valley Athletic Centre in Edmonton. The delegates were a mixture of reception staff, practice managers, practice nurses and GPs across Enfield. A number of local and nationally recognised speakers delivered presentations on the key areas of safeguarding both in children and adults at risk. The symposium was chaired by Dr Peter Green, Chairman of the National Network Designated Health Professionals. The aims of the conference was to: To deliver a joint safeguarding conference on changes within the safeguarding arena, including FGM, Prevent Ensure front line workers are clear about their responsibilities in safeguarding Ensure staff are appropriately equipped with the knowledge on how to 50

51 recognise and manage safeguarding cases in their practice Delegates were also asked to list the top 3 things they had learned to use in practice. The top three topics reported were: Referral pathways into the Multi-Agency Safeguarding Hub FGM Domestic Violence London Ambulance Service Safeguarding Supervision This project is to assist with introducing safeguarding supervision into ambulance service. A project manager will be in post for one year to scope what level of safeguarding supervision is required by different staff groups, find a suitable company to train the supervisors and to pilot the introduction of supervision. The project has: Scoped out who requires what level of supervision and have already piloted some group and individual supervision Supervisors have been trained Supervision policy is currently in draft format Feedback from pilots has been very encouraging The project is to continue for a further year to ensure it is fully embedded into the trust practice and processes. NHSE supporting with this Croydon FGM Project The Croydon FGM Project was extended further twelve months from July 2016-July 2017 (originally it was funded for 12 months via Croydon CCG non recurrent Quality Premium funding). The project in Croydon and has received recognition from NHS England as an example of good practice in tackling FGM at a local multi agency level through the implementation in Croydon of an FGM Risk Assessment Tool, Strategy and Steering Group, multi-agency training, streamlining of referral systems and pathways and dedicated mental health provision for survivors of FGM. Some of the aims of the project are: Reduction in the numbers of women and girls who are at risk of FGM through early identification and interventions Better health outcomes for women who have already undergone FGM through the improvement of identification, support and service delivery. All women to feel better understood, supported and safe in seeking advice, 51

52 support and medical attention around issues relating to FGM. As a result of the project, we are seeing an increase in high quality risk assessed appropriate referrals into Croydon MASH for children at risk of FGM. There have been two arrests in the Borough using FGM legislation and two mandatory reports for FGM to the police. Croydon is identifying more women who have undergone FGM and signposting them into the new services that have been set up/improved as part of the service. Croydon is now seeing a change in attitudes amongst the multi-agency partnership professionals are following protocols and pathways and prioritising their duty towards those at risk of FGM or surviving FGM just as they would for other areas of safeguarding. What an amazing representation of 4 inspirational women they are both humbling and inspiring Totally against FGM girls are human beings and should be treated with respect London Ambulance Service Safeguarding Resource NHS England were keen to support London ambulance service with this initiative as could see need for additional awareness and training for ambulance personnel when responding to patients with dementia. Patients usually access help from ambulances at a time of crisis which increases anxiety and disorientation so to be supported by personnel who can understand the patients perspective and concerns clearly helps to provide safe and person-centred care. The project was to deliver four bespoke films for pre-hospital awareness of dementia: Film 1 awareness and understanding of peoples reality in dementia Film 2 Positively responding ( over telephone) Film 3 Creating relationships- assessment on scene Film 4 Acting on safeguarding concerns, home or Care home. 52

53 We were really impressed by the quality of the resource that was developed and showed this to the London Directors of Nurses meeting who thought it would be useful and applicable to other clinical groups. The resource will really help to increase the confidence of staff caring for patients and enable patients to receive the right care. We particularly liked how the resource could be aimed at the different staff groups depending on their role. For trusts to use education aid as they see fit in their trusts. In London we are introducing in core training and via elearning for existing staff. We have also shared these DVD s with our feeder universities for them to use in their training of paramedics. LAS were nominated for a HSJ award for this piece of work around safeguarding in the region. 53

54 9.2. Commissioned Safeguarding Projects Spend Safeguarding Adults Recipient Project cost ADASS Safeguarding adult board chairs audit tool NHS England Printing Adult safeguarding summit report NHS England Best Interest Assessor training room hire North Middlesex hospital Learning disability nurse resource NHS England Pressure Ulcer resources Safeguarding Children and Young People Recipient Project Cost City and Hackney CCG Identification, coding and recording of information in relation to vulnerable children in Primary Care. Camden CCG Safeguarding conference NHS England Child sexual exploitation leaflet NHS England LADO training NHS England LSA conference Wandsworth CP-IS Merton CCG CP-IS 800 Merton CCG LGBT learning event Merton CCG LAC learning events Merton CCG Signs of Safety Kingston CCG SCR learning outcomes workshop Safeguarding Adults, Children and Young People Recipient Project Cost Barnet Enfield and Harringey Domestic homicide co-ordinator CCG Bromley CCG Domestic abuse in primary care event NEL CSU Network review NHS England Prevent conference Sutton CCG CP-IS RCN RCN Domestic abuse pocket guides Modern slavery pocket guides London ambulance service Supervision additional funding NHS England Printing reports Female Genital Mutilation (National work stream) Recipient Project Cost Croydon CCG Extension of project

55 NEL CSU Data modelling RCN Pocket guides 549 Metropolitan Police Conference Inter-confederation of Conference midwives NHS England 2 x Programme officers NHS England Workshops x Middlesex university Training strategy NEL CSU FGM MoU

56 Responses Safeguarding Annual Update (London Region) 9.3. Looking forward into 2017/ What Safeguarding Leads said: findings from consultations During 2016/17, Designated and Named Safeguarding Professionals from across London were surveyed to determine what they thought the priorities should be moving forward into 2017/18. They were asked what they would like to see continued as priorities in the next year. The first question was: Please select what, in your opinion, should continue being a priority in the next year (2017/18) : Current prioirties that should continue being a priority in 2017/ CSE MCA/DoLS LAC FGM Prevent Safeguarding area The Designated and Named Safeguarding Professionals noted that they felt equally passionate about keeping a focus on both CSE and MCA/DoLS. LAC was also noted as being a priority area for safeguarding. FGM and Prevent were reported as not being in the top three priorities listed. This could reflect the amount of work done by the safeguarding team over the past year and the year prior, to raise awareness and equip staff in these areas. The Designated and Named Safeguarding Professionals Safeguarding were also asked, if they could decide a safeguarding focus area for the next year that is not currently a priority, what it would be. 56

57 They answered that: 1. Self-neglect (26%) and; 2. Domestic violence (24%) were to the two overwhelming majority areas of focus. With the following three being: 3. Modern slavery (13%); 4. Mental health (10%), and; 5. Alcohol and other drugs (8%). Unaccompanied asylum seeking children 3% Prevention 3% Fabricated illness 3% Spirit possession 2% What should be priorities that are not already? Thresholds 3% Self-neglect 26% Child Deaths 5% Alcohol and other drugs 8% Mental health 10% Modern slavery 13% Domestic violence 24% 57

58 Proposed Projects for 2017/18 For the financial year 2017/18, the Nursing Directorate safeguarding team developed the annual work plan which details the following proposed projects. Safeguarding Adults Scope the development of a prison safeguarding leads network to increase support and expertise Continue to support work on MCA/DoLS Safeguarding against self-neglect Safeguarding Children Support the implementation of Child Protection Information System (CP-IS) across London Implement new natonal guidance on Child Death Overview Panels (CDOP) Support school nurses to safeguard and identity local safeguarding leads in health for them to network with and support supervision Scope the development of a youth offending safeguarding leads network to increase support and expertise Safeguarding Adults and Children Review safeguarding arrangements and commissioning/provision opportunities by STP footprint review of safeguarding issues following CQC inspections in acute, MH and primary care organisations, LSCB/SAB inspections in London to improve safeguarding in London Improved safeguarding supervision across London Improve our channels of communication across the region and nationally Strengthen safeguarding Workforce across London Support our designates to include commissioning, leadership and legal training Improve the health response to Domestic Violence in London and make national recommendations Learn from case reviews via the live database to capture themes and trends as investigations are published Improve information sharing and support our safeguarding leads to understand info sharing legislation/policy Multiagency London region safeguarding conference Strengthening safeguarding in performance and revalidation within the medical directorate Improve coverage and levels of training for each directorate/team within London region to reach >80% as an aggregate for level 1 and TBC for levels 2 & 3 58

59 10. Conclusion I hope the review of the year has given a sense of the amount of work undertaken by the regional team and the wider system over the last year, I would like to personally thank all those involved for the never ending enthusiasm and hard work to make the safeguarding system stronger despite some of the challenges faced. We have worked closely too with the national team and other regions to share good practice and develop a consistent approach that works for London. Our priorities for 2017/18 have been consulted on, checked with partners and shared with other regions. The priorities are: 1. Work with each of the five STP areas in London to embed safeguarding 2. Continue to learn from case reviews 3. Undertake a metaanalysis of inspection reports to identify key areas for improvement 4. Work with partners to improve CP-IS roll out 5. Work with Medical Directorate on safeguarding in GP revalidation 6. Undertake safeguarding workforce review 7. Provide guidance on best practice in supervision 8. Continue to lead the work on FGM and Modern Slavery, and take the lead on Domestic Violence 9. Work with partners to understand the impact of the Wood review 10. Support the development of a new regional School Nurses forum 11. Support targeted learning events for LAC 12. Improve our channels of communication across the region and nationally 13. Host a regional safeguarding conference Vanessa Lodge Director of Nursing North Central and East London Regional Lead for Safeguarding National FGM Lead 59

60 11. References Department for Education. (2016). Children looked after in England (including adoption) year ending 31 March HM Government. Retrieved from: Department of Health. (2015). Female Genital Mutilation Risk and Safeguarding: Guidance for professionals / _DH_FGM_Accessible_v0.1.pdf General Medical Council. (2017). Confidentiality: good practice in handling patient information. Retrieved from: Engl ish_0417.pdf_ pdf Goddard, A., Harewood, E. & Brennan, L. (2015). Review of pathway following sexual assault for children and young people in London. NHS England London Region. Retrieved from: HM Government. (2011). Counter-terrorism strategy (CONTEST). HM Government. Retrieved from: /strategy-contest.pdf HM Government. (2013). Disclosure Barring Scheme. Retrieved from: /DBS_Framework_Document.pdf HM Government. (2015). Working together to safeguard children: A guide to interagency working to safeguard and promote the welfare of children. Retrieved from: /Working_Together_to_Safeguard_Children.pdf Home Office. (2015). Channel guidance. HM Government. Retrieved from: /Channel_Duty_Guidance_April_2015.pdf Home Office. (2015). Prevent duty guidance. HM Government. Retrieved from: Metropolitan Police. (2016). Domestic abuse flagged offences, Victims and People Proceeded against across the MPS. HM Government. Retrieved from: =0ahUKEwjml42qtNbTAhWoJ8AKHeGOCP8QFggtMAI&url=https%3A%2F% 2Fbeta.met.police.uk%2Fglobalassets%2Ffoimedia%2Fdisclosure_2016%2Fjune_2016%2Finformation-rights-unit--- 60

61 alleged-incidents-of-domestic-violence-reported-to-the-mps-in-the-last-12- months&usg=afqjcnfo9xjhmmc4cu6pzev3ih3jyxasog Metropolitan Police. (2016). Domestic abuse in England and Wales: year ending March HM Government. Retrieved from: ins/domesticabuseinenglandandwales/yearendingmarch2016 Metropolitan Police. (2016). Domestic abuse incidents recorded in FY1516 broken down by borough. HM Government. Retrieved from: Domestic%20Abuse%20Incidents%20FY1516.xls.pdf National Crime Agency. (2017). National Referral Mechanism. Retrieved from: National Institute for Health and Care Excellence. (2017). Child Abuse and Neglect In development [GID-SCWAVE0708]. Retrieved from: NHS Digital. (2015a). Mental Capacity Act 2005, Deprivation of Liberty Safeguards (England), Annual Report HM Government. Retrieved from: NHS Digital. (2016a). Female Genital Mutilation (FGM) - October 2016 to December 2016, Experimental Statistics Report. HM Government. Retrieved from: +genital+mutilation%22&sort=most+recent&size=10&page=1%20-%20top NHS Digital. (2016b). Female Genital Mutilation (FGM) July 2016 to September 2016, Experimental Statistics Report. HM Government. Retrieved from: +genital+mutilation%22&sort=most+recent&size=10&page=1%20-%20top NHS Digital. (2016b). Mental Capacity Act 2005, Deprivation of Liberty Safeguards (England), Annual Report HM Government. Retrieved from: NHS Digital. (2016c). Female Genital Mutilation (FGM) April 2016 to June 2016, Experimental Statistics Report. HM Government. Retrieved from: +genital+mutilation%22&sort=most+recent&size=10&page=1%20-%20top NHS England. (2014). Framework for Managing Performer Concerns. HM Government. Retrieved from: NHS England. (2015). Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework. HM Government. Retrieved from: 61

62 accountability-assurance-framework.pdf NHS England. (2015). Serious Incident Framework. HM Government. Retrieved from: Office for National Statistics. (2016). Domestic abuse in England and Wales: year ending March HM Government. Retrieved from: ins/domesticabuseinenglandandwales/yearendingmarch2016 Public Health England (2017a). Public Health Profiles: Child Health Profiles. Retrieved from: Public Health England (2017b). Public Health Profiles: Adult Health Profiles. Retrieved from: 3/ati/102/are/E Taillieu, T. L. & Brownridge, D, A. (2010). Violence Against Pregnant Women: Prevalence, Patterns, Risk Factors, Theories, and Directions for Future Research. Aggression and Violent Behavior, 15(1)

63 12. Appendices Appendix i: Abbreviations ADASS CAIT CCG CDOP CH CIRC CNO CP-IS CQC CSA CSE DBS DH DHRs DoLS DON DV FGM GMC GSTT HLP HSCIC IRCs LA LAC LAS LSASG LSCB MASE MASH MCA MCA MET MHHRs MOPAC NAG NSPCC NSSG PAG PFDNs PLPD PSHE QCGC QI RCGP RCM RCN RHIs RPC SAB SCRs SI STEIS UASC WRAP Association of Directors of Adult Social Services Child Abuse Investigation Team Clinical Commissioning Group Child Death Overview Panel Child House Clinical Innovation and Research Centre Chief Nursing Officer Child Protection Information Sharing Care and Quality Commission Child Sexual Abuse Child Sexual Exploitation Disclosure and Barring Scheme Department of Health Domestic Homicide Reviews Deprivation of Liberty Safeguards Director of Nursing Domestic Violence Female Genital Mutilation General Medical Council Guy s and St Thomas NHs Foundation Trust Healthy London Partnership Health and Social Care Information Centre Immigration Referral Centers Local Authority Looked After Children London Ambulance Service London Safeguarding Adolescents Steering Group Local Safeguarding Children Board Multi-Agency Sexual Exploitation Multi-Agency Safeguarding Hub Mental Capacity Act Mental Capacity Act Metropolitan Police Mental Health Homicide Reviews Mayor s Office for Policing and Crime Nursing Accountability Group National Society for the Prevention of Cruelty to Children National Safeguarding Steering Group Performance Advisory Group Preventing Future Death Notices Performers Lists Decision-making Panel Personal, Social, Health and Economic Education Quality and Clinical Governance Committee Quality Improvement Royal College of General Practitioners Royal College of Midwives Royal College of Nurses Return Home Interviews Regional Prevent Co-ordinator Safeguarding Adult Board Serious Case Reviews Serious Incident Strategic Executive Information System Unaccompanied Asylum Seeking Children Workshops to Raise Awareness of Prevent 63

64 Appendix ii: Relevant Legislation and Statutory Guidance Care Act 2014 Care and Support Statutory Guidance Child Care Act 2006 Children s Act 2004 Counter-Terrorism and Security Act 2015 Domestic Violence Crime and Victims Act 2004 Modern Slavery Act 2015 Promoting the Health and Well-being of Looked After Children 2015 The Mental Capacity Act 2005 Working Together to Safeguard Children

65 Appendix iii: Acknowledgements Amelia Howard Former-Prevent Regional Coordinator (London) Caroline Alexander Former-Regional Chief Nurse Edward Farrall Former-Prevent Regional Coordinator (London) Elaine Ruddy Former-Safeguarding Adults Lead Jemma Sharples Quality Manager (Safeguarding), South London Joey Buckley Safeguarding Programme Officer Kate Tuohy Former-Safeguarding Children Lead Lorren Stainton Safeguarding Programme Officer Lucy Botting Former Head of Quality and Safeguarding Lead Misha Upadhyaya Prevent Regional Coordinator (London) Oliver Shanley Regional Chief Nurse Paul McCann Prevent Regional Coordinator (London) Sarah Green Clinical Quality Manager (Safeguarding), North West London Shruthi Belavadi Clinical Quality Manager (Patient Safety), North Central & East London Stephan Brusch Former-Safeguarding Adults Lead Trisha Sharma Former-Prevent Programme Officer Vanessa Lodge Director of Nursing, North Central and East London Regional Safeguarding lead National Female Genital Mutilation Lead 65

66 Appendix iv: NHS England (London Region) Safeguarding Meetings Attended 2016/17 Meeting name Hosting Attendee/s organisation Pan-London Safeguarding London Safeguarding Children Board Meeting London Councils Vanessa Lodge Oliver Shanley London Safeguarding Adults Board Meeting London councils Vanessa Lodge Oliver Shanley London Safeguarding Adults Network London Councils Jemma Sharples Provider Safeguarding Adults Meeting NHS England Jemma Sharples Paul McCann Misha Upadhyaya CCG Safeguarding Adults Meeting NHS England Jemma Sharples Paul McCann Misha Upadhyaya London LSCB Chair Meeting London Councils Vanessa Lodge London Safeguarding Adolescents Steering Group London Councils Lorren Stainton London Named GP for Child Safeguarding Meeting NHS England Vanessa Lodge Sarah Green CSA/CSE Pan-London Child House Steering Group MOPAC Lorren Stainton NCL CSA Hub Steering Group Tavistock Lorren Stainton SWL CSA Hub Steering Group NSPCC Croydon Lorren Stainton CSE Task and Finish Group London Councils Lorren Stainton FGM National FGM Steering Group NHS England Vanessa Lodge London FGM Steering Group NHS England Vanessa Lodge Joey Buckley FGM Task and Finish Group London Councils Vanessa Lodge Joey Buckley Modern Slavery Modern-day Slavery Steering Group Meeting (London) London Councils Joey Buckley London Prevent Network Prevent Hammersmith and Fulham Local Authority Prevent Paul McCann Misha Upadhyaya Counter Terrorism Safeguarding Board National Counter Terrorism Policing HQ Paul McCann Misha Upadhyaya 66

67 London Prevent Board London Councils Vanessa Lodge London Prevent Task and Finish London Councils Paul McCann Misha Upadhyaya CONTEST Board London Councils Paul McCann Misha Upadhyaya MCA NHS England Mental Capacity Act Sub Group Meeting NHS England Jemma Sharples London Mental Capacity Act Forum London Councils Jemma Sharples Homelessness Rough Sleepers Working Group London Councils Jemma Sharples Learning Disability London and the Home Counties Learning Disability Acute Liaison Network NHS England Jemma Sharples Learning Disability Leadership Forum NHS England Elaine Ruddy Jemma Sharples Local Safeguarding Local Safeguarding Adults and Children s Boards London Boroughs All 67

68 Appendix v: NHS England LADO and Performance of Independent Contractors 15 th December 2016, 10.00am 13.00pm, The Novotel Hotel Blackfriars 46 Blackfriars Road SE1 8NZ LONDON TIME TOPIC PRESENTER 09.30am 10.00am 10.15am am Registration and Refreshments Context and purpose of the workshop Examples of PDLP cases with a safeguarding concern Challenges Concerns Support The Role of the LADO and performance of Independent contractors Helene Brown Medical Director North Central and East London Vanessa Lodge Director of Nursing North Central and East London Nick Pratt LADO ( Local Authority Designated Officer) Strategic Commissioning London Borough of Newham 11.30am Group work with Case Studies Small groups to consider a case Issues Process Action Learning Training needs 12.00am Feedback from groups and discussion Summary and Close Vanessa Lodge Helene Brown Reflections Next steps 68

69 Appendix vi: Seeking Assurance via Self-Assessment NHS England London Region SELF-ASSESSMENT ASSURANCE TOOL 2016/17 NHS England London Region, as with all other NHS bodies has a statutory duty to ensure that it makes arrangements to safeguard and promote the welfare of children and vulnerable adults from harm and abuse. The following self-assessment tool aims to assist NHS England London Region in examining the effectiveness of these arrangements and provide assurance that they are discharging their statutory duties accordingly. 69

70 not met partially met fully met Safeguarding Annual Update (London Region) THEME 1 Safeguarding is everyone s responsibility There Is a Culture of Safeguarding within the Organisation Ref Standard Evidence how NHS England London Region meets standards Are any actions required to improve effectiveness? 1.0 Safeguarding and promoting welfare considers the voice of the children and vulnerable adults Safeguarding Team are linked in with Public and Patient Voice, Safety and Quality Leads. Raising the awareness of FGM workshop has been held with survivor s and professionals. CSA Hubs and Child House models have been developed and co-designed with NHS England, MOPAC and children and young people A Multi-Agency Modern Slavery Trainer the Trainer package has been developed in conjunction with Stop The Traffic, Police and London Councils Safeguarding Teams have developed robust links with provider forums who represent these patient groups 70

71 1.1 Culturally relevant/appropriate safeguarding processes/procedures NHS England (London Region) has policies in place to inform equality and diversity. Staff are trained yearly on equality and diversity. This is mandatory. Translation service provided. Information is provided in a range of fonts, formats and languages consistent with NHS England policy on communications. This includes plain English, accessibility and languages Where NHS England provides services to vulnerable adults (i.e. through Specialised Commissioning for mental health services or commissioning through adult services) advocacy services are available. Staff are made aware of advocates, information and the appropriateness of types of advocacy NHS England produced the accessible information standard (2016) CHC, Transforming Care staff and case manager s workloads are managed appropriately to enable staff to undertake the highest quality of care. This will include frameworks for MCA and DOLS. 71

72 1.3 A senior Board level Lead takes responsibility for the organisations safeguarding arrangements The Board level accountable person is Jane Cummings, Chief Nurse, and NHS England. OVERALL EVALUATION IN RESPECT OF THEME 1 Fully Met A culture of safeguarding children & vulnerable adults is embedded throughout the organisation. 72

73 not met partially met fully met Safeguarding Annual Update (London Region) THEME 2 A Safe Organisation Ref Measure Evidence Action needed 2.0 Safe recruitment procedures for individuals whom the organisation will permit to work regularly with children & vulnerable adult.. Policies are in place to undertake to ensure that the level of DBS checks are appropriate for the specific roles Enhanced DBS checks are carried out on all staff whose roles require this. Managing Safeguarding Allegations Policy can be found at: All staff induction As a standard, all job descriptions include information that relates to the NHS England s position on safeguarding children and Adults and the expectations of staff in relation to their responsibilities. Safeguarding children and Adult training is embedded into the induction programme of all new members of staff. 73

74 2.2 All NHS ENGLAND staff complete children & adult safeguarding training which is at the appropriate level for their role & responsibiliti es All staff are expected to complete level 1 mandatory safeguarding training via an e-learning platform. The safeguarding leads provide advice, information & face to face training for staff requiring additional training in order to fulfil their role and responsibilities. A Safeguarding Training Strategy has been developed for staff in NHS England which has been developed in line with the recommendations from Sec 11 of the Children Act 2004, Working Together 2015 and the Care Act It is the responsibility of the directorate leads/ identified Safeguarding Training links to ensure that staff within their area have been trained at the correct level of Safeguarding as appropriate for their role in line with the above Training recommendations. Safeguarding Training data is kept for all staff via the ESR process for Level 1 Training. The overall figure for NHSE London is 83% A Safeguarding Training sub group to be held on a quarterly basis to which the Safeguarding training links from each directorate will be invited to attend. This will enable the Safeguarding Training figures to be reported on and any omissions to be addressed. These figures to be reported via the quarterly Quality reports and the Safeguarding steering group. To co-ordinate dates with national team and local LSCB s for levels, 2, 3, and 4 training. 2.3 Effective supervision is available to all staff A supervision policy is in place & can be found at: Staff have regular opportunities to review and reflect on their own practice and share concerns Staff have opportunities through the PDP and appraisal process each year to identify their safeguarding training needs and personal development. 2016/17 data has identified that there are a number of staff with outstanding appraisals. In June 2016 all Directors were requested to ensure that staff have completed appraisals. We will review this in the Autumn There is a quarterly Safeguarding Steering group meeting which the Safeguarding links from the different directorates within NHSE attend. As part of this process a Serious Case Review is presented and discussed to enable learning to take place. The Safeguarding Team to commence drop in- Safeguarding Supervision sessions for all staff on a monthly basis. A monthly Safeguarding team meeting is held and chaired by the Regional Lead for Safeguarding. This provides the opportunity for peer group supervision as well as discussing any concerns, learning from case reviews, intelligence and future planning Contact details for the Safeguarding Team to be distributed in all areas within Skipton House. 74

75 The Safeguarding Team are available for any staff within the organisation to approach and raise concerns/ get support around any Safeguarding issues or concerns. A monthly Teleconference is held by the Director of Nursing and Safeguarding Link within Specialised Commissioning to enable staff to discuss any Safeguarding concerns. A member of the Safeguarding Team to link in with Specialised Commissioning and attend their Safeguarding Teleconference Calls A review of Safeguarding Supervision has been undertaken with regard to consideration of what best practice should look like. It has been recommended that a restorative approach is undertaken and this has been forwarded to the National Team for further consideration. An audit of the quality and effectiveness of supervision to be undertaken by the Safeguarding Team during 2017/ All staff are aware of safeguarding policies and they are clear and accessible The Assurance and Accountability Framework 2015 sets out the requirements of NHS England to discharge its statutory duty for safeguarding children, young people and adults at risk. Safeguarding policies and procedures are in place & can be found at: (INCONJUCTION WITH WORKING TOGETHER AND CARE ACT) Staff receive regular briefings in relation to safeguarding. These to be undertaken on an annual basis. Staff are aware of their safeguarding leads & training champions and who to contact for advice and guidance There is a mandatory induction for all staff which includes familiarisation with safeguarding policies, procedures & training. 2.4 Clear whistle blowing procedures for staff NHS England has a whistleblowing policy: Addressing concerns voiced by staff in external organisations regarding NHS services (Sept 2016) and Voicing your concerns for staff, an internal policy (Sept 2016) 75

76 2.5 Effective complaints system in place which is in line with current statutory guidance for the public, and staff, to make complaints about safeguarding or concerns about care 2.6 Child-friendly complaints systems A concerns and complaints policy is in place and all complaints are dealt with in a timely and fair way via the complaints team at NHS England London region. There are excellent lines of communication and liaison between the complaints, medical and nursing teams. An updated Safeguarding Template has been designed to be used to ensure consideration of any Safeguarding concerns during the PLPD/PAG process. One of the Safeguarding Leads also sits on this committee to ensure that any Safeguarding issues are identified, raised and discussed. All calls are first screened and triaged via the National Contact centre who will advise NHS London Team f there are any Safeguarding concerns. Staff are trained in Safeguarding and this is part of the checklist for all calls made to the complaints team and appropriate referrals made. 2.7 Allegations of abuse against staff There is a code of conduct for staff working directly with adults at risk, concerning acceptable and unacceptable behavior including NHS England has a culture in place that supports staff to raise concerns and includes appropriate referral to the disclosure and barring service NHS England as an organisation has a code of conduct for staff working directly with adults at risk concerning acceptable and unacceptable behavior 76

77 discriminatio n and bullying OVERALL EVALUATION IN RESPECT OF THEME 2 Partially met due to data collection issues around safeguarding training & outstanding staff appraisals. 77

78 not met partially met fully met Safeguarding Annual Update (London Region) THEME 3 Assurance & System Leadership Ref Measure Evidence Action needed 3.0 NHS ENGLAND London provides leadership, support, training & advice to safeguarding professionals NHS ENGLAND hosts & chairs a number of key meetings for safeguarding professionals including, London LAC Nurse Meeting, Named GP s, Adult leads, Designated professionals, Named Nurses and Midwifes There is regular engagement with London Chairs meeting and the London safeguarding group (adults, children and Prevent). Two conferences were held in 15/16 which included best practice for children and adults. A review has been undertaken of the Safeguarding Networks and Groups and is embedded in this report. 3.1 NHS ENGLAND London ensures that safeguarding duties are being met in relation to the services that it directly commissions & that effective safeguarding assurance arrangements are being implemented across the health system In 2016 NHS ENGLAND undertook a Grip on Providers review NHS ENGLAND has worked closely with the London Safeguarding Adult Board chairs and developed The Safeguarding Adults at Risk Audit Tool. This provides a consistent framework to assess monitor and/or improve their Safeguarding Adults arrangements There is a medical performance team who manage any performer concerns in relation to the performer list regulations. A member of the Safeguarding Team attends this committee. To review and liaise with designated Safeguarding leads around Private providers to ensure that pathways are in place to enable robust information sharing and communication between private and NHS providers. Key Safeguarding improvements are factored into NHS England s 78

79 yearly work plan. Safeguarding is aligned strongly to NHS England Quality Assurance Process and Practice Safeguarding Team to work with the Primary care revalidating Team to ensure that Safeguarding is always considered as part of practitioners revalidation process 3.2 NHS ENGLAND London drives improvement by ensuring that there are robust processes in place to learn lessons from cases where children or adults die or are seriously harmed & abuse & neglect is suspected A SCR tracker is in place at NHS England to log each case and any actions Each individual investigation is reviewed and discussed at the safeguarding steering group There is attendance at every domestic homicide review in London NHS England (London Region) undertakes to action all the themes and trends from lessons learnt for SAR/SCR/DHRs as appropriate. NHS England (London Region) holds a database setting out themes and trends from SAR/SCR/DHRs. High level themes and trends in the London Region and nationally comprise the work plan priorities for the year head. NHS England (London Region) facilitates the communication of learning from reviews to partners e.g. To have midwifery Safeguarding Representation on the Maternity Morbidity and Mortality Group to ensure that any Safeguarding learning can be disseminated appropriately and in a timely manner. To enhance the database for collecting data from SAR/SCR/DHR to ensure that it efficiently pulls themes from reviews 3.3 NHS ENGLAND London engages with local safeguarding boards & any local arrangements for safeguarding both adults & children. As per the risk assessment paper above there is named lead for each Board. There is attendance at the Safeguarding Chairs meeting and the London Safeguarding Board Further engagement work with Boards in relation to the Wood s review to be undertaken in 20017/18. 79

80 3.4 Quarterly monitoring in place and action plans to address issues and communicated to staff A Safeguarding update, themes and exceptions report is provided on a quarterly basis via the Quality Report for NHS England (London Region) and is shared with NHS England (London Region) executives and directors. A quarterly Safeguarding Newsletter to be sent out to all staff which highlights any learning from Serious Case Reviews/ recent issues in Safeguarding 3.5 NHS England (London region) directly commissioned services have positive outcomes for children and vulnerable adults To ensure that any NHSE Commissioning arrangements include the monitoring of Section 11 responsibilities via the Health Outcomes Monitoring Tool to provide evidence and assurance that there are robust safeguarding processes in place. OVERALL EVALUATION IN RESPECT OF THEME 3 Partially met - NHS England to develop a Safeguarding Outcomes monitoring tool to provide assurance around specialised commissioning services, health and justice, primary care, dentistry. Optometry and pharmacy. To continue to work with the recommendations from the Woods review once changes in structure to LSCB s have been finalised to ensure that any changes and engagement with boroughs remain consistent. 80

81 Appendix vii: London LSA Conference Agenda LONDON LSA CONFERENCE Millwall Football Club Conference Centre, Zampa Road, London, SE16 3LN 24 th February 2017 Facing the future: Opportunities and challenges for the midwifery profession Arrival & Registration 09:00-09:15 09:15 10:00 10:00 11:00 11:00-11: :55 Welcome and Introduction Perspectives from the RCM on the current state of midwifery Introducing a new model of supervision guidance for implementation Feedback from the A-EQUIP Model Pilot Sites experience in London Tea / Coffee Introduction to the safeguarding session and quick update FGM and Safeguarding Use of NHS maternity services by women trafficked in the UK: findings from the PROTECT study Honour based abuse: focus on breast ironing an emerging traditional harmful practise Jane Clegg, Director of Nursing and Interim Regional Deputy Chief Nurse NHS England (London Region) Jessica Read, London LSAMO Cathy Warwick Chief Executive Royal College of Midwives Prof Jacqueline Dunkley-Bent Head of maternity and children services at NHS England Pilot site leads: Sinead Farrell, The Whittington & Lorraine Imber, BHRUT Vanessa Lodge Director of Nursing North Central and East London Safeguarding regional lead FGM national lead Vanessa Lodge Geraldine Joyce, Safeguarding Midwife & Supervisor of Midwives, GSTT Debra Bick Professor of Evidence Based Midwifery Practice/Editor in Chief Midwifery journal King s College London Allen Davis Inspector Partnership Team SOECA Command Metropolitan Police Service 13:00- Lunch 14: Afternoon Session 14:00 14:40 14:30 15:00 Electronic fetal monitoring overuse, underuse, overkill? An expert s opinion Joint Partners in the Safety of Mothers and Babies in London Edwin Chandraharan Consultant Obstetrician, St. Georges Hospital, Tooting Amanda Mansfield Consultant Midwife, London Ambulance Service 81