Safeguarding Adults Framework

Safeguarding Adults Framework

SAFEGUARDING ADULTS FRAMEWORK Introduction Prevention and effective responses to neglect, harm and abuse is a basic requirement of modern health care services. Safeguarding adults involves a range of additional measures taken to protect patients in the most vulnerable circumstances, patients that are currently defined within No Secrets (DH 2000) as vulnerable adults. This may be due to illness, impaired mental capacity, physical or learning disability or frailty brought about by age or other circumstance. Safeguarding adults includes: Prevention of harm and abuse through the provision of high quality care; Effective responses to allegations of harm and abuse in line with local guidance; Using learning to improve services to patients Purpose of this Framework This Framework sets out West Lancashire Clinical Commissioning Group s arrangements for fulfilling its duty to have regard to the need to safeguard and promote the welfare of vulnerable adults. The Framework aims to: Support the commissioning of high quality care for patients in the most vulnerable circumstances; Address failures in care with providers in line with Lancashire Safeguarding Adult Board Policies and Procedures; Improve services to patients through learning from all serious case reviews/serious untoward incidents; Improve services to patients through the involvement of vulnerable adults in the development and improvement of services In doing so, it is recognised that this Framework has been developed utilising current guidance as it applies to Primary Care Trusts, the NHS legal entity most closely aligned to the future role and function of the CCG. PCTs will end as entities by April 2013, with CCGs establishing as part of the new NHS structure from that date. West Lancashire CCG will thus review this framework in the light of any revised guidance published during 2012/13. For the purposes of this Framework, reference to PCT duties in current national guidance is taken as indication of the most likely expectation of CCGs with regard to adult safeguarding. Legislation, Regulations and Guidance People have fundamental rights contained within the Human Rights Act 1998. Commissioners as public bodies have statutory obligations to uphold these rights Version 2. 20/08/2012 2

and protect patients who are unable to do this for them selves. Other legislation particularly relevant to safeguarding adults includes: Equality Act 2010 Mental Capacity Act 2005 Safeguarding Vulnerable Groups Act 2006 Mental Health Act 1983. NHS Act 2006 The No Secrets (DH 2000) sets out the standards for the NHS for multi-agency working to safeguard vulnerable adults. Whilst it is the Local Authority who is the lead agency, other agencies such as health, police and housing all have responsibilities with regard to safeguarding vulnerable adults. More recently, the Department of Health guidance Safeguarding Adults: The Role of NHS Commissioners (March 2011) sets the expectation that NHS commissioners must work proactively with all contractors and service providers to ensure safeguarding arrangements are in place that maintain the safety and well being of those adults who are contractually under the care of the NHS. Safeguarding is also central to the quality of care and the NHS Outcomes Framework (Dept. of Health, 2010), particularly: Domain 4: Ensuring people have a positive experience of care. Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm. The Care Quality Commission s Essential Standards for Quality and Safety (2010) sets specific outcomes for safeguarding and safety as a requirement for registration for all providers of NHS care. Commissioners have responsibilities to address failures of care in addition to the responsibilities of the CQC. Where the CQC take enforcement action, commissioners have a key role in managing the impact this has on the local health economy. Roles and Responsibilities of West Lancashire CCG West Lancashire CCG need to demonstrate that they are meeting their responsibilities to safeguard and promote the welfare of vulnerable adults. In addition they need to demonstrate they are supporting and complying with Lancashire Safeguarding Adults Board Policies and Procedures. There are six fundamental actions expected of NHS commissioners for safeguarding adults: 1. Safeguarding adults is a fundamental part of the commissioning strategy. 2. Systems and processes are in place that set safeguarding adults into all parts of the commissioning cycle. 3. Systems and processes are in place that enable assurance to be sought as to the appropriateness of a providers safeguarding arrangements; and to address failures of care with providers. 4. A strong leadership (strategic and operational) and a safe, competent and capable workforce. Version 2. 20/08/2012 3

5. To work collaboratively with the Local Safeguarding Adult Board, patients and key partner agencies to create safeguards for patients. 6. To ensure accountability and use learning to bring about improvement Governance Arrangements in NHS West Lancashire CCG Safeguarding arrangements are an integral part of the CCG s Quality and Governance Frameworks and, as such, will be managed in accordance with the Frameworks and their supporting policies. West Lancashire CCG will be expected to have a clear line of accountability within the organisation for safeguarding adults. As such ultimate accountability for safeguarding adults will be with Chief Officer. In order to ensure the duties related to this accountability are discharged and to secure significant senior level management and Board leadership, West Lancashire CCG s Board Lead for Safeguarding will be responsible for ensuring the CCG has the correct procedures and capacity in place and that West Lancashire CCG is fulfilling in full any partnership duties. In doing so the Board lead for safeguarding will work closely with the designated nurse and doctor for safeguarding. Table 1 below outlines the roles and responsibilities of these 2 key members of West Lancashire CCG s Governing Body, whilst appendix 1 details the commissioning responsibilities of West Lancashire CCG and how these responsibilities will be discharged. Table 1: Roles and responsibilities of Chief Officer and Board Level lead for safeguarding Chief Officer Ensures that the health contribution to safeguarding adults is discharged effectively across the whole local health economy through the organisation s commissioning arrangements. Ensures that the CCG not only commissions specific clinical services but exercises a public health responsibility in ensuring that all services users are safeguarded from abuse or the risk of abuse Ensures that safeguarding is identified as a key priority area in all strategic planning processes Ensures the CCG co-operates with the Local Authority in the operation of the Local Safeguarding Adult Board (LSAB); Ensure that staff directly or indirectly employed by West Lancashire CCG are aware of their roles and responsibilities for CCG Board Lead for Safeguarding. Ensures that the CCG has management and accountability structures that deliver safe and effective services in accordance with statutory, national and local guidance for safeguarding adults Ensures that service plans / specifications/contracts/invitations to tender etc. include reference to the standards expected for safeguarding vulnerable adults Provides very senior clinical leadership acting as local champion and advocate for safeguarding vulnerable adults in CCG business and, in particular, in Primary care Represents the CCG at Local Safeguarding Adult Board Ensure that staff directly or indirectly employed by West Lancashire CCG are aware of their roles and responsibilities for Version 2. 20/08/2012 4

safeguarding and know who to act on concerns in accordance with local LSCB / LSAB policies and procedures Ensures that all health organisations with whom the CCG has commissioning arrangements have links with the LSAB and that there is appropriate representation at an appropriate level of seniority; and that health workers contribute to multi-agency working. Ensures Board level scrutiny of safeguarding To ensure that any system and processes that include decision making about an individual patient (e.g. funding panels) takes account of the requirements of the Mental Capacity Act 2005; this includes ensuring that actions and decisions are documented in a way that demonstrates compliance with the Act. safeguarding and know who to act on concerns in accordance with local LSCB / LSAB policies and procedures Responsibility for ensuring procedures and capacity to fulfil safeguarding duties Reports at Board level on all aspects of safeguarding adults who may be vulnerable including regular reporting to the Quality Improvement Committee Responsibility for ensuring that systems and processes are in place to allow for a safe competent and capable workforce. Ensures that commissioning decisions in respect of adult care placements (e.g. in care homes, nursing homes or independent hospitals) are based on knowledge of standards of care and safeguarding concerns Lancashire Safeguarding Adults Board West Lancashire CCG will be a key member of the established Lancashire Safeguarding Adults Board. The CCG will co-operate in the work of the Board whilst operating in shadow form, recognising the importance of the LSAB to the CCG post-authorisation in April 2013. West Lancashire CCG is represented on the LSAB by the Board Lead for Safeguarding. The Designated Nurse for Safeguarding will act as a deputy. NHS National Commissioning Board West Lancashire CCG expects that the role of the NHS National Commissioning Board (NCB) will include a responsibility for ensuring the health commissioning system as a whole is working effectively to safeguard and promote the welfare of vulnerable adults. As such West Lancashire CCG fully expects to be reporting to the local regional office of the NCB on local arrangements for discharging its duties regarding safeguarding. Conclusion NHS West Lancashire CCG expects and wants to fulfill the responsibilities and duties placed upon it regarding Safeguarding Adults. The CCG has set out in this Version 2. 20/08/2012 5

Framework how it will set in place arrangements to discharge the safeguarding duties placed on NHS commissioners; the CCG will review this Framework on publication of any further national guidance. The CCG will set these arrangements in place prior to its establishment in April 2013, recognising the importance of having clear arrangements in place during this period of transition. Version 2. 20/08/2012 6

Appendix 1: NHS West Lancashire CCG s Responsibilities and Arrangements for Safeguarding Adults Responsibility Local arrangements Lead 1. Safeguarding adults as a fundamental part of the commissioning strategy. Public health lead 2. Ensure a culture of listening to and engaging in dialogue with vulnerable adults, taking account of their wishes and feelings both in individual decisions and the establishment or development and improvement of services. 3. Systems are in place to set safeguarding adults into all contracting and procurement processes 4. Commissioners have assurance for safeguarding adults standards and processes to escalate concerns and risks 5. Commissioner have processes in place to ensure they can make adult care placements (such as in care homes, nursing homes or Joint Strategic Needs Assessment routinely focuses on vulnerable communities and adults; outputs are used to inform commissioning strategy and Joint Health & Well Being Plan Quality & Safeguarding is a key portfolio/role of one of the 5 elected GP members of the CCG s Governing Body Routine involvement of service users & their carers in commissioning plans and service reviews The CCG will continue to involve service users and their families in the review and development of its services. Multiple methods will be used dependent on the service under review including one-off consultations, ongoing user groups, gaining feedback through different digital media. The CCG expects all providers to comply with the safeguarding standards within the CCG safeguarding policy and the policies and procedures of their local safeguarding adult board. Commissioned services will be required to demonstrate that they have all the appropriate arrangements in place to safeguard vulnerable service users. Safeguarding Adults is integral within standards for all contracts as a minimum Contracts specify compliance with CQC Essential Standards and related legislation (including Mental Capacity Act, Mental Health Act, Deprivation of Liberty Safeguards, Safeguarding Vulnerable Groups Act) Regular assurance/reporting from all providers on safeguarding to be developed as part of quality/safety reporting for all NHS providers. The CCG expects these reports to be shared between providers and the Local Authority as the Safeguarding lead agency. CCG works collaboratively with the local authority in quality assuring the care in adult care placements including the sharing of information where there are multiple concerns that are CCG Chair Senior Operating Officer & Deputy general Manager Senior Operating Officer/CSU communication & engagement Deputy General Manager/Safeguarding Deputy General Manager/Safeguarding Deputy General Manager/Safeguarding Version 2. 20/08/2012 7

independent hospitals) based on knowledge of standards of care and safeguarding concerns. 6. Commissioners report on safeguarding adults as part of assurance and accountability. 7. There are clear workforce arrangements in place for safeguarding adults including CCG staff training and development on safeguarding 8. There are effective working relationships and partnership working in place for safeguarding adults indicative of early warning signs. Routine information about all providers regarding standards of care or any safeguarding concerns being available to the placement (eg Continuing HealthCare, Nursing Homes) at the time the package of care is being determined. Placements are made on the basis of individual need and quality/safety of the provider. Routine review of adult safeguarding reports from all providers as part of quality/safety reporting; information used as necessary within contract/performance reviews with providers. Regular reporting on safeguarding to the Quality Improvement Committee. CCG Chief Officer holds ultimate responsibility for CCG s safeguarding adults duties. In addition, the CCG will identify a Board Level lead for safeguarding adults. The CCG will secure capability/capacity to provide specialist expertise for safeguarding adults (i.e. leading investigations, clinical leadership across the local economy) The CCG will have in place clear Safeguarding workforce/hr policies that include recruitment and staff training. Staff directly or indirectly employed by West Lancashire CCG are aware of their roles and responsibilities for safeguarding and know who to act on concerns in accordance with local LSCB / LSAB policies and procedures The CCG will be a member of the Lancashire Safeguarding Adults Board (LSAB) The CCG will adhere to and endorse the policies and procedures of LSAB The CCG will endorse and support the inclusion of a specific Safeguarding objective within the Joint Health & Wellbeing Strategy Deputy General Manager/Safeguarding Chief Officer Chief Nurse/Safeguarding Chief Nurse Chief Officer CCG Chair Version 2. 20/08/2012 8