Appendix 3 Safeguarding Children and Vulnerable Adults Update Executive Summary This paper provides the Salford CCG Governing Body with an update report in relation to the work undertaken by the CCG Safeguarding Team. The paper includes an update on the recruitment processes required in response to the changes to the Safeguarding Team structure and advises the Governing Body of the development of the CCG Safeguarding Policy and Training Strategy. It provides a safeguarding vulnerable adult update in relation to relevant topics including training, the ongoing Domestic Homicide Review, the ongoing adult Serious Case Review and identified concerns about Care Homes. This paper also provides safeguarding children information which includes an update on the work undertaken with General Practices to improve the quality of their safeguarding arrangements, the Care Quality Commission Child Safeguarding and Looked After Children Inspection programme, and an SSCB and Child Death Overview Panel update. Introduction and Background The NHS Salford CCG Safeguarding Team provides bimonthly update papers for the CCG Governing Body. These updates provide information about the work undertaken by this team and highlight the key safeguarding children and vulnerable adult issues pertinent to the Governing Body. Revised Safeguarding Team Structure The work of the CCG Safeguarding Team is now included within the portfolio of responsibilities held by the Head of Quality and Innovation. The agreed revision and enhancement of the Safeguarding Team structure is progressing well. Following interviews held on 14 November 2013, the previous Band 8A Designated Nurse Adult Safeguarding was appointed to the Band 8B Designated Nurse Adult Safeguarding post within the new structure and the previous Specialist Nurse Safeguarding Children for Independent Contractors was appointed to the new post of Deputy Designated Nurse Safeguarding Children. These changes became effective from 2 December 2013. The revised Safeguarding Team structure includes the new posts of Specialist Nurse Safeguarding Adults and Specialist Nurse Safeguarding Children. Interviews for these two posts are now arranged for 14 and 15 January and it is anticipated that the successful applicants will commence in post at the beginning of April 2013.
A CCG Datix Lead is to be recruited and the successful post holder along with the CCG Patient Experience Lead are also included within the revised Safeguarding Team structure. The rationale for the change to the Team structure and increased Team resource is as follows: The new Specialist Nurse Safeguarding Adults and Children posts will enable additional preventative work and further work to improve the quality of safeguarding arrangements with General Practitioner (GP) Practices to be undertaken; The restructure will facilitate effective business continuity and succession planning for the CCG in relation to consistently having access to the statutory Designated Nurse Safeguarding Children resource; The additional safeguarding children resource will facilitate increased CCG involvement in the work of Salford Safeguarding Children Board (SSCB) and its subgroups and in the Multi-agency Risk Assessment Conferences (MARAC) for high risk victims of domestic abuse. It is also anticipated that the CCG will be represented at the MARAC meetings in order to ensure that General Practitioners receive all appropriate feedback in a timely manner. The increased safeguarding adult resource will facilitate increased work in Care Homes including improving Care Home staff knowledge and awareness of safeguarding concerns. The inclusion of the Patient Experience and Datix Leads within the Safeguarding Team will enable prompt consideration as to whether reported incidents or feedback from patients relate to safeguarding concerns which require additional actions. CCG Safeguarding Children and Vulnerable Adults Safeguarding Policy and Training Strategy The draft CCG Safeguarding Policy and Training Strategy was discussed and agreed at the Executive Team Meeting on 18 December 2013. The policy will now be implemented and included within the contracts for provider services for the financial year 2014/15 along with the appropriate annual safeguarding audit tool. Domestic Homicide Review The Domestic Homicide Review (DHR) which commenced after the death of a young woman as a result of a domestic homicide in June of this year is ongoing. The CCG is represented on the DHR Panel by the Designated Nurse Safeguarding Children. The draft report is currently being compiled by the Independent Author commissioned for this review process. A further meeting is to be arranged for January or February on completion of the draft report.
Safeguarding Children Update Child Death Overview Panel (CDOP) and Bolton, Salford and Wigan Sleep Safe Campaign Due to the retirement of the previous Independent Chair of the Child Death Overview Panel, an Interim Chair has been secured and the recruitment processes have commenced. The Bolton, Salford and Wigan Sleep Safe campaign is now in its third and final year. The Chair of the Project Group for this campaign is currently finalising a report which will include feedback from the formal evaluation and options for continuance of the campaign. This paper will be discussed at the Business Meetings of the three involved LSCBs and each LSCB will be required to decide whether to provide additional funding in order for the campaign to continue after May 2014. Salford Safeguarding Children Board (SSCB) There are no Serious Case Reviews (SCR) currently in progress. A complex case in which a young girl aged around ten years was trafficked into Salford whilst being presented as a twenty year old woman and kept as a domestic slave for a period of ten years has been discussed at a Screening Panel Meeting following the completion of the criminal proceedings. The Screening Panel Meeting to determine whether or not this case met the criteria for an SCR was held on 11 November 2013 and was attended by Senior Managers for both Children s and Adult Services and relevant members of both the Safeguarding Children and Safeguarding Adult Boards. This was agreed due to the fact that a child who was deaf and could not speak was presented as an adult and therefore any services in contact with her and understanding her to be an adult should have considered her to be a vulnerable adult. The CCG was represented at this meeting by the Designated Nurse and Doctor for Safeguarding Children. The recommendation from the Screening Panel Meeting was that, whilst neither the SSCB nor the SSAB SCR criteria were met, the case should be reviewed through involved agencies completing Individual Management Reviews (IMR) and the development of a multi-agency chronology. A General Practitioner IMR is required and this will be authored by the Salford CCG Neighbourhood Lead GP with Safeguarding Children responsibilities with support from the Safeguarding Team. These IMRs will be scrutinised and a report compiled by a Panel comprised of members of the Safeguarding Adult Board and four members of the SSCB Case Review Subgroup. The CCG will be represented on this Panel by the Designated Nurse Safeguarding Children and the Designated Nurse Adult Safeguarding. A Peer Review of SSCB was undertaken during October 2013 by Derby Local Safeguarding Children Board (LSCB). The Peer Reviewers presented their findings from this review to SSCB members on 2 December 2013.
The overall findings were positive, however there were recommendations in relation to the need for SSCB to ensure that all evidence of work undertaken is collated for easy access and for the Annual Report format to be revised. The current Independent Chair of SSCB has made a decision to leave this role in February 2014 and therefore recruitment processes have commenced. CQC Child Safeguarding and Looked After Children Inspection Programme The new Care Quality Commission (CQC) Child Safeguarding and Looked After Children Inspection programme commenced on 30 September 2013 following the decision by Ofsted to defer the introduction of multi-agency inspections of child protection arrangements and services for Looked After Children. The current national two year CQC programme of reviews of health services within each Local Authority area will review how effective health services are in keeping children safe and promoting the health and wellbeing of Looked After Children and care leavers. The CQC will give two working days notice of the review to a Clinical Commissioning Group and the reviews will be carried out by CQC specialist Children s Services Inspectors. The review process will last for up to five days. The methodology includes review of documents requested by the CQC followed by case tracking the health services provided for 12 individual children/ young people in order to review the arrangements for safeguarding and health for Looked after Children, Care Leavers and those receiving early help. This process will include meeting with the key involved health professionals for each case in order to discuss the healthcare provided and to review the records. Some other health professionals involved with that child may be contacted by telephone to discuss their involvement as opposed to a face to face meeting. This review process does include General Practitioner involvement in the cases. The cases to be reviewed are to be identified prior to the start of the review and the cases overall must involve specified health services including Health Visiting, School Nursing, Child and Adolescent Mental Health Services, Adult Mental Health Services, Midwifery, and teenage Sexual Health services. A summary report for each case must be prepared and provided by the lead health professional at the start of the review process. The review process will also include visiting Accident and Emergency and meeting some of the children and families of the cases reviewed. The CCG Designated and Deputy Designated Nurses Safeguarding Children are meeting with the SRFT and GMW Safeguarding Children Leads on 10 January 2014 to ensure that the health economy is prepared for and ready to respond quickly to an inspection notification. The CQC will publish a report for each local area after inspections and will routinely send a pre-publication report to the Local Safeguarding Children Board Chair. Following the completion of the inspections in April 2015, the CQC will publish a national report to detail the overall findings.
Safeguarding Children Training The continued aim for NHS Salford CCG is to ensure that GPs and all Practice staff members have access to and have undertaken Safeguarding Children training appropriate for their role in accordance with the statutory guidance Working Together to Safeguard Children (2013) and the Intercollegiate Document (2010). The training undertaken by staff will feed into the overall mandatory training schedule and safeguarding training strategy for the CCG. Individual Practice based training sessions were offered within General Practices in Salford from June 2012 until December 2013. Training throughout 2014 will be delivered via monthly training seminars which will encompass a variety of safeguarding subjects whilst continuing to include the mandatory level 2 and 3 safeguarding training. Table 1 shows the GPs, Practice Nurses (including other nurse clinicians) and other staff by Cluster who have received face to face level 2 training and GP only level 3 training up to December 2013. Table 1. Broughton Ordsall & Langworthy Claremont/ Weaste Eccles Swinton Irlam Little Hulton Walkden Total GPs (Level 2) 86% 84% 63% 93% 100% 92% 100% 100% 90% GPs (Level 3) 50% 36% 19% 54% 64% 62% 25% 29% 46% PN 63% 79% 100% 91% 100% 100% 60% 100% 84% Other 76% 62% 44% 82% 89% 88% 85% 100% 77% E-learning This e-lfh training offers Level 2 and 3 Safeguarding Children training on line. GP Practices have accessed this training and the evidence of completion of this training has been incorporated into the training figures. Whilst this offers flexibility in accessing training it would be expected that GPs also gain local knowledge by accessing at least one taught Safeguarding Children training session or seminar within Salford. Safeguarding Training Seminars - Additional safeguarding seminars in 2014 will include dissemination of lessons learnt from recent local and national Serious Case Reviews. These seminars will have capacity for a larger number of participants and their facilitation will be supported by the Designated Doctor Safeguarding Children. Domestic Abuse and Multi Agency Risk Assessment Conferences (MARAC) The provision of feedback to GPs from MARAC meetings continues. Information is disseminated from the Deputy Designated Nurse Safeguarding Children to indiviual GP Practices after each fortnightly MARAC meeting. The feedback to GPs includes detailed information about the victim, children and the perpetrator. This also includes the risk assessment undertaken prior to the MARAC meeting and an action plan from MARAC detailing specific agency responsibilities and ongoing work to promote the safety/protection of the victim and the children. Since October 2013 GPs have also been providing any relevant health information on the victim and/or children to feed into the MARAC meeting as apprporiate. The
purpose of this process is to alert the GPs to the victims and children who are high risk cases of domestic abuse within their Practice in order to further inform their treatment and management of this vulnerable client group. Initial Case Conference Report Completion Work has continued with GPs in relation to their provision of reports for Initial Child Protection Case Conferences via the specifically developed report proforma for GP Practices. The precentage of reports completed by GPs between January 2013 and December 2013 has been on average 63%. However, in the last quarter of the year there has been an increase to 72% compared to the other quarters (see table 2). The action plan that was agreed in July 2013 to progress this issue through the Neighbourhood Clinical Commissioning Group (NCCG) meetings was completed by October 2013. Individual Practice figures related to completion of case conference reports were discussed at each NCCG meeting with a view to increasing compliance (see table 3). Table 2 GP reports completed for Intial Case Conference (ICC) by Quarter by Neighbourhood Cluster January 2013 Dec 2013 Overall Quarter 1 (Jan - Mar) Quarter 2 (Apr-Jun) Quarter 3 (Jul-Sept) Quarter 4 (Oct-Dec) No of ICC No of Children TOTAL 308 574 57% 58% 70% 72% Broughton, Low er Kersal & Irw ell Riverside 34 80 20% 44% 56% 67% Ordsall & Langw orthy 58 100 53% 59% 60% 85% Claremont, Weaste & Seedley 29 49 44% 80% 50% 67% Eccles, Barton & Winton 47 77 89% 53% 67% 80% Irlam & Cadishead 18 35 25% 33% 100% 80% Sw inton & Pendlebury Cluster 45 87 64% 67% 86% 83% Little Hulton 31 71 50% 50% 80% 60% Walkden, Boothstow n, Ellenbrook & Worsley 19 31 100% 83% 100% 25% 100% or increase on previous quarter No increase or decrease on previous quarter 0% or decrease on previous quarter
Table 3 GP reports completed for Intial Case Conference (ICC) monthly by Neighbourhood Cluster September 2013 Dec 2013 Overall SEPTEMBER OCTOBER NOVEMBER DECEMBER No of ICC 2013 TOTAL 308 83% 70% 71% 79% Broughton, Low er Kersal & Irw ell Riverside 34 0% 100% 33% 67% Ordsall & Langw orthy 58 83% 75% 83% 100% Claremont, Weaste & Seedley 29 50% 0% 80% N/A Eccles, Barton & Winton 47 100% 60% 100% 100% Irlam & Cadishead 18 100% 100% 100% 0% Sw inton & Pendlebury Cluster 45 100% 100% 50% 100% Little Hulton 31 100% 50% N/A 100% Walkden, Boothstow n, Ellenbrook & Worsley 19 100% N/A 0% 50% 100% or increase on previous month No increase or decrease on previous month 0% or decrease on previous month The significant level of support for GPs in completing these reports provided by the Deputy Designated Nurse Safeguarding Children on request has continued consistently throughout this time period. Post Conference reports are being increasingly requested by Case Conference Chairs if the GP has not completed a report prior to the Case Conference. The Deputy Designated Nurse Safeguarding Children continues to be actively involved in this process. Case Conference Report Audit An audit to review the quality of the Case Conference reports provided by GPs was undertaken from July September 2013 this involved assessing the quality and content of all the reports received for a period of eight weeks. The findings and feedback was discussed at the GP Safeguarding Leads Forum in November 2013 and disseminated to each Practice GP Safeguarding Lead. The actions from the audit findings included continued education around completion of the Case Conference reports via Level 3 Safeguarding Children training, the review and simplification of the report proforma and continued individualised support for GPs from the Deputy Designated Nurse Safeguarding Children in relation to completion and feedback on Case Conference reports.
Safeguarding Practice Audit 2013 Under Section 11 of the Children Act, 2004, NHS Salford CCG has a responsibility for ensuring the health contribution to safeguarding and promoting the welfare of children is discharged effectively across the whole health economy. A 2013 audit of safeguarding arrangements within GP Practices is currently being undertaken. The audit tool has focused on safeguarding provision and quality within General Practice including the key safeguarding requirements of training, application of a safeguarding policy, identification of a Practice Safeguarding Lead and safe recruitment practices. The findings of this audit will further inform the work priorities for the NHS Salford CCG Safeguarding Team in 2014. GP Safeguarding Practice Leads Forum This forum has recently been established and the first meeting was held in November 2013. Regular bi-monthly meetings have been arranged for 2014 between the Designated Nurse Safeguarding Children, the Designated Doctor Safeguarding Children, the Deputy Designated Nurse Safeguarding Children and the GP Safeguarding Leads from within each GP Practice in Salford. The aim of the forum is to provide the opportunity to discuss and disseminate current safeguarding information between the CCG safeguarding Team and the GP Safeguarding Leads. The GP Safeguarding Leads will be expected to share information from the meetings with their Practice colleagues and their increased knowledge may also enable the GP Safeguarding Leads to provide initial support and case advice around safeguarding within the Practice. Safeguarding topics and practice issues will be raised and discussed at subsequent meetings and will provide an additional method for cascading information to and from the GP Practices.
Adult Safeguarding Update Serious Case Review update One adult serious case review is in progress involving the death of a 33 year old lady. IMR s have been made available and shared for comments prior to a meeting to be held later in January. During this meeting, key themes will be identified and the method for dissemination of key lessons learnt established. Training update Provision of adult safeguarding training is continuing across general practices in Salford and a number of sessions have been planned for the coming months. Figure 1 shows the GP s, practice nurses (including other nurse clinicians) and other staff by Cluster who have received face to face adult safeguarding training up until 8 January 2014. Figure 1 A series of seminars around the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs) have been planned for 2014 for all GP practice staff. Prevent Training
The healthcare setting is a key partner in the delivery in the HM Governments Prevent strategy. Salford CCG are committed to safeguarding and supporting vulnerable individuals, including staff, who may be at risk of being radicalised by violent extremists and to support this the Designated Nurse for Adult Safeguarding is currently working in collaboration with Department of Health approved trainers in SRFT and GMW to deliver a programme of training to all staff. A series of HealthWRAP seminars have been planned throughout 2014 for general practice staff to raise awareness of their responsibilities for recognising vulnerable people, susceptible to radicalization and be aware of the appropriate systems in place for reporting such cases. Care Homes update There are currently no care homes in serious concerns in Salford. Claremont Lodge were being monitored closely by the local authority, environmental health and infection control and now appear to have addressed a lot of the concerns raised. Since the retirement of Management at The Willows Nursing Home, some preliminary concerns have been raised by the CCG Funded Care Team, Tissue Viability and residents families. Both the Funded Care Team and the Local Authority Review and Extra Care Team are working in conjunction with the proprietor to investigate the concerns raised. Trends in respect of safeguarding alerts within care homes are currently monitored and concerns specific to health will continue to be investigated by the Designated Nurse for Adult Safeguarding. The future recruitment of the Specialist Nurse for Adult Safeguarding will provide further resource to work proactively with the care homes across Salford to improve the quality of patient care utilizing effective monitoring of data (currently being submitted by Nursing Homes across Salford to the NHS Information Centre) and improve knowledge and awareness of safeguarding. Good Practice example Intentional Rounding update A third residential care home has now adopted the intentional rounding tool following positive feedback from the two previous care homes involved in the pilot. It is anticipated that this will be adopted by all residential care home across Salford.