DATE OF MEETING 24 June 2014 REPORT FOR Trust Board of Directors Public REPORT FROM Dr Karen Dunderdale, Chief Nurse CONTACT OFFICER Craig Ferris, Head of Safeguarding SUBJECT Annual Adult and Children Safeguarding Report 2012-2014 BACKGROUND DOCUMENT (IF ANY) REPORT PREVIOUSLY CONSIDERED BY & DATE(S) NA EXECUTIVE COMMENT (INCLUDING KEY ISSUES OF NOTE OR, WHERE RELEVANT, CONCERN AND / OR NED CHALLENGE THAT THE BOARD NEED TO BE MADE AWARE OF) The purpose of the report is to provide the Board with an annual report of the work undertaken in 2013-2014 giving assurance that the Trusts is compliant with its safeguarding duties and those responsibilities specified under section 11 of the Children Act 2004 and current safeguarding adults legislation. Present proposed developments for 2014-2015 based on the local, regional and national safeguarding agenda. HAVE THE STAFF SIDE BEEN CONSULTED ON THE PROPOSALS? HAVE THE RELEVANT SERVICE USERS/CARERS BEEN CONSULTED ON THE PROPOSALS? ARE THERE ANY FINANCIAL CONSEQUENCES ARISING FROM THE RECOMMENDATIONS? IF YES, HAVE THESE BEEN AGREED WITH THE RELEVANT BUDGET HOLDER AND DIRECTOR OF FINANCE, AND HAVE ANY FUNDING ISSUES BEEN RESOLVED? ARE THERE ANY LEGAL IMPLICATIONS ARISING FROM THIS PAPER THAT THE BOARD NEED TO BE MADE AWARE OF? WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO THE NHS CONSTITUTION IN ANY DECISIONS OR ACTIONS PROPOSED? WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO SUSTAINABILITY IMPLICATIONS (QUALITY & FINANCIAL) & CLIMATE CHANGE? THE PROPOSAL OR ARRANGEMENTS OUTLINED IN THIS PAPER SUPPORT THE ACHIEVEMENT OF THE TRUST OBJECTIVE(S) AND COMPLIANCE WITH THE REGULATORY STANDARDS LISTED ACTION REQUIRED BY THE BOARD The Board are asked to receive the annual Safeguarding Report and approve the plans for 2014-2015
Safeguarding Children and Adults Annual Report Northern Lincolnshire and Goole NHS Foundation Trust Board Lead Director: Dr Karen Dunderdale: Chief Nurse Lead Officer: Craig Ferris: Head of Safeguarding tel: 01472 875215 email: craig.ferris@nhs.net Key points: The purpose of the report is to provide the board with an annual report of the work undertaken in 2013-2014 giving assurance that the Trust is compliant with its safeguarding duties and those responsibilities specified under section 11 of the Children Act 2004 and current safeguarding adults legislation. Category of paper Decision Position statement Information Present proposed developments for 2014-2015 based on the local, regional and national safeguarding agenda. It is recommended the Board: i) Receive the safeguarding report. ii) Approve the plans for 2014-2015 Page 1 of 15
Report checklist Category Is there an effect? Yes No Further information (if there is an effect, either briefly explain what it is, or point to the section of the report which discusses it in more detail) Financial impact, including value for money Is a risk assessment required? Patient focus Children and Families & Adults Impact on equality Impact on health Policies address inequalities inequalities Impact on safety Policies address patient safety Legal issues Compliant with Section 11 (children Act 2004) Workforce issues Training and updating in place Any issues re. Standing Orders Consultation with committees and key stakeholders Standards for Better Health domain(s) 1, 3, 4, 7 Freedom of Information status Method of communicating report content to staff and stakeholders Available to the public Publication of Board Paper Page 2 of 15
1.0 Purpose of Report The purpose of the report is to provide the Board with an annual update of the work undertaken in 2013-2014 with regard to safeguarding children and adults and the proposed areas of development for 2014-2015. 2.0 Legislative Background 2.1 Safeguarding Children The statutory inquiry into the death of Victoria Climbié (2003), and the first Joint Chief Inspectors report on Safeguarding Children (2002) highlighted the lack of priority status given to safeguarding. Since this time the Government has been engaged in a programme of work to improve safeguarding, with the Government s vision being a shift in focus from protecting children from harm to a prevention focus. In 2010 the Secretary of State for Education commissioned an independent review of child protection in England and in May 2011 Professor Munro completed her review making various recommendations as to the future practice of safeguarding Safeguarding and promoting the welfare of children is defined in Working Together to Safeguard Children 2013 as protecting children from maltreatment; preventing impairment of children s health or development; and ensuring that children are growing up in circumstances consistent with the provision of safe and effective care; and undertaking that role so as to enable those children to have optimum life chances and to enter adulthood successfully. The Government recognise that early intervention is essential if children and young people are to be safeguarded effectively. This shift in focus from protecting children from harm to preventing abuse and neglect forms part of the Government s whole system reform for children s services as part of the Every Child Matters: Change for Children programme. The Children Act 2004 underpins the implementation of the reforms. Safeguarding Children is everyone s responsibility, Section 11 of the Children Act 2004 places a duty on key persons and bodies to make arrangements to ensure that in discharging their functions, they have regard to the need to safeguard and promote the welfare of children. Part 1 of the guidance sets out the arrangements that are common to all agencies whilst part 2 deals with implementation in each particular agency. At an organisational or strategic level, key features which must be adopted by NHS organisations are: Senior management commitment to the importance of safeguarding and promoting children s welfare; A clear statement of the agency s responsibilities towards children for all staff; A clear line of accountability within the organisation for work on safeguarding and promoting the welfare of children; Service developments that takes account of the need to safeguard and promote welfare and is informed, where appropriate, by the views of children and families; Staff training on safeguarding and promoting the welfare of children for all staff working with or in contact with children and families; Safe recruitment procedures in place; Effective inter-agency working to safeguard and promote the welfare of children Effective information sharing. NHS organisations must also demonstrate they are meeting their responsibilities in accordance with Children Act 1989 and Children Act 2004 plus supporting guidance Working Together to Safeguard Children (HM Govt 2013), and the Framework for the Assessment of Children in Need and their Families; NHS Core Standard C2 as identified within the Health and Social Care Standards and Planning Framework for 2005-8, National Standards, Local Action; Page 3 of 15
Standard 5 of the National Service Framework for Children, Young People and Maternity Services (DH 2004 ) along with those elements of the NSF beyond Standard 5 that deal with safeguarding and promoting the welfare of children; including the letter from Jacqui Smith, the then Minister of State for Personal Social Services, dated 28 January 2002; CQC Standard 7: Safeguarding people who use services from abuse The relevant sections of What to do If You re Worried a Child Is Being abused (HM Govt 2003) updated (2006). An audit of Section 11 duties is undertaken by each Safeguarding Children Board and any subsequent action plans will be monitored in line with the current governance arrangements 2.2 Safeguarding Adults Safeguarding Adults has not yet been given statutory status and the expectation that the No Secrets document originally produced in 2000, would be shortly updated as not materialised however following the publication of the draft Care and Support Bill on 11 th July 2012 there is a proposal for a single, modern law for adult care and support that replaces existing out-dated and complex legislation and is the largest overhaul of the law around adult care and support in 60 years. The new care bill will become statutory on the 1 st April 2015. Implications for Safeguarding Vulnerable Adults The draft bill sets out the first statutory framework for adult safeguarding, to set out local authorities responsibilities, and those of the local partners. In brief, these include: Membership Each local authority must establish a Safeguarding Adults Board (SAB) of which core members are the local authority, representative from the Clinical Commissioning Group and the Chief Officer of Police. The membership can also include other members the local authority considers appropriate, but these should have the required skills and experience. Core members must meet regularly to discuss and act upon local safeguarding issues. NLaG already sit on the three safeguarding adult boards The local authority must appoint as the chair a person who they consider to have the required skills and experience. Each Board has or is in the process of appointing an independent chair Requirements The SAB s obligations will be set out in guidance. The SAB must produce a plan for each financial year which sets out its strategy for achieving its objectives and what each member is to do to implement the strategy. In preparing the strategic plan the SAB must consult with the Local Healthwatch organisation and wherever possible the local community. Each Board has or is currently strengthening its business plan The SAB must produce an annual report as soon as possible after the end of each financial year which states its progress against its strategic plan. The Bill states this should be sent to the chief executive and leader of the local authority, the local policing body, the local Health watch organisation and the chair of the Health and Wellbeing Board. Each board already produces an annual report Page 4 of 15
Safeguarding enquiries by local authorities The proposed legislation will require local authorities to make enquiries, or to ask others to make enquiries where they reasonably suspect that an adult in their area with care and support needs is at risk of abuse or neglect. The purpose of the enquiry is to establish what, if any, action is required. The Bill does not provide powers for local authorities to enter a person s property or take other similar action to carry out the enquiry. Safeguarding Adults Reviews SAB will have to arrange for a safeguarding adults review to take place in certain circumstances, where an adult dies or there is concern about how one of the members of the SAB conducted itself in the case, The aim of the review is to ensure that lessons are learned, not to allocate blame, but to improve future practice and partnership working, to minimise the possibility of it happening again. This is already in place within the three boards should the need arise The Care and Support Bill will provide a statutory framework for safeguarding adults however in the initial year following approval will not have a noticeable impact within the local areas in so much as the three boards already function in line with most of the suggested changes. In March 2011 the Department of Health produced a series of documents Safeguarding Adults: The role of health services: Department of Health - Publications advising commissioners, Trust boards, managers and front line staff of their duties. The key document for Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) is entitled The role of health service managers and their boards. The document reminds health service managers and their boards of their statutory duties to safeguard adults. It aims to assist managers in meeting their responsibilities to safeguard adults and supports, No Secrets (DH 2000) the statutory multi- agency guidance. The ongoing government reforms aim to put patients and the quality of their care at the heart of the NHS. The government s commitment to patient choice, control and accountability includes support and protection for those in the most vulnerable situations. Managers have responsibilities for the safety and well being of all their patients. However, they have particular duties for those patients who are less able to protect themselves from harm, neglect or abuse. In keeping with the government s approach to decentralisation and local flexibility, the document does not prescribe processes or targets. However, the government has agreed safeguarding principles that can provide a foundation for achieving good outcomes for patients. Safeguarding Principles Principle 1 Empowerment Presumption of person led decisions and consent Principle 2 Protection Support and representation for those in greatest need Principle 3 Prevention Prevention of neglect harm and abuse is a primary objective. Principle 4 Proportionality Proportionality and least intrusive response appropriate to the risk presented Page 5 of 15
Principle 5 Partnerships Local solutions through services working with their communities Principle 6 Accountability Accountability and transparency in delivering safeguarding Whilst not mandatory the department of health suggest that health service managers and their boards assure themselves that they are meeting statutory duties to safeguard adults. This self-assessment was undertaken during 2011-2012 and reported back to the Board by way of the Trust governance and assurance committee. Presently a series of assessments are being undertaken by the Local safeguarding adult s boards in the region to ensure statutory partner agencies are functioning at appropriate levels 2.3 PREVENT What is PREVENT? The Office for Security and Counter Terrorism (OSCT) in the Home Office is responsible for providing strategic direction and governance on CONTEST. As part of CONTEST, the aim of PREVENT is to stop people becoming terrorists or supporting terrorism. CONTEST is primarily organised around four key principles. Work streams contribute to four programmes, each with a specific objective: PURSUE: PREVENT: PROTECT: PREPARE: to stop terrorist attacks to stop people becoming terrorists or supporting terrorism to strengthen our protection against a terrorist attack to mitigate the impact of a terrorist attack. The Health Service is a key partner in PREVENT and encompasses all parts of the NHS, charitable organisations and private sector bodies which deliver health services to NHS patients. PREVENT has 3 national objectives: Objective 1: respond to the ideological challenge of terrorism and the threat we face from those who promote it Objective 2: prevent people from being drawn into terrorism and ensure that they are given appropriate advice and support Objective 3: work with sectors and institutions where there are risks of radicalization which we need to address The Health Sector contribution to PREVENT will focus primarily on Objectives 2 and 3. PREVENT training undertaken in line with Objectives 2 and 3 is known as HealthWRAP training. Why Health care staff? The overall principle of health is to improve the health and wellbeing through the delivery of healthcare services while safeguarding those individuals who are vulnerable to any form of exploitation. PREVENT is also about protecting individuals. PREVENT aims to protect those who are vulnerable to exploitation from those who seek to get people to support or commit acts of violence. Healthcare staff are well placed to recognise individuals, whether patients or staff, who may be vulnerable and therefore more susceptible to radicalisation by violent extremists or terrorists. It is fundamental to our duty of care and falls within our safeguarding responsibilities. Page 6 of 15
Every member of staff has a role to play in protecting and supporting vulnerable individual who pass through our care. Whilst PREVENT is not yet a statutory duty, there is an expectation that training of health staff will be added as a safeguarding indicatory during 2013 2004 The PREVENT trainers forum (a subgroup of the Safeguarding adults forum) is presently responsible for implementing the policy and rolling out the training. 3.0 Designated and Named Professionals for the Trust and its Commissioners 3.1 Children - The terms designated and named professionals (children) are clearly defined in Working Together 2013 as professionals with specific roles and responsibilities for safeguarding children. All Clinical Commissioning Groups are required to have a designated doctor and nurse whose responsibility it is to take a strategic, professional lead on all aspects of the health service contribution to safeguarding children across the commissioned area, which includes all providers. The designated professionals are also in place to provide professional advice on matters relating to safeguarding children for other professionals, NHS Commissioners, Local Authority children s services and the safeguarding children boards. The Trust is presently commissioned to provide the designated doctors for North Lincolnshire and North East Lincolnshire and as such benefits from the experience that these posts bring All NHS Trusts must also identify a named doctor, a named nurse and a named midwife (where maternity services are provided) for safeguarding with the focus of named professional on safeguarding children within their own organisation. These professional are in post within the Trust and include two lead anaesthetists for child protection as recommended by the Royal College of Anaesthetists (2012) 3.2 Adults No structure or requirement is yet in place statutorily to have a Designated or Named professionals for safeguarding adults, however the proactive approach by the Trust has been to develop the safeguarding adult service and as such the Head of Safeguarding holds the lead for both children and adults. In April 2011 the Trust became the lead organisation for the North Lincolnshire community health services and in doing so gained some further resource in relation to a Designated Nurse for Safeguarding Adults. In 2013 the CCG appointed separately to the post of Designated Nurse safeguarding adults and the post within NLaG was redesigned to provide the Trust with a Named Nurse for safeguarding adults and as such a slight increase in capacity. 4.0 The NLaG Safeguarding Team The Safeguarding Children Team has been in place for several years within the Trust but only incorporated Safeguarding Adults In March 2011. As such the team are now responsible for Child Protection (NLaG), Adult Protection (NLaG) and Looked after Children s health needs (North East & North Lincolnshire), the PREVENT agenda (NLaG) and the service for Sudden Unexpected Deaths In Infants (SUDIC) across North East and North Lincolnshire A full structure of the current safeguarding team can be found at Appendix 1. 5.0 NLaG Safeguarding Governance Arrangements The responsibility for safeguarding rests ultimately with the Chief Executive Officer, Karen Jackson supported by the Executive Director with board responsibility, Dr Karen Dunderdale. The Trust has a safeguarding children s forum and a safeguarding adult s forum which report to the Trust Governance and Assurance Committee (figure 1). Both these groups are active in their management of the current action plans issues within their specialist areas. Both groups are chaired by the head of safeguarding. Page 7 of 15
Figure 1 Board Trust Governance and Assurance Committee Safeguarding Children Forum Safeguarding Adult Forum PREVENT Trainers Forum 6.0 Local Safeguarding Children Boards and Local Safeguarding Adult Boards Safeguarding Children Boards were set up as a statutory body in April 2006 in compliance with Section 13 of The Children Act 2004 and replaced the former Area Child Protection Committees (ACPC). They are a partnership of the relevant statutory, voluntary and community agencies involved in safeguarding and promoting the welfare of all children and young people. Safeguarding Children Boards exists to safeguard and promote the welfare of all children and young people. They do this by co-coordinating the safeguarding work of member agencies so that it is effective. Monitoring, evaluating and when necessary, challenging the effectiveness of the work and advising on ways to improve safeguarding performance. Whilst not yet on a statutory footing until 1 st April 2015, Safeguarding Adults Boards operate in the same way and are expected to promote a culture of safeguarding and promoting the welfare of vulnerable adults The Local Safeguarding Children Boards of North Lincolnshire, North East Lincolnshire and East Riding all have Independent Chairs and membership has been reviewed ensuring that attendance at the Boards is at the required levels and members have sufficient seniority The Trust is represented by the Head of Safeguarding at the following Boards: North East Lincolnshire LSCB and LSAB North Lincolnshire LSCB and LSAB East Riding LSCB and LSAB There is representation by other key professionals on the sub committees of the above Board. During 2013 2014 there has also been closer working with the Lincolnshire LSCB due to ongoing serious case reviews across the Lincolnshire and North east Lincolnshire boards. 7.0 Serious Case Reviews (SCR s) 7.1 Children Serious Case Reviews have been in place for many years under the former Area Child Protection Committees. Nationally about 100 take place every year. An SCR is always carried out by the Safeguarding Board when a child dies and abuse or neglect is known, or suspected, to be a factor in the death. Working Together (2010) guidance also states that LSCB should consider holding an SCR where a child has sustained a life threatening injury through abuse or neglect, serious sexual assault, or through serious and permanent impairment of health or development through abuse or neglect. LSCBs should also consider holding an SCR where a case gives rise to concerns about the way in which local professionals and services worked together to safeguard and promote the welfare of children, and cases where a parent has been killed in a domestic violence incident, and where a child has been killed by a parent with mental illness. The Page 8 of 15
purpose of an SCR is to establish what lessons can be learnt about the way professionals and organisations worked together, how they will be acted upon and what is expected to change in order to improve inter-agency working and improve safeguarding practice to children. SCRs are exercises in learning and improving policy and practice and outcomes for children and young people. They are not inquiries into how a child died or who was culpable; this is the business of Coroner s and the Criminal Court. A SCR is commissioned by the LSCB and involves setting up a multi-agency review panel of senior and experienced managers, with an independent chair, to ensure objectivity and impartiality. The panel must produce a report to the LSCB on lessons learnt, the LSCB then ratifies the conclusions and recommendations for actioning the lessons. The report also goes to the Trust board and Ofsted / CQC for their scrutiny and response. All relevant agencies are expected to produce and implement an action plan, based on the recommendations, which is overseen by the LSCB SCR panel. During 2013 2014 the Trust has taken part in two SCR (one on-going) and a third SCR about to commence. All current action plans have been completed and signed off during 2013. 7.2 Adults Serious case reviews within the safeguarding adults process are relatively new and like the boards do not form part of a statutory process. Nationally however there have been several reviews over the last 12 months. Processes are in place to undertake SCR locally should the need arise. 8.0 Child Protection Cases The number of children having a child protection plan over the last 9 years from April 2005 to March 2013 is presented in Figure 2. All areas covered by the Trust hold child protection conferences on each working day. The numbers for children who currently have a child protection plan vary on a daily basis Monday to Friday and can be influenced by families moving in and out of the local authority however the numbers of children on plans has significantly risen over the last 24 months and the increase is not expected to abate in the short to medium term. This increase as placed a significantly greater workload on the safeguarding team and this is being monitored to ensure the service remains effective Figure 2 Number of children having a child protection plan within Local Authority areas currently receiving services from NLaG (April 2005 March 2013) 250 200 150 100 North East Lincs North Lincs East Riding 50 0 2005 2007 2009 2011 2013 Page 9 of 15
9.0 Adult Protection cases Adult protection is a rapidly growing field with increasing workload not only within the safeguarding team but impacting on the general roles within the Trust i.e. Complaints / PALS, Matrons. The number of safeguarding adult cases that the Trust are actively investigating is rising in number and systems are being developed to allow for improved tracking and for trend analysis. General trends from these investigations highlight issues of poor nursing care, lack of coordinated discharge and poor communication / record keeping. Issues which are already reflected within the work undertaken as part of the Mortality review and also recently reflected within the CQC inspection reports Locally the trend is an increase in the number of safeguarding adult referrals being made (based on all referrals received by the LA safeguarding adult teams). Figure 3 2500 2000 NEL 1500 East Riding 1000 NL 500 0 2008/ 2009 2010 /2011 2012 / 2013 Cases Investigated in NLaG 10.0 Legal statements / Court process The safeguarding team have continued to strengthen and develop its remit of supporting staff in statement writing and court attendance. With changes in the child care legal process, it is likely that the current trend for the production of more legal statements will continue. Over the next 12 months work will be jointly on-going with medico-legal to streamline the process and ensure that new timescales which come into effect on the 1 st April 2014 are able to be met 11.0 Safeguarding Clinical Supervision 11.1 Children Effective clinical supervision is important to promote good standards of practice and support individual staff members. Supervision allows time for reflective practice and is a vital component in the protection of children. Supervisors should be available to practitioners as an important source of advice and expertise and may be required to endorse judgements at certain key points in time, and ensure each individual child has an effective plan of action. The Safeguarding team provide direct supervision to professionals which includes reflecting on, scrutinising and evaluating the work carried out, assessing the strengths and weaknesses of the practitioner and providing coaching, development and pastoral support. Page 10 of 15
During 2013-2014 a review of safeguarding clinical supervision standards has taken place and the safeguarding supervision policy for child protection as been amended. Supervision data is now held centrally within OLM. This is to ensure that the safeguarding team is consistently applying high standards, which are measurable. 11.2 Adults Presently there is no systematic process to provide safeguarding supervision for adult protection cases, although supervision is provide to staff who require it on a needs lead basis. Development work for 2014 to 2015 will be to build on this initial work and develop a more robust process for safeguarding adult s supervision in line with the safeguarding adult s self-assessment 12.0 Training and learning Safeguarding training has always been a high priority to the Trust and has been delivered in a variety of ways and at different levels across the organisation. A training plan has been in place for safeguarding children and safeguarding adults and the safeguarding team have delivered a significant amount of sessions throughout the year. Safeguarding adults training was only introduced during 2009 2010 and the number of staff receiving it has steadily increased. In March 2011 a review of the current training strategies was undertaken and as a result new training plans were developed in May 2011 to strengthen the Trusts position in relation to training and bring it in line with statutory guidance with targets of 80% compliance to be achieved by April 2014. As a result of realignment with statutory guidance the reported training levels with the Trust as of 1 April 2011 were as follows Child protection Level 1 48% Child protection Level 3 54% Adult Protection level 1 32% Over the last 24 months a great deal of work has taken place to develop an accurate training data base linked to individual staff records. As a result of this there have been several fluctuations in training figures however we are now in a position to accurately monitor training attendance and identify staff groups who are nearly out of compliance 15 April 2014 Child Protection Level 1 84% Child Protection Level 2 77% Child Protection Level 3 80% Adult Protection Level 1 83% Figure 4 Actual training trajectory 2013 2014 Axis Title Training Trajectory Dec 2013 to March 2014 100 50 0 Jun-11 Oct-11 Feb-12 Jun-12 Oct-12 Feb-13 Jun-13 Oct-13 Feb-14 CP level 1 CP Level 2 CP level 3 AP level 1 Page 11 of 15
Safeguarding training remains on the Trust risk register and a management plan is in place however it is expected that the risk is removed in the coming months. 13.0 Safeguarding issues within Pregnant Women In 2012 midwifery introduced family files at DPoW which was a new way of recording concerns about women during their pregnancy. This had already been long established at SGH. One of the reasons for the introduction was to have one system of recording and communicating concerns between midwives.. During 2013 2014 the role of the named midwife has developed and ensured a greater insight into the areas of substance misuse in pregnancy and also that of domestic violence. In 2013 NLaG became the provider of Community Midwifery services within Lough and as such there has been an increase in the number of cases which the team have dealt with, specifically in relation to domestic violence issues and attendance at MARAC within the Lincolnshire area.. 13.1 Number of Family files Reason for family file 2013 Number of women identified 2011/12 2012/13 2013/14 Domestic abuse 13 26 44 Child Protection 16 88 67 Substance use 12 23 24 Teenage pregnancy 28 50 50 Mental Health Not recorded Not recorded 22 TOTAL 69 187 207 14.0 Looked After Children Children and young people who are looked after are amongst the most socially excluded groups in England and Wales. They have profoundly increased health needs in comparison with children and young people from comparable socio-economic backgrounds who have not needed to be taken into care. These greater needs however, often remain unmet. As a result, many children and young people who are looked after experience significant health inequalities and on leaving care experience very poor health, educational and social outcomes. NLaG currently provides the looked after health service for the children of North East Lincolnshire and North Lincolnshire Figure 5 Number of Children in care within North East Lincolnshire and North Lincolnshire who currently (NEL) and in the future (NL) will receive services from NLaG 300 250 200 150 100 North East Lincs North Lincs out of area 50 0 2005 2007 2009 2011 2013 Page 12 of 15
Of significance is the number of out of area children placed within our geographical boundaries that also receive services from NLaG. All of these children require assessments which currently are absorbed by the NLaG team. From 1 st April 2013 a national tariff was introduced and depending on the commissioning pathways this may allow the team to income generate from this point. During 2013 2014 the Looked after children service (North East Lincolnshire) has been on the Risk register due to the continuing increase of children entering the care system ( both Looked after and Adopted). Additional funding has been sort from the CCG to boost the current staffing establishment and a new service level agreement is presently being approved which will see additional workload taken on by the team but with an increase in staffing to ensure the service can deliver at the required level 15.0 Domestic Violence / Multi-agency Risk Assessment Conference (MARAC) Nationally, 52% - 66% of child protection cases involve domestic violence and 30% of domestic violence cases start during pregnancy. Involvement with domestic violence and the Multi-Agency Risk Assessment Conference (MARAC) continues to build with 371 (2013 2014) cases attended in North east Lincs (58% increase) and 388 in North Lincs (34% increase). The purpose of the MARAC is to provide a structured forum for the sharing of information, risk assessment and safety planning in relation to victims, offenders and their children in cases of domestic abuse to also ensure support services are aware of a high risk or potential risk of domestic abuse situation and that adequate and appropriate support is available to the victim and any dependents. Each organisation involved has an information sharing agreement that details what information that organisation will make available to partners. With recent increase in numbers, the MARAC sessions have now moved to 3 weekly in NL and 4 weekly in NEL. Each month the team are committed to attending the full day MARACs in both North Lincolnshire and North East Lincolnshire with an average of 24 cases discussed at each conference. Since taking over the management of Community Midwifery in Lough, the team are also now attending several MARACs within the Lincolnshire area The Trust Domestic Violence Policy as recently been updated and additional training has been provided to key professionals to ensure earlier identification and a more proactive stance against the abuse A Business case is presently being developed to identify specific funding for MARAC workload 16.0 Safeguarding Developments for 2013-2014 Developments identified within the last annual report: Undertake section 11 audits in line with LSCB requirements (Completed) Undertake a safeguarding adults self-assessment in line with current department of health guidance (Completed) Roll out PREVENT training ( including Trust Board Briefing) (On-going) Work with Commissioners to develop a Service Specification for NLaG to undertake Initial health assessment for LAC ( North East Lincs) (on-going) Achieve 80% plus compliance across all safeguarding training levels (nearly completed) Developments for the next 12 months Review safeguarding adults self-assessment in line with current department of health guidance Review the impact of MARAC commitment on the team and develop a business case for additional funding Recruit to New Service specification for NEL LAC Page 13 of 15
Review service Specification for NL LAC Continue to raise the profile of PREVENT 17.0 Conclusion This report demonstrates the continued development and increased awareness of safeguarding children and safeguarding adults issues within the Trust. The Trust continues to respond to the rapid national and local pace of change as well as maintaining an input external to the Trust. The safeguarding governance structures continue to develop and the forums are actively managing the current action plans as well as moving services forward. The forthcoming year promises to be full of further developments and challenges for both the team and the Trust 18.0 Recommendations It is recommended the Board: i) Receive the safeguarding report. ii) Approve the plans for 2014 2015 Page 14 of 15
Safeguarding Team 01472 875215 (DPoW) 01724 387887 (SGH / Goole) Midwifery team Paediatric team Appendix 1 Chief Nurse (Executive lead for safeguarding) Head of Safeguarding Children & Adults Secretary to Safeguarding Children team Admin Support Safeguarding SGH / DPoW Named Nurse CP X 2 (SGH) / (DPoW) Named Nurse CP (North Lincs Community) Designated Nurse LAC (North Lincs) Designated Nurse LAC (North East Lincs) Named Nurse Adult Protection Named Midwife X2 Named Doctor SGH Named Doctor DPoW Specialist Nurse Safeguarding 1 WTE Secretary safeguarding Secretary LAC Secretary LAC Admin Support LAC SUDI Nurse Admin Support safeguarding Named Nurse LAC Specialist Nurse LAC Paediatric Liaison Nurse Specialist Nurse Safeguarding X 2 Page 15 of 15