Ealing Safeguarding Adults Annual Report 2013 SAFEGUARDING ADULTS PARTNERSHIP BOARD

SAFEGUARDING ADULTS ANNUAL REPORT 2013 EALING SAFEGUARDING ADULTS PARTNERSHIP BOARD Promoting Independence - Protecting Vulnerable Adults - Preventing Abuse

CONTENTS 2 Foreword 3 Introduction 5 The Safeguarding Adults Partnership Board 7 National developments and research 9 Key local developments and achievements 10 Review of the last year 25 Review of data monitoring information 44 Appendix One Safeguarding Adults Strategic Plan Review of 2012/13 2

FOREWORD It is my pleasure to introduce the 2012/13 Safeguarding Adults Annual Report on behalf of the Ealing Safeguarding Adults Partnership Board. Ealing Council and its partners have continued to work together to safeguard and protect those who are the most vulnerable and at risk of harm. Our position summary and approach to Safeguarding Adults is that it continues to be a high priority for us an all of our partners in the statutory and third sectors. We continue to have a strong multi agency foundation for Safeguarding Adults work in Ealing and this is evident in the wide membership and attendance at our well established Safeguarding Adults Partnership Board (ESAPB). London multi agency policy and procedures continue to be well established and training is provided to staff on an on-going basis throughout the year. We have an annual Safeguarding Adults training strategy and this year we have introduced more training targeted at the key local issues. Our commitment to working in partnership with all agencies involved in the wellbeing of Adults at risk has seen us develop initiatives with the London Fire Brigade and we have welcomed the Probation Service to our Partnership Board. We continue to work closely on a local level with our colleagues across the NHS in Ealing Hospital and West London Mental Health Trust and hope very soon to have representation from NHS England to ensure commissioners are represented. The new Care Bill will bring challenges and rewards. For the first time Safeguarding Adults Partnership Boards will be put on a statutory footing and have statutory duties. The boards will have a responsibility for people where there is a reasonable cause to suspect that the person has needs for care and support, is experiencing or at risk of abuse or neglect and is unable to protect himself or herself against abuse or neglect or the risk of it. The challenge for 2013/14 is to incorporate the requirements of the Care Bill into the Safeguarding service and to build on the awareness raising we have undertaken over the past few years so that people know what abuse is and how to report it, and that they seek to prevent it. Stephen Day Chair Ealing Safeguarding Adults Partnership Board 3

INTRODUCTION This is the seventh annual report. This report summarises safeguarding activity undertaken in 2012/2013 by Ealing Council and includes updates from our key partners and stakeholders that have engaged in contributing to safeguarding vulnerable adults in our local area. The report draws on local performance data and compares it with the nationally produced data, the Abuse of Vulnerable Adults (AVA) statistics. The five priorities for the council over the coming year as set out in the corporate plan, include making Ealing Safer. Safeguarding adults at risk continues to be a central and fundamental priority of the work carried out by Adult Services. This has been supported by the Ealing Safeguarding Adults Partnership Board, which has responsibility for overseeing how organisations across Ealing work together to safeguard adults who are vulnerable and may be at risk of harm or have been abused or harmed. The No Secrets guidance was published by the Department of Health in 2000 and places responsibility on both social care and health to safeguard vulnerable adults, with social care as the lead agency. This guidance was issued under section 7 of the Local Authority and Social Services Act 1970. Ealing continues to use the Pan London procedures Protecting adults at risk: London Multi-agency Policy and Procedures to safeguard adults from abuse. This is due to be reviewed in 2014. The purpose of this report is to; Outline the role of the Ealing Safeguarding Adults Partnership Board (ESAPB) Identify national developments and achievements over the course of the year Summarise the key local developments and achievements over the last year Provide statistical data on safeguarding adults alerts received and to provide an analysis of this data and compare it with the national data (the Abuse of Vulnerable Adults Comparator Report). THE SAFEGUARDING ADULTS PARTNERSHIP BOARD 4

The Ealing Safeguarding Adults Partnership Board (ESAPB) meets four times a year. It is chaired by Stephen Day, Director of Adults for Ealing Council. The purpose of the ESAPB is to monitor all the safeguarding adults work within a multi-disciplinary multi-agency framework. The board oversees how organisations across the Ealing work together to protect vulnerable adults who may be at risk of harm or have been abused. The ESAPB has recently reviewed its Terms of Reference to incorporate the recommendations in the Social Care and Support Bill, which is likely to come into force in 2015. The Care and Support Bill places Adult Safeguarding Boards on a statutory footing. In March 2013 ADASS and the LGA published a paper giving advice to Directors around the strategic direction of safeguarding services, to ensure that they are effective and would stand up to the external scrutiny. The paper recommended that: The Chair of the Safeguarding Adults Board has independence, knowledge and the skills to challenge, lead and hold board members to account. Local Authorities need to regularly review the board s constitution The board must ensure that it has the capacity to plan and carry out its strategies and objectives. The ESAPB has incorporated these recommendations into the Terms of Reference. Metropolitan Police Involvement Some London Safeguarding Adults Partnership Boards are challenged by Metropolitan Police engagement and the seniority of police involvement. Most London boroughs have a DCI on the Board and this is the case in Ealing. This is problematic as the representative on the board needs to be able to make decisions and commit resources on behalf of the Police and a DCI cannot do this. This issue is being taken forward at a London Wide level. Current Representation on the ESAPB 5

In 2012/2013 this was: Safeguarding Adults Team, Ealing Council Older Peoples Services, Ealing Council Disabilities Services, Ealing Council and NHS Integrated Care Organisation Integrated Mental Health Services Forensic Mental Health Services, Ealing Council and West London Mental Health Trust NHS Ealing Ealing Hospital Trust, NHS Community Safety Unit, London Metropolitan Police Ealing Homes Legal advisors to Ealing Council Integrated Commissioning for Adults Services, Ealing Council and NHS Ealing Service user representatives, Older People s Consultative Network/Forum Carer s representatives Social Care Training, Ealing Council Third Sector representatives (Dementia Concern Ealing, Age UK Ealing) Crime and Safety Unit, Ealing Council Acton and West London College Safeguarding Children Team, Ealing Council Care Quality Commission (CQC) Reablement service, Ealing Council London Ambulance Service London Fire Brigade NATIONAL DEVELOPMENTS AND RESEARCH The Social Care Institute of Excellence (SCIE) will review the London Safeguarding Adults Policy and Procedures in 2014. The Care Bill 6

At the time of writing this is at the final stages of the legislative process. It will make Safeguarding Adults Partnership Boards mandatory with core members specified from the Local Authority, Health and the Police. The chair of the board must be someone who the Local Authority considers to have appropriate skill and experience. The boards will have a responsibility for people where there is a reasonable cause to suspect that the person has needs for care and support, is experiencing or at risk of abuse or neglect and is unable to protect himself or herself against abuse or neglect or the risk of it. The SAPB must publish on an annual basis what it has done to achieve its objectives and implement its strategy and the strategic plan for the following year. The Care Bill (s.44) states that a SAPB must arrange a review for a case involving an adult in its area with needs for care and support (whether or not the local authority has been meeting any of those needs) if: (a) (b) There is reasonable cause for concern about how the SAPB members or other persons with relevant functions worked together to safeguard the adult, and Conditions 1 or 2 are met Condition 1 is met if (a) the adult has died, and (b) the SAPB knows or suspects that the death resulted from abuse or neglect (whether or not it knew about or suspected the abuse or neglect before the adult died). Condition 2 is met if (a) the adult is still alive, and (b) the SAPB knows or suspects that the adult has experienced serious abuse or neglect. A SAPB may also arrange for a review of any other case involving an adult in its area with needs for care and support (whether or not the Local Authority has been meeting any of those needs). There is a requirement for each member of the SAPB to co-operate and contribute to the carrying out of review to identify the lessons learnt from the adult s case, and to apply those lessons to future cases. 7

The Care Bill (s.45) also places a requirement on organizations and people to supply SAPBs with information if this would assist the board in fulfilling its functions and relates to the organization or the person in question. Safeguarding Adults- Advice and Guidance to Directors of Adult Social Services In March 2013 The Association of Directors of Adult Services (ADASS) and the Local Government Association (LGA) published a paper Safeguarding Adults- Advice and Guidance to Directors of Adult Social Services. This paper was designed to give practical advice to Directors with statutory responsibility until new legislation comes into force. This paper complements and does not replace ADASS/LGA National Framework of Standards Department of Health Guidance No Secrets and its later update. London Safeguarding Adults Chairs Meeting Towards the end of 2011 a London Adult Safeguarding Chairs Group was set up to provide a multi-agency strategic overview of the policy and practice developments in relation to dignity in care, adult safeguarding and the Mental Capacity Act 2005 in London. All chairs of London Borough Adult Safeguarding Boards are represented. The headlines emerging are: Making Safeguarding Personal There is a national initiative Making Safeguarding Personal and the ESAPB Chair is considering how we can incorporate this in our practice. This initiative focuses on person centred practice and recording desired outcomes at the start of the process with the person at risk, and recording results and the customer s experience at the end. The project is looking at how information on recorded outcomes can be aggregated so that Boards can look at trends. Learning from this project will help 8

authorities in capturing data as part of the new performance returns for safeguarding in the future. NHS Safeguarding Vulnerable People in the reformed NHS: Accountability and Assurance Framework In March 2013 the NHS Commissioning Board published this paper. The framework focuses on the statutory requirement to safeguard children and applies the key principles to safeguarding adults who are vulnerable. The aims of the framework are to: Promote partnership working to safeguard children and adults at risk of abuse, at both strategic and operational levels. Clarify NHS roles and responsibilities for safeguarding in the Clinical Commissioning Groups. Set out that safeguarding is the responsibility of communities and professionals. KEY LOCAL DEVELOPMENTS AND ACHIEVEMENTS The primary aim of Safeguarding Adults policies and procedures is to assist adults at risk to live a life that is free from abuse and neglect. A detailed strategic plan for the financial year 2012/2013 based on the ADASS standards of excellence in safeguarding adults and highlighting priority work areas, is at Appendix One. The format of the plan will be reviewed during 2013/2014 and will continue to link safeguarding to national and local strategic priorities. The Safeguarding Team continues to work closely with health services including the Clinical Commissioning Group, and the Care Quality Commission. Increased emphasis in working with the local Fire Brigade over the last year has raised awareness in the whole system of the need to identify vulnerable adults who are at risk of domestic fires. The London Fire Brigade message is that many domestic fires can be prevented, through early intervention, education and equipment such as smoke alarms which the fire service will fit during a Home Fire Safety Visit. 9

In Ealing there has also been a focus on the Dignity in Care agenda. Ealing has used this as a vehicle to seek to improve the care of vulnerable adults in nursing homes and hospital settings. Ealing Council sent dignity champions into local homes to speak with residents and their families about promoting excellence in Social Care Services and how individuals could challenge any poor treatment of vulnerable adults. Since the Winterbourne View findings in 2011 there have been working groups to address strategic and operational issues for Ealing Borough lead by the Head of Disabilities. The Service Manager for Safeguarding has provided safeguarding advice to those groups. There has been a review led by the Learning Disabilities Psychologists, of the needs of Ealing customers living in a hospital setting. The Psychologists have further led on the development of a revised care plan for each person. The focus of the review has been to look at whether the individual could be discharged to an alternative and less restrictive setting. Those detained under the Mental Health Act have not been included in these reviews. Since 2012 there have been 14 people who have been discharged from hospital settings to either an alternative placement or they have returned to the community with support. The aim of the Winterbourne Delivery Plan looks at preventing future admissions to hospital and long stay institutions. REVIEW OF THE LAST YEAR The Safeguarding Team continues to provide support, training and advice to the locality Team Managers and the Mental Health Community Teams to discuss complex cases and to track progress on current safeguarding referrals open to the Team. There is concern that for a variety of reasons some Safeguarding referrals are not resolved in a timely fashion. The Safeguarding Team is sending out regular management information to improve this. The Pan London Guidance states that strategy meetings must occur within 5 days of the referral and the investigation should occur within 20 days of the referral. It is noted that in some instances this 10

cannot happen especially where the police are involved, however, it needs to be recorded clearly why timescales cannot be adhered to. The Ealing Safeguarding Adults Partnership Board The Ealing Safeguarding Adults Partnership Board (ESAPB) continues to meet quarterly. The purpose of the ESAPB is for all partners that have signed up to the Ealing Safeguarding Adults Policy to ensure that their agencies are following the policies and guidance around adult safeguarding and raising any concerns they may have on a strategic or operational level. In the last year the ESAPB has explored whether the board should have an independent chair. The conclusion is that the board is compliant with the advice published by the LGA and ADASS in March 2013 and requirements of the proposed legislation and that at this juncture there will not be a change. Performance Management and Quality Assurance The case file audit process has continued in 2012/2013. Managers at all levels in the organisation audit cases. The audit tool was revised and re launched in June 2011 in accordance with the Multi Agency Policy and Procedures. A further model of auditing was introduced in 2011/2012 for team managers based on the peer audit model. This is designed to help councils and partners examine achievements and identify how improvements could be made. The standards employed have been developed by the LGA and its partners and the standards are based on; Outcomes for and the experience of people who use the service Leadership, strategy and commissioning Service delivery, effective practice and performance and resource management Working together As part of the annual Action Plan we will be looking at the audit process and whether it needs to be revised in light of the new legislation that will be coming into force. 11

The Safeguarding Team continues to work with the Contracts and Commissioning Sections of the Adults Department to ensure that any concerns regarding provider performance and safeguarding are addressed and actions plans completed and monitored where necessary. The Safeguarding Team has continued to visit establishments with Contracts managers where there have been Establishment Concerns. There have also been reviews of all the residents carried out by the Teams. We anticipate that the Safeguarding Peer Audit will take place in Ealing within the next year or so. This audit involves colleagues from other boroughs auditing our cases and safeguarding process in order to improve services. 3.1 Training Safeguarding Adults Training Attendance Stats 2012-2013 CourseTitle Number Attended Commis sioning & Busines s Manage ment Student s External Forensic Services Housing Learning Disabilities Mental Health Physical Disabiliti es O lder People O ther (Ealing) BEST INTEREST DECISION MAKING 6 5 1 ISA BRIEFING 8 1 5 1 1 PREVENTING THE ABUSE OF ADULTS AT RISK 8 1 5 1 1 SAFEGUARDING ADULTS AND DOMESTIC VIOLENCE 11 1 3 5 2 ABUSE IN RESIDENTIAL SETTINGS 27 26 1 SAFEGUARDING ADULTS: ACHIEVING BEST EVIDENCE & DISCLOSURE INTERVIEWS 19 1 (LBHarro w) 3 1 3 2 9 1 SAFEGUARDING ADULTS: ALERTERS STAGE 1 101 4 53 5 3 4 32 SAFEGUARDING ADULTS: ALERTERS STAGE 2 26 2 7 5 2 1 8 1 STRATEGY MEETINGS AND CASE CONFERENCES (took place at LBHarrow) 1 1 SAFEGUARDING ADULTS: INVESTIGATORS 10 2 2 2 4 SAFEGUARDING ADULTS: MULTI-AGENCY REFERRERS SAFEGUARDING ADULTS: PAN LONDON 7 7 PROCEDURES 27 3 6 1 5 1 11 SAFEGUARDING ADULTS: RECORDING AND REPORT WRITING INC FWI 10 10 Totals 261 4 15 103 7 1 12 19 8 86 6 Percentage who attended from each service 12 1.50% 5.74% 39.50% 2.70% 0.32% 4.59% 7.30% 3.10% 32.95% 2.30%

The table above is a breakdown of staff training that has taken place as per division. An annual training plan and strategy for work force development is in place. During the 10 months a total of 261 people attended training. This represents a 41% drop in the number trained and reflects the stability of the workforce both internally and externally. 3.2 Training is multi-agency and specialist single-agency training is also commissioned where necessary. 3.3 An E-Learning module, for Basic Awareness of Safeguarding Adults at Risk issues, has been updated by an external provider and the Training Officer for Safeguarding Adults, so that it is now in line with the Pan London Procedures. This module aims to bring learning from a variety of sources together and can be used on its own to provide up to date guidance on recognising and responding to abuse. 3.4 New training courses developed, and delivered in 2012/ 13 were: Achieving Best Evidence Disclosure Interviews, for qualified social work staff. Duties in the Relation to the Disclosure and Barring Service (DBS) for managers in both the Private and Voluntary sector, as well as local authority managers. A course to assist staff to complete all the necessary safeguarding forms on our internal customer record system. 3.5 We have embarked on a course sharing arrangement with Harrow Council where staff in each authority can attend safeguarding courses in the other borough. 4. Finance/Budget The Safeguarding Adults Service has a dedicated budget and cost centre. 13

5. Public Awareness Community engagement is a key priority for the ESAPB. Presentations have been made to local voluntary sector groups. Each year the Council celebrates World Elder Abuse Awareness Day (15 th June) with events across the borough. The theme for WEAAD this year was Fire Safety amongst the Elderly. Over the course of the year we have worked very closely with the local Fire Service to raise awareness and prevent domestic fires in private dwellings. The local Borough Commander has provided a number of training sessions focused on hoarding and self-neglect as these issues affect many vulnerable people in the community at higher risk of domestic fires. Articles in Around Ealing and these public awareness campaigns have engaged the wider community in thinking about safeguarding as a community issue. 6. Domestic Violence The Safeguarding Adults Team was involved in the Domestic Violence Task Group and in the implementation of the Ealing Domestic Violence Multi-agency Risk Assessment Conference (MARAC). The Ealing MARAC meets on a monthly basis for full day meeting. The Safeguarding Senior Care Manager attends the meetings and has assisted in processing referrals to Adult Services for those vulnerable adults subject to Domestic Violence. There will be training events for practitioners in the CAADA DASH Risk Indicator Checklist (RIC). This is an assessment tool to identify high risk situations of domestic violence and honour based violence, to decide which situations should be referred to MARAC and to look at what other support might be required. 7. Our Partners A significant change in 2012/13 was that Ealing Clinical Commissioning Group (CCG) replaced Ealing Primary Care Trust. The Heads of Service for Older 14

People were involved in training at the CCG conference to give GPs and others an overview of Adult Services and Safeguarding. The National Health Service A training strategy was developed in 2012 and reflects best practice standards for the period of 1 st April to 31 st March 2013. Since April 2013 Ealing Hospital NHS Trust has implemented levels two and three for Safeguarding Adults, and level two for Mental Capacity and Deprivation of Liberty Safeguards. The hospital contractual requirement is now for staff attendance at safeguarding adults levels one to three to increase to 90% in 2013/14. A Safeguarding Adult Training Action Plan is in place to achieve this. 8. Analysis of Safeguarding Adults cases across Ealing Hospital Trust ICO, including Ealing, Harrow and Brent Community Services. The total number of Safeguarding Adult alerts involving Ealing Hospital Trust for the period 1 st April 2012 31 st March 2013 was 83. Of this group the majority of referrals (25), were made by EHT Staff alleging abuse and neglect by external services, for example, Nursing Homes. The second largest category (19), involved referrals made to Adult Services by the ICO staff alleging abuse and neglect by community staff. These predominantly concerned pressure ulcers. 15

Key: Category One - Category two Category three Category four Unknown Table 1 Referrals made by an external agency/organisation alleging abuse and neglect by ICO staff Referrals made by ICO staff against ICO staff Referral made by ICO staff alleging abuse and neglect by external agency /organisation Referral involving patients who are subject safeguarding procedures and the ICO are not delivering care at the time of the alleged abuse/neglect Category not known while patient is subject to the safeguarding process. 8.2 In acute Services, the Directorate of Medicine generated the highest level of referrals for this period (24) with the majority of these relating to allegations of abuse and /or neglect about external agencies. The Surgical Directorate raised 6 alerts. Women and Children s Directorate reported 2 cases of domestic abuse. 8.3 In Community Services, Ealing Community Services reported the highest number of Safeguarding referrals (27) with the majority relating to category 2. 8.4 Where allegations are made against ICO staff these are investigated and the 16

Appropriate action taken over the last 12 months includes; Increased Supervised working Redeployment to non- patient facing duties Suspension Performance Management Disciplinary action resulting in s written warning 8.5 The majority (58) of safeguarding adults referrals for this period involved those where alleged neglect had taken place for patients who acquired a grade 3 or 4 pressure ulcer while under the care of Ealing Hospital NHS Trust. 1 st April 2012-31 st March 2013 Type No. Financial 1 Neglect 10 Physical 10 Neglect Pressure ulcers 58 Sexual 1 Psychological 1 Total 83 Table 2 There is underreporting to the Safeguarding Adults team in relation to grade 3 and 4 pressure ulcers. Data collected by the Trust highlights that there were 100 reported grade 3 and 4 pressure ulcers across Ealing Hospital NHS Trust for the period 1 st April 2012 to 31 st March 2013. This compares to only 58 safeguarding adult referrals made to social services. An improvement plan will be developed. 9. Outcomes of Safeguarding Adult Referrals 17

Outcome Total Ealing Community (ICO) Inconclusive/Not determined Not substantiated Substantiated 2 4 3 Ealing Acute (Hospital) Inconclusive/Not determined No further action Not substantiated Substantiated 1 4 13 4 Grand Total 31 Table 3 9.1.1 Of those cases that have been upheld or substantiated, the key issues emerging involved concerns related to maladministration of medication, poor inpatient care and issues related to pressure sores. ICO Picture of Mental Capacity (MCA) and Deprivation of Liberty (DOLs) 9.1.2 Ealing Hospital NHS Trust continues to drive forward the importance of implementing MCA within all practice of work for adults who do not have the capacity to give consent or make decisions. 9.1.3 There were no DoLS applications in 2012/13. 9.2 Community Safety Unit The Safeguarding Team continues to work closely with the Community Safety Unit (CSU). The London Policing Model (LPM) was introduced in 2012 and involved additional officers in neighbourhood teams. It has changed the way the Metropolitan Police operates in relation to community safety. There are now three teams responding to domestic violence incidents. There is also funding available for a Domestic Violence Intervention Team to assist people subject 18

to domestic violence to obtain a Non Molestation Order. The new team will also provide a faster arrest for suspects and follow up with perpetrators on release from prison to deter reoffending. During 2012/2013, the police investigated 127 cases. Of these referrals, 39% of the allegations were regarding financial abuse, 35% were about physical abuse and 26% referred to other categories of abuse Relationship of the person to the alleged perpetrator is presented below: The conviction rate is increasing as a result of lessons learnt from the Dormers Wells Lodge investigation and by working more closely with the Crown Prosecution Service. In order to strengthen the referral and investigation process further the CSU will be providing training on the safeguarding adults training program for staff. 9.3. The London Fire Brigade The Borough Commander has advised that it can be predicted from analysis of where fires have occurred over the last 5 years where fires are most likely to occur in the future. In this way vulnerable geographical areas can be identified. These areas are further considered from the type of housing stock, housing density, the prevalence of overcrowding and demographic risk. In combination 19

these identify increased fire risk and classified as Priority 1 areas (P1). Within Ealing these P1 areas occupy less than 15% of the borough. Due to the LFB preventative strategy the number of fires and associated injuries within these areas is less than would be expected. It is recognised that there is additionally a significant fire risk associated with some vulnerable residents including those with disabilities, mental health issues, who smoke or use alcohol or drugs, older people and those on a low income The main thrust of the preventative strategy is to stop a fire occurring in the first place. This is progressed through a Home Fire Safety Visit (HFSV). This is a free service and these visits focus on three key areas: To identify the potential fire risks within the home and give advice on how to reduce or prevent those risks. The provision of a smoke alarm where needed and advice on how to maintain the alarm. To provide advice on planning an escape route should a fire occur. In Ealing the Fire Brigade set a target to complete 3,024 HFSV this year and completed 3,219. More than 80% of those visits were in a high risk area or to a person in a high risk group. From analysis, the victims of fires (where there is injury or death) are vulnerable and are known to Adult Services. As a response the referral pathway has been strengthened and a new referral form developed. A series of training sessions took place at Ealing Fire Station for managers, care workers and call centre staff. This included a fire hazard training house to address risk prevention and hazard identification. To advertise the free HFSV service to vulnerable residents a letter was sent to all those that have received support from Adult Services in Ealing. A code was 20

established to evaluate the referral source and to date there have been 139 referrals. The London Fire Brigade Hoarding Policy provides clarity on identifying and assessing the level of hoarding using a Clutter Image scale. his scale ranges from 1-9 and requires action to be taken by the Borough Commander at level 4 of the scale. West London Mental Health Trust The Safeguarding Team Coordinator represents Ealing at the WLMHT Safeguarding Adults Clinical Governance Meeting. The Director of Safeguarding Children and Vulnerable Adults has summarised their activity and key achievements: 9.3.1 Achievements The West London Mental Health Trust has made progress developing safeguarding adult governance arrangements in the last year. The Trust has developed quality assurance measures for safeguarding that are reported to the Trust board on a monthly basis. Measures include awareness of numbers of safeguarding adult referrals made by staff in the organisation and linking this to our incident review processes. In addition, the organisation s awareness of adult safeguarding matters has been informed by establishing a Trust-wide Safeguarding Adult Governance Forum. This meeting is embedded in the Trust clinical governance structure and has representation from Local Authority Safeguarding Adult Teams in all the London Boroughs in which the Trust delivers services. This is now enhanced by including the Safeguarding Adult Lead from the local CCG in the membership of the meetings. WLMHT completed a second Safeguarding Adults Self-Assessment Assurance Framework in 2012. The submission was presented to the Ealing Safeguarding Adult Board and validated centrally by NHS London. The Trust was identified 21

as an example of best practice on a range of outcomes by the overview report produced by NHS England London region. WLMHT has put considerable resource into developing mandatory training and review of Safeguarding Adults Training was part of this drive to increase staff knowledge levels. The content of the training has been reviewed in line with latest guidance and training levels for safeguarding adult awareness training is consistently managed at levels above 85%. The staff training has been benchmarked in an external validation exercise and we were reviewed to be performing amongst the top Trusts for achievement of mandatory training compliance. The Trust has recently reviewed its Safeguarding Adult Policy and Procedures in order to support staff development and knowledge and to enhance partnership functioning by facilitating and clarifying the expectations for staff of the Trust. This revision includes additional guidance on PREVENT and identifies Domestic Violence as a specific priority issue. The Trust has commissioned a review of Safeguarding Adults across the organisation by an external auditing agency to identify relative strengths and weaknesses in relation to safeguarding performance. The Trust board will consider the report and recommendations for development will be used to strengthen existing processes and resources. Although the PREVENT agenda needs to be developed in the Trust, staff awareness is increasing and the Trust has made its first referral using the Channel Protocol. 9.3.2 Challenges Safeguarding Adults capacity remains an issue as the Trust recognises the incremental increase in expectations placed on staff in respect of their 22

responsibilities and duties relating to safeguarding adults. It is expected that the full audit of safeguarding procedure will inform the development of resource. The organisation s knowledge of its use of the Mental Capacity Act and Deprivation of Liberty (MCA/DoLS) is not fully developed. This has been identified as an area for review over the coming year. Systems for collecting information about this activity need to be developed. The intranet pages informing staff about relevant safeguarding adult information have been re-designed but due to capacity issues the implementation has been delayed. This will be prioritised as it forms a core route for communication with, and informing staff about, best and current practice. User involvement in Safeguarding Adults is not yet well-established. The Trust has started to routinely collect information about user experience and this dataset will be developed to include information about safeguarding. In addition, a service user leaflet providing information about adult safeguarding needs to be developed. The PREVENT agenda needs to be embedded in the Trust Safeguarding Training and plans are under way to develop this resource. 9.4 Safeguarding Adults Self-Assessment and Assurance Framework (SAAF) In July 2012 NHS London requested that clusters utilise an Adult Safeguarding Self-Assessment Assurance Framework (SAAF) to demonstrate their focus on robust safeguarding adults at risk arrangements across commissioning and provider organisations. This was a requirement in the Operating Framework for the NHS in England 2012/13. Provider organisations were required by NHS London to report on four targets safeguarding strategy, systems, workforce and partnerships in the year 2012/13. Organisations submitted their SAAF returns to local safeguarding adults boards for oversight and challenge. These submissions were sent to the relevant Director of Nursing for validation. Each section held a validation meeting with NHS London to 23

demonstrate understanding of the safeguarding capacity and capability of all NHS Commissioning and Provider organisations within the cluster. NHS London agreed to publish a detailed London-wide overview report from the SAAF submissions. 9.5 Care Quality Commission CQC published a new protocol in February 2013 Our safeguarding protocol: The Care Quality Commission s responsibility and commitment to safeguarding. The protocol was formulated and developed to address their role in safeguarding adults. The protocol replaced all previous protocols and it covers all the relevant health and social care sectors for which CQC has regulatory responsibilities and provides the principles for how CQC will monitor that vulnerable people are protected. CQC have attended meetings with respect to concerns relating to particular establishments. 10. Establishment Concerns In December 2011, a number of safeguarding concerns emerged regarding The Grange Nursing Home, a Life Style Care provision. This resulted in a formal suspension of placements whilst the Commissioning and Safeguarding Teams worked collaboratively with The Grange to address the issues. The high volume of safeguarding concerns continued throughout 2012 and the suspension remained in place. The Grange appointed a new regional manager and increased their staffing to achieve managerial oversight of every unit. With these changes The Grange improved and the embargo on new placements was lifted in January 2013. A supported living provider- Positive Living was investigated because of the high rate of safeguarding concerns at the Woodend Gardens site. Positive Living had recently been acquired by the Priory Group and had gone through a number of changes which were thought to have negatively impacted on staff performance. A number of unannounced and planned visits were undertaken 24

and Positive Living delivered an action plan which was monitored by the Commissioning Team and Safeguarding Team. The suspension of new placements was lifted once the improvements in service were evidenced and maintained. Dormers Wells Lodge (now renamed Telford Lodge) was under suspension of new placements from 2010 until September 2012. Considerable work was undertaken with Dormers Wells Lodge until improvement was maintained. The Safeguarding Team has continued to work closely with the manger and the management committees to ensure standards. REVIEW OF DATA MONITORING INFORMATION 1. Introduction The following section of this report examines the data relating to all safeguarding adult referrals made to Adult Services between 1 st April 2012 and 31 st April 2013. 2. Notes I. Percentages may not add due to rounding II. The statistical information relates to safeguarding alerts. III. Where comparisons to national statistics are made, this relates to the NHS report: Abuse of Vulnerable Adults in England 2010-11: Experimental Statistics 3. Summary The safeguarding adults referral rate for 2012/13, showed a significant increase over the previous year (14.5%). This year there have been 51 additional alerts which is an increase of 6.8%. In line with all previous reporting years, the customer group most referred is older people The majority of safeguarding referrals were made by health and social care 25

professionals and family members There were more referrals regarding women than men The ethnicity of the adult at risk in the majority of safeguarding adult referrals was White British Most reports of alleged abuse were of Neglect and Physical Abuse In a large proportion of referrals, the abuse was reported to have taken place where the adult at risk lived There were high levels of alerts within the Norwood Green and Greenford Broadway wards in Ealing. Southall Green and East Acton wards had the fewest allegations in 2012/13. Where the alleged person causing harm was known it was most frequently a paid carer. In 22% of referrals the adult at risk lived with person alleged to have caused harm. In 30% of referrals the adult at risk was cared for by the person alleged to have caused harm 85% of the alerts were investigated under safeguarding adults procedures The allegation of abuse was substantiated in 26% of investigated cases 4. Referral Rates Difference between alert and referral During the reporting period, Ealing Council received 800 safeguarding adult alerts. An alert is a concern of a safeguarding nature raised with the Local Authority. The alert is screened by a Care Manager and if there is an indication that significant harm may have occurred it is progressed to a referral for further investigation. 26

4.1 Alerts by Annum 900 800 700 749 800 600 653 654 602 500 400 448 300 200 276 281 248 100 195 32 0 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 There was a small increase in safeguarding alerts in 2012/13. There has been an upward trend over the last 12 years which is attributed to an increased awareness generally in the community and in professionals of safeguarding issues. There is a proven correlation between awareness raising and the confidence to make a referral. It should be noted that these figures relate to reported cases of alleged abuse and that not all allegations of abuse are reported. Of the 800 safeguarding alerts, 679 (85%) became referrals and were investigated under the safeguarding procedures and 121 (15%) were taken no further. Of those 679 cases, investigations for 486 cases (61%) were completed within the reporting period and 193 referrals (24%) were still under investigation because of the complexity of the cause of the abuse. 27

4.2 Alerts by Client Group Client Group Alerts Number Percentage Older People 545 68% Physical Disabilities 72 9% Learning Disabilities 102 13% Mental Health 81 10% The highest proportions of safeguarding alerts were of adults known to Older People Services Mental Health Services had the fewest safeguarding referrals however there has been a slight increase compared with last year s figures (69 referrals). The trend has been that adults aged 65+ are much more likely to be referred under safeguarding adults procedures. There are many possible reasons for this, some examples would be: We live in an ageing society. The 2011 Census showed that over 16% of the population in Ealing were aged 65 and over the highest seen in any census. Research has shown that vulnerability to abuse increases with age There is a greater national awareness around Elder Abuse with campaigns such as World Elder Abuse Awareness Day and promotions from the charity Action on Elder Abuse Anecdotally, we often find there is a general perception that adult abuse equates to elder abuse A higher proportion of older people will live in residential or nursing care homes or receive assistance from domiciliary care agencies. Part of the Registration requirement is the reporting of concerns of abuse 4.2.1 Comparisons with 2011/12-Alerts and Client Group Older People Physical Learning Mental Heath Disabilities Disabilities 2011 / 12 67% 11% 11% 11% 2012 / 13 68% 9% 13% 10% 28

4.3 Number of customers referred who are in receipt of Commissioned Services 509 (64%) of safeguarding alerts related to adults at risk who were receiving Ealing Council commissioned services. 10% of customers were not in receipt of services and a further 3% of customers were self-funders. 29

4.4 Alert/Referral source Referrer relationship category Social Care Staff Referrer relationship Referrals Percentage Domiciliary staff 31 4% Residential care staff 39 5% Nursing care staff 115 14% Day care staff 22 3% Social worker / care worker 97 12% Carers employed by the 0 0% customer Other care staff 60 7% Health staff Primary / community health staff 101 13% Secondary care staff 25 3% Mental health staff 52 6% Other Self-Referral 36 4% Family member 128 16% Friend / neighbour 19 2% Other adult at risk 1 0% Housing officer 10 1.5% Police officer 10 1.5% Unknown to adult at risk 11 1.5% Emergency services worker 13 2% Main Carer 10 1.5 Not recorded 20 3% Referrals were received from a wide variety of sources 45% of referrals were from social care staff and 22% of referrals came from health staff. Within the social care staff category, nursing (home) care staff and social workers/care managers made the highest number of referrals Family members made 16% of the total referrals On a national level, the majority of referrals come from professionals - 44% of 30

referrals from social care staff and 22% from health staff. The Other Care Staff category includes voluntary agencies and providers that support customers in personal care, advocacy and befriending services. 4.4.1 Comparisons with 2011/12 Referral source There have been changes in recording systems and categories of referral sources since last year, but despite this, there are trends: Family members continue to make the highest number of referrals The percentage of self-referrals has decreased slightly (4%) The referral level from social workers has also decreased (14% last year, 12% this year). The reasons for this are not clear and this will be further investigated and monitored. 5. Adult at Risk Profile 5.1 Age Age Alerts Percentage 18 30 67 9% 31 40 40 5% 41 50 59 7% 51 60 48 6% 61 70 85 11% 70 80 171 21% 80+ 330 41% Under 60 214 27% Over 60 586 73% The likelihood of allegations of abuse increases significantly in the over 70 age groups 73% of referrals were regarding people aged 60+ The UK Study of Abuse and Neglect of Older People: Prevalence Survey Report found that the risk of abuse increased with age and the safeguarding adults referrals support this finding. This is also the case across all the London 31

Boroughs 5.2 Gender Gender Alerts Percentage Male 311 39% Female 489 61% As in the past there were more referrals for women than men. Last year there were 59% referrals for females and 41% referrals form males The figures show an increase in referrals regarding women. Nationally, 62% of referrals were regarding females 5.3 Ethnicity Ethnicity Alerts Percentage White British 467 58% White Irish 27 3% White Gypsy/Roma 1 0% White Any other white background 37 4% White TOTAL 532 65% Mixed White and black Caribbean Mixed White and black African 3 0.5% 0 Mixed White and Asian 3 0.5% Mixed Any other mixed background 3 0.5% Mixed TOTAL 9 1.5% Asian or Asian British Indian Asian or Asian British Pakistani 30 4% 11 1.5% 32

Asian or Asian British 10 1.5% Bangladeshi Asian or Asian British 95 12% Any other Asian background Asian or Asian British 146 19% TOTAL Black or Black British - 56 7% Caribbean Black or Black British 11 1.5% African Black or Black British 9 1% Any other Black background Black or Black British 76 9.5% TOTAL Other ethnic group 2 0.5% Chinese Other ethnic group Any 23 3% other ethnic group Other ethnic group TOTAL 25 3.5% Not stated information 9 1% yet to be obtained Not stated - refused 3 0.5% Not stated TOTAL 12 1.5 The ethnicity of the adult at risk in the majority of safeguarding adult alerts was White British (58%). White British made up 59% of referrals in 10/11, 51.5% in 09/10 and 52.5% in 08/09. 65% of the alerts were for adults who stated their ethnicity as White. The national average is 89%. 33

33.5% of safeguarding alerts were adults from BME groups and this reflects the wide cultural mix within the Borough. This is the same proportion as last year. Nationally the average is 8%. Abuse profile These definitions of abuse have been summarized from Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse (SCIE 2011). Discriminatory Abuse Discriminatory abuse is psychological abuse and harassment that is racist, sexist or linked to a person s age, disability, sexual orientation, cultural background or religion. Discriminatory abuse includes hate crimes, racial harassment and harassment based on gender or sexual orientation Financial Abuse This is the misappropriation of an individual s funds, benefits or savings, or any other action that is against the person s best financial interest. Examples of this are: Theft of money, possessions, property or other material goods The misuse of money, including fraud or extortion of material assets. Persuading a vulnerable adult to enter into a financial agreement which is to their detriment. Institutional Abuse This is abuse occurring in a social or health care establishment. It includes poor practice, ill treatment and gross misconduct. Examples of this are: Lack of individual care No flexibility of bedtimes or waking Lack of stimulation. 34

Neglect Neglect is the deliberate withholding or intentional failure to provide appropriate and adequate care and support. This includes failure to: Keep the person clean, warm and in good health Provide reasonable care Give prescribed medication Afford privacy and dignity Provide supervision for behaviour which could be dangerous Provide nourishment Manage tissue viability (which could lead to pressure sores) Physical Abuse Physical abuse is the physical ill treatment of an adult which may or may not cause physical injury. This includes: Assault Misuse or withholding medication Unwarranted or inappropriate restraint forced isolation Rough handling Psychological Abuse Psychological abuse is being repeatedly made to feel unhappy, anxious, afraid, humiliated or devalued by the action or inaction and or the attitude of others. This includes: Humiliation or ridicule Threats of punishment or exclusion Intimidation, name calling and verbal abuse. 35

Sexual Abuse This is the involvement of a vulnerable person in sexual activities which they have not freely entered into including because they lack the mental capacity to do so. This includes: Rape Sexual assault including inappropriate touching Indecent exposure Non-contact abuse (includes involvement in pornography) Sexual harassment 6.1.2 Comparisons with Previous Years Type of Abuse Discriminatory Financial Institutional Neglect Physical Psychological Sexual 2012 / 13 1% 20% 3% 35% 28% 9% 4% 2011 / 12 1% 18% 3% 34% 22% 18% 4% 2010 / 11 1% 24% 2% 33% 23% 15% 4% 2009 / 10 1% 22% 5% 22% 27% 18% 5% The most frequently referred types of abuse in 2012/13 were Neglect, Physical and Financial Abuse. Collectively they were the cause of 83% of all safeguarding alerts. Neglect has been the highest category of alleged abuse reported in the last two years with an increase of 1% this year. There is now mandatory reporting of pressure sores which come into this category. The percentage of reported alleged Financial Abuse has increased by 2% and is likely to be the result of increased vigilance in this area. Psychological abuse has decreased significantly to half of that reported in previous years. It is consistent with the national trend and work on a national level is being undertaken to explore this. 36

6.1.3 Does the Abuse Constitute a Crime? The alleged abuse was judged by the Police to constitute a crime in 35% of the referrals. The Police investigated 127 safeguarding adult cases. 6.1.4 Location where Alleged Abuse takes place 350 300 250 200 150 100 50 0 Own Home 347 218 Care Home Person Causing Harm's 60 1 19 29 15 9 Hospital Other Health Se ng Supported Day Centre/Service 73 29 Public Place Other Not Known/Recorded The location of alleged abuse has remained consistent over the past 3 years. In 74% of alerts, the abuse occurred where the adult at risk lived. It is important to note that the reporting of incidents in care homes is required under The Care Standards Act 2000. In Ealing there are a number of care homes that accommodate customers from other boroughs. 6.2 Location of Abuse 6.2.1 Geographic Location of Abuse Of the 800 alerts, the location of the alleged abuse was recorded in 684 cases. 37