The Royal Wolverhampton NHS Trust Trust Board Report Meeting Date: 28 th July 2014 Title: Executive Summary: Safeguarding Annual Update The Trust s Joint Safeguarding Children Group and Safeguarding Adult Group continue to develop and monitor the safeguarding arrangements of the Trust with the aim of increasing awareness of safeguarding and implementing processes to ensure adherence with the safeguarding policies of the City and to reflect national legislative strategic direction. Both groups have annual work schedules to monitor compliance to actions required by audit findings, peer reviews, CQC, NHSLA,OFSTED, DoH & Home Office standards, and priorities for the organisation agreed with the relevant Wolverhampton Safeguarding Boards. Child safeguarding Level 1 and 2 percentage of up take has improved from last year s figures. Business case currently in process to increase medical and nursing provision for Looked after children services Imminent expectation of OFSTED inspection Adult safeguarding will be within a legislative framework from April 2015 driven by recent Select Committee recommendations on the Mental Capacity Act 2005 - Postlegislative scrutiny [March 2014] and the Cheshire West Supreme Court judgement on 19 March 2014 Adult Safeguarding activity is increasing as a result of greater awareness by our staff, partner agencies and the public. Action Requested: Report of: Author: Contact Details: Resource Implications: Public or Private: (with reasons if private) Adult Safeguarding Internal Audit. [Overall ranked green.] To receive for information and to provide assurance and exception reporting in relation to compliance with safeguarding standards and policy Chief Nurse Head of Safeguarding Tel 01902 698787 Email lynne.fieldhouse@nhs.uk non Public Session
References: (eg from/to other committees) Presented at Quality Governance Assurance Committee 23/6/14 Appendices/ References/ Background Reading NHS Constitution: (How it impacts on any decision-making) In determining this matter, the Board should have regard to the Core principles contained in the Constitution of: Equality of treatment and access to services High standards of excellence and professionalism Service user preferences Cross community working Best Value Accountability through local influence and scrutiny Background Details 1 Background. The Trust s Joint Safeguarding Children Group and Safeguarding Adult Group continue to develop and monitor the safeguarding arrangements of the Trust with the aim of increasing awareness of safeguarding and implementing processes to ensure adherence with the safeguarding policies of the City and to reflect national legislative strategic direction. Both groups have annual work schedules to monitor compliance to actions required by audit findings, peer reviews, CQC, NHSLA,OFSTED, DoH & Home Office standards, and priorities for the organisation agreed with the relevant Wolverhampton Safeguarding Boards.Both groups provide periodic reports to the Wolverhampton Safeguarding Boards. 1. Safeguarding Children. 1.1 This has a long history of legal statute and has developed exponentially following widespread media coverage of institutionalised abuse, child deaths, human trafficking, female genital mutilation, self-harm, the growth in numbers of Looked- after Children [LAC] and outcomes of serious case reviews. There is increasing scrutiny of care, child protection and actions taken by health and social care. Child safeguarding is subject to inspection whereby CQC participates in a programme of joint inspections with Ofsted, examining the arrangements in place for safeguarding children. CQC s role in these inspections is to inspect and report on arrangements for safeguarding children within the NHS. The inspections explore multi-agency working as well as compliance with statutory guidance for safeguarding children. 1.2 At RWT there are currently 5 nurses employed for Safeguarding Children [Lead Nurse, plus 4 named nurses for Looked after children, Domestic Violence and 2 generic]. The numbers of Looked-after Children and their health needs has driven a recent business case to increase both nursing and medical provision for LAC services. Page 2 of 6
1.3 The Trust is statutorily obliged to contribute to the work of the local Safeguarding Children Board. Recent adverse media for both Coventry and Birmingham has highlighted the complexity and commitment to multi-agency serous case reviews and the work of such Boards has come under criticism. The commitment by RWT to the Wolverhampton Board cannot be overstated. 2 Activity. 2.1 The rising numbers of Wolverhampton children in the care system has meant an increased demand on health resources since 2008. In 2013 the Trust received an average of 17 requests for Initial Health Assessments per month and an average of 44 Review Health Assessments. In total 204 Initial Health Assessments were requested and 537 Review Health Assessments. 3 Training and education. 3.1 Safeguarding Training is monitored monthly through OLM. The current compliance is: Safeguarding Children Level 1 - eligible 6431, trained 6292 = 97.8% Safeguarding Children Level 2 - eligible 3066, trained 2717 = 88.6% Safeguarding Children Level 3 - eligible 751, trained 639 = 85.1% Level 1 and 2 compliance has improved from last year s figures, of Level 1 =96% and Level 2 =72%. Level 3 training is currently delivered as part of the RWT training program but in the future the Level 3 training provided by the Safeguarding Board multi-agency training will be utilised Across the Trust the importance of Safeguarding Children has been highlighted via a new campaign THINK CHILD with new branding and reinforcement of key child protection messages to practitioners within adult services along with a strengthened referral pathway promoted via Trust website page and in wards / community in a poster format. This reinforces staff s duty to report their concerns about children and to better utilise the Safeguarding Children s team to discuss their concerns. 4 Key Achievements. The flagging of children on child protection plans available on clinical portal to be accessed by Emergency Department staff and will be accessible to the Phoenix Walk in Centre by September 2014. Compliance to action plans stemming from several serious case reviews The Policy for the Management of Deliberate Self-Harm in Young People was authored in partnership with the local mental health Trust (BCPFT). The validity and reliability of this policy will be determined by audit in July 2014. The pathway for referral to community school nurses and CAMHS is clearly identified utilising the Health Visitor Liaison service which is based in ED Page 3 of 6
In January 2014 a Health / Social care event was held at The Medical Institute New Cross Hospital. Staff from the acute hospital: children s, ED and maternity services met with social workers for a case study discussion which increased understanding of roles between both groups. This event was valued by both groups of staff and will enhance perceptions of other professions when questioned by Ofsted at any future inspections. The Trust has representation on every Wolverhampton Safeguarding Children s Board sub- group. This means that the major provider of health services within Wolverhampton can contribute to the local child safeguarding agenda at every level. 5 Key Risks/challenges. Business case currently in process to increase medical and nursing provision for the health/assessments requirements of Looked After Children services Imminent expectation of OFSTED inspection Multiple action plans as a result of Serious Case Reviews and Domestic Homicide Reviews 6. Safeguarding Adults 6.1 Adult safeguarding has come of age, it will be within a legislative framework from April 2015 driven by recent Select Committee recommendations on the Mental Capacity Act 2005 - Post-legislative scrutiny [March 2014], the Cheshire West Supreme Court judgement on 19 March 2014 specifying how health and social care staff should now judge whether a person might be deprived of their liberty, and the volume, complexity, high professional and public expectations for organisations to protect those at risk in our society and in our care. 6.2 From April 2015 there is a statutory obligation for contribution to the work of the local Adult Safeguarding Board. 6.3 2014 has seen a marked increase in the requirement for RWT to complete work in support of both Domestic Homicide Reviews and Serious Case Reviews 6.4 NHS Standard Contract 2013/14 Service Conditions SC32 6.4.1 The Trust is compliant to the service conditions relating to safeguarding. Against the standard of compliance with the principles contained in the Counter Terrorism agenda of PREVENT the Trust has 7 accredited trainers and has delivered training to c1,200 staff since May 2013. These staff constitute both a phased and risk stratification targeted training [emergency portals, school nurses, Health Visitors, Drug and Alcohol Liaison Team], and new starters to the Trust. 6.4.2 Head of Emergency Planning and Business Continuity & Head of Safeguarding have Home Office security clearance and represent the Trust at City Counter Terrorism Panel [Channel] to develop procedures and relevant Trust policies. The alert process, Trust governance process and prioritised training programme agreed with local Counter Terrorism Unit [CTU] officers. Page 4 of 6
7. Activity. 7.1 Safeguarding activity is increasing as a result of greater awareness by our staff, partner agencies and the public. 7.2 Alerts raised by RWT 2011/12 2012/13 2013/14 46 68 123 7.3 Safeguarding referrals made against RWT April 13 February 14 =31. All required internal 48 hour investigation completed on time. 12 closed at alert stage as they did not meet the west midlands safeguarding threshold. Remaining 19 required on going RWT input as part of Local Authority investigations. Many related to HAPUs (pressure ulcers) and poor communication in respect to discharge arrangements. The RWT 48hr reporting framework is recognised by social services as sufficiently robust to constitute our full contribution to the investigation. 2 allegations against the Trust were substantiated, patients did not come to harm but policies were not adhered to [DNAR] 7.3 Domestic Homicide Reviews x 3 have all required substantial investigation by the Trust in respect of access to health care by perpetrator, victim and named family members. There is independent scrutiny of such reviews and the media attention is considerable, with potential impact on the reputation of the organisation. 8. Training and education 8.1 Safeguarding Adults @ May 2014: 99% compliance of 6,520 staff for awareness [level1] training. 78% compliance to level 2 training for the target audience of 46 64% compliance of the 14 staff requiring level 3 training. There is a review of training requirements during late 2014 to reflect new national guidance There is also much work to be done in the safeguarding fields of Forced marriage, Female Genital Mutilation, Human Trafficking, and care of those with learning disability and other vulnerabilities such as dementia. 9 Internal audit. [Overall ranked green.] 9.1 An audit of Safeguarding Adults was undertaken as part of the approved internal audit periodic plan for 2013/14. Taking account of the issues identified, the Board can be given substantial assurance that the controls upon which the organisation relies to manage this risk are suitably designed, consistently applied and effective. The audit raised one medium and one low recommendation. 9.2 Low recommendation The Safeguarding Adult Team job descriptions should be reviewed to ensure that they accurately reflect their roles and responsibilities with regard to safeguarding within the Trust. To be addressed at appraisal in July 2014. Page 5 of 6
9.3 Medium recommendation A more formal mechanism should be in place to ensure that any findings and recommendations made following substantiated referrals are communicated to all staff to reinforce the adult safeguarding responsibilities across the Trust. To be addressed June 2014 through current governance processes and communication forums. 9.4 Good Practice Identified During the Audit The Trust has made efforts to inform both the public and its staff of the importance of safeguarding adults through its adult safeguarding website. The processes in place to facilitate referrals within the Trust are effective as they ensure that the authorities can receive the Trust s version of events in a timely manner. The Trust had full attendance to the Wolverhampton Safeguarding Adults Board meetings within 2012/13. 10 Key achievements. Development of Trust Safeguarding Adults at Risk Website available under quick links, intranet site includes contemporary information, guidance to staff, referral documentation and reference to local and national resources. An investment in the infrastructure to provide adult safeguarding services. Moving from a position where the Head of Nursing Education and the Senior Matron for Renal and Diabetes services have safeguarding responsibilities within their existing portfolios to a recruitment plan for completion by September 2014. Additional staff to be appointed to the adult safeguarding functions include secretarial support from June; Practice Education Facilitator from August and a discrete Head of Safeguarding from September Independent Domestic Violence Advisor [IDVA] Project. The success of the pilot and the perceived benefit to patients, families and staff has resulted in the Trust investing and recruiting to a substantive IDVA post from July 2014. 11 Key Risks. Actions required by the Trust following statutory changes from April 2015 Changes to deprivation of liberty procedures following high court judgement[cheshire West] Page 6 of 6