Safeguarding Adults Annual Report: 2016 / 2017

Safeguarding Adults Annual Report: 2016 / 2017 July 2017 1

Contents 1 Introduction 2 Purpose of the report 3 Leadership and Accountability 4 Safeguarding Adults National Context 4.2 Safeguarding Adults within the NHS 5 NHSE Competency Guidance for NHS Staff 6 Local Picture 7 Haringey Safeguarding Adult Board 7.2 Activity 2016-2017 7.3 Summary 7.4 How has this data informed our work 8 Multi-Agency Safeguarding Arrangements and Partnership Work 9 Safeguarding Monitoring of Commissioned Services 10 NHS HCCG Safeguarding Adults Training Compliance 11 Reviews Inspections, Audits 12 Service Developments 13 Key Objectives for April 2016 March 2017 Page 3 3 4 5 6 6 7 8 8 14 14 16 18 23 23 26 33 2

1. Introduction 1.1 Safeguarding is everybody s business. 1.1.1 NHS Haringey Clinical Commissioning Group (HCCG) is committed to working with partner agencies to ensure the safety, health and well-being of the local people in Haringey. Protecting the vulnerable is a key part of the CCG s approach to commissioning and, together with a focus on quality and patient experience, is integral to our working arrangements. Our approach to adult Safeguarding is underpinned by quality and contracting systems and processes that aim to reduce the risk of harm and respond quickly to any concerns. 1.1.2 This is the fourth NHS Haringey CCG Safeguarding Adults Annual Report and will provide assurance on how HCCG is meeting its statutory requirements for Safeguarding Adults at risk of abuse and neglect. The report will also provide an overview of the progress made during the year 2016-17 and the key challenges. 1.1.3 The report will illustrate how HCCG has continued to improve outcomes for Adults at Risk through governance and assurance processes and moving forward how HCCG will fulfil its statutory duty to promote the wellbeing principle 1 through its safeguarding arrangements. 1.1.4 Key areas of priority for Safeguard Adults were established in the Safeguarding Annual Report 2016-17; and progress against these priorities is detailed in the Action Plan page 26. 2. Purpose 2.1.1 The purpose of this report is to provide assurance that NHS Haringey CCG is in line with statutory guidance, and takes account of the responsibility of all NHS funded organisations and healthcare professionals, to ensure that people in vulnerable circumstances are not only safe but also receive the highest possible standard of care. In addition to providing assurance of HCCG commitment to prevent and reduce the risk of abuse and neglect of adults and of continuing to improve Safeguarding practice in the NHS. 2.1.2 The report will: Set the context for Safeguarding Adults in Haringey Demonstrate how HCCG is fulfilling its Safeguarding Adults statutory responsibilities Report on governance and accountability arrangements within HCCG and the provider health organisations including representation to and involvement in the Haringey Safeguarding Adults Board (HSAB) Highlight service developments and significant issues and report on progress of the team s 2016/17 objectives Agree the Safeguarding Adults Team s objectives for 2017/18 1 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/366104/43380_23902777_care_act_boo k.pdf 3

3. Leadership and Accountability 3.1.1 Leadership and responsibility for safeguarding at Governing Body level is achieved through the Director of Quality and Executive Nurse. The role of Executive Nurse within the CCG provides representation on both the Local Safeguarding Children Board (LSCB) and Haringey Safeguarding Adult Board (HSAB). Safeguarding expertise in the CCG is provided through by the Designated Professional for Safeguarding Adults at risk who is also a member of the HSAB, attends the SAB subgroups is the co-chair for the Mental Capacity and Deprivation of Liberty Sub Group and the Safeguarding Adult Review sub group. Table 1 HCCG Membership and Attendance Board Member Attendance Safeguarding Adult Board (SAB) Executive Nurse Designated professional for 3/4 4/4 SAB sub group Quality Designated professional for 4/4 Assurance SAB sub group Prevention and Training SAB sub group Mental Capacity and Deprivation of Liberty SAB sub group Safeguarding Adult Review Designated professional for Designated professional for Designated professional for 4/4 4/4 5/5 Local Safeguarding Meeting Prevent delivery group Channel Panel Adult at Risk Panel LBH Information Sharing panel Care homes information sharing panel Provider internal Safeguarding Committees North Middlesex Hospital Whittington Trust Designated professional for Designated professional for Designated professional for Designated professional for Designated professional for Designated professional for Designated professional for 4/4 10/12 5/6 4/4 6/10 6/6 6/6 4

Barnet, Enfield and Haringey Mental Health Trust London professional meetings NHS London Safeguarding Adult Leads NHS London Prevent Adult Leads London Councils Mental Capacity and Deprivation of Liberty Safeguards Leads Making Safeguarding Personal Leads Designated professional for Designated professional for Designated professional for Designated professional for Designated professional for 4/6 4/4 4/4 4/4 1/1 3.1.2 The Designated Professional for Safeguarding Adults at risk is directly accountable to the Director of Quality and Executive Nurse. As safeguarding expert and strategic leader, the Designated Professional provides a vital source of advice to the CCG, NHS London, Local Authority and HSAB. The Designated Professional also provides advice and support for health professionals in the wider health economy. This role ensures that HCCG fulfils its statutory functions for Safeguarding as detailed in statutory and national guidance, providing assurance to executive leads for safeguarding, that there is a systematic approach to Safeguarding across HCCG. The Designated Professional for Safeguarding Adults reports bi monthly into HCCG quality committee and produces twice yearly reports. 3.1.3 There are safeguarding leads at Executive level and Named Professionals within each individual health provider organisation locally as required. 3.1.4 Safeguarding service specifications for our main local providers have been drawn up by the CCG commissioners, outlining clear service standards consistent with the requirements of NHSE Safeguarding Accountability Framework 2015 and are Care Act 2015 compliant. There are also clear specifications in the contract relating to the PREVENT adult agenda for safeguarding that is currently required nationally by all Trusts. 3.1.5 Health providers complete the annual at risk audit tool to monitor Safeguarding standards on an annual basis and provide a quarterly safeguarding adult dashboard submission. This enables providers to submit evidence of compliance within their own policy standards. The CCG has quarterly meetings with its main provider organisations in which contract standards, as well as other ongoing action plans, including the Care Quality Commission (CQC) safeguarding action plans, Safeguarding Adult Review Action Plans, are monitored and reviewed. 4. Safeguarding Adults National Context 4.1.1 The statutory Safeguarding duties of CCGs have in this reporting period (April 2016 March 2017) been clarified through a number of national documents and the impact of 5

the Care Act requirements has generated a wide array of policy requirements and guidance in support of these new responsibilities. Whilst many of these were only in the early stages of development during 2016/17, they are referenced here as they are intrinsically linked to the ongoing developments required for 2017/18. 4.2 Safeguarding Adults within the NHS 4.2.1 NHS England Accountability and Assurance Framework 2015 2 sets out the responsibilities of the safeguarding roles, duties and responsibilities of all organisations commissioning NHS health and social care. The framework aims to: Identify and clarify how relationships between health and other systems work at both strategic and operational levels to safeguard children, young people and adults at risk of abuse or neglect. Clearly set out the legal framework for safeguarding as it relates to the various NHS organisations in order to support them in discharging their statutory requirements to safeguard children and adults. Promote empowerment and autonomy for adults, including those who lack capacity for a particular decision as embodied in the Mental Capacity Act 2005 (MCA), implementing an approach which appropriately balances this with safeguarding. Outline principles, attitudes, expectations and ways of working that recognise that safeguarding is everybody s business and that the safety and well-being of those in vulnerable circumstances is at the forefront of our business. Set out how the health system operates, how it will be held to account both locally and nationally and make clear the arrangements and processes to be undertaken to provide assurance to the NHS England Board with regard to the effectiveness of safeguarding arrangements across the system; and Outline how professional leadership and expertise will be developed and retained in the NHS, including the key role of Designated and Named Professionals for Safeguarding Children and Designated Adult Safeguarding Managers. 4.2.2 There is a distinction in the framework between provider responsibilities and those for commissioners who need to assure themselves of the safety and effectiveness of the services they have commissioned. Good partnership working is important and healthcare commissioners and professionals should have developed relationships and collaborative working arrangements with colleagues across the Safeguarding system. 5. NHSE Competency Guidance for NHS Staff 5.1.1 In order to support and enable healthcare agencies NHSE has developed a set of required competencies and roles within Adult Safeguarding. The Intercollegiate Document: The Safeguarding Adults: Roles and Competences for Health Care Staff (2016) is the first intercollegiate document for Safeguarding Adults and is a recognition of the statutory responsibility for partner organisations in. All health care organisations have a duty outlined in legislation to make arrangements to safeguard and promote the welfare of adults at risk of harm or abuse, also to co-operate with other agencies to protect individuals from harm or abuse. Chief Executive Officers / Chief Officers of CCGs have a responsibility to ensure that all staff are able to meet this requirement. In line with the 2 https://www.england.nhs.uk/wp-content/uploads/2015/07/safeguarding-accountability-assurance-framework.pdf 6

publication of the intercollegiate guidance, the HCCG Safeguarding Adult Training Policy will require updating. Notable changes are: All health staff who come into contact with Adults have a responsibility to safeguard and promote their welfare and should know what to do if they have concerns about safeguarding issues. They must also clearly understand their own responsibilities and should be supported by their employing organisation to fulfil their duties. Chief Officers and Independent Contractors, such as GPs, have a responsibility to ensure that all staff across their organisations have the knowledge and skills to meet this requirement. General Practitioners will be required to undertake level 3 training. There is a recommendation for a named GP within CCGs. 6. Local Picture 6.1.1 Haringey is an exceptionally diverse and fast-changing borough. We have a population of 267,540 according to 2014 Office for National Statistics Mid-Year Estimates. Almost two-thirds of our population, and over 70% of our young people, are from ethnic minority backgrounds, and over 100 languages are spoken in the borough. Our population is the fifth most ethnically diverse in the country 3. 6.1.2 Haringey is the 30th most deprived borough in England and the 6th most deprived in London, 7 of Haringey s 19 wards are within the most deprived 10% nationally. All of these wards are in the east of the borough where Northumberland Park remains the most deprived. There are more incidents of abuse in the east of the borough than the west although there are significant pockets within the west notably within fortis green Highgate 4. 6.1.3 Women live longer but in poorer health life expectancy 60 years plus 25 years in poor health, life expectancy (84.7) Men health life expectancy 64 years plus 16 years in poor health life expectancy (80.1). 6.2 Adults in Need of Care and Support 6.2.1 People with care and support needs, such as older people or people with disabilities, are more likely to be abused or neglected. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it. 5 5.6% (3,492) of the Haringey 50+ population are adult Social care service users. This rises to 11.4% (2,807) for 65+ and 20.4% (2,223) for 75+. 6.2.2 The top 3 primary presenting reason for adults approaching adult social care for help are, Physical Support (69%), Support with Memory and Cognition (12%) and Learning Disability Support (7%). 61% of 50+ users are female, compared to 42% of Under 50s 39% of 50+ users are male, compared to 58% of Under 50s 3 http://www.haringey.gov.uk/social-care-and-health/health/joint-strategic-needs-assessment/jsna-summary-2013-14 4 http://www.haringey.gov.uk/social-care-and-health/health/joint-strategic-needs-assessment-jsna 5 http://www.scie.org.uk/publications/ataglance/69-adults-safeguarding-types-and-indicators-of-abuse.asp 7

38% of 50+ users are BME, compared to 54% of under 50s. Total Haringey 50+ population BME figure is 34.1% In 2014/15, 62.5% of users had long term support (over 12 months) 6.2.3 During 2016-2017 55% of females were subject to a safeguarding concern compared to 45% males. 18-64 age groups have the highest number of safeguarding concerns - 52% the next highest group which is 75-84 at 19% this is constant with the demographics of Haringey and those who would meet the criteria for a safeguarding concern. During 2016-2017 the Designated Professional for Safeguarding Adult s worked as part of a task and finish group to develop a suit of awareness raising leaflets that could be distributed throughout Haringey. The information was completed March 2017 and rolled out across the borough. 7. Haringey Safeguarding Adult Board 7.1.1 The Haringey Safeguarding Adults Board is a statutory body that works to make sure that all agencies are working together to help keep adults in Haringey safe from harm and to protect the rights of citizens to be safeguarded under the Care Act 2014, Mental Capacity Act 2005 and the Human Rights Act 1998. 7.1.2 The work of the Board is driven by its vision is that Haringey residents are able to 6 live a life free from harm, where communities: Have a culture that does not tolerate abuse; Work together to prevent abuse; and Know what to do when abuse happens. 7.1.3 The work of the Haringey SAB is underpinned by the safeguarding principles which were set out by the government in the statutory guidance accompanying the Care Act 2014. The Board has agreed four statutory SAB purposes under the Care Act 2014 for achieving its vision and meeting its statutory duties to ensure that local safeguarding arrangements are in place. These form the basis of our Strategic Plan in which we set ourselves, the partnership and community specific actions to prevent and respond to abuse: We are assured that safeguarding practice is person-centred and outcomes focused We prevent abuse and neglect We respond to abuse and neglect in a timely and proportionate way We are committed to learning and improving 7.2 SAB Activity 2016-2017 7.2.1 Any person may raise a concern with the local authority where they are concerned that an adult with care and support needs is experiencing, or at risk of abuse and neglect (including self-neglect). In these circumstances, the local authority will undertake an initial Enquiry to determine how to respond. This includes working to understand the adult s desired outcomes and agreeing with the adult how their concerns will be acted upon. Where the concern is not resolved by the initial Enquiries, the local authority will need to decide on the most proportionate response. This may include either: A formal S 42 enquiry to establish the facts, and gather evidence to support a Safeguarding Plan. 6 http://www.scie.org.uk/publications/ataglance/69-adults-safeguarding-types-and-indicators-of-abuse.asp 8

Risk Management Response, the term given to a range of actions that may be required to safeguard the adult from the risk of abuse and neglect. 7.2.3 Data in relation to all safeguarding issues is monitored both locally and nationally. All safeguarding concerns and enquiries are recorded and co-ordinated by Haringey Council. Progress from initial concern through to conclusion is monitored for timeliness and quality across a wide variety of measures including the nature and location of harm, service user groups, outcomes, age, gender, ethnicity, etc. This information is scrutinised by the SAB Quality Assurance Sub-group who report key issues and trends into the Safeguarding Adult Board. 7.2.4 Haringey Council submits annual returns to the Department of Health (DoH) for collation and comparison of the key data across all authorities in England. The following commentary includes extracts from Haringey Local Authority data and trends in Haringey. 7.2.5 In the period 2015/16 2016/17 there was a 76% increase in the numbers of individuals for whom a safeguarding referral has been made, from 872 in 2015/16 to 1,538 in 2016/17. During 2015 the Care Act came in to force which placed safeguarding as statutory duty for all Organisations. Around this time there was much publicity and an increase in awareness raising across the sector. The statutory partners for Safeguarding Adult Boards are Local Authority, Police and CCGs. Of the 1,538 safeguarding referrals 39% were from health and 30% from police. 7.2.6 Whilst it is positive that agencies are referring safeguarding concerns there are still lack of understanding across agencies of what constitutes safeguarding. During 2016-2017, 1,538 Safeguarding concerns were raised 50% of safeguarding concerns raised had no Safeguarding issues and (24%) of these went on to Section 42s investigations. Although 50% of concerns did not meet the threshold for S42 enquiry there is evidence that the referral led to other outcomes for adults at risk. The increase has remained constant month on month with slight peaks in June 2016 and Dec 2016. 7.2.7 During 2016-2017 90% of cases closed had their safeguarding risk removed or reduced. 9

7.2.6 Location of Safeguarding Concern Table 2 Location of Concern 7.2.7 Abuse can happen anywhere; in someone s own home, in a public place, in hospital, in a care home for example. It can happen when someone lives alone or with others. It is important to understand the circumstances of abuse, including the wider context such as whether others may be at risk of abuse, whether others have witnessed abuse and the role of family members and paid staff or professionals. During 2016 2017 the Location of Safeguarding Concern profile remains similar for, with location of concerns most frequently originating in the individuals own home. This is constant with the national picture included in the Adult Social Care Statistic Report 2015 2016 7 which sited out of the 102,970 S42 enquires conducted during this period 42% of enquires location of abuse was in the persons home. This is also consistent with the London region picture 53% of location of abuse is within adults own homes and 23 % in care home. Residential Homes saw an increase and this was largely due to 2 care homes subject to Establishment Concerns Process. 7 http://www.content.digital.nhs.uk/catalogue/pub21917/sac_%201516_report.pdf 10

7.2.9 Safeguarding Borough Profile Table 3 Borough Profile 7.2.10 There are more incidents of abuse in the east of the borough than the west although there are significant pockets within the west notably within Fortis Green Highgate. During 2016-2017 there were a number of safeguarding concerns in respects of a care home which is based in fortis green which can account for the high numbers in this area. 7.2.11 Types of Abuse Table 4 Types of Abuse 7.2.12 The abuse type profile for both years is very similar with Neglect, Psychological/Emotional, and Financial and Physical abuse prominent. There has been an increase in the proportion of Neglect cases and a decrease in Emotional/Psychological cases. This is consistent with the regional picture included in the Adult Social Care Statistic Report 2015 2016 8 which highlight the most common type of abuse in the London region as Neglect and Acts of 8 http://www.content.digital.nhs.uk/catalogue/pub21917/sac_%201516_report.pdf 11

Omission at 33% with physical abuse at 24%. 7.2.13 Age Range of Safeguarding Concerns Table 5 Age Range 7.2.14 The proportion of age bands across the two year period remains relatively consistent, which is constant with the adult social care profile and Haringey demographics. The national picture shows the majority of Section 42 enquires are undertaken for adults aged 65 and over (63 per cent) compared to those aged below 65 which is 35%. 7.2.15 Gender of Safeguarding Concerns Table 6 Gender 7.2.16 The gender profile across the two year period has shifted to be more even, however there is still 20% more concerns then male and an increase from 55% of individuals in 2016/17 were female, compared to 60% in 2015/16. 12

7.2.17 Ethnicity of Safeguarding Concerns Table 7 Ethnicity 7.2.18 Year on year the ethnic breakdown of individuals for whom a safeguarding referral has been made is similar, with the two main ethnic groups White and Black/African/Caribbean/Black British. This year there was a larger proportion of unknown, accounting for 20% of concerns, however the proportions of the other ethnicities remains constant. 7.2.19 Safeguarding Concerns by Referral Source Table 8 Referral Source 7.2.20 During 2016-2017 39% of safeguarding concerns in the year came from NHS the majority from Ambulance service, 30% were from Police, 12% other source, 8% from housing agencies, 4% from family member / friend, 7% from social care. Safeguarding referrals from GP services remain low. 13

7.2.21 Making Safeguarding Personal (MSP) Table 9 MSP 7.2.22 Making Safeguarding Personal For those individuals who had an outcome at the end of the Safeguarding period (Jan Mar 2017), 73% said that their MSP target was either partially or fully met, which is a decrease on prior quarter s performance. Prior to this, over time the proportion of MSP s achieved has increased from 50% in Q2 (2015-16), to 82%in quarter 3 (2016-17). 7.3 Summary 7.3.1 In 2016-17 there were 1,538 Safeguarding concerns with 515 (24%) of these Section 42s. 50% of safeguarding concerns raised had no safeguarding issues. 25% of safeguarding concerns came from the Police and 95% resulted in no issues found. There has been a significant increase in neglect cases in Q4. Domestic Abuse cases have decreased steadily throughout the year. Overtime there was an increase in safeguarding cases where the abuse location was family home. 90% of cases closed had their safeguarding risk removed or reduced. 7.4 How has this data informed our work? 7.4.1 Prevention, Training, Learning & Development Sub-group 7.4.2 The subgroup has responsibility for the Prevention Strategy s Delivery Plan to increase awareness of safeguarding and co-ordinate single and multi-agency training. 7.4.3 The Quality Assurance and Training and Prevention SAB Sub group, use this data to set out the priorities of the board in the coming year. The data highlights were there maybe gaps in knowledge and commission training accordingly. During 2016-2017 the Sub Group looked at the development of training for partners in the area of S42 enquirers, raising concerns, chairing strategy meetings and bespoke training for new areas including Modern Slavery, Self-Neglect, Financial Abuse and Coercion and Control. 7.4.4 In addition to the core work of the group, we have used the data to look at areas that require further development and example of this would be the 2016-2017 awareness raising campaign. In which I worked as part of a task and finish group in the development of a suit of awareness raising leaflets and posters for Haringey organisations and community on 14

specific topics such as financial abuse, self-neglect and domestic abuse. The leaflets and posters have been rolled out to acute trusts, GPs and community services. Other developments for the subgroup were improvements to safeguarding data collection by addition of first language reporting. During 2016-2017 all 3 trusts training package were evaluated and quality assured by the group. 7.4.5 Quality Assurance Sub-group 7.4.6 The sub group supports the HSAB to assure itself of the effectiveness of safeguarding arrangements in delivering the outcomes that people want. 7.4.7 During 2016-2017 I supported LBH to review a number of polices including: Safeguarding Adults Multi Agency Policy and Procedure Safeguarding Adults Multi Agency Hoarding Protocol Market oversight/provider Concerns Safeguarding Adult Review Protocol Haringey s Joint Establishment Concerns Procedure Mental Capacity Act and Deprivation of Liberty Safeguards Procedure Joint Safeguarding Adults S42 Enquiry Framework Information Sharing Protocol and Practitioners Guide Multi Agency Pressure Ulcer Protocol and Decision Pathway 7.4.8 In addition to this a market oversight and provider concerns report was developed in conjunction with LBH commissioners and the HCCG Quality Matters in Care Homes Team which provides a quarterly report to the Quality Assurance SAB Sub-group on quality and care home activity and actions to mitigate risk. 7.4.9 Safeguarding Adults Review (SAR) Sub-group 7.4.10 The sub group considers referrals of any case which may meet the statutory criteria and to make decisions on this basis; to make arrangements for and to oversee all SARs; to ensure recommendations are made, messages are disseminated and that lessons are learned. I am co-chair of the sub group during 2016-2017 the group met 7 times and received 4 referrals for consideration as SARs. Following evaluation of these against the statutory requirements and in line with the HSAB s SAR Protocol, the HSAB did not commission any SARs this year. Although the referrals did not meet the criteria for a SAR, the sub-group retained oversight of the single agency investigations and learning processes and agreed to disseminate learning from them across the partnership two involved NHS Serious Incident investigations. The SAR sub-group will be monitoring the improvement actions undertaken in response to these investigations. 9 7.4.11 Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) Sub Group 7.4.12 The MCA and DoLS SAB Sub Group oversee the ongoing implementation and operation of the Mental Capacity Act (MCA), including the Deprivation of Liberty Safeguards (DoLS). 7.4.13 I am co-chair of the subgroup in 2016-2017 the subgroup over saw the administration of the Deprivation of Liberty Safeguards (DoLS) by the local authority, reviewed the Law Commissions response to DoLS and provided a collective response. Supported the 9 http://www.haringey.gov.uk/sites/haringeygovuk/files/safeguarding_adults_board_annual_report_2015-2016_pdf_639kb.pdf 15

implementation of the DoLS forms. In addition to using data to assist in the identification of gaps in knowledge around MCA and DoLS to inform learning and development such as age lack of understanding of DoLS in relation to the age group 16-18. 7.4.14 Supported the Continuing Health Care Team (CHC) and Quality Matters in Care Homes Team (QMiCHT) to undertake refresher training on MCA and DoLS. Secured funding from NHSE to support one CHC staff member to undertake the Best Interest assessor training. 7.4.15 HCCG 7.4.16 Understanding safeguarding data means that HCCG can work in a proactive to promote residents wellbeing. In Haringey CCG there is a good joint working and collaboration between HCCG and LBH commissioning team, care homes team and continuing health care team sharing responsibilities associated to safeguarding concerns within care homes, domiciliary care and hospital. This has supported the sharing of information between teams, understanding which team is most appropriate to lead an S4S enquiry or provider assurance visit and further effective liaison with our key agencies such as the Care Quality Commission. 8 Multi-agency Safeguarding Arrangements and Partnership Work 8.1 Care Homes 8.1.1 The collaborative work with Haringey Local Authority and other partners including the Care Quality Commission (CQC) has continued during 2016/17 to ensure a robust approach to address concerns and compliance within the Care Home sector In Haringey. HCCG continues to actively monitor contract compliance to all the Care Homes in Haringey. 8.1.2 The HCCG Quality Matters in Care Homes Manager is the lead support for Care Homes and Is supported by the Designated Professional for Safeguarding. 8.1.3 The Designated Professional for Safeguarding and the Care Homes Manager works closely with the Continuing Health Care, Quality, Commissioners, CQC and Haringey Local Authority in relation to monitoring quality and safety within care homes. As part of sharing information HCCG has initiated a monthly Care Homes Information Sharing Meeting with a view to having a shared approach to improving quality across the sector. In addition to this the CCG safeguarding and QMICHT have refreshed the monthly data base to identify and intervene at an early stage with care homes on a downward trajectory. The QMICHT, Safeguarding Team and CHC team have developed a bi yearly care home quality audit which aligns to CQC Key Lines of Enquiry and provides a more in depth assessment covering essential areas of care. Following audit each care homes is provided with a report of the audit findings and any actions required to improve quality in care. QMICHT in conjunction with LBH commissioners oversee the improvement action plans. 8.1.4 The intention of more proactive work and support with providers to share good practice and focus on early intervention has been realised with the introduction of the quarterly Care Homes Forum and attendance at the LBH provider forum. 8.1.5 Through the NHS England Quality Surveillance Group, HCCG liaises closely with local authorities and CCG s to consider any concerns arising from the providers of residential, nursing and domiciliary care. This process has enabled early intelligence sharing across not only the local health and social care community but also national early warnings to be considered where providers have multiple sites across the country. The Designated 16

Professional for Safeguarding provides regular updates to the director of quality in relation to activity with commissioned providers. 8.1.6 During the period 2016-2017, 6 % of section 42 enquires pertained to a residential care home whilst 27% pertained to nursing home (this is largely due to 2 nursing homes under EC process). 8.1.7 During the period 2016 2017, out of 11 care homes in Haringey 8 care homes were rated as good 2 as requires improvement and 1 as inadequate. Where care homes have been rated as requires improvement or inadequate there has been a joint approach to monitoring improvement plans with CQC and LBH. 8.2 Information sharing panel 8.2.1 I am HCCG representative for the Haringey Information Panel, which is a confidential, multiagency, collaborative information sharing group. This provides a forum for partners to share information in relation to concerns around quality and safety of services (including where there are serious concerns and multiple safeguarding alerts). The purpose of the information sharing is to triangulate presented information and intelligence to inform decision making and next steps, which may include escalation to establishment concerns or prompt CQC unplanned inspection. 8.2.2 The panel meets on a quarterly basis and receives information from a variety of sources where concerns have been identified regarding residential, nursing and domiciliary care providers. The information received will inform decisions about how best to support providers who have been identified as requiring improvements and escalate as appropriate. During 2016 2017 the information sharing panel met 4 times and have supported several providers to improve quality within their service. 8.3 Prevent Strategic Group 8.3.1 I am the HCCG representative for the Haringey Prevent Strategic Group and have supported the development of the borough wide Strategy. Haringey is one of the 19 London boroughs identified by the Home Office as a Priority Area (at risk and threat of extremism). Haringey s Prevent Strategy is aimed at preventing violent and non-violent extremism, but is also very much about protecting our communities and supporting vulnerable people who may be targeted by extremists trying to recruit or radicalise them. The group review local intelligence and data and including analysis of referrals to channel panel which informs the strategy and priority areas. This year has seen the piloting of Dovetail which has seen a shift in the channel process with Local Authority s taking more control of the function of the Channel Panel, with the police remaining as key partners. The Local Authority is leading on assessing cases and holding initial meetings with those referred to Channel and is also taking responsibility for commissioning Intervention Providers and other appropriate professionals to provide support to individuals. This shift in delivering Prevent brings it in line with existing provisions for safeguarding and the change in approach has seen a much more collaborative approach to sharing information, decision making and sharing risk across health, LBH and the Metropolitan Police. The panel has met with key leaders from the home office as part of reviewing the pilot. 8.3.2 The safeguarding team provide support and advice to health care professionals to help identify staff and patients in their organisations who may be at risk of radicalisation and appropriately signpost for intervention. We maintain close links with the Regional Prevent 17

Coordinator and the local authority Prevent coordinator. The safeguarding team ensures that relevant referrals are made to the Channel Panel, which aims to divert those at risk of radicalisation. Haringey CCG must seek assurances from providers and evidence that they are committed to ensuring at risk individuals are safeguarded from supporting extremism or being drawn into extremism as part of the Home Office counter terrorism strategy Prevent. 8.3.3 I am the CCG Lead for the Channel Panel. Channel is a programme which focuses on providing support at an early stage to people who are identified as being vulnerable to being drawn into extremism. The programme uses a multi-agency approach to protect vulnerable people by identifying individuals at risk, assessing the nature and extent of that risk and developing the most appropriate support plan for the individuals concerned. The panel meets on a monthly basis and has provided positive interventions for a number of individuals. The panel is attended by the Prevent Lead for BEH. 8.4 High Risk Panel 8.4.1 The Haringey High Risk Panel (HHRP) is a meeting where information is shared on cases presenting with the highest risk and/or complexity, and involves representatives of the local authority, HCCG, housing and fire brigade. The HHRP considers cases in respect of adults aged 18 years or over, where existing mechanisms within agencies for resolving or minimising risk have not achieved this outcome and where the risk remains for the individual and/or others. The main focus of the HHRP is on addressing the risk to the adult at risk but in doing this it will also consider other persons affected and managing the behaviour of any perpetrator. The panel will decide on the best approach to managing the overall risk to the person/community at large and on effective safety planning strategies. The panel meets monthly and is a collaborative approach to sharing risk and providing positive outcomes for individuals. 9 Safeguarding Monitoring of Commissioned Services 9.1.1 HCCG as commissioners of local health services need to be assured that the organisations from which they commission have effective safeguarding arrangements in place. 9.1.2 HCCG largest health providers are: Whittington Health (community and hospital services), North Middlesex University Hospital Barnet Enfield & Haringey Mental Health Trust. 9.1.3 HCCG also commissions Continuing Health Care (CHC) services for Haringey residents who are eligible for CHC or Funded Nursing Care (FNC) via a number of smaller providers. 9.1.4 The effectiveness of the Safeguarding system is assured and regulated by a number of bodies and mechanisms. These include: Provider Safeguarding Adults Committees, internal assurance processes and Board accountability. The Safeguarding Adult Board. HCCG Quality Committee. Clinical Quality Review Group meetings (CQRG). External regulation and inspection CQC. Effective commissioning, procurement and contract monitoring. Haringey information sharing panel. 18

Establishment Concerns process. 9.1.5 All provider services, are required to comply with the Care Quality Commission Essential Standards for Quality and Safety which include safeguarding standards (Standard 7). NHS Haringey CCG performance manages each provider organisation via Formal contract review meetings led at Director Level. In addition the following arrangements are in place to strengthen the CCG s assurance processes: Safeguarding Leads are members of each Provider Trust s internal Safeguarding Committees. Joint commissioner/provider quality contract meetings always considers safeguarding issues/priorities and receive updates on action plans from Serious Case/Domestic Homicide Reviews. Systematic reviews of serious untoward incident reports are routinely received from NCL Commissioning Support Unit. 9.2 NHS Trust Providers 9.2.1 All NHS Acute providers have a Safeguarding Adult lead within their organisation. All NHS providers follow their own internal governance structures with regards to the reporting of Safeguarding activity; there is a variation across providers in these governance arrangements. All organisations have Adult Safeguarding processes and performance monitored by their own trust boards and by representation on the HSAB. 9.2.2 Improvements in the way in which trusts collect data have improved. The introduction of the NCL quarterly dashboard has provided a consistent approach to data collection.. 9.2.3 Additionally, all NHS providers are responsible for ensuring that all Serious Incidents, including those with Safeguarding elements, are reported to the Strategic Executive Information System (STEIS), which reports to the Department of Health via NHS England. 9.2.4 Haringey CCG the Designated Professional for Safeguarding Adults attends all providers Safeguarding Adults Committees. The Designated Professional for Safeguarding Adults utilises attendance at the committees as one way of gaining assurance that Provider Trusts are ensuring high quality Safeguarding Adults practice is embedded within their organisations and providing supportive challenge where required. The Designated Professional for Safeguarding Adults monitors compliance with the Trusts respective Safeguarding Adult training strategies through representation on the committees and takes action as required. Information obtained from these meetings is included in the Quality Committee Safeguarding Briefings. 9.2.5 The Safeguarding Adults Committees (which have representation from Interprofessional and inter agency groups) provide that strategic direction to Safeguarding Adult activities within the Trusts and monitor that Safeguarding commitments are met. One of the purposes of the committees is to promote engagement with departments internally and all agencies and to gain assurance that standards set out in the Pan-London guidance Protecting adults at risk: London multi agency policy and procedures to safeguard adults from abuse 10 are 10 http://www.scie.org.uk/publications/reports/report39.pdf?res=true 19

met. 9.2.6 In all three Trusts, the Safeguarding Committees are chaired by either the Deputy Director of Nursing or the Director of Nursing and report to the Trust Risk and Quality Committee. This ensures that scrutiny can be achieved at several levels that also involve Trust Non-Executive Directors. The Safeguarding Adults Committees also maintain an organisational overview of the implementation of the legal provisions in the Mental Capacity Act and the associated Deprivation of Liberty Safeguards (DoLS) and Prevent duty. 9.2.7 The three Trust Boards receive an Annual Safeguarding Adults Report and Work plans and these are shared with HCCG. 9.2.8 North Middlesex University Hospital NHS Trust (NMUH) 9.2.9 NMUH has an established Safeguarding Adults Committee which has representation from inter professional and inter agency groups. It provides the strategic direction to Safeguarding adult activities across the Trust and ensures that all Safeguarding commitments and responsibilities are met. Its purpose is to promote engagement with all agencies and to gain assurance that standards set out in Care Act 2014 are met. 9.2.10 The Safeguarding Adults Committee is chaired by the Director of Nursing and reports to the Trust Risk and Quality Committee. This ensures that scrutiny can be achieved at several levels which also involve Trust Non-Executive Directors. The Trust Board receives an Annual Report and work plan on the Trust s Safeguarding Adults arrangements. 9.2.11 The Trust Safeguarding Adults Committee meets Bi Monthly to provide strategic direction to Safeguarding activities across the Trust and to ensure that the Trust meets its legal requirements. A Bi monthly report is tabled at Safeguarding Adults Committee which summarises progress relating to training, activity, policy, updates and learning from Serious Case Reviews and Serious Incidents relating to Safeguarding. 9.2.12 Level one and two training is provided via e learning and face to face training sessions and is delivered as part of the induction program and at 3 yearly intervals. Mental Capacity and Deprivation of Liberty Safeguards training is delivered via elearning package and Prevent training is delivered face to face. 9.2.13 NMUH were compliant with level one Safeguarding Adults training. Prevent training compliance is 85% by April 2019, the trust has made Prevent training mandatory and has commissioned 4 training sessions per month to ensure they achieve target. Table 10 NMUH Safeguarding Adult Training Data. Level Quarter 1 Quarter 2 Quarter 3 Quarter 4 Level 1 88% 93% 91% 87% Level 2 74% 62% 83% 78% 20

Prevent 11% 11% 33% 40% 9.2.14 Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT) 9.2.15 The Trust has an internal joint adults and children Safeguarding Adults Committee which meets on a quarterly basis which reports to the Trust s Governance and Risk Management Committee. The Committee is chaired by the Executive Director of Nursing, Quality and Governance who is the Board Lead for Safeguarding Adults. Members of the committee consist of service managers from each Service line, Local Authority partners and commissioning colleagues from the 3 boroughs the Trust provides services for. 9.2.16 The Board receives an Annual Report and work plan on the Trust s Safeguarding Adults activities. At each public Board meeting the Trust Board receives an update on training compliance, alerts, investigations and their outcomes. 9.2.17 Level one and two training is provided via e learning and face to face training sessions and is delivered as part of the induction program and at 3 yearly intervals. BEH-MHT was compliant with level one and level two Safeguarding Adult training. Table 11 BEH Safeguarding Adult Training Data. Level Quarter 1 Quarter 2 Quarter 3 Quarter 4 Level 1 86% 85% 93% 89% Level 2 Prevent 86% 85% 44% 61% 85% 85% 67% 72% 9.2.18 Whittington Hospital NHS Trust (Whittington Health) (WH) 9.2.19 The Director of Nursing and Patient Experience is responsible for Adult Safeguarding. The Trust has a Safeguarding Adult Lead and a Lead Doctor for Safeguarding Adults. Whittington Health has a Safeguarding Adults Committee which meets Bi Monthly and is chaired by the Deputy Director of Nursing and Patient Experience. It is attended by internal divisions and external partner agencies and commissioners. The Safeguarding Adult Lead produces a Bi monthly progress report in line with the Safeguarding Adult Assessment Framework and action tracker. The Trust Provides a Safeguarding Adults Annual Report to its Trust Board and quarterly reports to its Quality and Safety Committee. 9.2.20 Level one and two training is provided via e learning and face to face training sessions and is delivered as part of the induction program and at 3 yearly intervals. 21

Whittington Health was compliant with level one and level two Safeguarding Adult training. Table 12 Whittington Safeguarding Adult Training Data. Level Quarter 1 Quarter 2 Quarter 3 Quarter 4 Level 1 Level 2 88% 86% 85% 88% 87% 90% 85% 85% Prevent - - - 90% 9.3 Independent Providers: Nursing/Residential Care Homes, Private Hospitals and Domiliary Care. 9.3.1 Safeguarding activity within Independent Providers is monitored through a variety of means including: Safeguarding Adult Board London Borough Haringey (LBH) Safeguarding Adult Team Quarterly Safety & Quality Information Panels with CQC and LBH Commissioning Team. Monthly care homes meetings with London Borough of Haringey and Quality Matters in Care Homes Team. Monthly meetings with Continuing Health Care (CHC) team. Quality-Matters-in-care-homes team monthly dash board. CHC annual reviews. 9.3.2 The sharing of information through meetings, forums and the collection of data enables HCCG to triangulate information to ensure that early on, concerns or issues are identified and prevention of avoidable harm is seen as a priority and measures are put in place to support this. 9.4 General Practitioner Services (GP) 9.4.1 CCGs have a duty to support improvements in the quality of primary medical care (NHS England Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework 2015). On the 1st April 2016 the CCG took over responsibility for cocommissioning of primary care GP services. 9.4.2 The CCG Safeguarding Team have continued to communicate safeguarding updates with General Practice in Haringey throughout the year. This has included:- Refresh of the GP portal safeguarding web page to include new pages on Prevent and extended resource page and contact details. Development or Safeguarding Adults awareness raising leaflets and posters for GP surgeries. Support for surgeries engaged in DHR and SARs. 22

Advice and support - The CCG Safeguarding Team are always available during office hours to provide advice, information and support to whoever requires this. The team contact numbers are readily available on the CCG website and intranet and are re-sent to all practices when the contact leaflet is updated. Briefing and links are included on a regular basis in the GP electronic newsletter. 10 NHS HCCG Safeguarding Adults Training Compliance 10.1.1 HCCG training strategy is currently based on the Bournemouth competencies 11 this will be reviewed in 2017-2018 in line with Safeguarding Adults: Roles and Competences for Health Care Staff Intercollegiate Guidance 2017. At the end of Q4 Level 1 safeguarding Adult training has fallen below compliance level. During February all staff were directly emailed to remind staff to complete within the required time frame. During February and March staff experienced several issues with completing e learning training, a brief guide was produced and sent out through the internal staff bulletin. The I.T issue has been resolved it is expected that compliance will be increased. Table 13 HCCG Safeguarding training data Number Requiring Training Numbers Safeguarding Compliance Trained Safeguarding Adults - Level 1 83 52 73% Safeguarding Adults - Level 2 5 5 100% Safeguarding Adults - Level 3 8 8 100% Safeguarding Adults - Level 4 2 2 100% Compliance Percentage 10.1.2 Bespoke training was arranged for the CHC and Care Homes team to ensure compliance with Safeguarding and Care Act 2014. All CHC and Care Home staff have achieved level 3 training. In addition to this both the CHC team Manager and Clinical Lead have both attended leadership and chairing safeguarding meetings training provided by LB Haringey. 10.1.3 The update of the CCG Safeguarding Training Strategy is currently under development but cannot be completed until the Safeguarding Intercollegiate Document for adult safeguarding has been re-published. This is anticipated to be autumn 2017. 11. Reviews, Inspections, Audits 11.1 Safeguarding Adults Reviews (SAR) 11.1.1 There has been one SAR during 2016-2017 out of borough. The review was led by an Independent Panel Chair and Independent Review Author. The overview report has addressed the Terms of Reference and specific concerns raised and includes findings and recommendations and focuses on lessons learned. The report was due to be published Sept 2016 however there was a delay in publishing and the likely date is Sept 2017. HCCG Continuing Health Care Team (CHC), Commissioning Team and Safeguarding Team fully participated in the SAR and have developed an SAR action plan which is monitored 11 http://www.scie.org.uk/publications/guides/guide45/files/bournemouth.pdf?res=true 23