Item 11 Report to Trust Board August 2016 Report Title Report from Tracy Luckett Director of Nursing and Allied Health Professions Prepared by Sarah Phillip Safeguarding Adults Lead State impact on CQC domain CQC Domain 1 Safe: Are people protected from abuse and avoidable harm. CQC Regulation 13: Safeguarding service users from abuse and improper treatment. State impact on corporate priorities Deliver the highest standards of patient experience, outcomes and safety across all of Moorfields sites Develop Moorfields people and the organisation as a great place to work and provide care List of attached appendices (if applicable) Reference documents that are not attached (e.g. previous reports or appendices) Appendix 1 Glossary of Terms and Abbreviations Appendix 2 References Summary Paper pages 1-5 1. Brief Summary of Report To report to the Trust Board on progress against the delivery of the safeguarding adults agenda in the Trust in line with legislation and statutory guidance 2. Action Required/Recommendation The Board is asked to note the content of this report.
Executive Summary: This report demonstrates to the Trust Board, Moorfields Eye Hospital NHS Foundation Trust s compliance with the statutory and mandatory requirements relating to the safeguarding of adults. All staff within the organisation have a responsibility to respond to and report concerns of abuse and neglect regarding adults at risk, and to ensure that safeguarding is an integral part of our governance systems. This report also demonstrates to the Care Quality Commission that the Trust is meeting its responsibilities under the Care Act 2014 and the requirements of regulation 13. It also details how the Trust is assessed on its performance both internally and externally regarding safeguarding adults. Related Trust Objective: Improving patient safety and satisfaction. Risk and Assurance: Maintaining effective safeguarding arrangements increases the safety of our patients and the quality of the services we provide, supporting the achievement of objective. Legal implications & regulatory requirements: Safeguarding Adults is governed by the statutory requirements in the Care Act 2014. The Care & Support Statutory Guidance (updated July 2016) and the London Multi-Agency Safeguarding Adults Policy and Procedures sets out how organisations and individuals must work together to protect adults from abuse and neglect, and to prevent abuse and neglect. The multi-agency safeguarding adults policies & procedures in Kent and Medway, Hertfordshire and Bedfordshire sets out how organisations must work in the areas where the Trust has satellite sites. The Care Quality Commission Regulation 13, safeguarding service users from abuse and improper treatment, is a fundamental standard. The intention of this regulation is to safeguard people who use services from suffering any form of abuse or improper treatment while receiving care and treatment. Actions for the Trust Board: This report updates the Trust Board on progress following the 2014-2015 report and is brought to the Board for information prior to dissemination to Islington Clinical Commissioning Group. The Board is asked to receive this report as assurance that the Trust is maintaining effective systems and processes to safeguard adults. Page 2 of 22
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Page 4 of 22 Section Content Page 1. Introduction 4 2. Safeguarding Adults Activity 2015 2016 9 3. Legislation, Policies and Procedures 11 4. Meetings 12 5. Safeguarding Supervision 13 6. Safeguarding Adults Reviews 13 7. Safeguarding Adults Training 13 8. Domestic Homicide Review 13 9. Employment Practice 14 10. Mental Capacity Act 15 11. Domestic Violence 15 12. Learning Disabilities 16 13. Dementia 16 14. PREVENT 17 15. Summary 18 Appendix 1: Glossary of Terms & Abbreviations Appendix 2: References Safeguarding Adults Board Report 2015 2016 Page 4 of 22
1. Introduction Safeguarding means protecting an adult s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances (Care & Support Statutory Guidance, July 2016) No decision is made about me without me (Making Safeguarding Personal, ADASS) This report sets out the work carried out across Moorfields Eye Hospital (MEH) NHS Foundation Trust throughout 2015-2016 to address the Safeguarding Adults Agenda, which remains a high profile nationally & locally. Safeguarding adults means helping adults at risk to live free from abuse and neglect. Adults at risk are people who are vulnerable because of their mental health, physical disability, age or illness and they may find it difficult to protect themselves from abuse. The Care Act 2014 came into effect in April 2015, superseding No Secrets. The Act introduced legal requirements, the 6 principles of adult safeguarding and the Making Safeguarding Personal approach. It introduced a responsibility to engage in multi-agency working and information sharing, to promote a person centred approach to safeguarding, and to enable choice and control for adults at risk. The London Multi-Agency Safeguarding Adults Policy and Procedures was substantially revised and launched in February 2016. It has been adopted across London. The Safeguarding Adults At Risk Group is committed to enabling the Trust to achieve the highest standards of safeguarding practice and asks for the Trust Board s support towards this aim. Safeguarding adults at risk is everybody s business & underpins the strategy to involve Trust staff at every level in this important endeavour. For the period of this annual report until February 2016, a substantive Safeguarding Adults Lead was in post. An interim Safeguarding Adults Lead was then in post until the end of May 2016, when another person took up the substantive post. In producing this report the information is gathered from a number of sources, including the Safeguarding Adults Six Month Report Quarter 1 & Quarter 2 2015, Safeguarding Children Annual Report 2015 2016, Safeguarding Adults At Risk Group Work Plans and Islington Safeguarding Adults Board 2015-2016 Annual Report. 1.1 Adult Safeguarding in the Headlines Since the previous Safeguarding Adults Annual Report (2014-2015) the government has increasingly focused on adult safeguarding and the Care Act Page 5 of 22
(2014) was introduced in April 2015. Safeguarding adults remains a high profile agenda locally, nationally and internationally. The government has drawn attention to the horrific impact of modern slavery and human trafficking (Islington Safeguarding Adults Board Annual Report 2015 2016), which is a new category of abuse, and a number of high profile cases have been reported in the media. Due to its hidden nature, modern slavery is hugely underreported. An independent inquiry (Mazar s report) into Southern Healthcare was published in December 2015. The report was commissioned by NHS England following the death of Conor Sparrowhawk in July 2013. The inquiry found that only 4% of unexpected deaths of people with a learning disability or mental health problems had been investigated. The Law Commission undertook a public consultation & review of the Deprivation of Liberty Safeguards in 2015. The government has focused on work to prevent people being radicalised or drawn into terrorism. A new duty, the Prevent Duty, has been introduced. It requires public authorities to have due regard for the need to prevent vulnerable adults being drawn into terrorism. 1.2 Key Messages & Quality Assurance This report demonstrates that: The Safeguarding adults agenda at the Trust developed significantly during 2015-16. The awareness and recognition of safeguarding adults concerns among staff improved, and awareness and understanding of the Mental Capacity Act and its role in practice improved. Robust training was delivered in line with legislation and guidance, and included practical Moorfields specific case examples to aid learning. The Trust adult safeguarding policies and processes were developed to ensure that they were Care Act and Mental Capacity Act compliant. A safeguarding adults work plan was in place and was regularly monitored by the Safeguarding Adults At Risk Group. Progress against the work plan was achieved. Risks identified were monitored by the Safeguarding Adults At Risk Group. During the first 9 months reporting period the Safeguarding Adults Lead was informed that a total of 29 concerns regarding abuse and neglect were raised with Adult Social Care. Training compliance for safeguarding adults level 1 was achieved and remained above the target 80% compliance from July 2015 onwards. There were no Serious Incidents declared that involved the Trust in relation to adult safeguarding during 2015 2016. There were 3 applications for Deprivation of Liberty Safeguards (DoLS) made by the Trust to the supervisory authority during 2015-2016. Complaints were reviewed and discussed with the Safeguarding Adults Lead where there may have been safeguarding adult concerns. There were no complaints raised during 2015-2016 which highlighted safeguarding adults concerns. Page 6 of 22
Effective partnership working arrangements were strengthened with key agencies including the Islington Safeguarding Adults Board and subgroups. A safeguarding audit was carried out by KPMG with an overall report rating of significant assurance with minor improvement opportunities - the later included the capacity of the existing safeguarding personnel. The safeguarding adult and children agenda across the Trust continued to be strengthened through the recognition that adults and children do not exist in isolation. The safeguarding adults agenda expanded with the introduction of the Care Act, and the increase in the types of abuse, and the responsibilities became increasingly broad and far reaching. The Safeguarding Adults Annual Report 2014-2015 was presented to the Clinical Quality and Review Group (CQRG) during this reporting period. 1.3 Key Achievements 2015 2016 The Four Steps to Safeguarding developed Trust wide to enable staff to take 4 steps in the safeguarding of children, young people and adults. Continued awareness of safeguarding adults with Trust staff raising enquiries from all disciplines. Safeguarding Snippets In house Quarterly Newsletter developed. Intranet Safeguarding Adults Site developed further. Safeguarding Risk Register established. Systems, policies and procedures to safeguard adults at risk were reviewed Standard operating procedures were developed for satellite sites, including information on local contacts. Mandatory training compliance for safeguarding adults improved. A 3 year training strategy was agreed for Safeguarding Adults. Mental Capacity Act training (basic awareness) was introduced. An audit on the implementation of the Mental Capacity Act highlighted significant areas for improvement across the Trust and as a result it became a key corporate priority for the Trust. An action plan w as developed focusing on aw areness raising, the implementation of training for clinical staff, launching the Mental Capacity Act and Deprivation of Liberty Safeguards Trust policy, and developing Trust templates. The Trust made a public commitment to the Dementia Action Alliance Dementia Friendly Hospital Charter The Trust held a Dementia awareness week including daily emails to staff and awareness stalls from external agencies Dementia friendly signage was implemented at City Road as a part of the Dementia Friendly Hospital Charter. Fire safety awareness and prevention pilot in partnership with London Fire Brigade and patient support services. Partnership working discussions commenced with other NHS Trusts to improve pathways for patients requiring crisis Mental Health interventions. A Dementia and Learning Disabilities work group was established to improve pathways and care for patients with a learning disability or dementia. New Trust Mental Capacity Assessments and Best Interests Decisions assessment templates were launched. Page 7 of 22
Collaborative working with the Trust Safeguarding Children s Lead in relation to aspects of the safeguarding agendas which straddle adults and children for example Learning Disabilities, Mental Capacity and PREVENT. The PREVENT Strategy was embedded into safeguarding PREVENT policy and procedures including the management of Prevent concerns relating to a member of staff were approved and ratified. Awareness of PREVENT included in face to face Safeguarding Adults, Level 1 and Level 2 Safeguarding Children Training. Workshops to Raise Awareness of PREVENT (WRAP) commenced. PREVENT page developed for Safeguarding Adults and Safeguarding Children Intranet Site. Channel Panel Information Sharing requests commenced. 1.4 Islington Safeguarding Adults Board Priorities 2015-2016 Islington Safeguarding Adults Board expects partners to contribute to their overall strategy & to achieving their strategic aims. The Trust contributed by: An information/awareness raising stall was held at City Road. A large number of people were spoken to raising awareness of neglect and abuse, particularly financial abuse, & many people discussed their personal concerns and worries. Basic awareness training on PREVENT was provided as part of the Safeguarding Adults training on induction. On-going domestic violence work was undertaken in conjunction with Solace Women s Aid. A training programme was provided across the Trust for staff in high risk areas. 1.5 Challenges and Issues As a tertiary service, the Trust sees adults from a wide geographical location. The Trust is also located within satellite units across pan-london, the Home Counties and the south east. This requires networking with numerous external agencies and staff which creates a challenge in accessing appropriate resources for adults at risk, as well as understanding the different way in which Adult Social Care departments work in different local authorities. The ambulatory model reduces the time window of opportunity to identify and respond to concerns, and combined with high outpatient attendance introduces a challenge. The capacity of the existing safeguarding adult personnel was highlighted in the KPMG Safeguarding Audit Report. The Safeguarding Adults Lead left the Trust during 2015 2016 and an interim lead came into post for a 3 month period, presenting a challenge in terms of consistency, achieving target timescales and robust reporting on activity. There was an increase in the audits and reports completed on safeguarding adults activity. The consistent application of the Mental Capacity Act, and robust documentation to evidence compliance with the Act, continued to be a challenge. The implementation and development of the Mental Capacity Act continued to be a key training and development need as well as a Trust corporate priority. Understanding of safeguarding adults concerns as separate and distinct from general health and social care needs, and so requiring a different response, was not consistent across the Trust. Mandatory compliance for safeguarding adults training improved but remained a challenge. The introduction of training for staff within clinical roles was still to be Page 8 of 22
to be introduced, creating risks in terms of staff having sufficient knowledge and skills. Governance and Accountability Arrangements Executive Lead for Safeguarding - Board Level Director of Nursing and Allied Health Professions Tracy Luckett Safeguarding Adults Lead (23 rd May 2016 to date) Safeguarding Adults Lead Sarah Phillip Interim Safeguarding Adults Lead (8 th Feb 27 th May 2016) Interim Safeguarding Adults Lead Julie Hall Safeguarding Adults Lead (20 th Jan 2015 3 rd Feb 2016) Safeguarding Adults Lead Edwina Curtis The Trust s Safeguarding Adults at Risk group meets bi-monthly and is chaired by the Executive Lead for Safeguarding. The group monitors the Trust s work plan, provides assurance and accountability structures, and a forum for anonymised discussions of incidents raised to identify trends and learning. This is shared as appropriate with the Serious Incident Panel, Clinical Governance Committee and the Clinical Quality Review Group (CQRG) and included in the Trust s Quality and Safety Report. Key Priorities for 2016 2017 To review & update MEH Safeguarding Adults at Risk policy, policy summary, & leaflets to reflect the Care & Support Statutory Guidance, & London Multi- Agency Safeguarding Adults Policy & Procedures. To develop consistent understanding across the Trust of the Care Act and the safeguarding adults agenda, & to embed in practice, ensuring concerns are responded to and reported appropriately. To embed the Mental Capacity Act into practice across the Trust, ensuring defensible decision making. To embed Making Safeguarding Personal in practice and adopt a person centred approach when working with adults at risk. To update the Moorfields Eye Hospital Carers Policy to be Care Act compliant & to respond to the needs of carers. To develop a robust data reporting system to capture accurate data on activity to enable reporting & analysis. To further address the Domestic Violence agenda with the commencement of domestic violence drop in surgeries at City Road. To explore the development of a Safeguarding Champions Model across the Trust. Page 9 of 22
To review and develop a Dementia & Learning Disability Champions model across the Trust. To further address the dementia & learning disability agendas with the commencement of Tier 2 training. To review the resource requirements within the safeguarding service to include additional safeguarding personnel and designated administrative input. 2. Safeguarding Adults Activity 2015 2016 2.1 Enquiries to the Adult Safeguarding Lead for advice & support During 2015 the number of enquiries to the Safeguarding Adults Lead for advice and support from staff across the Trust gradually increased. Tables 2.1, 2.2 and 2.3 below show a breakdown of the number and types of advice sought and concerns raised in Quarter 1 & Quarter 2: 2015/16. In both quarters, advice regarding mental capacity was the most common reason for contact. Table 2.1 Enquiries to Safeguarding Adults Lead 2014-2015 2015-2016 80 70 60 50 40 30 20 10 0 66 67 52 41 Quarter 4 Quarter 1 Quarter 2 Quarter 3 The increase in activity was felt to directly result from increased training, the Safeguarding Snippets Internal Newsletter and further development of the Safeguarding Adults Intranet site, which all raised awareness. Page 10 of 22
Table 2:2 Advice sought from Safeguarding Adult Lead Quarter 1 2015-2016 5 7 Safeguarding Adults Concerns Raised Mental Capcity Advice 8 17 Domestic Abuse cases reported Mental Health Concerns advice given Table 2.3 Advice sought from Safeguarding Adult Lead Quarter 2 2015-2016 15 1 12 Safeguarding Adults concerns raised Mental Capacity Advice Domestic Abuse cases reported 13 4 19 Mental Health Concerns advice given Vulnerable patients advice given Other The Safeguarding Adults Lead left the Trust at the end of Quarter 3 and then an interim lead came into post impacting on the robust reporting on activity during Quarters 3 and 4. 2.2 Safeguarding Concerns Raised with Adult Social Care During Quarter 1, 2 & 3 the Safeguarding Adults Lead was informed by staff across the Trust that in total 29 concerns regarding abuse & neglect had been raised with Adult Social Care. During 2014-2015, the safeguarding adults lead was informed of 22 concerns raised with local authorities. This evidences a clear increase in the reporting of concerns regarding abuse and neglect to Adult Social Care. This could be due to either an increased awareness among staff and/or a lower threshold for intervention by adult social care introduced by the Care Act. 2.3 Incident Reporting Page 11 of 22
Table 2.4 Location of Alledged Abuse or Neglect recorded ontrusts Incident Reporting System 2 2 1 12 Own Home Residential or nursing home Sheltered Housing Outside in a public place No concerns were raised that were located in hospital, day centres or other day services, or supported living centres. 2.4 Deprivation of Liberty Safeguards (DoLS) Regarding Deprivation of Liberty Safeguards (DoLS), during 2015 2016, the Trust made three referrals to supervisory authorities (Local Authority) seeking authorisation of a Deprivation of Liberty. One was deemed not to be a deprivation, and two deprivations were authorised. This is an increase from the previous reporting year where there had been one referral regarding a deprivation of liberty. 2.5 Independent Mental Capacity Advocates (IMCAs) There were four recorded referrals for an Independent Mental Capacity Advocate (IMCA) within the Trust during 2015 2016. Under the Mental Capacity Act, IMCAs are a legal right for people over 16 who lack mental capacity and do not have a family member or friend to represent them, and serious medical treatment is proposed or there are safeguarding concerns. This is an increase on the previous reporting year where there was one recorded referral for an IMCA. 3. Legislation, Policies and Procedures 3.1 Legislation The Care Act 2014 sets out a clear legal framework for safeguarding adults, introducing statutory duties for Local Authorities & partner agencies. The Care & Support Statutory Guidance (updated July 16) sets out how this should be applied in practice. The Care Act introduced 3 new types of abuse: domestic violence, modern slavery, and self-neglect. It introduced a change in language. Safeguarding referral was replaced with safeguarding concern, safeguarding investigations was replaced with safeguarding enquiries. Section 42 places a duty on a local authority to make enquiries (or cause to be made) if they suspect that an adult in its area has needs for care and support and is experiencing, or is at risk of experiencing abuse or neglect. The threshold is lowered and there is a stronger focus on risk management. The Local Authority Page 12 of 22
retains responsibility as the lead coordinating organisation. All other partners, including NHS Trusts, owe legal duties that centre on partnership working, management of risk, cooperation, timely information sharing and prevention, both strategically & operationally. The Care Act & Guidance state that safeguarding: Is person led. Engages the person from the start to the end of the process. Is outcome focused (not systems focused). Is based on a community approach from all partners. The six principles of adult safeguarding underpin all adult safeguarding work: Empowerment People being supported and encouraged to make their own decisions. Prevention It is better to take action before harm occurs. Proportionality The least intrusive response appropriate to the risk presented. Protection Support and representation for those in greatest need. Partnership Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. Accountability Accountability and transparency in delivering safeguarding. 3.2 Policies & Procedures The London Multi-Agency Adult Safeguarding Policy and Procedures were significantly revised and launched in February 2016, to ensure they reflect the Care Act principles and the Making Safeguarding Personal approach. The following Trust policies and procedures were developed or revised during this reporting period: Title of Document Type of document Status Domestic Violence and Abuse Policy and Procedures Revised Managing Adults At Risk Policy and Procedures Revised Managing Individuals Who Pose A Risk of Harm Policy and Procedures New PREVENT Strategy Policy and Procedures New Safeguarding Supervision Policy and Procedures New Learning Disability Policy and Procedures Revised Awaiting approval and ratification Type of document Status Did Not Attend Policy and Procedures New Page 13 of 22
4. Meetings 4.1 Safeguarding Adults Board participation & membership Moorfields Eye Hospital (MEH) NHS Foundation Trust is represented on the appropriate safeguarding committees and can demonstrate full engagement and commitment to multi-agency working. The Trust is represented at the Islington Safeguarding Adult Board (ISAB) meetings by the MEH Executive Lead for Safeguarding. The Safeguarding Adult Lead attends the Learning and Development subgroup, and the Communications and Policy subgroup. Information is cascaded to the Trust Safeguarding Adults at Risk Group. 4.2 Moorfields Safeguarding Adults at Risk Group The group continues to meet bi-monthly and is well attended by clinical and managerial staff. The Head of Safeguarding Adults at Islington Council and the Designated Professional for Safeguarding Adults at Islington CCG are members of the group, providing constructive challenge and expertise. The group monitors the Trust s progress against the implementation of its work plan, identifies potential risks in relation to safeguarding adults and acts as a conduit between the ISAB and the Trust Board. The SAR Group reports into the Clinical Governance Committee. 4.3 Membership and participation in other groups The Safeguarding Adults Lead routinely attends the NHS England London Region Safeguarding Adult s network meetings and PREVENT network meetings, to share good practice, gain updates and contribute to national, regional and local developments relating to safeguarding. Internally to the Trust, the safeguarding adults lead is a member of the Dementia & Learning Disability work group, the Privacy and Dignity Group, the Safeguarding Children s group, and Clinical Governance Committee. 5. Safeguarding Supervision Support, guidance and supervision are provided to the Safeguarding Adults lead by the designated professional for Safeguarding Adults in Islington CCG. Safeguarding Supervision Policy was approved and ratified and combines both adult and children safeguarding supervision. 6. Safeguarding Adults Review (SARs) The Trust has not been directly involved in any safeguarding adult reviews (SARs) during the reporting period. As a member of the Islington Safeguarding Adults Board (ISAB), the Trust must ensure learning is taken and shared from all SARs undertaken. 7. Domestic Homicide Reviews (DHRs) Page 14 of 22
The Trust were involved in providing information in relation to a Domestic Homicide Review convened by Ealing Community Safety Partnership. The publication of the final DHR report and any multiagency recommendations are pending. 8. Safeguarding Adults Training Level 1 Safeguarding Adults training continued to be delivered on a rolling 3-year cycle to all staff. 8.1 Training review Level 1 training was delivered through in house face to face training. New starters to the Trust undertook an Induction Programme which included face to face safeguarding training delivered by the safeguarding adult lead. E-Learning safeguarding modules hosted by E-Learning for Health for Level 1 became available with a direct link to update staff s learning record on INSIGHT. Compliance is reported to the Trust Mandatory Training Group, the Safeguarding Adults at Risk Group, and Islington Clinical Commissioning Group. Mental Capacity Act training was introduced. WRAP (Workshop To Raise Awareness Of Prevent) Training was introduced. A training strategy was developed to implement Level 2 and Level 3 Safeguarding adults training within 3 years. The target was to start delivering Level 2 training by April 2016. 8.2 Training figures - Safeguarding Adults Training Figures take into account staff turnover and are provided by the Learning and Development department via INSIGHT Safeguarding Adults Level 1 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Target 78% 80% 83% 81% 80% Training compliance during Quarter 1 increased by 10% and in Quarter 2 met the compliance rate of 80%. In quarter 1 the low compliance was felt to be directly related to the transfer to the new learning and development system (INSIGHT) and mostly non-clinical staff not having this training requirement allocated to their profile. 9. Employment Practice 9.1 Allegations against staff The Director of Nursing and Executive Lead for Safeguarding is the Named Senior Officer with overall responsibility for ensuring the organisation has appropriate arrangements in place for the management of allegations of abuse against staff and volunteers. During the year 2015 2016 there have been no allegations of abuse or neglect in relation to adults made against staff working in the Trust. 9.2 Compliance with DBS checks Page 15 of 22
This continues to be undertaken by the Human Resources department. All new employees and internal promotions in positions that require DBS checks are required to complete a check prior to employment / promotion. Renewal of DBS checks for existing eligible staff is undertaken every 3 years. 9.3 Job adverts and job descriptions Job adverts and job descriptions make reference to Safeguarding Adults at Risk and Children. 9.4 Safer recruitment practice These specific documents demonstrate the Trust commitment to managing relevant concerns. Human resources staff support managers in using these documents to manage any of the issues using the processes outlined. Capability Policy, Disciplinary Policy, Recruitment Policy and Whistleblowing Policy. 9.5 Workforce There is a process in place to ensure up and coming renewal registrations are captured and followed through for example GMC, NMC, GPhC, General Optical Council and HCPC. Discussions were held to review the eligibility criteria for DBS exempt checks stipulated to ensure the changes did not have the potential to place children and/or adults at risk. It has been agreed that some of the exempt posts within Moorfields would undergo DBS checks e.g. estates staff. 10.0 Mental Capacity Act and Deprivation of Liberty Safeguards The Trust made significant progress around the understanding & application of the Mental Capacity Act. There were 36 enquiries/requests for advice to the Safeguarding Adults Lead regarding mental capacity during Quarter 1 & 2, which represented a significant increase. This was supported by: The provision of Mental Capacity Assessment pocket prompts. Increased training sessions for staff regarding the Mental Capacity Act. The development and rollout of the Mental Capacity Assessment and Best Interest Meeting templates. This improved recording and assisted governance. Specialist training for Medical staff was commissioned with Edge Training. 10.1 Mental Capacity Act Training During Quarter 1 and Quarter 2, 160 Trust staff received specific bespoke basic awareness Mental Capacity Act training provided by the Safeguarding Adults Lead. The Safeguarding Adults training strategy highlighted the proposal for all clinicians & staff who undertake consent duties to have Mental Capacity Act training as a mandatory requirement, in addition to basic awareness of the Act provided in Level 1 Safeguarding Adults training. This was agreed in September 2015 by the mandatory training group. Edge Training provided 3 hour MCA training sessions commencing in October 15. Page 16 of 22
Number of medical staff undertaking MCA training 2015-2016 Number of other staff undertaking MCA training 2015-2016 Total number of staff trained in 2015-2016 11. Domestic Violence The Care Act 2014 introduced domestic violence as a new category of abuse. Domestic violence includes psychological, physical, sexual, financial, emotional abuse & so called honour based violence, including female genital mutilation (FGM) and forced marriage A new offence of coercive and controlling behaviour in intimate and familial relationships was introduced into the Serious Crime Act 2015. During 2015 2016: 199 144 343 The Trust signed up to the Department Of Health Domestic Violence Pledge. Commenced partnership working with Islington Solace (Women s Aid) who held an inaugural domestic violence stall which was well attended by staff seeking information and asking questions as well as patients and visitors. The Safeguarding Adults Lead and Safeguarding Children Lead Nurse updated MEH Domestic Violence Policy in line with the Care Act, with was ratified in April 2016. Further partnership working will include the delivery of face to face domestic violence training and the commencement of domestic violence drop in surgeries at City Road. 11.1 Domestic Violence / Abuse Awareness Training Total number of staff undertaking domestic violence training 2015-2016 148 12. Learning Disabilities The Trust continues to raise awareness of Learning Disabilities through basic awareness training for staff which is included in the mandatory Safeguarding Adults Training which is refreshed every 3 years. E-learning for all staff is available on Insight. Improving pathways for patients with Learning Disabilities has been identified as one of the key objectives for the 2015 / 2016 year. As a result: A Learning Disability & Dementia workgroup was established to support improving the pathways for patients with Learning Disabilities and Dementia, including the review of easy read information. 13. Dementia During 2015-2016 the Trust made a public commitment to the Dementia Action Alliance, Dementia Friendly Hospital Charter as a part of the second phase of the Right Care initiative. This initiative provides high-level principles of what a dementia friendly hospital should look like and actions to be taken, and is in line Page 17 of 22
with the Prime Minsters challenge in Dementia 2020. The charter includes providing a Trust commitment that: Patients receive care from staff who are appropriately trained in dementia care and ensure that reasonable adjustments and effective staffing ratios are offered to provide effective care We work in partnership with other agencies and carers of patients to provide the best possible care Ensure that patients have access to appropriate assessments and advice from specialist dementia / mental health services and consider the holistic care of a patient Ensure that patients receive care that is person centred and responsive to individual needs Ensure that the hospital environment enables patients to find their way around the hospital and supports independence and well-being Hospital manages ensure that the governance is managed effectively, including seeing improvements in quality of care for patients, their carers as well as support for staff who deliver dementia friendly care In responding to the needs of people with a dementia the Trust: Introduced Dementia friendly signage as per the Kings Fund recommendations at City Road. Held a Dementia Awareness week in May 2015 at City Road, which included stalls at City Road from the Alzheimer s society, Age UK Islington, Camden and Islington Dementia Navigator service, and Islington Carers Hub. Satellite sites also engaged in the awareness week and notably MEH at Northwick Park also held an awareness stall with information for patients. A daily newsletter on dementia was circulated to all members of staff during this week. A dementia & learning disability workgroup was established to support the improvements of patient pathways and environments for patients with dementia. 14. PREVENT PREVENT is part of CONTEST, which is the abbreviated name for the UK Government s counter terrorist strategy. The aim of PREVENT is to help identify vulnerable people who are at risk of engaging in or supporting terrorism or terrorist activity. Approximately 30 areas of the UK have been identified as priority boroughs where there is a greater danger that radicalisers and extremists will operate. The highest numbers of priority areas are within London and therefore London as a whole is considered a high priority area for Prevent and therefore a priority for the Trust. The Trusts Prevent Policy & Procedures was drafted and considered for comments by the Safeguarding Adults at Risk Group in July 2015. Following feedback and national developments the policy was ratified in April 2016. This is a key requirement as a specified authority and the Trusts new statutory duties under the Counter Terrorism and Security Act 2015. Page 18 of 22
14.1 PREVENT Training Basic awareness of PREVENT is delivered via face to face Safeguarding Adult training. PREVENT awareness is also included in Level 1 and level 2 Safeguarding Children face to face training. WRAP (Workshop to Raise Awareness of Prevent) Training was introduced and delivered by the Safeguarding Leads, and included in quarterly PREVENT returns submitted to NHS England. Number of staff undertaking Basic Awareness of PREVENT 2015-2016 Number of staff Undertaking WRAP training 2015-2016 988 21 ] 15. Summary This report outlines the work that has been carried out in relation to Safeguarding Adults across the Trust from the 1 April 2015 31 st March 2016 and demonstrates the breadth of activity involved in the adult safeguarding agenda, and the variety of safeguarding issues for the adults who access or have contact with Moorfields services. The Board is asked to note this report Page 19 of 22
Page 20 of 22 Appendix 1 Glossary of Terms & Abbreviations Abuse Adult at risk A&E ASC Care Act 2014 CCG CQC CQRG Deprivation of Liberty Safeguards (DoLS) DHR Female Genital Mutilation (FGM) HSCIC ISAB Making Safeguarding Personal (MSP) Mental Capacity Act (MCA) MEH NHS NICE NSF PREVENT Safeguarding Concern Safeguarding Enquiry SI s Harm that is caused by another person. The harm can be intended or unintended. An adult who needs care & support because of their age, disability, physical or mental health & who may be unable to protect themselves from abuse. Accident and Emergency Adult Social Care An Act that reforms the law relating to care & support for adults Clinical Commissioning Group Care Quality Commission Clinical Quality Review Group A legal protection for people who lack mental capacity to make decisions about themselves. A deprivation of liberty must be authorised to be in someone s best interests. Domestic Homicide Review Also known as female circumcision or female cutting. The removal of part or all of the external female genitalia for non-medical reasons. Health and Social Care Information Centre Islington Safeguarding Adult Board An approach that puts people at the centre of processes for care & support and establishes desired outcomes and enables choice & control. The Act applies to everyone involved in the care, treatment & support of people aged 16 & over who may lack capacity to make decisions for themselves. It is designed to protect people who lack capacity. Moorfields Eye Hospital National Health Service National Institute for Clinical Excellence National Service Framework A cross-government policy that forms one of the four strands of CONTEST: the United Kingdom s Strategy for Counter Terrorism. Prevent includes the anti-radicalisation of vulnerable adults and children to stop them becoming terrorists or supporting terrorism A concern regarding potential or actual abuse or neglect that is reported to Adult Social Care. A duty on Local Authorities to make enquiries to establish whether action is needed to prevent abuse or neglect to an adult at risk. Serious Incident/s Safeguarding Adults Board Report 2015 2016 Page 20 of 22
References Appendix 2 The Care Act 2014 (HM Government) http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted Care & Support Statutory Guidance (HM Government) https://www.gov.uk/guidance/care-and-support-statutory-guidance London Multi-Agency Safeguarding Adults Policy & Procedure (revised February 2016) http://www.islington.gov.uk/publicrecords/library/adult-careservices/information/guidance/2015-2016/(2016-02-22)-london-multiagency-policyand-procedures_february-2016.pdf The Mental Capacity Act 2005 (HM Government) http://www.legislation.gov.uk/ukpga/2005/9/contents Mental Capacity Act Code of Practice (HM Government) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/ Mental-capacity-act-code-of-practice.pdf PREVENT Strategy (2011) (HM Government) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/97976/pr event-strategy-review.pdf The Counter Terrorism and Security Act 2015 (HM Government) http://www.legislation.gov.uk/ukpga/2015/6/contents/enacted Care Quality Commission Regulation 13 Safeguarding service users from abuse and improper treatment. http://www.cqc.org.uk/content/regulation-13-safeguarding-service-users-abuse-andimproper-treatment#legislation-links Counter Terrorism Strategy (CONTEST) (HM Government) https://www.gov.uk/government/publications/counter-terrorism-strategy-contest Mazar Report (2015) Independent review of deaths of people with a Learning Disability or Mental Health problem in contact with Southern Health NHS Foundation Trust April 2011 to March 2015 https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2015/12/mazars-rep.pdf Multi-agency safeguarding adults policy, protocols and guidance for Kent and Medway (updated 1 April 2015) http://www.kent.gov.uk/ data/assets/pdf_file/0018/11574/multi-agency-safeguardingadults-policies-protocols-and-guidance-kent-and-medway.pdf Safeguarding Adults at Risk; The multi-agency policy, procedure and practice for working with adults at risk of abuse or neglect in Hertfordshire (March 2015) http://www.hertsdirect.org/docs/pdf/s/hcs666i9.pdf No Secrets (Department of Health) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194272/n o_secrets guidance_on_developing_and_implementing_multiagency_policies_and_procedures_to_protect_vulnerable_adults_from_abuse.pdf Safeguarding Adults Board Report 2015 2016 Page 21 of 22
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