Safeguarding Vulnerable Adults in Cumbria Integrated care in action Dr Venetia Young Adult safeguarding GP lead Cumbria CCG

Safeguarding Vulnerable Adults in Cumbria Integrated care in action Dr Venetia Young Adult safeguarding GP lead Cumbria CCG

The task Ensure that all health agencies in Cumbria are working together to safeguard vulnerable adults with quality, dignity and compassion at the heart of what they do. CPFT mental health UNITY drug and alcohol CCG and NHSE GP surgeries Acute Hospitals Community Hospitals NWAS

Experience Family Therapy training Solution Focussed training Family Therapist in AMH - Safer Systems service GPSI MH, Eden MH lead 12 years Many SEA case discussions in GP practices to implement NSF Tavistock training in Organisational dynamics MUS and frequent attenders work at Lakes Medical Practice and training nationally.

The five blind men Ear Trunk Tail Legs Body 5 blind doctors 5 blind researchers

Gastroenterology Functional diarrhoea IBS dyspepsia Diabetes Poor control Respiratory Cough Brittle asthma Neurology Dissociative disorders Funny turns Cardiology Noncardiac chest pain Syndrome X Tital Gynae Pelvic pain Recurrent discharge Pain Clinic Opiate addiction

Elephants in the Consulting Room Domestic Violence Sexual Violence Alcohol and drug misuse problems Distress (MUS) DSH, suicide Care of the elderly

Why are they unacknowledged? Lack of knowledge about care pathways Lack of communication skills the can of worms Lack of reflective practice Not my job. No time. Fear. Siloed thinking: DV is police job. Suicide is Mental Health. Sexual health is GUM (except for contraception) Poor understanding of stress in the body/mind Medical model and narrow focus. Limited training Research into soft issues not given a priority Fear of aging

Three year incidence of 10 common symptoms and the proportion with organic disease 12 10 8 6 4 2 0 Kroenke & Mangelsdorff 1989

What is the evidence the elephants are there? Survivor s Trust 1 in 10 women with SMI raped every year. 6x incidence of being victim of violence Chronic pain 60% have suffered lifetime abuse: domestic violence and sexual abuse 70% people with Borderline Personality Disorder 80% those in CJS Alcohol related harm costs Cumbria 325 a head: violence, multiple illnesses and recurrent admissions Case Histories in Domestic Homicides Suicide and its antecedents

Professional networks for role SARC MARAC ops group. DHRs UNITY Suicide prevention pathway. DSH Older adults: social care, public health and mental health. Adult Safeguarding Board CLIC

Adult safeguarding training Complex case discussion across departments and agencies with safeguarding case at heart of each case. Facilitated Significant event audits of complex cases in practices Frequent attender audits in all departments and surgeries. 5-10 patients each. Saving time means more reflective time. GP registrars at heart of audits An effective multiagency training plan Safety pack: DV, SV Alcohol suicide and DSH mitigation Protocol in Primary care that includes all of these Safeguarding Passport

Rationale Clinicians like case discussions and rarely have time Evidence that this works: A&E, GP, psychiatry, reflective teams (Prof Michael West) SEA (Mike Pringle) Evidence there are cost savings: David McDaid LSE Gets staff working together and begins a patient centred multi-agency quality improvement, which has safety at its heart Put primary care at the centre as it sees the whole elephant grow from cradle to grave

Changes prompted so far A&E Frequent Attenders meeting: Police to investigate MARAC plus Pan London initiative Crisis team to work more closely with UNITY ALIS meetings OOH service committed to supporting ambulance and police to triage A&E admissions OOH service training plan to include DV, PD, and MUS Safeguarding nurses to work on FA lists in CHOC and A&E Unity enabled to establish scheduled care detox pathway. Revamping of primary care referral pathway. Training of Shared care GPs on working with families

Emerging Training plan with GP trainees Week intensive for GP trainers, registrars and first five years post qualifying Alcohol RCGP accredited day Dr Peter Howarth Suicide risk ASIST or STORM 2 days Domestic violence Sexual violence Incorporating child and adult protection throughout MUS Elderly care and care planning Trainees want to be trained with other professionals

Where is adult safeguarding in this as defined by the Care Act 2014? Each case discussed and each training day has clear care pathways. Each case is complex and has a safeguarding core. Appropriate risk assessment tools are taught and used: CAADA, AUDIT etc Each case explains the role of different agencies and parts of agencies and gives the contact numbers Appropriate legislation is incorporated: MCA DOLs etc Participants leave training events with a plan of how they are going to enact change in their organisations, towards prevention, early intervention and active management. Suicide prevention: is it the Safeguarding Adults Board responsibility?

Safeguarding nets

What themes underpin the changes? Relationship building Finding the hidden psycho-bio-social cause of presentations Creating services based on what people need, rather than what professionals want to provide. (Seddon) Culture change to co-missioning. Walking alongside Supporting staff in their difficult work to enable compassion

References and helpful books Prof Michael West Effective Teamwork Leoncini 5 Dysfunctions of the Team and Death by Meeting The Go-Giver. Burg and Mann Who moved my cheese? Spencer Johnson The Elephant and the Twig. Geoff Thompson Asen, Tomson, Tomson and Young 10 minutes for the family Pringle significant event auditing in primary care David McDaid LSE on www.primhe.org John Seddon Vanguard. Saving money by doing the right thing

Dr Venetia Young Adult Safeguarding Lead GP Lonsdale Unit Penrith Hospital Bridge Lane Penrith Tel: 01768 245666 email venetia.young@cumbriaccg.nhs.uk