AGENDA ITEM NO.
REPORT TO: Social Affairs, Health & Housing Scrutiny Committee
REPORT OF: Head of Adult Social Care, (Statutory Director of Social Services)
REPORT NO: HASC/02/12s
DATE: 11th January 2011
CONTACT OFFICER: Chris Pearson (Head of Service Mental Health) Ext: 8462
SUBJECT: Annual Adult Protection Report 2010/11
1. PURPOSE OF THE REPORT
This report provides Scrutiny Committee Members with details of Wrexham’s Adult Social Care Department’s performance in relation to the Protection of Vulnerable Adults from abuse for the year 20010/11. In addition, the report provides a current summary of activity and action plans.
2. SUMMARY
Adult Social Care has a duty to ensure there are effective arrangements in place to identify abuse and respond it accordingly. The key aspect of this report for Members is to highlight the current performance for the period 2011 of Adult Protection procedures in Wrexham.
This report also provides the opportunity for Members to review Wrexham’s performance management data for the period April 2010 to March 2011. Welsh Government data have still not reported from its Adult Protection data collection for 2010/11 therefore no comparisons can be made with other Local Authorities across Wales but the Department has gathered information from North Wales authorities. (Appendix 1, Table 1), and also where appropriate comments are included relating to our current performance data.
3. RECOMMENDATIONS
That Scrutiny Committee considers this report and provides comment to the Department as appropriate.
That Scrutiny Committee receives a further annual report to review the previous 12 month period as required by Welsh Government, and to consider the current effectiveness of Adult Protection arrangements in Wrexham.
Because the delayed timeframe of comparative data reporting by the Welsh Government means it is reported 12 months out of date, it is recommended that reporting of Wrexham’s data and activity performance is brought into line by presenting to Members in July of each year commencing 2012.
4. INFORMATION
The key factors emerging from Adult Protection data for 2010/2011 (appendix 1) are:
4.1 Referrals to Adult Protection
4.1.1 There has been a slight reduction in the total number of referrals from 274 in 2009/10 to 259 in 2010/11. This variation is minimal and is not a significant trend compared to previous years and apart from this year it is estimated referral rates will continue to increase year on year.
4.1.2 The statistical data sent to Welsh Government, includes only those Adult Protection cases that have been closed during the year so that means of the 259 referrals only 226 cases were counted for the period April 2010 – March 2011.
4.1.3. An analysis of those reporting Adult Protection shows some interesting trends, the highest proportion of referrals continues to be from provider agencies, Social Services Providers and Social Workers. There is an increase in referrals from hospital, an increase reported by relatives and an increase reported by the Ambulance Service.
· There is an increase in reporting referrals from hospital settings (22 in 2009/10 to 29 in 2010/11),
· An increase in relatives (13 in 2009/10 to 22 in 2010/11) and
· the Ambulance Service (0 in 2009/10 to 3 in 2010/11).
· The highest proportion of referrals continues to be from provider agencies, Social Services Providers and Social Workers.
Direct links were made with the Ambulance Service in 2010/11 to better inform on reporting of Adult Protection. The reporting of referrals by the Wales Ambulance Service Trust is significant because not only have they recently become a member of the Local Adult Protection Committee but also because our Department instigated better communication links locally on reporting adult protection issues.
4.1.4. The National Indicator on the number of referrals has now been deleted by the Assembly Data Unit; however, the Department has retained it as a Local Performance Indicator as it helps to identify demand and capacity.
Local Performance Indicators / 2009/10 Performance / 2010/11 TargetNumber of Referrals per 1,000 pop aged 18+ / 2.62 (274 referrals) / 2.6 (Expected range 270 – 300)
Local Performance Indicators / 2010/11 Performance / 2011/12 Target
Number of Referrals per 1,000 pop aged 18+ / 2.46 (259 referrals)
Percent population from GB / 2.6 (Expected range 270 – 300)
4.2 Following the CSSIW Inspection Report of Dec 2009, the Department has now embedded the recommendation to improve the gathering and recording of their strategy discussion to determine if a case requires further investigation. The use of Wrexham’s Proforma to record this stage in the Adult Protection Procedures has shown a significant improvement in the quality of information and decision making as to whether the referral should progress to a Strategy Meeting. The process has been further enhanced by the introduction of a Case Management Record to record strategy discussion. This became operational on the 1st April 2011 and is now fully implemented in Wrexham with the introduction of the new Wales Interim Policy and Procedures.
4.2.1 Adult Protection is triggered when a concern is raised with a professional who reports the matter to the line manager. If there is evidence of a criminal offence at any stage in the Adult Protection process, this is reported directly to the Police. For any non-criminal allegations, the Local Authority will determine who will take the lead in any investigation. All Managers have responsibility to notify the Adult Protection (Safeguarding) Officer when a case is first referred and arrangements are put in place for a Strategy Meeting. At this stage a key focus is to determine if an investigation is required, identify the lead Agency and ensure any immediate actions are taken to protect the Vulnerable Adult.
4.2.2 Adult Social Care Managers are responsible for the operational management of co-ordinating, monitoring and evaluating local Adult Protection procedures and their effectiveness. This monitoring is overseen by the Adult Protection (Safeguarding) Officer. In Wrexham, Adult Protection Strategy Meetings and Case Conferences are chaired by the appropriate Team Manager, the Adult Protection (Safeguarding) Officer or the relevant Head of Service.
Investigation
4.2.3 The National Performance Indicator, which gathers information around cases that lead to an adult protection investigation, has been removed as a National Indicator. However, the Department has retained it as a local indicator in order to give an overview on the number of cases that are referred that lead to an investigation.
It’s expected that this performance target will remain in the top quartile where strategy meetings have determined cases require an investigation.
Local Performance Indicators / 2010/11 Performance / 2010/11 TargetPercentage of Adult Protection referrals that lead to an Adult Protection investigation. / 80.09%
87.2% (2009/10) / Expected range of 85% to 90%
4.3 Risk Management Plans
4.3.1 This indicator that has been retained by Welsh Government and is much more focussed upon Risk Management. The risk assessment tool and the Adult Protection plans are an integral part of a risk reduction strategy and to support this Adult Social Care has arranged for training for Professional staff on Risk Management training during 2011/12.
4.3.2 This performance indicator shows Wrexham remains in the top quartile. It is expected it stays in top quartile taking into account there will always be a percentage of people who. As consenting adults do not wish to have allegations of abuse investigated.
National Performance Indicators / 2010/11 PerformanceRisk Removed or Reduced / 2011/12 Target
The number of referrals completed where the risk has been removed or reduced / 93%
86.4% (2009/11) / >80%
4.4 Current Practice relating to Adult Protection in Wrexham
4.4.1 There is a quality monitoring audit system of Adult Protection within Adult Social Care. This is a whole system approach from referral to outcomes for
service users to ensure the sharing of good practice or to identify service improvements across multi-agency working together.
Audits focus upon the quality of managing Adult Protection cases from the point of referral to outcomes for service users. The outcomes from the audits are reported quarterly to all managers through the Adult Social Care Performance Meetings. This arrangement was commended by CSSIW Inspection in 2009 in enabling a culture in the Department to assess its own performance to ensure continuous improvement. The audit process has been shared across other Local Authorities as an aspect of good practice. Any matters that raise concern following an audit are referred in writing to the Head of Service and Designated Lead Manager to action any service
improvement notice.
4.4.2 The good practice that has been evidenced through the audit quality monitoring system has shown that;
· There was evidence that immediate protective measures were taken at the point of referral to ensure individual vulnerable adults were safe and this was clearly recorded.
· There is good evidence of consultation with Vulnerable Adults and their carers or family involved throughout the process.
· There are clear outcomes and Adult Protection Plans recorded in Adult Protection minutes. In future cases there will be individual and general protection plans agreed and signed off during the Adult Protection Meeting – copies will be distributed at the time.
· There is positive evidence of joint multi-agency working between Adult Social Care, Regulators, Police, Voluntary Organisations, Provider Agencies and Health which has resulted in effective outcomes for the Vulnerable Adults.
· There is evidence of a good standard of record keeping and a thorough knowledge of implementing the Adult Protection Policy and Procedures and effective interagency communications at operational level.
· During 2011/12 a Service User Engagement Questionnaire has been developed in Wrexham aims to learn from Service User experiences in order to improve our engagement with them. This questionnaire has been adopted regionally across the North Wales Adult Protection Forum.
4.4.3 A number of Service improvements have been identified during 2011/12
and these are:
· The Wales Interim Adult Protection Procedures are now being implemented since their introduction in North Wales from April 2011. Implementation within Wrexham will continue to be monitored and outcomes will be reported to Members in the annual report. The procedures are dependent upon amendments by the Welsh Government in conjunction with the Review of In Safe Hands which is to take place during 2012/13.
· Wrexham has implemented the new Risk Assessment Tool and training has been developed, commissioned and is being provided for professionals who have the responsibility for the completion of the Tool. Audits will take into account the completion of Risk Assessments.
· CSSIW recommended in 2009 that Adult Protection Plans should be separate to the minutes. This is now incorporated into the Wales Interim Policy and Procedures and Adult Protection Safeguarding Officer is auditing minutes to ensure adult protection plans are clearly recorded and is outcome focused. Managers are currently receiving training on this implementation and it is intended that Wrexham will be fully compliant with this requirement. Team Managers and Heads of Service will ensure completion of the protection plans during Adult Protection meetings and those with the responsibility of carrying out any of the actions will be asked to sign their agreement.
· It is important to ensure that people are safe at the point of referral and an investigation should only take place after a strategy meeting. This ensures a multi-agency approach is maintained in adult protection cases. This issue has been reinforced to managers and is incorporated into level 3 /4 training and this is an area identified for improvement.
· The Adult Protection (Safeguarding) Officer as part of the audit process examines standards of minute taking as well as business support to strategy and case conference meetings. Training is in place for staff to take adult protection minutes but there are still areas for improvement around the quality of minutes and time spent by managers to check them prior to authorisation. This issue is being addressed within an Adult Protection Safeguarding Project which is reviewing current adult protection arrangements.
· Mental capacity issues (Mental Capacity Act 2005, Mental Capacity Code of Practice and Deprivation of Liberty Safeguards) become significant in Adult Protection around decision making for those who lack capacity. There are emerging case law issues around capacity, safeguarding and best interest decision making that present challenges to adult protection which are not replicated in legislation or case law in Children’s Services. This means managers need to understand the interface between the Mental Capacity Act and Adult Protection and the need to invoke an Independent Mental Capacity Advocate (IMCA) who is there to safeguard a vulnerable adult’s best interests. It is evident that referrals to an IMCA or Advocate need to be improved and to promote this an IMCA trainer presents at Adult Protection training to professional staff.
· Improvements have been made to recording practise by using a Case Management Record which includes detailing Mental Capacity issues for vulnerable adults. This better informs the decision making process at the point of referral and strategy discussion and ensures that capacity issues are considered and addressed under adult protection.
· The audit process has identified that the Health Board (BCUHB) within Accident/Emergency Department continue to send through to the Department the obsolete referral forms. This matter has been raised within the Local Adult Protection Committee and highlighted to the Adult Protection Lead and Assistant Director of Safeguarding within the BCUHB.
· There have been some concerns raised regarding CSSIW’s attendance to Adult Protection meetings when it was felt they should have been present. This has being raised regionally during a recent North Wales Adult Protection Forum Meeting when the Assistant Chief Inspector was in attendance. He confirmed it was an issue that CSSIW would be addressing as part of their Agenda for Change.
4.5 Strategic Developments:
4.5.1. Social Services Improvement Agency (SSIA) invited bids from local authorities to promote models of learning and good practise relating to safeguarding adults from abuse. Wrexham were successful in obtaining £8,000.00 funding to develop a DVD specifically for use within Mental Health Services. This was based on research evidence that mental health service users are not confident in reporting abuse. This DVD project involved Service Users, supported by Hafal, who were in receipt of services. The DVD has raised awareness around stigma and discrimination of mental health and given a better understanding in how to report safeguarding issues in mental health services. The DVD is now a resource for use across Wales and can be accessed on the SSIA Web-site (see web-site address below). Leslie Griffiths AM launched the Safeguarding DVD in Wrexham on 29/07/2011.