Safeguarding Adults Annual Report 2012/13 May 2013 1
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Contents 1. Introduction 2. Key Professionals 3. Accountability and Structure 4. Governance and Statutory Arrangements 5. Safeguarding Monitoring 6. Safeguarding Training 7. Service Developments 8. Future Objectives 9. Appendix 1 CCG Safeguarding Structure p3 p3 p4 p5 p6 p8 p8 p9 p14 3
1. Introduction/Current Context 1.1. The term Safeguarding Adults covers everything that assists an adult at risk to live a life that is free from abuse and neglect and which enables them to retain independence, well-being, dignity and choice. It is about preventing abuse and neglect, as well as promoting good practice for responding to concerns on a multiagency basis. Whilst the responsibility for coordinating Safeguarding Adults arrangements lies with Borough councils with social care responsibilities, effective safeguarding is based on a multi-agency approach. Haringey CCG is accountable for ensuring its own safeguarding adults structures and processes, and those in agencies from which we commission services meet the required standards. Haringey CCG is committed to the principles and definitions set out in the Pan- London multi-agency policy and procedures to safeguard adults from abuse. (Source: Haringey CCG Safeguarding Adult Policy April 2013) 1.2. This annual report will set out the current national and local context for safeguarding Adults, the key achievements of 2012/13, the challenges anticipated in 2013-14 and future objectives. The report reflects the following themes: Governance and accountability arrangements within NHS North Central London (Haringey) and the provider health organisations in Haringey including representation to and involvement in the Haringey Safeguarding Adults Board Key adult safeguarding priorities, developments and challenges. Future objectives for 2013-14. 2. Key Professionals 2.1. Until June 2012, Haringey PCT safeguarding adults strategic responsibility was included in the Head of Adult Commissioner s role. This role was operationally supported by the Safeguarding adult lead from Whittington Health NHS Trust. Due to long term absence from June 2012, the Safeguarding Adults service was initially supported from June 2012 by the Designated Nurse for child protection and then in addition, a part time interim safeguarding lead from January 2013 until March 2013. A full time Safeguarding Adults lead was appointed in December 2012 and commenced post in April 2013. 4
Safeguarding Adults Team in Haringey CCG from April 1 st 2013 Richard Christou Safeguarding Adults Lead 1.WTE Buena Cordero Senior Safeguarding Administrator 1.WTE (shared with safeguarding children team) The Executive Lead for Safeguarding in Haringey Clinical Commissioning Group (HCCG) is Sarah Price; Chief Officer who is a member of HCCG Governing Body. 3. Accountability and Structure 3.1. With the transition to Clinical Commissioning Groups over 2012/13, the safeguarding adults accountability and governance arrangements in Haringey have been reviewed and revised. There has been increasing dual reporting from 1 st October 2012 to Haringey CCG Governing Body, Haringey Professional Executive Committee and to NHS North Central London Board to facilitate the safe transition from the cluster arrangement of NHS North Central London to Haringey CCG. 3.2. NHS Haringey Clinical Commissioning Group s Chief Officer is the executive lead for the CCG s safeguarding adults agenda and has the responsibility for ensuring the contribution by health services to safeguarding and promoting the safety of adults at risk and vulnerable people. In addition, that safeguarding adult practice is strongly embedded across the whole local health economy. This is operationally delivered through local commissioning arrangements. The Chief Officer is a member of Haringey CCG Governing Body. 3.3. The Director of Quality and Integrated Governance (who reports to the Chief Officer) is responsible for ensuring that the monitoring of safeguarding adults across Haringey takes place through the Quality Committee of the Haringey Clinical Commissioning Group s Governing Body and the Haringey Safeguarding Adults Board (SAB) and for reporting any appropriate safeguarding risks or achievements to the Chief Officer. 3.4. From 1 st April 2013 when Haringey PCT ceased to exist and Haringey CCG was authorised to commence work the Safeguarding Adults Lead had commenced post and reported directly to the Director of Quality and Integrated Governance. 3.5. The Senior Safeguarding Administrator will continue to report to the Designated Nurse for Child Protection but provide administrative assistance to the Safeguarding Adults Lead as required. 3.6. Haringey CCG s Governing Body General Practitioner (GP) Lead for Adults has specific responsibility for safeguarding adults within her portfolio of responsibilities when considering commissioning services for the residents of Haringey 5
3.7. Structure charts regarding adult safeguarding strategic leads have been included in this report (see appendix 1) to include: As Haringey PCT (NCL): June 2012 January 2013 As Haringey CCG: October 2012 December 2013 (Shadow CCG) January 2013 March 2013 (Shadow CCG) April 1 st 2013 on-going (Formation of CCG) Proposed structure changes to Safeguarding Team 4. Governance Arrangements and Statutory Arrangements 4.1. Haringey Safeguarding Adults Board The Executive Lead for Safeguarding and the Governing Body Lead GP for adults, are members of the Haringey Safeguarding Adults Board (SAB). In addition the Safeguarding Adults Lead will contribute to the operational work of the safeguarding service, which is managed through the local authority. The Safeguarding Adults Lead represents the CCG at a number of sub groups of the SAB, examples of these include a group looking at safeguarding adult training and a prevention group. The main providers of healthcare in Haringey namely Barnet, Enfield and Haringey Mental Health Trust (BEH- MHT), Whittington Health and North Middlesex Hospital are represented at Director level on the SAB. Representation from Provider Services at Haringey SAB meetings from April 2012 to March 2013 evidenced good attendance. The Designated Nurse for child protection represented both children and adult services from the July 2012 meetings. 4.2. Serious Case Reviews There has been one Serious Case Review commissioned by the council concerning an adult with a learning disability whose care was the responsibility of Islington council but the person lived in a Haringey care setting. As a result of this review there is now a protocol in place for out of borough placements that are made in Haringey which clarifies the role and responsibilities of placing councils to ensure that any adult is referred and accepted by local community health services. 6
5. Safeguarding Monitoring 5.1. Acute Providers For the 2012/2013 year the CCG s largest providers; North Middlesex University Hospital NHS Trust Whittington Health NHS Trust Barnet, Enfield and Haringey (BEH) Mental Health Trust (MHT) had their adult safeguarding processes and performance monitored by their own trust boards and by representation on the SAB. In addition, all Trusts were required to have their core adult safeguarding processes, procedures and alerts monitored by their respective local authority. This is because the local authority remains the lead in the locality for adult safeguarding. 5.2. Independent Providers (e.g Nursing/Care Homes) Independent Providers are monitored through the Safeguarding Information Panel which is a six weekly meeting chaired by the local authority and attended by the Care Quality Commission and the Safeguarding Lead for the CCG. These meetings were set in place to allow key partners responsible for the safety of vulnerable people to assess any concerns in respect of both quality and safety and to plan actions to address any concerns identified. 5.3. Establishment Concerns The establishment concerns joint policy was ratified at the SAB in April 2013. This joint health and social care strategy has been developed as a means for managing large scale investigations of Care Providers. It is a response to the concerns raised in Serious Case Reviews (SCR) about the quality of care and safety of people, most recently the South Gloucestershire report on Winterbourne View Private Hospital and the Francis Report on the failings found at Mid-Staffordshire NHS Foundation Trust. It is not however exclusive to the findings and recommendations of these reports, it has also taken forward the organisational learning from other SCR s, management investigations, commissioning accreditation findings and safeguarding investigations managed by the lead agency for safeguarding - Haringey council. This policy is intended to reflect the Safeguarding Principles of: Empowerment - Presumption of person led decisions and informed consent. Protection - Support and representation for those in greatest need. Prevention - It is better to take action before harm occurs. Proportionality Proportionate and least intrusive response appropriate to the risk presented. Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. Accountability - Accountability and transparency in delivering safeguarding. 7
5.4. Winterbourne View Project Group The Department of Health published the final report Transforming care: A national response to Winterbourne View Hospital 1 in December 2012, setting out actions to improve care and support of vulnerable people with learning disabilities. The report lays out clear, timetabled actions for health and local authority commissioners working together to transform care and support for people with learning disabilities or autism who also have mental health conditions or behaviours viewed as challenging. The Transforming Social Care Report, Winterbourne View Hospital 2 describes 14 key objectives which when delivered collectively are intended to: Improve commissioning across health and care services for people with behaviour which challenges with the aim of reducing the number of people using inpatient assessment and treatment services. Clarify roles and responsibilities across the system and support better integration between health and care. Improve the quality of services to give people with learning disabilities and their families choice and control. Promote innovation and positive behavioural support and reduce the use of restraint. Establish the right information to enable local commissioners to benchmark progress in commissioning services which meet individuals needs, improve the quality of care, and reduce the numbers of people in in-patient services for assessment and treatment. An action plan was developed in response to Winterbourne View and a Multi-agency Project board set up and had its first meeting 28.2.13 and was represented from safeguarding by the Interim Adult Safeguarding Lead with the Lead CCG representation being the Commissioner for Mental Health and Learning Disabilities. (Source: Winterbourne View Response, Haringey Learning Disabilities Partnership and Haringey Clinical Commissioning Group, 2013) 1 Transforming care: A national response to Winterbourne View Hospital December 2012 Department of Health: https://www.wp.dh.gov.uk/publications/files/2012/12/final-report.pdf 2 Transforming care: A national response to Winterbourne View Hospital December 2012 Department of Health: https://www.wp.dh.gov.uk/publications/files/2012/12/final-report.pdf 8
6. Safeguarding Training 6.1. GP Training There are currently 52 GP practices in Haringey with a total of over 600 staff. A rolling programme of safeguarding adult training offered to GPs in 1.5 hour sessions was delivered by the Safeguarding Lead from Whittington Health NHS Trust from April 2012 to December 2012. From January 2013 until April 2013 four additional training sessions were delivered by the interim Safeguarding Adults Lead. 6.2. NHS Haringey Training Safeguarding Adults training was offered by the Safeguarding Lead from NHS Whittington Health NHS Trust from April 2012 to December 2012 and overseen by the learning and development department of NHS North Central London. 7. Service Developments 7.1. Authorisation The Designated Nurse for child protection contributed to the safeguarding aspects of the CCG authorisation process and took part in the management of the Selfassessment Assurance Framework (SAAF). In 2010 an initial pilot of the SAAF for Healthcare Services was developed. In 2011 and 2012 the then Primary Care Trust completed Section 5 (Commissioning) of the SAAF and submitted its assessment to the Local Authority Safeguarding Adults Board (SAB) and the North London Cluster. Safeguarding leads in the NHS and local authority also reviewed and audited submissions from Provider services. Haringey CCG audited North Middlesex University Hospital and its findings were shared with NHS Enfield who in turn audited submissions from BEH-MHT and Chase Farm Hospital. Section 5 relating to Commissioning of the SAAF identified that there was work needed in order the CCG to receive a rating of excellent. In Haringey the local authority and CCG worked together and presented findings to the January Board on North Middlesex University Hospital. Colleagues in Enfield and Islington presented findings to their respective Boards on Whittington Health and BEH Mental Health Trust. The CCG Safeguarding adults policy and procedure has been revised and updated as part of this process and implemented by Haringey CCG from 1 st April 2013. Haringey CCG was authorised with no safeguarding conditions. 7.2. Mental Health Complex Care Pathway Panel (including Winterbourne View reviews) NHS Mental Health commissioners from Barnet, Enfield and Haringey CCGs have been developing care pathways which ensure clients with complex mental health needs receive quality services which are local, cost effective, personalised and which help early recovery. Support for individuals in regaining and maintaining good mental health and well-being should be offered in the least restrictive settings possible. 9
Care coordinators oversee clients placed in medium and low secure out of borough placements and the panel facilitates a return to in-borough placements as soon as appropriate. Following the Winterbourne View scandal (as mentioned in section 5.4), the department of health has developed a programme of initiatives to map out services to people with a learning disability. The aim is to work towards all people receiving a local service to meet their needs that offer the greatest opportunities for people to live and be part of local communities rather than recipients of institutional care. 7.3. Nursing Homes working group This group was convened to continue to develop a proactive approach to quality healthcare and well-being, which should be offered in the least restrictive settings possible; and to further develop a proactive approach to quality assuring care within care homes and an early warning system if concerns arise. This work is being taken forward by the Quality Matters in Care Homes project. 8. Future Objectives/Challenges The challenges for safeguarding over the coming year is to continue to develop, expand and embed safeguarding practice within the core work of the CCG; and to build up partnership working with the local authority, local health providers and NHS England (London). 8.1. Safeguarding Strategy and Action Plan The interim safeguarding adults lead drew on local and national sources to produce an action plan for the Safeguarding Adults function in the CCG. This Action Plan takes forward the work of NHS England (London) to ensure that across London people are in receipt of safe quality services. Integral to this is assurance for people who use services, and their carers that the NHS vision for the delivery of services is built on firm foundations. NHS London s vision for Safeguarding Adults at Risk sets out 4 main themes. Strategic Clinical Leadership Quality care and Performance development Partnership Working Regional network information (NHS London Safeguarding Adults Leads) Safeguarding Policies and Procedures The focus for this plan is to assess where the CCG may have any gaps or omissions, agree the standards and goals that it wants to achieve and; prioritise work plans that are SMART and can stand up to external scrutiny Acknowledging that the Local Authority remains the safeguarding lead, this Action Plan also considers work that the CCG can usefully achieve by pooling resources, producing joint policy and procedures, and working together where it makes sense to do so. A key example, learning from Winterbourne is improving outcomes for people living in nursing homes and other care establishments and being assured that people are safeguarded from harm and abuse. 10
The third area that this Action Plan draws on is the Essential Standards under the Health and Social Care Act 2008 regulated by the Care Quality Commission. The two outcomes that are pertinent are: Outcome 7: Safeguarding people who use services from abuse. The objective being that, people should be protected from abuse and staff should respect their human rights. Outcome 4: Care and welfare of people who use services. The objective being that, people should get safe and appropriate care that meets their needs and supports their rights. Included in both outcomes is the implementation of the Mental Capacity Acts and the Deprivation of Liberty Safeguards. This Action Plan has 5 main planks which consider the elements of the 3 local and national drivers as above, to enable the CCG to evidence that it provides safe, quality services. 1. Strategy: There is strategic planning that encompasses the views of all stakeholders in particular people who use services that are translated into practice. This is in synergy with the Local Adults Safeguarding Board plans and reflects the standards set by the NHS to meet quality and safety for people who use services, their carers and staff. 2. Safeguarding Practice: Practice reflects the strategic objectives to deliver an accessible, responsive, quality service to adults at risk maintaining consistent high standards measured through performance data and assured by a robust quality assurance framework. 3. Workforce Development: All staff are equipped to safeguard adults at risk and enhance their knowledge and skills through a multi-agency training and development programme. Staff are supported to achieve standards through effective supervision, appraisal and management oversight. 4. Prevention: There are strategic plans that address preventing abuse that includes the Prevent agenda and the wider remit of safeguarding 5. Organisational Learning: The CCG develops a culture of learning that enriches its work with adults at risk that is disseminated across the NHS and shared with its strategic partners An overarching safeguarding vulnerable adults strategy will be developed and will use the action plan to ensure its implementation. 8.2. Safeguarding Monitoring From 2013/14 The CCG Safeguarding Adults Lead will be attending all three Providers Safeguarding Adults Committees (North Middlesex NHS Trust, Whittington Health NHS Trust, BEH Mental Health Trust). The Safeguarding Adults Lead will utilise attendance in the committees as a resource of gaining CCG assurance that Provider Trusts are ensuring high quality safeguarding adults 11
practice is embedded within their organisations and providing supportive challenge where required. The Safeguarding Adult Lead will monitor compliance with the Trusts respective safeguarding adult training strategies through representation on the committees and take action as required. Information obtained from these meetings will be reported to the Director of Quality and Integrated Governance and to the CCG quality committee. 8.3. GP Staff Training From the 2013/14 year it is the responsibility of NHS England to Provide GPs with their mandatory training, including ensuring competencies and skills around safeguarding adults. Until GPs are further appraised of details from NHS England regarding training the CCG will continue to support GPs to ensure they are appropriately trained to identify and safeguard adults at risk. The Safeguarding Adults Lead will work with the Governing Body Adults Lead General Practitioner with a view of supporting GPs to access e-learning training to help improve uptake rates of training and allowing GP staff to access training at a time convenient for them. 8.4. CCG Staff Training The Safeguarding Adults Lead will work closely with People Development Business Partner from the North and East London Commissioning Support Unit (NELCSU) in agreeing processes in which CCG staff undertake and record their mandatory adult safeguarding training. It is anticipated that e-learning safeguarding adult training will be available to CCG staff from July 2013. 8.5. Multi Agency Risk Assessment Conference (MARAC) Haringey holds a MARAC monthly, chaired by the police. It is a forum where information about high risk domestic abuse victims (those at risk of serious harm) is shared between local agencies. By bringing all agencies together at a MARAC, a risk focused, coordinated safety plan can be drawn up to support the victim and help ensure their safety free from harm. There are close links between domestic violence and adult safeguarding. In the 2013/14 year the Safeguarding Adults Lead will consider becoming a member of the local MARAC to ensure there is a representation regarding vulnerable adults in addition to the children s representation by the CCG s Named Nurse Child Protection. 12
8.6. Haringey Care Homes Project The Care Homes Project will promote harm free care by supporting Haringey Care Homes to reduce: number of hospital admissions number of 999 calls number of visits to A & E departments from residents of local care homes number of pressure ulcers sustained In the 2013/14 year The Safeguarding Adults Lead will work alongside the Quality Assurance Lead Nurse to provide support and guidance around safeguarding concerns relating to the Project s four main outcomes: The Safeguarding Adult Lead, along with the Quality Assurance Lead Nurse, will attend the Safeguarding Information Panel (see section 5.2) six weekly to discuss the safety and quality of care in local establishments. The Safeguarding Adults Lead will work collaboratively with the Quality Assurance Lead Nurse and share information regarding poor care practice, the implications this may have for adult safeguarding and thus indicating providers where improvements are necessary to improve both care, quality and reduce the number of safeguarding alerts. END OF REPORT Authors: Richard Christou Safeguarding Adult Lead Haringey CCG and Lorraine Stanforth Interim Safeguarding Adult Lead Haringey shadow CCG 13
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