Safeguarding Adults and Children

Safeguarding Adults and Children

Annual Report

2013- 2014

Produced by:

Tracy Luckett

Director of Nursing & Allied Health Professions

Board of Directors Meeting

(26th June 2014)

1.0 Introduction

This report outlines the work that has been undertaken by the trust over the past year (April 2013 -March 2014) in respect of its responsibility to protect and ensure the safety of children and adults at risk who receive healthcare within the organisation. The report highlights progress against objectives within the work plans and provides an overview on the trust’s position against statutory requirements.

2.0 Safeguarding Adults

Definition of adult at risk:

An adult aged 18 years or over may be at risk if they:

are elderly or frail due to ill health, have a physical disability or cognitive impairment

have a learning disability

have mental health needs including dementia

are unable to demonstrate the capacity to make a decision and are in need of care and support

have a long term illness/condition

are subject to abuse (domestic violence)

The London multi agency policy sets out the principles and values that organisations should adopt.In summary the main points include a duty to:

report in a timely way any concerns or suspicions that an adult at risk is being or is at risk of being abused

ensure that the dignity, safety and well-being of the adult at risk is given priority

work under the guidance of their own internal operational procedures

ensure staffare familiar with policies, know how to recognise abuse and how to report and respond to it.

2.1 National policy guidance

The trust continues to work within the remit of regulatory guidance and within the last year has embedded the guidance included in the NHS England publication Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework NHS Commissioning Board. The safeguarding group is tasked with the implementation and monitoring of standards specified by the Care Quality Commission ‘Our Safeguarding Protocol’, specifically Outcome 7 – Safeguarding people who use services from abuse. The group also supports the delivery of the borough’s strategydriven by Islington’s Safeguarding Board;this is currently a non statutory board although this will change due to the recent legislation and publication of the Care Act.

2.2Safeguarding Adults Assurance Framework

The Pan London policy was supported by the introduction of the Department of Health policy Safeguarding Adults: TheRole of Health Service Managers and their Boards which sets out the six key principles that health care organisations should work towards:

Empowerment

Protection

Prevention

Proportionality

Partnership

Accountability

Following the publication of this document healthcare organisations were requested to complete a self- assessment document to assess the compliance against the key principles. In 2012 the Trust completed a selfassessment and the process was repeated in early 2014. It was encouraging to report that areas highlighted as needing improvement had been actioned; namely strengthening the supervision arrangements for staff who are involved in complex cases and improve training compliance across the organisation.

The 2014 audit reflected areas of good practice, such as the Trust has a robust policy that outlines the roles and responsibilities of staff in relation to safeguarding. The audit did identify areas for improvement that posed a challenge to all NHS organisations in the sector. This included:

Integration of the PREVENT strategy (protecting patients and staff who may be a target for radicalisation) into the Trust’s safeguarding policy.

To be more inclusive with service users; ensuring that lessons learned are disseminated to patients and carers in addition to staff.

Monitoring compliance against the outcomes of the safeguarding assurance audit is included in the 2014/15 work plan.

2.3 Islington Safeguarding Adults Board

As part of the trust’s adult safeguarding responsibilities it is required to provide representation on the local multi-agency safeguarding adults’ board. The trust is currently represented on the Islington board by the Director of Nursing and Allied Health Professions, who is also the trust’s executive lead for safeguarding.

As the Moorfields representative on the board, the Director of Nursing plays a key role in the decision making processes around the development of local policy, specifically related to healthcare, and provides the board with assurance about the safeguarding arrangements within the trust.

The trust also provides representation on the board sub committees, including the education and training sub committee.

The Board is committed to achieving its objectives set out in the 3 year strategy ‘Making our Vision Real 2013-16’ The strategy is based on the six key principles that form the composition of the SAAF.Each Board partner has pledged their commitment to working towards the six principles

Moorfields has recently provided a presentation to the Board that detailed the progress to date on our commitment to keeping our patients free from harm and reporting and acting on possible cases of abuse. The presentation also made reference to the national nursing strategy – the six Cs,highlighting two areas of action ‘Quality Assurance and Compassion’. The presentation was well received by partner organisations.

2.4Moorfields Safeguarding Adults Group

The trust’s safeguarding adults group meets bi-monthly.Its remit is to support the implementation of national and local policy and provide assurance that there are effective systems in place to protect adults that access our health services, who may be at risk of abuse. The group’s membership includes representation from nursing, medical, operational management, facilities and the human resource department.The meeting is also attended by the Adult Safeguarding Lead from Islington Council. The group reports to the Clinical Governance Committee.

2.4.1 Achievements against work plan for 2013 – 2014

The work plan concentrates on achieving the following outcomes:

Effective communication and sharing of information

The application of a robust policy

Identifying concerns and acting on them

Improving the knowledge base of Moorfields staff

The work plan also incorporates actions identified in the Safeguarding Assurance Framework.

Achievements within year include:

Development of a Domestic Violence policy and the production of a patient information leaflet detailing support services for victims of domestic abuse.

Introduction of clinical supervision for staff who regularly deal with safeguarding cases

Introduction of support sessions for dementia link nurses.

Achievement ofthe training target as part of the UCLP dementia awareness campaign and subsequently awarded a good practice award.

Introduction of a transport monitoring meeting; this has resulted in changes to the transport booking procedure which has reduced the waiting time for patients transport.

Audit

Within the year the team have audited staff awareness of safeguarding policies. A paper questionnaire was sent to a random selection of 200 staff. The response rate was 27%.

The results demonstrated that 76% of staff were aware of the Trust policy and knew where to locate it.

96% of staff indicated that they knew how to complete a safeguarding alert form and who to speak to if they needed to raise a concern.20% requested additional awareness about safeguarding, including training. The responses,albeit from a small sample, demonstratethat there is a general awareness of where to locate the safeguarding policy and who to contact for advice. The group is currently exploring alternative methods to increase response rates in preparation for a future audit.

2.5Safeguarding adultalert referrals

The trust lead for safeguarding received 54 alerts during 2014/15,similar to the 2012/13 figures.

There has been a slight decrease in referrals from City road; 42 this year compared to 46 reported in 20123/13. Likewise the satellite sites reported 12 cases this year in comparison to 8 in the previous year.

There has been a smallincrease in telephone queries asking for support with issues pertaining to mental capacity and consent and wider social issues such as assistance with financial or housing support. This information is helpful as it provides the safeguarding adults group with intelligence that helps agree priority actions for the forthcoming year. For example, the group will focus on raising awareness of how to assess mental capacity as part of the 2014/ 15 work plan.

All referrals are reviewed by the adults safeguarding lead. A decision is then taken whether the referral should be referred to the appropriate social servicesor referred to other agencies such as a general practitioner, mental health services,district nurses and in cases of domestic violence, the police.

Between 2013-14 twenty nine referrals were made to social services, compared to13 the previous year. The increase suggests that staff have a better understanding of the referral process and are more confident in their communication with patients, therefore providing better quality referrals. An on-line safeguarding incident reporting system is now fully operational and has the ability to provide immediate feedback on the outcome of alerts.

2.5.1Alert Types

21 referrals were for cases of domestic violence

10 referrals were for neglect

 7 referrals were for physical abuse

 5 referrals were for psychological abuse

 5 referrals were made for mental health issues

The above alerts make up the majority of referrals. There are also alerts pertaining to self-harm, financial abuse and social isolation.

All incidents and referrals are discussed at the safeguarding adult’s group andfeedback is sought from the relevant borough social services. During 2013-14 the trust was not required to attend any strategy meetings.

2.6 Training

During 2013 a greater emphasis has been placed on improving training compliance.

The below graph demonstrates improved compliance with training and in April 2014 the Trust achieved the 80% target although there is an expectation to improve this performance during 2014

The current training provision consists of:

Introduction to adult safeguarding for all new staff, this is delivered on general trust induction and included on medical induction.

Face to face training, accessible on the annual clinical update. ad-hoc sessions delivered throughout the year including updates at the trust’s clinical governance half day.

The training content includes consent and mental capacity, domestic violence and PREVENT. Current training guidance states that all staff should undergo training every 3 years. Staff should also be kept updated on significant changes to policy and practice when necessary.

2.6.1Dementia training initiative

In addition to generic safeguarding training the trust has also delivered dementia training to 670 staff(37% of the workforce).This training initiative, driven and supported by UCL partners is part of the NHS England campaign to raise dementia awareness. The trust’s target was to train 15% of the workforce. The training initiative will continue during 2014 and the training package featuring ‘Barbara’s story’ has been incorporated into the trust’s clinical governance days.

2.6.2External training

Trust representatives have participated in mental capacity training and the trust now has representation at the Violence against Women and Girls network meetings. The safeguarding lead has also attended multi agency training delivered by the local borough.

2.7 Mental capacity and deprivation of liberty

The deprivation of liberty safeguards first came into force on the 1st April 2009. These legal safeguards are designed to protect patients who lack capacity to make an informed decision regarding treatmentorcare. Trusts are obliged to follow an application process if they wish to treat such a patient. The process is managed by the relevant local authority lead who will liaise with the courts in the event of an application from the trust.

In early 2014 the Supreme Court published its judgement on a case (known as the Cheshire West case) concerning the deprivation of liberty of three individuals in care homes. As a consequence of this judgement an ‘acid test’ has been introduced for what now should constitute a deprivation of liberty.

This can include any individual who is under continuous supervision and is not free to leave. This may have consequences for hospitals and care homes where adults require long term support with their healthcare needs. To date the trust has not submitted any applications under the Act. This isentirely in line with the expectations of the local authority lead, given the trust’s model of care.

2.8Learning disabilities

The Learning Disability patient passport is well embedded in the organisation and is fundamental in ensuring that patients receive individualised care. Passports are introduced at the initial visit and prompt an alert on the Patient Administration System (PAS). The patient is then ‘flagged’ on the system as someone that may require additional assistance. Patients who attend as emergencies are usually referred to the relevant nurse specialist and thelearning disability champion for that specific area. Easy read patient information material is available for patients who attend out-patient clinics and those that require surgery.

2.9 Dementia

Moorfields has signed up to the Dementia Action Alliance (DDA) which commits the trust to supporting patients and their carers to the best possible experience when using our services.

Patients with dementia are supported through their care episode by the use of Personal Information for the Patient with Dementia (PIPD) assessment documentation.

In September 2013 the Trust engaged with Health Education North Central London and UCLPartners in a joint initiative to deliver dementia awareness training to frontline staff. The aim ofthe initiative was to train 15% of frontline and within the year; the trust achieved 37%.

The training programme will continue into 2014/15.

The Trust promoted Dementia Awareness week by facilitating a dementia awareness raising event during January. The event, held at City road included participation from the Alzheimer’s Society Islington, Age UK Islington and Islington Carers Hub.

3.0Safeguarding Children

The trust continues to work hard to protect children and adolescents who may be at risk of abuse and the named professionals provide assurance that the organisation has robust systems and processes in place to protect children when in our care. The revised ‘ Working Together to Safeguard Children’ publication, published in 2013 continues to endorse the importance of working closely with other agencies and ensuring that adequate governance processes are in place to identify and act on concerns.

3.1Islington Safeguarding Children Board

One of the trust’s responsibilities in relation to safeguarding children is to provide representation on the local multi-agency safeguarding children’s board. The trust is currently represented on the Islington board by the Director of Nursingand Allied Health Professions who is also the trust’s executive lead for safeguarding children. This is a statutory role.

As the Moorfields representative on the board, the Director of Nursing and Allied Health Professions plays a key role in the decision making processes around the development of local policy, specifically related to healthcare and provides the board with assurance on safeguarding arrangements within the trust. Within year the board has reviewed agencies’ compliance against the Section 11 Self-Assessment tool (a document that measures an organisation’s effectiveness against the key principles set out in the Children’s Act 2004).Moorfields was noted to perform well against this audit. The trust is also represented on the board’s training subcommittee.

Within the last year the trust has submitted three documents to the board for review:

progress against the Board’s five priorities

review of the Section 11 audit

audit of training compliance

The five priories incorporate the core board business, domestic violence, neglect, early intervention;focussing on parents with learning difficulties and evaluation of the effectiveness of training. Examples of the trust’s progress with the priorities includes following up families who fail to bring their child for essential treatment as this can be a sign of neglect. The paediatric team have also adapted the trust “Welcome” booklets for parents with learning difficulties.

With regards to compliance, the Section 11 audit encompasses the standards that should be in place to reduce the risk to children and therefore protect them from harm. A recent audit review confirmed that the trust was compliant with six of the eight standards and is working towards achieving the remaining two.The outstanding work includes updating the complaints policy to include a section on children and young people. There is also a standard on the effectiveness of training, which includes monitoring the compliance levels.

3.2Moorfields Safeguarding Children’s Group

The trust has a responsibility to ensure we achieve compliance with relevant national policy and we have systems and processes in place to reduce the risk to children. The trust’s safeguarding group remains active and is well attended byboth clinical and managerial staff. The designate nurse for NHS North Central London Commissioning group(Islington) is also a member of the group and acts as a critical friend both in terms of providing clinical expertise and constructive challenge.

The groupmonitors the trust’s progress against the implementation of its work plan, identifies potential risks in relation to safeguarding and acts as a conduit between the local safeguarding board and the trust board. The group also reviews every safeguarding concern form that is submitted to the named professionals.The trust is also required to submit a quarterly monitoring template to the Islington commissioning support unit who review and assess our performance against core standards. The group reports into the Clinical Governance Committee.