APPENDIX I Safeguarding Adults Annual Report 2009 2010 Authors Neil Boyland Sue Leathers
1. Definition All persons have the right to live their lives free from violence and abuse. This right is underpinned by the duty on public agencies under the Human Rights Act (1998) to intervene proportionately to protect the rights of citizens. These rights include Article 2 the right to life: Article 3 Freedom from Torture (including humiliating and degrading treatment); and Article 8 Right to family Life (one that sustains the individual) Any Adult at risk of abuse or neglect should be able to access named persons within the Royal United Hospital Bath for appropriate interventions which enable them to live a life free from violence and abuse. This report covers the period April 2009 to March 2010. It provides an update on Safeguarding Adults work in the Royal United Hospital Bath over this period. The Safeguarding Adults Team consists of the following: Francesca Thompson Executive Lead, Director of Nursing Neil Boyland Operational lead, Matron for Critical Care Services Sue Leathers Operational Lead, Matron for Older Persons Operational lead, Tissue Viability Nurse Specialist Kate Peacock Medical Lead Consultant Geriatrician 2. The Safeguarding Adults Team s main focus for 2010-2011: Setting up a robust system for quarterly reporting in line with the Quality Schedule. It is envisaged that this will be linked in with the incident reporting system. To redefine and restructure the approach to raising awareness training to all relevant hospital staff. This will aim for all staff on the RUH Trust induction. To continue to review all patients with Grade 3 and 4 pressure ulcers in line with the safeguarding adults framework. To establish an audit trail of vulnerable patients referred to the safeguarding adults operational team. To provide evidence for Care Quality Commission Standards Outcome 7 for Safeguarding Adults. To strengthen the systems more formally for lessons learnt. 3. Overview of Safeguarding Adults and the National Context. No Secrets (Department of health 2000-2009) is mandatory guidance issued under the Local Authority and Social Services Act 2007. It says that all agencies working with vulnerable adults living within a local authority boundary, must work together to protect them from abuse. It defines a vulnerable adult as a person who is, or may be in need of community care services by reason of mental or other disability, age or illness; and who is, or may be Agenda Item: 12 Page 2 of 9
unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation. The Royal United Hospital Safeguarding Adults group has been established for 4 years and consists of the following group members: Name Francesca Thompson Neil Boyland Sue leathers Tricia Mills Dr Kate Peacock Andrew Guy Representative from Social Services in BANES and Wiltshire Title and area of Clinical Work Director of Nursing and Executive lead for Safeguarding Adults. Matron for Critical Care and Operational Lead for Safeguarding Adults. Matron for Older People and Operational Lead for Safeguarding Adults. Head of Organisational Development. (Previous lead in Safeguarding Adults) Consultant Geriatrician Medical Lead Operational lead and Tissue Viability Senior Nurse Police Constable Vulnerable Adult Wiltshire Police Force. This report will be the second report for the Trust Board since the group has been established. The safeguarding adults group continues to raise awareness amongst staff within the Royal United Hospital to enable them to recognise and report abuse and to understand their roles within the Safeguarding Adults procedures. The RUH Safeguarding Group are aware of the national developments that raise the profile of safeguarding adults work and sets its direction for the future. The National developments are: Raising the profile of the Mental Capacity Act (2007) and the introduction of the Independent Mental Capacity Advocacy (IMCA). The IMCA service that services the RUH is based in the city and offers a 09.00-5.00 service 5 days a week. The Mental Capacity Act puts a duty on local authorities and health Trusts to provide an IMCA to vulnerable people who have no family or friends to speak on their behalf and who lack the mental capacity to make specific decisions. The future introduction of the new vetting and barring list that will replace the present protection of Vulnerable adults list. (POVA). Agenda Item: 12 Page 3 of 9
4. Royal United Hospital Bath Safeguarding Adults Group s approach and progress of Safeguarding Adults There is a well established Safeguarding Adults group to drive the focus in: An effective and workable Safeguarding Adults policy which was reviewed and ratified in March 2010 Improving communication with social services by attending sub group safeguarding adults meetings, this is mainly between Wiltshire and BaNES and these meetings usually occur every 3 months Representing the Royal United Hospital at Early Strategy meetings and case conferences with the relevant Social Services. Continuing to have a strong infrastructure of senior nursing staff to lead vulnerable adults. This group meets every 2 3 months and has terms of reference for the meeting. Maintaining weekly training for Vulnerable Adult awareness currently undertaken on the Trusts Mandatory Core Skills Training. This will be transferred to RUH Trust Induction from early Autumn 2010 Raising awareness of completing Incident Reports 5. Training The aim for 2009 2010 is to transfer safeguarding Adults training to the RUH Trust Induction to capture all new staff starting in employment in the RUH. Core skills training will continue subject to resources from the Safeguarding Adults operational team. All staff will be alert to the potential abuse of vulnerable adults and the policy, through awareness raising, via nurse and Health care assistant local induction, and mandatory training. BaNES and Wiltshire continue to offer Safeguarding Adult Training throughout the year to all RUH staff. BANES led an awareness training event at the RUH regarding the revised Policy and procedures. 760 RUH Staff attended Safeguarding awareness training April 2009 31 st March 2010. 20 RUH staff have attended Safeguarding adults investigators training Mental Health and Deprivation of Liberty training attendance numbers are to be validated 1. Vulnerable Adult Protection Process Agenda Item: 12 Page 4 of 9
An investigator trained in adult protection will lead the assessment assisted if necessary by the Consultant and/or Matron. The purpose of the assessment is to ascertain whether Social Services or the Police need to become involved. In any case of significant harm, Social Services and police must be alerted and further assessment stopped to prevent contamination of evidence which may be needed to allow the police to pursue a prosecution. If the assessment raises concerns but no evidence, the RUH care team (investigator, Matron and Consultant) will decide how to progress the situation. 6.1 Referrals There has been significant numbers of referrals since the operational leads have raised the profile of Safeguarding Adults Number of Referrals made to Royal United Hospital April 2009 March 2010 Social Services Referals 2009-2010 90 80 70 60 N u m b ers 50 40 30 20 10 0 Wiltshire Banes Somerset total Social Services 6.2 Number of Incidents / Serious Untoward Incidents (SUI s) Agenda Item: 12 Page 5 of 9
There have been no serious case reviews and 3 serious untoward incidents reported by the RUH (see section 8). 7. Outcomes and Evidence Currently there is limited data to quantify the outcomes of RUH Inpatients that have been referred to the Operational Leads, as once the referral is made to the Lead agency (social services) RUH involvement is reduced. This will however be addressed when the planned database, becomes operational. The safeguarding adults group with liaison with the relevant social work team will always aim for the following plan: To reduce the patient not to be at risk. Ensure that risks have been minimised Confirm that outcomes are conducive to the operational plans and social work team. To ensure that the patient is in a place of safety. 7.1 Lessons Learnt A formal process to address lessons learnt is required to be further strengthened than what currently exists, particularly multi agency partnership learning. Face to face meetings have been routinely held between staff and families where appropriate throughout the year. 7.2 Complaints There have been no formal complaints recorded relating to the safeguarding of adults within the RUH. 7.3 Actions following RUH completion of the BaNES Self Assessment Action Audit Complete audit proposal. Audit proposal to be agreed by clinical audit Strengthen incident reporting system by understanding any gaps as part of the above audit. Clinical Supervision Policy To formalise peer supervision for operational leads. Completion date September 2010 September 2010 Lead Boyland/Rob Eliot As above/alexandra Lucas Boyland Service Development Agenda Item: 12 Page 6 of 9
Introduce an assessment section on the Millennium admission document.this has already been planned and developed in preparation for the admission document. Awaiting finalisation from millennium steering group. Local resolution Case note review to be incorporated into clinical governance systems by operational leads Effective inter agency working. Referrals database Incident forms Clinical audit planning Spring 2011 November 2010 October 2010 Boyland Boyland Boyland Rob Eliot 8. Pressure Ulcer Reporting within the Royal United Hospital In line with NICE best practice and CQUIN, the RUH collects and reports data for grade 2, 3 and 4 pressure ulcers. For the period April 2009 March 2010, 27 in-patient areas submitted weekly pressure ulcer reporting forms which provide the data for pressure ulcer incidence monitoring. In line with the local safeguarding of adults frameworks, grade 3 and 4 pressure ulcers are cross referenced via the root cause analysis. During 2009/10 the total (RUH acquired and community) pressure ulcers determined 18% grade 3 and 3% grade 4. The total of 3 grade 4 RUH acquired pressure ulcers, accounted for 0.4% of all reported pressure ulcers and these were investigated as Serious Untoward Incidents. Although lessons were learnt there were no issues relevant to activating safeguarding procedures. 8.1 Tissue Viability Pressure Ulcer Reduction Strategy We aim to reduce RUH acquired grade 3 pressure ulcers by 50% during the coming year and zero grade 4. New strategies to help achieve this include a zero tolerance to pressure damage and prevention of all avoidable pressure ulcers (High Impact Actions 2009). The recent recruitment of a second Tissue Viability Nurse. This allows for more targeted pressure ulcer prevention and faster referral response times. All patients with grade 3 or 4 pressure ulcers are now seen by a Tissue Viability Nurse. Agenda Item: 12 Page 7 of 9
A Serious Untoward Investigation is completed for all Grade 4 RUH-acquired pressure ulcers and a Root Cause Analysis (RCA) is undertaken for RUH-acquired grade 3 pressure ulcers. The Tissue Viability service will continue to provide a comprehensive training/education programme to support pressure ulcer reduction. The Tissue Viability service launched a new pressure ulcer risk assessment tool in 2009 and the prevalence audit in December 2009 demonstrated that adherence to trust pressure ulcer prevention and management policy has significantly improved since it s introduction. The RUH will continue to provide high-specification pressure relieving mattresses and cushions for the prevention and management of pressure ulcers. We also provide over 20 different wound dressings and are currently reviewing these to ensure they are clinically and cost-effective. The Tissue viability service has recently produced a patient information leaflet which can be provided for any patient at risk of developing / with an existing pressure ulcer. A new pressure-ulcer prevention tool called PRIMED will be launched in June 2010. This is a simple tool to help staff deliver more effective pressure-relieving care. The pressure ulcer reporting form and database has recently been reviewed and revised in order to promote more accurate / sensitive reporting. Every patient with a pressure ulcer will be reported via the weekly pressure ulcer incidence reporting form. All RUH-acquired pressure ulcers are to be investigated as adverse clinical incidents and investigated locally by department managers as per trust policy. Ward sisters will ensure that all patients with grade 3 and 4 pressure ulcers are referred to the TVN within 24 hours of the pressure ulcer being identified. 9. Summary Agenda Item: 12 Page 8 of 9
The Safeguarding Adult group is active in working within the sphere of Safeguarding Adults. The group have developed partnership working within the PCTs, Police and Social Services. The increase in the number of safeguarding adult referrals demonstrates that the awareness training is proving effective. The safeguarding adult leads have had large complex safeguarding issues ranging from all of the categories of abuse identified in this report. The safeguarding adult group strive for best practice for patients and their families and will progress this work for 2010-2011. Agenda Item: 12 Page 9 of 9