Mental Health Service Specification

Protection of Vulnerable Adults

(POVA) Team

Operational Policy

November 2009 Revised May 2011

Contents

1. Introduction

1. Structure of the service

1. Aims of the service

1. Users of the service

1. Model of service delivery

1. Operational procedures

1. POVA duty system

1. Allocation of POVA referrals

1. POVA referral thresholds

1. Extraordinary referrals

1. Meeting processes

1. Data Management

1. Staff skills and attributes

1. Engagement with Service User / representatives

1. Links with Adult Services

1. Links with Customer Services

1. Links with Contract and Commissioning Services

1. Links with Legal Services

1. External links

1. Continual service evaluation and improvement

1. POVA Team Standards

1. Equal opportunities statement

1.Introduction

1.1The Protection of Vulnerable Adult (POVA) team uses a preventative approach to the Protection of Vulnerable Adults by working with Statutory, Independent and Voluntary agency partners to raise awareness and improve the quality of the response to abuse referrals. The POVA team leads agency partners by coordinating the POVA process.

1.2 The POVA team works across all Caerphilly County Borough Council Adult Services to ensure that practice develops and policies are implemented. The team assists other agency partners to implement the interagency POVA policy.

2. Structure and description of the service

2.1 The team consists of a Service Manager, four POVA Coordinators, an

Administrative Officer, three Administrative Assistants and a Clerical Assistant. A structure chart is provided below:

2.2 The team has also benefited from a rolling six month secondment post to ensure practice is shared across POVA and adult services teams. The team has benefited from secondments where social work practitioners have brought their expertise to share with the team and gained enhanced POVA coordination skills that are then taken back and shared with area social work teams. However as the work of the team develops it has been decided that a permanent 5th post would be of benefit and this is now under consideration as to whether the post will be joint with Aneurin Bevan Health Board.

2.3 The team is situated in the Ty Penallta council building where most of the strategy meetings and case conferences take place. However room availability, maximising attendance and comfort of service users and family are some of the factors that affect the selection of the meeting venue. Case conferences may be held at the service users residential accommodation if they so wish, for example a care home or their own home. Case conference may also be held at hospital or general practitioner surgery meeting rooms.

2.4 The teams hours of operation are Monday to Thursday 8:30 – 5.00 p.m. and Friday 8:30 – 4.30 p.m. The team uses a single telephone number to respond to requests for advice in relation to adult protection issues, with an answer machine that redirects callers to out of hours support as required. There is a POVA team email address and a safe fax to facilitate easy transmission of information. The team uses secure email, Government Connect Secure Extranet (GCSx) to liaise with statutory partners.

2.5 The South East Wales Emergency Duty Team (SEWEDT) are available to respond to urgent POVA matters outside office hours. SEWEDT complete any required referral forms and communicate any out of hours POVA activity thus ensuring a smooth transition of information to the Adult Service Duty and Information Team (ASDIT).

3.Service Aims

The service will:

• Consistently respond to all referrals of abuse and neglect of vulnerable adults where the allegation relates to a community setting in Caerphilly. Community settings include a variety of accommodation and services and an individual’s own home or relative’s home. The Aneurin Bevan Health Board responds to referrals regarding abuse alleged to have occurred in a hospital or primary health care setting. However information is shared where appropriate between the two organisations.

• Give advice in relation to POVA matters that may or may not go on to form a referral, making safeguarding recommendations where necessary. POVA advice is recorded in order to aid trend analysis and the review of thresholds.

• Engage in strategy discussion to identify the need for: further exploration at a strategy meeting, an immediate investigation and protection steps required to reduce risk.

• Undertake POVA investigations on occasions in line with the guidance on completing non criminal investigations

• Discuss and record the results of an investigation at a case conference to which the service user / representative are invited to attend.

• Review the completion of objectives set out in any adult protection plan that has been prepared and consider the need for longer term protection arrangements along with those involved in supporting the service user.

• Lead on methods to reduce abuse and neglect through the use of formal education and awareness raising activities with agency partners, service users and the public.

• Lead on methods to reduce abuse and neglect through the use of awareness raising activities within the Council through delivery of POVA education at corporate induction, meetings and development sessions.

• Promote partnership working through regular and detailed liaison with statutory partner agencies for example Police, Health Inspectorate Wales (HIW), Care and Social Service Inspectorate Wales (CSSIW), and the Aneurin Bevan Health Board.

• Share good practice with POVA coordinators in the Gwent region to ensure consistent practice in line with the Regional POVA policy. Communication across Wales takes place through attendance and network interaction with members of the All Wales POVA coordinators group.

• Communicate effectively with other local authorities across England and Wales where the team hosts a POVA process for a service user living in the Caerphilly area that is funded by another local authority.

• Ensure service users/representatives are involved at all stages of the POVA process through seeking their consent to refer and investigate. Explain clearly where consent may need to be disregarded due to risks to other vulnerable adults or children.

• Ensure adequate communication with service users/representatives, the referrer and the alleged perpetrator.

• Ensure outcomes in relation to longer term protection are received in relation to each POVA case e.g. referrals to the Independent Safeguarding Authority, referrals for Prosecution and referrals for disciplinary action.

• Contribute to early intervention systems to reduce the risk of and actual abuse and neglect. The POVA team will participate in the Provider Performance Monitoring activity through representative attendance at the Quality Assurance meeting and any resulting Provider Performance meetings, sharing information received through the POVA process relating to risks to other vulnerable adults.

• Contribute to and implement the Adult Services Service Improvement plan and from those documents set out our business for each financial year in our team plan.

• Develop and implement our own POVA Team plan.

4. Users of the service

4.1 ‘Vulnerable adults’ in accordance with the definition included in the Wales Interim POVA policy and procedures for the Protection of Vulnerable Adultsfrom abuse may be defined as a person over 18 years of age 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 unable to take care of himself or herself, or unable to protect himself or herself against significant harm or serious exploitation”

Ref: Law Commission (Who decides? making decisions on behalf of mentally incapacitated adults1997).

4.2 This service will be provided to vulnerable adults who are receiving a service that is funded by Caerphilly County Borough Council or another local authority or health body. Therefore, in line with the principles of ‘In Safe Hands’ (WAG 2000), the team coordinates the POVA response and any investigation on behalf of other authorities where the incident takes place in our borough. The service is also provided to vulnerable adults who are paying for their own care services.

4.3 The team will capture data relating to referrals for each service user group:

Older people

Physical disability

Learning disability

Hearing or vision impairment

Elderly mentally infirm

Mental health problems

Substance misuse problems

4.4 The POVA team will review data along with Adult Services Divisional Management Team and the Caerphilly Area Adult Protection Committee (AAPC) thus providing opportunity to identify trends and target responses.

5. Model of the service

5.1 All POVA referrals are directed from ASDIT to the POVA team who coordinate all responses through the use of the POVA process.

5.2 Adult services ensures that there are strong links between the assessment / care management service and the POVA team in order that there is good communication and joint working to ensure the vulnerable adult is supported during the POVA process and longer term where appropriate.

5.3 To maximise the protection of vulnerable adults the team will continue to operate a strong preventative focus through reviewing individual case situations, sharing lessons learned from practice within and outside of the team and through the team awareness raising strategy.

6. Operational Procedures

6.1 The POVA team will use a range of mechanisms to operate its protection service:

6.2Internal Communication

Internal communication - The team benefits from a range of systems to communicate and develop. Team meetings coordinator meetings and administrative meetings will continue to be held monthly. The team will liaise with adult service colleagues through Extended Divisional Management Team (XDMT) meetings and management briefing on a quarterly basis. The service manager will attend the assessment care management bimonthly meeting.

6.3 External communication

The POVA coordinators will continue to represent the team at the Commissioning Provider forums (small care homes, residential and domiciliary care) and will chair each of the three Area Adult Protection Committee subgroups (Education and training, Performance Review and POVA Practice Improvement Forum).

7POVA Duty system

The POVA coordinators operate a duty system where by one staff is available each day to provide both telephone advice and email (via POVA mail box) internally and externally regarding concerns and referrals. A record is maintained within the team and the SWIFT electronic service user record database. Where it is identified following discussion that a referral is required the caller is usually directed to ASDIT to share the specific personal details that are required for the completion of the Wales Interim POVA Policy referral form. The POVA advice process is set out below:

8 Allocation of POVA referrals

8.1 Referrals will be forwarded to the team from ASDIT using the POVA referral

form. The duty POVA coordinator will assess the level of risk on receipt of the

referral, determine the priority and allocate to a POVA coordinator.

8.1 The POVA team will work across Caerphilly, with a total adult population of

133,994 (2010 mid year). Cases will not be allocated on a service user group,

service setting or geographical basis, rather POVA coordinators consider trends, current caseload previous involvement and the level of training awareness and development work they are involved in as factors to determine the allocation of work.

9 POVA referral thresholds

9.1 Key factors will be considered and a peer / strategy discussion held to

determine the appropriateness of the referral. The following information provides points for consideration to guide practitioners’ decision-making in relation to concerns and referrals of abuse and neglect.

9.2 When concerns are raised and it is not clear whether significant harm has

occurred it may be useful to discuss the detail to ensure the any referral is forwarded to the most appropriate department and arrives without delay, this may result in an allocation to the social worker, signposting to another organisation or provider, forwarding information to contract monitoring or customer services staff or indeed the completion of a POVA referral.

9.3 Discussion of the concern may take place firstly between the individual and

their:

1. Line managers in provider services
2. Senior social worker or Team manager
3. Customer services
4. POVA team coordinators - if it is felt that significant harm may have occurred

9.4 Threshold Principles

• Is the person referred a vulnerable adult?
• Is it abuse/neglect?
• Is it significant harm?

9.5 A strategy discussion or meeting will be held if any of the

following are noted:

• Several people / agencies have concerns and sharing information

will help decision-making.

• Other individuals may be at risk.
• Several agencies may need to take action.
• A criminal investigation is considered.
• Other legal or regulatory action may be taken.
• One or more members of staff have been implicated / suspended.
• The issue may attract media attention because of its public interest.

9.6 The consideration of significant harm is challenging due to the nature of individual perception and impact upon the service user and their representatives. The Wales Interim Policy and procedures for the Protection of

Vulnerable Adults from Abuse (November 2010) provides the following

information to assist the identification of significant harm:

• Ill treatment [including sexual abuse and forms of ill treatment that are

not physical];

• Impairment of, or avoidable deterioration in physical or mental health;
• Impairment of the vulnerable adult's physical, intellectual, emotional,

social or behavioural development.

• Significant harm may come about because of a series of incidents that seen

in isolation do not seem significant, but when repeated become serious.

9.7 The POVA policy promotes shared decision making and the Caerphilly POVA

team implements this principle through discussion of referrals:

• At the point of referral to the POVA Team - POVA coordinator hold discussions with their peers within the team, area social work team managers and / or the service manager for the protection of vulnerable adults
• During strategy discussion and strategy meeting with multi agency partners.

9.8 Where the issue of significant harm is not clear the discussion and resulting

decision will take account of following points:

• Does the referral relate to a Provider who is being monitored via Provider performance monitoring process or discussed due to concerns being raised regularly at the monthly Quality Assurance meeting or under provider performance monitoring process?
• Does the data collected by the POVA team (POVA referrals received or enquiries to POVA duty officer or advice given) indicate a trend of increasing concerns (organisation, care home setting, alleged perpetrator)?
• Is this a repeat referral or an escalation where POVA concerns have previously been reported in relation to this service user?

9.9 Consent by the vulnerable adult to a POVA investigation.

Where the vulnerable adult does not consent to a POVA investigation and there are no risks to other vulnerable adults or children, there are no paid carers involved and no public interest points, the referral will not be progressed. Other courses of action may include signposting back to care management or other organisations such as advocacy, domestic abuse. As the POVA referral form has been completed a case management record and data collection form will be also be completed. An adult protection plan or general action plan may also be drawn up.

However consent may be overridden in cases of public interest where other vulnerable adults or children are at risk or the alleged perpetrator is a paid carer.

9.10Capacity and consent in relation to the POVA process

In the ethos of the Mental Capacity Act, capacity is assumed unless stated otherwise.

ASDIT staff will seek clarification in relation to capacity and consent while on the phone taking the information that forms the POVA referral. The following points of information required are:

• Is the vulnerable adult aware of the referral?
• Has the vulnerable adult consented to the referral?
• Is there any evidence to suggest that the vulnerable adult lacks mental capacity to consent to this referral??

9.11Investigation

Some cases may progress from POVA referral / strategy discussion to investigation with immediate protection steps put in place via an adult protection plan. An example of this may be where police are involved very early on and immediately begin an investigation.

This decision is taken between the local authority and another agency partner and is documented on the case management record. The terms of reference for the investigation are confirmedin ane-mail to the investigating officer. The investigation report must be provided to the Designated Lead Manager (DLM) 5 days in advance of the meeting for the DLM to review as part of preparation for the meeting.

9.12Points to consider in relation to the following types of referrals:

9.12.1Medication Omission

-Length of omission

-Frequency of omission

-Underlying condition

-Impact of missed medication / significant harm

-Type of medication

-Falsifying documentation

-Trends in the organisation

9.12.2Missed domiciliary care calls

- Length of time

- Number of missed calls

- Impact

- Achieved late calls or just consider missed

- Trends with the domiciliary care agency

9.12.3Domestic abuse

- Current pattern of abuse

-Historical patterns

-Recent referral re alleged perpetrator type

-Level of harm consider psychological harm where no visible marks

-Injury – abrasion /bruising

-Drug / alcohol / mental health issues

-Witnesses

-Explanation given

(This protocol was agreed in July 2009 and is reviewed annually as part of this operational policy)

10 Extraordinary cases

10.1Service manager (POVA) and POVA coordinators discuss referrals during monthly supervision sessions and POVA coordinators seek informal advice on case practice as and when required. However it was felt there are particular cases that would need to be immediately brought to the service manager attention.