Safeguarding Children & Adults Annual Report 2010/2011 July 2011
Contents Executive Summary 2 1 Purpose of the Report 4 2 NHS Northamptonshire s strategic approach to safeguarding 4 3 The National Context, Legislation and Safeguarding Arrangements 5 4 Safeguarding Children 6 4.1 Introduction 6 4.2 Interagency safeguarding arrangements 7 4.3 Safeguarding children within healthcare 7 4.4 Quality Assurance for safeguarding children 7 4.5 Serious case reviews Children and Young People 9 4.6 Key achievements in 2010/2011 10 5 Safeguarding Adults 12 5.1 Introduction 12 5.2 Interagency safeguarding arrangements 13 5.3 Safeguarding adults within healthcare 13 5.4 Quality assurance for safeguarding adults 13 5.5 Serious case reviews - adults 14 5.6 Deprivation of Liberty Safeguards 14 5.7 Key achievements in 2010/11 16 6 Care Homes 17 6.1 Introduction 17 6.2 Quality Assurance for Care Homes 17 6.3 Key achievements in 2010/11 18 7 Areas for Development 2011/12 19 1 P a g e
Executive Summary This report reviews the work undertaken by NHS Northamptonshire s (NHSN) safeguarding team during 2010-2011. Under the NHS reforms statutory duties to safeguard children and adults will transfer to Clinical Commissioning Groups. The Government has emphasised that safeguarding children and adults remains a priority for the National Health Service and transition plans must demonstrate sustaining these critical functions. Alongside these changes, there are likely to be changes in the statutory guidance for safeguarding children and the introduction of legislation for safeguarding adults. Safeguarding Children There has been a substantial increase in the number of children with a child protection plan. This increase puts us on par with our statistical neighbours and is likely to be largely due to improving referral practice as well as a genuine increase in the numbers of vulnerable young people. NHSN continues to be a major contributor to the inter-agency partnership. A joint inspection by Ofsted/Care Quality Commission (CQC) in March 2011 gave Northamptonshire an overall rating of adequate but rated the contribution of health agencies as good. The CQC report acknowledged strengths such as the good engagement of GPs; robust quality assurance processes and the valuable role of designated staff. There were six recommendations for improvements, four of which related to Looked After Children. An action plan has been generated to address these recommendations. Along with ongoing quality assurance work with our providers, NHSN has had a number of key achievements during 2010/11. These include establishing GP fora; a joint review for Looked After Children and extending the child protection medical service. Learning from five serious case reviews has been used to improve inter-agency working as well as a number of specific improvements for health providers. Safeguarding Adults NHSN continues to work with providers to make safeguarding adults integral to patient care. All provider trusts play an active role in safeguarding adults, with dedicated leads, internal committees and active interagency engagement. 2 P a g e
NHSN includes standards for safeguarding adults in all contracts. There are robust assurance frameworks in place and close working with other key patient quality and safety functions to assure standards are met and to identify early warning signs of failures in care. There has been a significant increase in safeguarding adults referrals. This is likely to be in part due to the improved awareness, governance and accountability of our health providers who made 32% of referrals. There were two serious case reviews during 2010/11. Significant progress has already been made on the actions plans arising from these reviews. Numbers of authorisation under Deprivation of Liberty Safeguards are the same as for 2009/10. Particular areas of progress during 2010/11 are in relation to training, developmental fora and developing clearer thresholds for referrals. Care homes NHSN has a team specifically employed to monitor and improve the quality of care within Northamptonshire s care homes. The team carries out a minimum of annual site visits, assessing a range of aspects of care and using information from primary care, residents and their families to assure how well care is delivered. As well as developing an assessment tool, achievements in 2010/11 include supporting the care homes workforce through a range of learning and development initiatives. Areas for development 2011/12 The annual report details a number of initiatives for 2011/12. Focus will be on preparation for safe transitions to new commissioning arrangements and clustering with Milton Keynes. NHSN s safeguarding strategy will be refreshed to reflect new priorities. Other specific developments include progressing the Ofsted/CQC action plan; continued development and support for GPs; improving quality monitoring arrangements for out of county placements and implementing an educational pilot in care homes. 3 P a g e
1. Purpose of Report This report provides NHS Milton Keynes and NHS Northamptonshire Cluster Board with an overview of the strategic framework for safeguarding across health services in Northamptonshire. The report reviews the work undertaken in 2010-2011, giving assurance that NHS Northamptonshire (NHSN) has discharged its statutory responsibility to safeguard the welfare of children and adults across the health services it commissions. The report includes areas for development during 2011 and 2012. 2. NHS Northamptonshire s strategic approach to safeguarding The PCT Chief Executive is ultimately responsible for ensuring that duties to safeguard children and adults within Northamptonshire are discharged effectively across the whole health economy. NHSN takes a cross generational approach to safeguarding children, young people and adults. This is delivered through a single integrated safeguarding team that provides strategic leadership for safeguarding across Northamptonshire s health economy. The Director of Nursing is the cluster board lead for safeguarding. The safeguarding team comprises the statutory roles in children s safeguarding of designated nurse and designated doctor for safeguarding, Looked After Children and child death. In addition, there is a professional lead for vulnerable adults & Mental Capacity Act and a team responsible for quality monitoring in care homes and domiciliary care. These roles provide leadership, quality assurance and specialist clinical advice on safeguarding to the PCT and across the health economy. The safeguarding team is managed by the Associate Director of Safeguarding, who in turn reports to the cluster Director of Nursing. To enable closer working across the generations, NHSN is currently working to a single safeguarding strategy for 2010 to 2013 that was approved by Board in July 2010. The safeguarding team has presented progress against the strategy work plan to NHSN s Quality and Risk committee on a quarterly basis. 4 P a g e
3. The National Context, Legislation and Safeguarding Arrangements The NHS reforms being implemented through the Health and Social Care Bill will have a significant impact on local NHS structures and the responsibilities to discharge statutory safeguarding duties. Subject to the passage of the Bill, by 2013, most of the statutory safeguarding responsibilities will transfer from Primary Care Trust s (PCTs) to the new Clinical Commissioning Groups. These changes to NHS structures coincide with other major changes to the public sector being driven by the Government. The changes to social care, housing and the benefits system alongside the current challenging economic climate, will all have far reaching implications for safeguarding children and adults. The Government has emphasised that safeguarding children and adults remains a priority for the National Health Service. The NHS Chief Executive, Sir David Nicholson s letter Managing the Transition 1 highlights that the transition plans should demonstrate how critical functions, including safeguarding, can be sustained through the transition. NHSN is working with our emerging Clinical Commissioning Groups to engage them early with our arrangements to safeguard our most vulnerable patients and to plan the transfer of these statutory duties. 3.1. Safeguarding legislation Children The Children Act (1989) provides the core legislative framework for safeguarding children, and is supported by the statutory duty on agencies to cooperate in making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act (2004). There are substantial amounts of additional statutory and supplementary guidance in Working Together to Safeguard Children (2010) 2 and other documents. A review of children s safeguarding by Professor Munro was published in 2011 3 and identified the amount of statutory guidance as potentially burdensome. The 1 Dept health: Equity and excellence: Liberating the NHS- Managing the transitions; Sir David Nicolson; gateway ref 14795; Sept 2010 2 HM Government: Working Together to Safeguard Children: A guide to the inter-agency working to safeguard and promote the welfare of children: Dept Children Schools and Families: March 2010 3 The Munro Review of Child Protection: Final report The child centred system professor Eileen Munro June 2011 5 P a g e
Government s response is anticipated in July and may result in changes to statutory guidance. Adults Within Safeguarding Adults, there is currently no single coherent statutory framework in place. Statutory responsibilities arise through a wide range of statute including The Equality Act 2010, Human Rights Act 1998, Health and Social Care Act 2008; Mental Capacity Act 2005 and the Safeguarding Vulnerable Groups Act 2006. The Law Commission report on adult social care 4 recommended a new statute that includes placing a duty on Local Authorities to investigate adult protection cases; establishing adult safeguarding boards and introducing a duty of cooperation from partner agencies. The Government had confirmed their support for statutory Boards and will consider the other Law Commission recommendations 5. These will be contained within the Social Care Bill in 2012. 4. Safeguarding Children 4.1 Introduction Safeguarding children continues to have a high profile both nationally and within Northamptonshire. In 2010/11, there has been a further increase in the number of children with a child protection plan (28 per 10,000 population in 2010/11 compared to 15 per 10,000 population in 2009/10) and the number of children being looked after (46 children for 10,000 population for 2010/11). In previous years, the rate for children subject to a child protection plan in Northamptonshire was significantly below that of statistical neighbours. The substantial increase now puts us on par with our statistical neighbours. The increase is likely to be due to a number of factors, such as heightened anxiety and risk aversion following high profile cases such as the death of Peter Connolly in Haringey in North London and Kyra Ishaq in Birmingham. It is likely however that this rise is also due to improving practice and better understanding across agencies in identifying child protection concerns and referring appropriately to Children and Young People s services. In addition the numbers in part reflects a genuine increase in the 4 The Law Commission: Adult Social Care: London Stationary office: May 2011 5 Dept health: Statement of Government policy on Adult Safeguarding: Gateway ref 16072: May 2011 6 P a g e
numbers of vulnerable young people, such as increases in numbers of unaccompanied asylum seekers who become Looked After Children. 4.2 Interagency safeguarding children arrangements Northamptonshire Local Safeguarding Children Board (LSCBN) is responsible for coordinating multi agency safeguarding arrangements and for ensuring the effectiveness of safeguarding across the county. NHSN is represented at the LSCBN by the cluster Director of Nursing. The designated nurse and doctor attend the main board as advisors. Together with other members of the NHSN safeguarding team, they also support the work of various committees of the LSCBN including: Practice and Procedures Committee Serious Case Review Committee Quality Assurance Committee In addition, there are improved cross generational linkages between the LSCBN; Safeguarding of Vulnerable Adults Board (SOVA); Multi Agency Public Protection Arrangements (MAPPA) and Corporate Parenting Board by the representation of the Associate Director for Safeguarding on all of these boards. 4.3 Safeguarding children within healthcare All provider services are required to comply with the Care Quality Commission Essential Standards for Quality and Safety that include safeguarding standards. In addition, NHSN includes contractual requirements relating to safeguarding children. Each of Northamptonshire s provider trusts has a director level lead for safeguarding children and named professionals responsible for the operational safeguarding arrangements within their trust. All provider trusts hold regular safeguarding team meetings which enable the Trust to monitor and continuously improve safeguarding performance. NHSN s designated professionals attend these meetings and provide a range of support to trusts including supervision to their named professionals and a quarterly forum for named and designated professionals. 4.4 Quality Assurance for Safeguarding Children There are currently two separate assurance frameworks in place: 1. Section 11 multi agency audit led by LSCBN 2. Markers of Good Practice, undertaken jointly with the SHA. 7 P a g e
In addition, in 2010 NHSN carried out a baseline audit of compliance with statutory duties to meet the health needs of looked after children. In 2010/11 external assurance has been provided through a joint Ofsted/CQC inspection. Section 11 Multi-agency Audit LSCBN introduced the first multi agency audit in December 2010. The audit standards were based upon statutory requirements under section 11 Children Act 2004. Out of 22 agencies, 20 completed a self assessment (90.9%). 100% of health agencies returned assessments. Collectively, Health providers were able to report effective or excelling against 99.3% of the indicators. The audit highlighted a number of potential issues for the multi-agency partnership. These included staff supervision; commissioning arrangements; safe recruitment; allegation management and whistle blowing. These will be addressed by the LSCBN 2011/2012 business plan. Markers of Good Practice The Markers of Good Practice tool is used across East Midlands Strategic Health Authority (SHA) to provide assurance on safeguarding standards and regulatory requirements. The SHA, PCT and providers meet annually to assess safeguarding effectiveness against these standards and agree action plans for improvements and to address any deficits. Assurance meetings were held with all main providers at the end of year. There were some minor areas for development identified for individual providers. However, all were able to evidence their trust s commitment to safeguarding, with some areas evidencing excellent development work; for example; the development of GP Forums across localities and use of audit to evaluate the impact of safeguarding training. There is substantial overlap between the Section 11 audit and the Markers of Good Practice framework. NHSN and providers have agreed to work towards integrating these tools so that the section 11 multi agency audit provides sufficient assurance on standards for health. Audit on the Compliance with Statutory Guidance on Promoting the Health and Well being of Looked After Children An audit of compliance with standards for Looked After Children was carried out in December 2010, completed March 2011. This baseline audit highlighted provider s 8 P a g e
commitment to Looked After Children but also enabled NHSN to identify and target areas for improvement. This information was particularly useful for the joint inspection by Ofsted/CQC that is reported below. Areas for improvement highlighted by the audit, were also highlighted by the inspectors. Ofsted/CQC Joint Inspection of Safeguarding and Looked After Children Northamptonshire was subject to an Ofsted/Care Quality Commission (CQC) joint inspection of children s services in March 2011. Northamptonshire s overall rating from Ofsted/CQC s was adequate. However the inspectors rated the contribution of health agencies to keeping children and young people safe in Northamptonshire as good. Within the report, CQC identified many strengths of health services in Northamptonshire. These included the contribution to partnership working; integrated commissioning; positive systems for early identification; good engagement of GPs and robust quality assurance processes. The valuable role the designated and named professionals play was recognised and it was noted that staff are proactive in appropriately challenging the Local Authorities responses to referrals. However the inspection highlighted a need to strengthen our role in a number of areas, particularly in relation to Looked After Children. The inspectors made 6 recommendations for improvements across safeguarding and Looked After Children services. An action plan has been generated to address these recommendations. Progress on the action plan will be reported through the LSCBN, Children and Young People s Partnership and Corporate Parenting Board as well as NHS Milton Keynes and NHS Northamptonshire s cluster governance structures. 4.5 Serious Case Reviews - Children & Young People The designated doctor and nurse are members of the LSCBN SCR committee and contribute to the reviews as report writers and/or as members of the SCR panel. The PCT is kept informed of reviews through quarterly reports to the Quality and Risk committee. There have been 5 published serious case reviews during 2010/11, three led by Northamptonshire and two led by other Local Authorities. 9 P a g e
Child A, relates to the death of an infant in April 2008. Following the death of Child A, a multiagency Teenage Pregnancy pathway has been established to ensure a shared approach to identification of needs and support planning. Child E, relates to the death of a child in a house fire in March 2007. Issues for Child E included the lack of consideration of child protection medicals following unexplained injury, and the lack of effective analysis of the extent and impact of neglect. A multiagency neglect assessment tool is now in use, and uptake of medical assessments for children in similar situations has increased significantly. Child F: relates to a young infant where there was a very significant delay in the recognition of physical abuse. In this case, some health workers recognised the significance of injuries but were not always able to communicate issues of diagnostic uncertainty or challenge decisions made by other practitioners. Assurance has been provided about the capacity of named professional to support staff. In addition, the hospital trust in this case has introduced safeguarding peer supervision meetings for medical staff. This is building a culture of consultation and supportive challenge in complex cases. The Ofsted evaluation of this review was good. Newton Family (a pseudonym): There is significant learning from this case, particularly around the management of sexual abuse concerns. This is being addressed through improved practice guidance and training. This report was published by Essex LSCB. Northamptonshire s Health provider contributions to the Serious Case Review were judged as good or outstanding by Ofsted. Child B: This case relates to a young child who suffered serious physical abuse over a period of two years, initially in Northamptonshire and subsequently in Cumbria. Key issues in Northamptonshire were the recognition of vulnerable carers who might represent a risk to a child; the response to safeguarding concerns raised by third parties such as extended family members, and the effective transfer of concerns when a child moves across boundaries. Clear policies are now in place to address these concerns and adult risks and vulnerabilities are now strongly emphasised in GP training. An executive summary was published by Cumbria LSCB in June 2010. 4.6.Key Achievements in safeguarding children 2010/2011 Safeguarding in General Practice Safeguarding in general practice continues to develop within Northamptonshire, led by the GP named doctor. The development of GPs was recognised within the Ofsted/CQC joint inspection as an area of strength Effective safeguarding arrangements are one of the Essential Standards for registration with the Care Quality Commission which will apply to independent contractors including GP s. 10 P a g e
In 2011, the named doctor launched locality safeguarding forums for GP s across Northamptonshire. The aim of the safeguarding forums is to support practices to meet good practice standards that have been developed from the Royal College of GP s safeguarding toolkit and serious case review recommendations. The forums are also supporting the development of safeguarding leaders and champions within the GP community and offer opportunities to share local good practice and address issues in interagency working. Currently the forums are supporting progress towards secure electronic information sharing for child protection conferences. NHSN continues to support GP training. A series of five half day educational events took place across the county in April, May and June 2010. The training was well evaluated and 95% of Northamptonshire GP s attended, along with many practice managers and nurses. Progress on the LSCBN business plan objectives The Director of Nursing, Associate Director and designated professionals have contributed directly and substantially to the work of the LSCBN in a number of areas. In particular, the development of the LSCB performance framework and the revised interagency safeguarding procedures. A positive outcome of this has been the launch of Integrated Working Procedures which provide clearer thresholds for responding to children in need and child protection concerns. Looked After Children review Northamptonshire County Council and NHSN undertook a joint review of services for looked after children during 2010. As a result of the review, NHSN has revised and clarified the roles and responsibilities of the Designated Doctor and Designated Nurse roles for looked after children and revised service specifications with providers to ensure clarity of organisational roles and performance targets. A Corporate Parenting Partnership Board was established in October 2010. This board oversees the recommendations in the review and the joint approach to the development of services for LAC in the future. A sub group of this board Be Healthy Aiming for Excellence Committee was established in January 2010 and is chaired by the Designated Doctor for LAC. This committee meets monthly and is responsible for progressing the recommendations of the review and of the CQC action plan. Child protection medical assessment services 11 P a g e
The dedicated clinical service which provides assessments for children as part of child protection investigations has undergone significant development in 2010. The service is provided by community paediatricians from both NGH and PCT provider services. In 2008, this service was provided on a limited basis, with appointments offered on 3 afternoons per week at Northampton General Hospital. In 2010 the service was expanded and now provides a week on call rota covering 9-5, Monday to Friday, with capacity to undertake joint assessments with forensic physicians at a Sexual Assault Referral Centre, for children where sexual abuse is suspected. Uptake of assessments was initially at a very low level but activity levels have increased very significantly during 2010-2011. (168 referrals during 2010-11, compared to approximately 34 in 2009/10) This service was identified as strength within the recent Ofsted/CQC joint inspection. 5. Safeguarding Adults 5.1 Introduction Safeguarding adults is an integral aspect of patient care, requiring services to work effectively together to prevent harm and intervene early where harm, neglect or abuse is suspected. The sad reports of abuse and neglect reported within the Health Ombudsman report Care and Compassion 6 (2011) and the report by Panorama (May 2011) into the abuse carried out in Castlebeck independent hospital, highlight how fundamental safeguarding is to the quality of patient care. During 2010/2011, there has been good progress in implementing safeguarding policy and practice across health services, with clear accountability and governance arrangements in place to support this. This increased awareness and accountability is likely to be a factor in the significant increase in safeguarding adults referrals (2403 referrals in 2010/11 compared to 1749 in 2009/10). 32% of these referrals were made by health services with a further 26% made by residential/nursing care staff. 6 Care and Compassion: report of the health Service Ombudsman on ten investigations into NHS care of older people: Parliamentary and Health Service Ombudsman 2011 12 P a g e
5.1. Interagency Safeguarding Adults Arrangements The Safeguarding Vulnerable Adults (SOVA) Board of Northamptonshire has strategic responsibilities to oversee the development of safeguarding of vulnerable adults. NHSN is represented at the SOVA Board by the Director of Nursing and Associate Director of Safeguarding. The SOVA Board is supported by committees related to training, quality assurance, professional practice and procedures and serious case review. NHSN is a member of each of these committees and is chair to the training committee. In September 2010 an inspection team from the Care Quality Commission (CQC), visited Northamptonshire County Council to assess how well it was delivering safeguarding in partnership with other agencies including NHSN. CQC concluded that the Council was performing adequately and with promising capacity to improve. An action plan has been devised to address the areas requiring improvement. 5.2. Safeguarding Adults within Health Care All provider services are required to comply with the Care Quality Commission Essential Standards for Quality and Safety that include safeguarding standards. NHSN ensures that adult safeguarding standards are included in all NHS contracts and that providers have effective clinical governance systems to safeguard patients. NHSN safeguarding team work closely with other key patient quality and safety functions within the PCT to assure these standards e.g. patient safety; complaints; mental health/learning disability services; care home quality monitoring. Each of Northamptonshire s provider Trusts has a safeguarding adults executive lead, an operational lead and their own safeguarding committees. Providers now play an active role within the multi agency safeguarding procedures both in identifying and responding to safeguarding concerns. NHSN s professional lead assures this process and supports providers through supervision, site visits, attendance at their committees and leading a peer development forum. 5.3. Quality Assurance for Safeguarding Adults Assurance is obtained from the main provider trusts through the Markers of Good Practice assurance framework for safeguarding and the Mental Capacity Act 2005. Positive achievements by providers include audits of clinical notes to ensure that the Mental Capacity Act 2005 is embedded into clinical practice; staff awareness of safeguarding practice and procedures; policies and procedures being revised to ensure 13 P a g e
to ensure that good practice for vulnerable adults is considered. Areas that require strengthening are the inclusiveness and feedback from service users and carers about the safeguarding process and training for all appropriate workforce. The Department of Health in March 2011 published guidance 7 on the role of health services in safeguarding adults. A self-assessment assurance framework was part of this guidance and will replace the markers of good practice for 2011/12. This assurance framework helps commissioners and providers focus on preventative measures as well as effective means of responding to neglect and abuse. Additional assurance measures include real time monitoring of providers through site visits to wards. 5.4. Serious Case Reviews - adults Northamptonshire have published the findings of two serious case reviews in safeguarding adults in 2010. NHSN contributed to both these reviews. Parkside House: following the death of five residents within a care home, which was subsequently closed. The executive summary was published in October 2010. NHSN has developed an action plan for the Care Home Monitoring and Continuing Healthcare teams to address the recommendations. Significant progress has been made with all but one of action points resolved. The outstanding action relates to developing an integrated data base between NHSN and the County Council and this is currently being progressed. Mr and Mrs Randall: following the death of an elderly couple living independently within the community. The executive summary was published in September 2010. NHSN had no specific actions attached to the action plan. However an action for all agencies with direct patient care related to disseminating learning and provision of Mental Capacity Act 2005 training. This action has been completed for the relevant NHSN staff. 5.5. Deprivation of Liberty Safeguards (DoLs) The Mental Capacity Act 2005 provides a statutory framework to empower and protect vulnerable people who are unable to make their own decisions. The Deprivation of Liberty Safeguards (DoLS) are provisions within the Mental Capacity Act. These 7 Department of Health (2011) Safeguarding Adults :The Role of the Health Services. London : DH 14 P a g e
safeguards create legal protection for adults who lack capacity to consent to care or treatment and their care constitutes a deprivation of liberty. A person may not be deprived of their liberty without legal authorization. The provisions place a duty on PCTs to assess and authorise the deprivation of liberty of patients within hospital settings, subject to the statutory criteria being met and the care being in the person s best interest. Assurance that providers are complying with statutory duties forms part of the assurance framework discussed above. Within Northamptonshire, DoLS is delivered on behalf of NHSN by the County Council. However the PCT retains responsibility for the final authorization. Subject to legislation, the role of the supervisory body in respect of hospitals under the Mental Capacity Act 2005, DoLs will move from PCTs to Local Authorities. Activity Report Assessment carried out in care homes and hospitals from 1 April 2010 to 31 March 2011 Deprivation of Liberty Activity Care Homes Local Authority responsibility Hospitals PCT responsibility Number of referrals to the service 73 10 Number of referrals leading to an 44 7 authorization of DoLs Number of referrals where the 29 3 individual was assessed as not being deprived of their liberty Number of authorizations in place 31 st March 2011 18 0 Breakdown of authorisations by Provider, covering period from 1 April 2010 to 31 March 2011 Deprivation of Liberty Activity NGH KGH NHfT Provider St Andrews Out of County hospitals Number of referrals to the 2 5 2 1` service Number of referrals leading to 2 4 1 an authorisation of DoLs Number of referrals where the individual was assessed as not being deprived of their liberty 1 1 1 15 P a g e
Number of authorisations in place at 31 March 2011 End of year statistics reveal that there have been ten referrals to the DoL s service in 2010/2011 which is the same reported as 2009/2010. Three were declined and seven were authorized, but have subsequently expired. All of the authorisations granted were for durations of much less than the twelve months allowed in law, averaging four weeks in duration. 5.6. Key Achievements in safeguarding adults 2010/2011 The attainments for 2010/2011 include: NHSN launched its three year safeguarding strategy, which was formed in partnership with health providers and other agencies. This important strategy outlines the Trust s approach to ensuring the safety of all vulnerable adults, children and young people. NHSN continues to be a committed and proactive partner within the Northamptonshire Safeguarding Adults Board and their sub-groups. The training sub group, chaired by NHSN, is able to report significant progress on their work objectives. This has included development of a multi agency training strategy; a training matrix for all agencies to report monthly training statistics and commissioning a customised e-learning package. As well as providing targeted training for continuing healthcare staff on safeguarding adults and the Mental Capacity Act 2005, lunch and learn events are held periodically for NHSN staff to promote basic safeguarding awareness throughout the organization. Engagement with GP s, dentists and primary care on safeguarding adults has continued over the year. Since September 2009, 365 primary care staff (including 172 GP s) and 204 dental staff (including 56 dentists) have received level one basic safeguarding adults awareness training from NHSN. Mental Capacity Act 2005 training has been delivered to 68 primary care staff (including 39 GP s). Safeguarding procedures revised to include thresholds for safeguarding referrals, developed between NCC and NHSN. Collaborative work with Nene Commissioning has ensured that information and the appropriate forms associated with safeguarding adults and the Mental Capacity Act 2005 is available on their web based information system for all primary care staff. 16 P a g e
Quarterly Health Providers Forums, led by NHSN have been used to improve practice across health providers and have included focused meetings with the Local Authority to address inter agency working and dispute resolution. A peer support group meets six to eight weekly for safeguarding leads to critically examine a safeguarding case in more detail. This also acts as a supervisory and reflective practice function. 6. Care Home Quality Monitoring 6.1. Introduction NHSN established a team of quality monitoring nurses in 2009. The team of three nurses and team manager monitor the quality of nursing care provided within Northamptonshire s care homes and to develop standards of care across these providers. The team reviews 103 care homes. They work closely alongside County Council partners and the Care Quality Commission, using a range of information gathered from health partners, families and residents to intervene early and address any concerns about the quality of care. The nurses are linked to specific homes and carry out a minimum of annual monitoring visits, working closely with them to improve practice. 6.2. Quality Assurance in Care Homes During 2010/11 all care homes within Northamptonshire where NHSN funds care, received a full monitoring assessment. These generated action plans and for some homes, follow up assessments. There were no home closures during the year though a number of care homes required more intensive levels of monitoring and targeted input to raise standards of care. Concerns related to areas such as nursing competence, staffing and management. Interventions have included providing training, access to specialist advisors and provision of guidance/tool kits. Five providers have been placed in suspension throughout the year due to levels of concern. During this time meetings were held with families and residents to inform them of the concerns about standards of care so that their views were heard and they were able to make informed choice about seeking alternative care. In all these situations, NHSN works closely with Northamptonshire County Council, (NCC), and Care Quality Commission, using an escalation plan to share information and coordinate actions between the agencies. 17 P a g e
6.3. Key achievements with care homes 2010/2011 Quality Tool A monitoring assessment tool has been developed by the Care Home Quality Monitoring Nurses. The tool reviews a range of clinical indicators, using red/amber/green rating to benchmark standards and clearly identify the areas that providers are required to improve. This quality tool is supplemented by information from primary care and from residents and their families. A questionnaire for this purpose was developed in consultation with patient and public groups. Safeguarding The Care Home Quality Monitoring Nurses took over responsibility for safeguarding adults investigations for all Continuing Health Care funded residents. These investigations are an important aspect of the quality monitoring process. The team also attend strategy meetings with NCC Safeguarding Adults and contract and commissioning teams, offering clinical advice as necessary. Department of Health Care Homes Contract The Department of Health, (DH), Care Homes Contract is now available on the DH website. Guidance on the NHS Standard Contract for Care Home Services 2011/12 has also been issued. NHSN will use this contract with all providers it currently commissions with. Learning and development initiatives There have been three nursing home forums held this year. 81% of those attended stated that the sessions had been very educational. The fora focus on specialist areas of nursing e.g., Parkinson s, COPD, Diabetes, as well as dignity in care, end of life and mental capacity. Mental Capacity Act and Deprivation of Liberty Safeguards training has been delivered specifically for care homes (11 sessions delivered). The analysis of this training state 91% of recipients felt the training met their objectives. 99% of the respondents would attend further training sessions delivered by the quality team. 18 P a g e
Pressure Area Care training has been delivered to 20 attendees from seven care homes. 95% state that the training met their objectives adding that the sessions enabled them to become familiar with new guidelines and increase their knowledge. Newsletters have been sent out on a quarterly basis and circulated to 109 providers. The newsletters focus on best practice, up to date advice and specialist contact details, support and training opportunities. Evaluation by providers Questionnaires have been distributed to all home managers. 45% responded stating they are aware of the Care Home Quality Monitoring Nurses. 47% of the respondents recorded that they felt the nurses helped improve the quality of care within their homes. Service user Questionnaire A service users and relatives questionnaire was developed in partnership with representatives from the care home sector, Local involvement Networks (LINKs); The Alzheimer s Society and Age UK. This questionnaire gathered a wide range of patient information about care homes in general. The results were shared with providers and helped to inform priorities for improvement. Discharge Protocol Monitoring highlighted recurring problems in admission and discharge between acute services and care homes. The Care Homes Quality Monitoring team facilitated a workshop to address this issue with stakeholders and developed an Admission and Discharge Information Sheet. This improves communication about the patient s needs, timeliness of assessments and safe discharge. 7. Areas for Development for 2011/2012 Overarching developmental areas 1. Refresh the NHSN Safeguarding strategy. This will be undertaken jointly by children and adult safeguarding leads, to reflect new strategic priorities as old objectives are achieved, and in particular to respond to changes in legislation, statutory guidance, health service structures and partnership priorities 2. Manage the safe transition of safeguarding children and adults work into new commissioning structures, building clinical engagement at operational and strategic 19 P a g e
levels and ssupporting commissioning consortia in preparation for future statutory safeguarding responsibilities 3. Work with Milton Keynes safeguarding services to ensure the most effective use of professional capacity, resources and best practice. 4. Maintain robust assurance processes to ensure safeguarding vulnerable adults and children remains a priority during a period of substantial structural change and economic challenge. 5. Support health providers undergoing restructuring to ensure that safeguarding arrangements are maintained through transitions, particularly those around transforming community services. Developments for Safeguarding Children 6. Progress the action plans arising out of the Ofsted/CQC inspection. 7. Build on the development of safeguarding within Primary Care, using the forums to develop local best practice guidance in relation to Serious Case review recommendations, and to prepare practices for CQC registration in future 8. Deliver a further sequence of training events for GPs in autumn 2011. These will be joint training events with children s social care staff, with the aim of building shared understanding of practice and challenges across the two disciplines. 9. Develop a single quality assurance framework for use with NHS providers in Northamptonshire, combining the multi agency section 11 audit tool with the SHA s Markers of good practice standards Developments for Safeguarding Adults 10. Work with providers and Local Authority to improve governance structures for safeguarding adults and the ability to identify and respond to safeguarding trends. 11. Work with the Local Authority and providers to capture qualitative and quantitative data regarding service user and carer experience of the safeguarding process. Developments for Care homes 12. Quality Monitoring in Domiciliary Care. Domiciliary care is an expanding area but one in which patients may be particularly vulnerable. A lead has been appointed to monitor of all 55 domiciliary care providers that are commissioned to provide health care packages Northamptonshire. 13. Deliver East Midlands Health Innovation Education Cluster Award (HIEC) pilot. NHSN has been awarded funding of 70,000 to improve practice within care homes. An educational toolkit directed specific aspects of nursing care e.g. a delirium risk assessment tool and safe withdrawal from anti-psychotic medication 20 P a g e
skills will be rolled out to 30 nursing homes throughout Northamptonshire and Leicestershire. This will improve care and deliver cost reductions in areas such as call out of GPs and district nurses. 14. Improve the quality monitoring of out of county placements. The disturbing reports of extensive abuse of patients with learning disabilities in a Castlebeck independent hospital (Panorama report May 2011) raised questions about how well such homes are monitored and how the care of these most vulnerable patients is assured. NHSN will improve our systems that quality assure these placements and develop a national protocol to improve communication of concerns between funding and local PCTs/Consortia 21 P a g e