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Directorate of Social Care and Children

OVERVIEW DELEGATED STATUTORY FUNCTIONS

REPORT

APRIL 2012 – MARCH 2013

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CONTENTS

Page No

Introduction

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Background

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Reporting

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Children’s Services

1. Children in Need 2. Child Protection 3. Looked After Children 4. Leaving and Aftercare, Young Homeless,

Separated Children 5. Adoption Services, including Intercountry

Adoption 6. Early Years Services 7. Children Order - Complaints and

Representations

8 8 9 10 16

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19 21

Mental Health and Learning Disability Services

1. Key Challenges 2. Analysis of Trust Reports 3. Data Tables 4. Issues specific to Trusts – Mental Health

Services 5. Issues specific to Trusts – Learning

Disability Services

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22 22 25 25

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Older People and People with a Physical Disability or Sensory Impairment

1. Introduction 2. Key Challenges 3. Programme Specific Issues 4. Analysis of Trust Reports

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28 28 31 34

Adult Safeguarding

1. Belfast HSCT 2. Northern HSCT 3. Southern HSCT

39 39 42 44

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4. South Eastern HSCT 5. Western HSCT

46 49

Conclusion

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Introduction This is an overview report, prepared by the Directorate of Social Care and Children detailing the requirements, processes and issues arising within Health and Social Care Trusts as reported under the Scheme for the Delegation of Statutory Functions. The Health and Social Care Board (HSCB) and Trusts apply a set of principles to govern the Discharge of Statutory Functions. These state that the Discharge of the Delegated Functions should:

minimise disruption to existing arrangements for service delivery;

ensure clarity as to who is actually responsible on the ground in any particular case;

be consistent with the strategic commissioning role of the HSCB; and

Preserve the operational freedoms of the Trusts.

The individual reports submitted by each Trust are available, but they represent only the beginning of a process of dialogue with the Trusts that continues throughout the year. Action notes and documented progress notes are produced and agreed with each Trust and updated throughout the year. This report provides the HSCB with an overview of the current issues and is supplemented by a statistical report which is appended. Background The Scheme for the Delegation of Statutory Functions sets out the arrangements between the Health and Social Care Board (hereafter referred to as the ‘Regional Board’) for the discharge, under The Health and Personal Social Services (Northern Ireland) Order 1994 of relevant Personal Social Services (PSS) functions by Health and Social Care Trusts on behalf of the Health and Social Services Boards. These functions were transferred to the Health and Social Care Board under Section 24 of the Health and Social Care (Reform) Act (Northern Ireland) 2009. The Scheme describes the fundamental principles, values and accountability relationships which will underpin the delivery of services. It specifies within the Personal Social Care Services programmes of care, including general services to people in need,

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the powers and duties which the HSCB has delegated to the Trusts. To assist the implementation of the 1994 Order, the Department of Health, and Social Services and Public Safety (DHSSPS) provided guidance on the accountability framework and on the arrangements which should exist between the Department, Boards and Trusts. This has been supplemented by the guidance set out in the Departmental Circular, HSS (Statutory Functions) 1/2006: Responsibilities, Accountability and Authority of the Department of Health, Social Services and Public Safety, Health and Social Services Boards and Health and Social Services Trusts in the Discharge of Relevant Personal Social Services Functions to Safeguard and Promote the Welfare of Children. Whilst the Circular deals specifically with children’s services, the accountability relationships and responsibilities of the Department, Boards and Trusts described in paragraphs 4.1 to 5.12 of the aforementioned Circular, hold true for the discharge of all PSS functions by each of these bodies.

Accountability is a key element in the Discharge of Statutory Functions and is part of the main provisions within the Scheme. Trusts, as corporate entities, are responsible in law for the discharge of statutory functions delegated to them. The HSCB is responsible for commissioning services to meet the needs of their populations and spending monies allocated to them to secure the delivery of Health and Personal Social Services in line with the Scheme for the Delegation of Statutory Functions. The 1994 Order requires the Trust to specify how it will discharge statutory functions in line with Departmental and HSCB guidance and current good practice. The Trust is accountable to the HSCB for the effective discharge of statutory functions delegated to them as well as the quantity, quality and efficiency of the service it provides. The HSCB also has a role in quality assuring the discharge of those relevant functions which they have delegated to Trusts. The HSCB and the Trusts have adopted a partnership approach to promote the welfare and safeguarding of children and vulnerable

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adults and maintains its responsibility to keep the Department informed of the outcome of the quality assurance arrangements in respect of Trusts discharge of relevant functions. Reporting The HSCB has agreed the monitoring arrangements with the Trusts together with the information that will be provided and at what intervals. The HSCB requires that the Trusts will produce an annual report in the specified format on how the Trust has discharged their functions no later than the end of May each year. The HSCB has also agreed arrangements to ensure that at the mid-point of the year the Director of Social Care and Children receives a report from the Trust Social Care Governance Officer on behalf of the Executive Director of Social Work. This report highlights issues and trends and in particular drawing to the Director’s attention any emerging breaches of statutory functions which require immediate action, updates on the Trust Risk Registers and the reporting requirements under Corporate Parenting duties as specified in Departmental Circular CC3/02. This interim report is due in October 2013. Within the reporting year 1st April 2013 to 31st march 2014 a series of reporting requirements will become quarterly. This will provide for more timely data, and relieve some of the burden experienced by Trusts as they complete the bi-annual Corporate Parenting report. These changes are being introduced in parallel with the ongoing review of the Departmental Circular CC3/02.

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CHILDRENS SERVICES

In compiling this section the Health and Social Care Trusts have provided data and information reflecting the duties outlined in DHSSPS Circular CC3/02 ‘Roles and Responsibilities of Directors for the Care and Protection of Children’. Commentary and analysis will therefore focus on the following service areas:

Children in Need, including children with disability, child and adolescent mental health services (CAMHS), young carers and unallocated cases;

Child Protection;

Looked After Children; this will comment on children in residential child care and foster care;

Care Leavers;

Adoption Services, including Inter-country Adoption;

Early Years Services; and

Representations and Complaints. 1. Children in Need

1.1 Referrals

Activity remains high across each of the Health and Social Care Trusts. Regionally, 24,473 children are reported as ‘children in need’, of whom 4,361 are children with a disability (17.8%), the majority of whom have a learning disability.

The number of unallocated cases within Trusts is constantly monitored and the position continues to improve. The continued progress over the past 12 month’s shows a position of 236 unallocated referrals. The highest number of unallocated cases at 31st March 2013 is within the Northern Trust (91) and the lowest within the South Eastern Trust (5).

Trusts advise they have no unallocated child protection cases.

1.2 CAMHS

All Trusts, with the exception of the Southern Trust reported a number of breaches of the 9-week allocation target for CAMHS during the reporting period. Trusts were subsequently required to

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implement an action plan to address the issue, at year-end the total number of breaches across the region had reduced from 192 at April 2012 to 29 at March 2013, a fall of 163 (85%).

2. Child Protection

2.1 Definition of Child Protection Register The HSCB continues to collate and monitor statistical information from each of the 5 Trusts on a quarterly basis. Data is shared with the Safeguarding Board for NI to assist it with the discharge of its duties.

Each Trust is required to keep a register of every child in its area who is considered to be suffering from, or likely to suffer, significant harm and for whom there is a child protection plan. The register is a list of children who have unresolved child protection issues and who are currently the subject of an inter-agency child protection plan (Source: Regional Child Protection Policy and Procedures, Section 7.1). 2.2 Child Protection Register

At the 31st March 2013, there were 1,961 children, whose names were on the register. This compares to 2,127 in March 2012, equalling a fall of 7.8%. Nationally, NI has the 2nd highest rate of registrations per 10,000 (45.52) of the 0-17 year population, Wales being the highest (45.63) and Scotland the lowest with 29.63. (The rate for Scotland relates to the 0-15 population). All Trusts, with the exception of the Northern Trust, had by 31st March 2013 moved to a single point of entry for Gateway Services, the aim being to improve service, consistency of response and interpretation of threshold criteria. The Northern Trust has indicated that they are experiencing difficulties in securing an appropriate facility, which has resulted in some delay. During the reporting period, 1,877 children were registered while 2,041 were deregistered; this activity is indicative of the on-going high volume of work undertaken by staff.

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2.3 Register Characteristics The Belfast, South Eastern and Southern Trusts have seen a year on year reduction from March 2010. The 2012 rise within the Western Trust is attributed to a number of contributory factors e.g. family size, the economic climate, these factors continue to influence the numbers of children whose names are on the register. Registrations continue to increase within the Northern Trust (30% of NI total).

Of the 1,961 children on the register at 31st March 2013 the highest age category was within the 5 -11 years age group (36%).

There were 26 children registered who have a disability (1.3%) the majority of whom had a learning disability. This number is considerably lower than the general population. This has been discussed with Trusts in order for the HSCB to be assured that safeguarding issues for children with a disability are being picked up and responded to.

The majority of children’s names remain on the register for less than 12 months - 69%, 28% of children’s names remain on the register for 1-3 years, with 3.5 % remaining on the register for 3+ years.

Of those children on the register for 3+ years the highest number are within the Belfast (21) and South Eastern Trusts (26).

All children on the Child Protection Register have a child protection plan and an allocated Social Worker.

The ethnicity of children registered also requires examination bearing in mind demographic changes and the need to ensure services are targeted and appropriate, greater attention needs to be paid to this requirement.

3. Looked After Children

3.1 Looked After Children - Population

At 31st March 13, there were 2,807 children looked after by Trusts an increase of 163 on the previous year. This is in keeping with an upward trend evident from 2001/02.

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The largest number of children looked after are within the Northern Trust (701) which has the largest 0-17 population. During the reporting period the Trust also had the most children discharged from care. A number of factors may contribute to this e.g. good care planning and early discharge, a high number of young people ageing out of the care system or the operation of a lower threshold for admission to care. Scrutiny is required by the Trust in order to ascertain the reasons for this. In contrast, the Southern Trust which has the second largest 0-17 population has the lowest number of children looked after while the Belfast Trust has the lowest 0-17 population has the 2nd highest number of children looked after.

3.2 Looked After Children - Placement

The majority of looked after children resided in foster care (75.2%). The configuration of placements continues to evolve with a reduction in children in residential care and an increase in those living in kinship foster care:

children placed in ‘Stranger’ (non-kinship) foster care has reduced by 1.6% (total 39.4% of children in care)

Placements with kinship foster carers has risen by 1.3% (30.8% of children in care).

There has also been an increase in terms of placements is within the Independent Sector, which is up from 3.1% to 5% of placements; the highest numbers being in the Northern and Belfast Trusts.

At 31st March 2013 there were 217 children residing in residential care (7.7%) compared with last year’s figure of 8.7%. The smallest number is within the Southern Trust (22), followed by the Northern and Western Trusts with 42 children. This reduction is indicative of compliance with Transforming your Care direction of travel.

The number of children looked after who are also subject to child protection procedures has reduced from 219 in 2011/12 to 189 in 2012/13. The highest number of children on the child protection register and looked after is within the Northern Trust (50) approximately 26% of regional total.

Overall, this indicates adherence to the Guidance on Protecting and Safeguarding Looked after Children 2010, which seeks to minimise the number of children who are subject to both child

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protection and looked after children procedures. Compliance within the Northern Trust is still some way behind and continues to be closely monitored by board officers. 3.3 Looked after Children - Legal Status

The majority of children looked after are subject to Care Orders. The highest numbers are within the Northern Trust while lowest within South Eastern and Western Trusts.

Some 16.4% of children are subject to Interim Care Orders while 27% of children are Accommodated the largest number being within the South Eastern Trust (208).

The progression of cases via legal proceeding acknowledges the Trusts’ requirement to have parental responsibility and affords an opportunity for scrutiny of the Trusts’ interventions.

3.4 Looked After Children -Religion and Ethnicity

Reporting in relation to religion and ethnicity needs to improve regionally, in order to ensure the recruitment and placement of children with foster carers meets the religious and cultural needs of the children.

3.5 Looked after Children - Placement Stability

In terms of placement stability, there is a regionally improved picture on last year, with the majority of children reported to be in settled placements.

In relation to children reported to have experienced 4+ moves (189) 86 are within the Northern Trust and 74 within the South Eastern Trust. This is in sharp contrast to the Southern Trust who report only 2 such moves. Discussion is required regionally to clarify if this variation is due to the interpretation and reporting of data or issues relating to sufficiency of placements and the capacity for better matching of children and foster carers.

3.6 Looked after Children - Offending behaviours

Regionally the number of LAC cautioned/remanded has fluctuated over the last 3 years despite the best efforts of Trusts and partner agencies who seek to prevent offending and support young people who are particularly vulnerable to such behaviour.

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In the last year to the 31st November 2013, 169 Looked after Children received a caution or were remanded and 97 were convicted.

3.7 Looked After Children - Education

The number of children with a Statement of Special Educational Needs has risen in the past 12 months by 84. There is an increase in children with statements in primary school.

Educational attainment remains similar to previous year’s figures. Personal Education Plans (PEPs) aimed at sustaining a focus on the educational journey and attainment of children looked after have been introduced with a requirement that all looked after children will have a completed plan by June 2013. Progress to date is positive. 3.8 Looked After Children - The Review of Arrangements

It is a legal requirement that the arrangements for each looked after child is reviewed. Reviews should occur within two weeks of a child becoming looked after, three months after this initial review and at six monthly intervals thereafter. Each Trust has a Permanency Panel established to ensure that children have a plan for permanence in place by the first 6-month review.

The Northern Trust who has the highest number of LAC (701) report carrying out the lowest number of LAC Reviews (931). If this figure is correct, this would suggest that children are not being reviewed as required or that a significant number of children leave care very quickly before reviews are held. Notably the Northern Trust also has the second highest number of reviews held outside of the timescale. This is a deteriorating picture within the Trust.

Regionally the number of Children’s Reviews being held outside of the statutory timescale has fallen over the last 3 years i.e. from 260 at 31/03/11 to 193 at 31/03/13 despite the number of children who are looked after rising. The Belfast, South Eastern and Southern Trusts show clear year on year decreases in overdue reviews, with the most significant improvement evident within the South Eastern Trust. The Western Trust has fluctuated from 80 in 2011, to 109 last year and 74 this year. Last year the Western Trust put in place new arrangements for monitoring reviews and permission to cancel a review had to be obtained from a senior manager. This arrangement proving effective in terms of reducing

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overdue reviews. The Northern Trust number of overdue reviews remained the same for 2011 and 2012 (31) however, this year numbers have increased by almost 100% (61).

3.9 Foster Care Population Data

Regionally, there are 2,125 registered fostering households providing 2,977 foster placements, of these 910 are stranger carers (offering 1,348 placements) and 727 kinship foster carers (offering 914 placements). Dual approved carers and those providing placements for young people aged over eighteen years who had previously been looked after provide the remaining households/placements.

Trusts endeavour to place siblings groups together unless this is contrary to the best interests of the children or where Care Plans differ. Access to resources or the express wish of parents or kinship foster carers may also lead to separation. The number of sibling groups accommodated together has increased regionally in the last 12 months. From 226 at March 2012 to 301 May 2013. There are 566 reported sibling groups which is an increase on the previous year.

Regionally there are 383 vacant foster care placements:

Kinship 24

Stranger 242

Dedicated 25

Dual Approved 92

Vacant placements may occur for a number of reasons: from approval criteria not currently meeting the needs of those children requiring a placement; to foster carers taking a break between placements; to registration suspended due to the investigation of a complaint/allegation. Trusts also report that the complex needs of some children are such that they require to be the only child in a placement resulting in technical vacancies.

Trusts report ongoing pressures in terms of the recruitment of foster carers, and three of the 5 Trusts remain reliant on the purchase of placements from the Independent Sector at 31st March 2013. A working group chaired by the Deputy Director of the Belfast Trust is carrying out an analysis of the situation with the hope of securing rates that are more competitive.

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In July 2012 the DHSSPS launched Minimum Kinship Care Standards for NI. Trusts advise that the new requirement to have all assessments approved by Trust Fostering Panels, ensure support for kinship foster carers from the start of the caring arrangement; together with the volume of referrals cannot be met within existing resources or by the reconfiguration of staff. It is of note that the vast majority of kinship fostering placements are immediate or emergency placements and therefore demand priority in order to promote safeguarding.

Trust reports show that not all foster carers are receiving an annual review as required. The annual review affords an opportunity to; reflect on the previous year and any issues arising in placement; review the development needs of the carers, and to consider the nature of approval moving forward. The position at 31st March 2013 showed an increase of 50% (109 to 164) from the 31st March 2012. This is accounted for by the position in the Northern Trust which showed an increase of outstanding reviews from 23 at 1st April 2012 to 99 at the 31st March 2013.

The Northern Trust report that almost 50% of the Reviews outstanding arise from within one particular team which has experienced on-going staff shortages. In addition increasing demand for assessments both traditional and non-kinship fostering has contributed to delays.

Increasing demand for assessments, staff illness and backlogged in terms of demands on fostering Panels are also reported as pressures by the other Trusts.

3.10 Private Fostering

In 2011/12 the DHSSPSNI issued an updated circular in respect of Private Fostering notifications outlining the duties and responsibilities of professional agencies. Trusts undertook to raise awareness within their Trust area and to keep this under review. The number of reported situations remains low; consequently Trusts need to further heighten awareness across a multidisciplinary and multiagency audience.

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4. Leaving And Aftercare, Young Homeless and Separated Children

4.1 Aftercare Population

At 31st March 2013 there were 1,388 young people who were subject to Leaving Care Legislation an increase of 120 on the previous year

At 31st March 2013, 226 young people were reported regionally as not having a personal adviser compared with 191 at March 2012. The number of young people without a personal adviser rose in all Trusts with the exception of the South Eastern Trust where significantly fewer young people are reported not to have a personal adviser. Qualifying young people have been included in some Trust figures as not having a personal adviser thus inflating numbers as there is no entitlement to a personal adviser for qualifying young people.

There is an improved position in relation to young people without a Pathway Plan with the Northern Trust showing notable progress.

In terms of those young people without a completed Needs Assessment progress has been made to reduce the numbers of young people without an assessment, at 31st March 2013 the figure was 22 compared to 42 at March 2012. The largest improvements being within the Northern Trust were the number reduced from 23 to 5 young people.

4.2 Care Placements

The majority of eligible young people reside in mainstream care placements; the highest number in residential care with a small number residing in jointly commissioned young adults’ supported accommodation. Four of the five Trusts (South Eastern report a nil return at the 31/3/2013) continue to have young people residing in unregulated placements.

4.3 Young People in Education, Training or Employment Each Trust has in place employability services that work with young people and employers to secure employment and learning opportunities. The Regional Employability Forum chaired jointly by the Director of Social Services HSCB and the Director of DEL oversees this work.

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The Belfast Trust has the highest number - 99 (36%) of former relevant young people who were not in ETE i.e. not engaging in education, training or employment. The Trust also reports the highest number of 16 Plus young people with learning a difficulty.

The South Eastern Trust has the second highest number of former relevant young people who are ETE inactive at 43 or 17%. This compared favourably with Belfast (36%), Northern (24%) and Southern (20%) of young people were not in education, training or employment.

The Western Trust has the lowest percentage of former relevant young people who are ETE inactive (13%).

The Target - that by March 2013 the percentage of care leavers aged 19 in education, training or employment should be increased to 62%. (…progressing to a standard of 75% from March 2013) has been exceeded i.e. 77% of the care leaver population aged 19 was in some form of ETE activity.

4.4 Young Homeless The number of young people aged 16-17 years old reported regionally as homeless has reduced by almost 100% from September 2011. The South Eastern and Western Trusts reports no young people within this age group as homeless, with the Belfast Trust reporting 5 young people and the Southern Trust reporting 4. The Northern Trust report the highest number of young people (10) who are homeless.

4.5 Admissions to Care of Young People aged 16 / 17

Analysis of Trust data at March 13 does show some increases in the admissions of 16/17 year olds in the Northern, Southern and Western Trusts from March 12 which will further affect 16 Plus Service resources, should they remain in care for a sufficient time to attain entitlement.

4.6 Separated Children

At March 2013 the total number of Looked After separated children was 10. The figure has remained consistent throughout the year with a decline in number in the Belfast Trust due to 2 young people

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aging out of the Looked After Service. The South Eastern and Western Trusts have consistently had a nil return.

5. Adoption Services, including Inter-country Adoption 5.1 Applications to Adopt Adoption remains a small but extremely important area of work within Children’s Services. During the period April 2012 to March 2013 there were 159 adoption applications received in respect of Domestic Adoption and in the previous year 110 applications were received, the majority arising in the Western Trust area. During the same period 17 applications were received in relation to Inter-country Adoption a decrease of 7 (24) on the previous year. This would indicate positive progress in terms of the capacity to meet the needs of children within NI. 5.2 Adoption Assessments At 31st March 2013, 56 prospective domestic adopters were awaiting assessment. The highest being within the Northern Trust area, (23), while 19, domestic adopter’s awaited assessment in the Western Trust area. Of the remaining 14 adopters, 8 were within the Southern Trust, 5 in Belfast Trust and 1 in the South Eastern Trust area. Of those waiting, 56% were waiting less than 3 months, while 4% were waiting longer than 6 months. The main reason provided for waiting was that no social worker was available to commence the assessment in 61% of applications (34). Twenty-two of these applications were within the Northern Trust Area. In 36% (20) of cases, waiting ‘applicants not ready to proceed’ was provided as a reason, 17 were within the Western Trust. During the year 114 domestic and 9 intercountry assessments were completed only 4 (2 domestic and 2 intercountry) assessments were refused or deferred. The Southern Trust completed 39 assessments. 5.3 Children Adopted The number of children adopted remained relatively consistent with the previous year at 126. The majority of adoption orders arising in the Belfast Trust (37) area. Freeing Orders were granted

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in respect of 77 children. Ten children were adopted as a result of Intercountry adoption. 5.4 Adoption Allowances

The number of children who meet the criteria for Adoption Allowances continues to rise with the figure for March 2012 of 426 rising to 456 in March 2013. The cost of adoption allowances coupled with the allowances paid in respect of children meeting the criteria under the Residence Order Allowance scheme continues to place considerable strain on Trust budgets. 5.5 Post Adoption Support

The demand for post adoption support services continues to grow. The HSCB provided some additional funding in respect of training for those working with adopted children to promote greater stability in 2012, together with some non-recurrent funding to enable Trusts to progress adoption assessments on a sessional basis. Some additional non-recurrent funding was also made available this year to enable Trusts to complete both adoption and fostering assessments on a sessional basis. 5.6 Inter County Adoption

Ten children were adopted from overseas. Presently Trusts each undertake this function for citizens living within their own Trust area (the exception being BHSCT who provide the service for SEHSCT), given the scale of this service, the cost implications and the specialist nature of the service, the potential to regionalise continues to be explored. 6. Early Years Services

6.1 Standards Trusts perform the role of regulator for early years providers, a role which includes initial registration and annual inspections.

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Currently Child-minding and Day Care are in the process of a significant reform agenda both in terms of process and the implementation of Minimum Standards, the aim being to develop a regulatory system that is “fit for purpose,” improves Trusts’ compliance with their statutory duties and provides regional consistency.

The reforms in process will include the development of a

consistent approach to the processes of Registration and Inspection including the production of standardised documentation, improved use of technology and a workforce analysis. In July 2012, the DHSSPS launched The Minimum Standards for child-minding and Day Care. The standards seek to improve practice and ensure a consistent framework for regulation. The Standards also introduce mandatory training requirements.

6.2 Registrations In the past year the total number of providers has risen from 5,320 to 5,336. While this overall increase may appear, small Trusts have registered 710 providers and deregistered 517. This high level of activity continues to place considerable demand upon Trusts’ Early Years Teams. 6.3 Unallocated Applications for Registration and Overdue

Inspections. In relation to unallocated applications for registration the regional position has improved with a reduction from 147 at 3rd March 2013 to 99 at 31st March 2013.The number of overdue inspections regionally (with the exception of the Northern Trust which has made a significant reduction in overdue inspections), shows a concerning increase. Belfast, South Eastern and the Western Trusts advise that the majority of inspections have been outstanding for less than 3 months. The Western Trust is of the view that the withdrawal of funding for additional staff that had enabled them to address the backlog in 2012-13 has led to the subsequent rise.

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Of the inspections overdue in the Southern Trust, 246 were child-minding inspections re-scheduled for the early period of 2013-14; the majority were overdue by less than 3 months.

7. Children Order - Complaints and Representations

7.1 All Trusts have confirmed that they have a robust system in place, which promotes awareness of the Children Order Complaints and Representations Procedure to service users. In addition, there is access to an independent advocacy and mentoring service provided by Voice of Young People in Care (VOYPIC). Monitoring returns on activity are received regularly and scrutinised to consider regional coverage and application.

7.2 It has also been recognised that Looked After Children can be particularly vulnerable and it is extremely important that engagement with children is transparent, that children fully understand how they can make a complaint and that staff are mindful as to the need to raise any matters of concern with Senior Managers. Each Trust has a Whistle Blowing Policy in place to facilitate staff in this regard.

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MENTAL HEALTH AND LEARNING DISABILITY SERVICES

1. Key Challenges

1.1 Transforming Your Care

The focus on prevention early intervention and personalisation; the shift from institutional care to community-based provision, and the desire to provide care as close to home as possible places huge demands on all aspects of health and social care delivery, including mental health and learning disability services.

1.2 Resettlement Targets

Resettlement of long stay patients and reducing the number of patients delayed in hospital by March 2015 remains a key challenge for the Trusts. While funding has been made available to support this initiative the complexity of some patients’ needs makes the provision of appropriate community placements a most difficult challenge. This is being addressed through the Regional Complex Needs Sub Group of the Community Integration Programme Board.

1.3 Increasing number of safeguarding referrals

All Trusts report an increase in the number and complexity of adult safeguarding referrals. This has impacted significantly on the work of the designated officers and the social workers undertaking joint protocol interviews, often reducing their ability to engage in service development work.

2. Analysis of Trust Reports - General Issues across Mental Health and Learning Disability

2.1 Approved Social Worker (ASW)

2.1.1 Conveyancing, that is the transfer of patients to hospital following an application for treatment, remains a significant area of concern for Trusts. The Regional Protocol between HSC, NIAS and PSNI is awaited eagerly. This work will be escalated within the HSCB to secure an agreed position

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2.1.2 GP delays in attending with Approved Social Workers (ASWs) for assessment, particularly after hours, is cited as an increasing difficulty.

2.1.3 GPs have been refusing to attend hospitals out of their practice area to complete Form 5s Medical Recommendation; this is causing some concerns and delays in some Trust areas.

Both these matters have been raised with the Integrated Care Directorate at the HSCB, who have issued an agreement about when and where GPs must respond and steps are being taken through the NI Locally Enhanced Services to progress this further.

2.2 Case Load Weighting

Trusts continue to explore caseload weighting models to ensure fairness of workload allocation, case complexity and risk issues. Given that there is a regionally agreed caseload management tool, developed through Choice and Partnership (CAPA) for adult mental health services, it is recommended that this approach is rolled out across NI for adult mental health services and considered for Learning Disability Services over the next year.

2.3 Social work supervision

Use of the range of supervision practices, their effectiveness and benefits to social work staff, needs further exploration. Regional decision making regarding Social Work supervision is on hold pending the above. It has been agreed that discussion following the annual DSF process will be carried out by each Social Care commissioning lead in their local area. They will clarify staff complement, roles and responsibilities to support a better understanding of the Adult Mental Health Social Worker Supervision process in Trusts. A regional paper will be provided which will outline the range of models and expected frequency of supervision for social work staff.

Plans are being developed in two of the Trusts to require Band 7 Approved Social Workers (ASWs) to take on supervising roles with band 5 & 6 Social Workers. This will be further considered within the Social Work Strategy implementation in their consideration of the senior practitioner role.

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2.4 Direct Payments

Direct Payments, personalisation and self-directed support are key approaches for the future and are strongly recommended in Transforming Your Care. Nevertheless the number of adults receiving direct payments and the number of carers receiving direct payments remain low particularly within mental health services. Trusts must consider what additional measures could be put in place to support this approach; in particular the ImRoc initiative should encourage Mental Health services to consider this more proactively.

2.5 Carers

Carers Assessments, both the number offered and the number of carer assessments completed, have increased this year across all five Trusts, for both mental health and learning disability

There are, however, zero returns for Young Carers within the Mental Health and Learning Disability returns, (except for Learning Disability Services in the Belfast Trust, who report two).

The Board has requested that the service areas review their practices in this regard. And provide assurance that staff are aware of issues pertaining to young carers and are accessing or providing appropriate support.

2.6 Transition from Children’s to Adult Services

Trusts continue to identify a particular cost pressure in relation to the transition phase for young people moving to adult services, particularly in learning disability services. In Belfast Trust the concern relates specifically to Looked After children with Disabilities graduating to Adult Learning Difficulty services.

Establishment of clear, live protocols in relation to transition planning are important in conjunction with the ongoing development of appropriate services utilising the funding streams available. This will be supported by the work of the Regional Transitions Group.

2.7 Care Management

A number of Trusts indicated that they are auditing their care management practices in the next year. This is encouraged and the Board will collate the findings from Trust audits.

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2.8 Day Opportunities

There is a high number of Day Opportunities in both the Northern and South Eastern Trusts compared to the other Trust areas. It would be beneficial to have commentary on these outlining the range of Day opportunities available and the benefit to patients/clients.

2.9 Issues arising from Judicial Review JR47

This case related to a resettlement patient waiting for over five years for funding for a discharge package. On appeal the Court found against DHSSPS in terms of a breach of duties under Article 15 HPSS (NI) Order 1972, and the patient was awarded compensation. There is a concern that this ruling will lead to a significant financial liability in respect of the entirety of the Primary Target List (PTL) or Delayed Discharge population. This liability may also extend to the mental health resettlement population.

3. Data Tables

The problems with information coherence and accuracy persist in this year’s DSF reports. This relates particularly to the Northern Trust where Dementia and Older People with Mental Health are not distinguished; this makes it difficult to make comparisons across the Trusts.

Statistical information within the same service area (i.e.; for client referrals or subsequent assessments for service) remains contradictory.

4. Issues specific to Trusts: Mental Health services

4.1 BHSCT

4.1.1 Suicide prevention

Belfast Trust identifies a risk associated with a potential failure to identify individuals known to the service at risk of suicide. The Board has sought assurances that protocols to identify and manage people presenting with self-harm have been fully implemented, and that arrangements for

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identifying and responding to those presenting in neighbouring Trust Emergency Departments are in place.

4.2 WHSCT

4.2.1 ASW Rota Issues

The Mental Health programme notes that the current ASW rota is maintained utilising staff from other programmes largely due to the impact of the new out of hour’s rota and plan to review this position on a corporate basis. HSCB to be kept updated on this work.

4.3 NHSCT

4.3.1 Hospital social work

There is limited information provided on the role and function of the social workers employed within the hospital setting. In addition the table for hospital social work has not been completed. This information is required in the next annual report.

5. Issues specific to Trusts: Learning Disability services

5.1 BHSCT

5.1.1 Carers Support

Belfast Trust Learning Disability service indicated difficulty in reporting the numbers of carers in receipt of support services. The Trust has been asked to review their information systems so that they can give a better indication of their work in this area.

5.2 WHSCT

5.2.1 Unallocated Cases

Last year there were 75 unallocated cases this has reduced to 40 in this report. Work on this needs to continue and link with the issue highlighted in the RQIA baseline report and the introduction of case load weighting.

5.2.2 Workforce Issues

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A number of workforce capacity issues are noted, these include the limited number of Social Workers highlighted in the RQIA baseline assessment and review of community services for adults with a learning disability; the Impact of three Approved Social Workers (ASWs) recruited to the regional out of hours service and the Reduction in ABE interviewers from 2 to 1.

5.3 SEHSCT

5.3.1 Ageing Carers

The data return indicates an increase in carers assessments offered and carer’s assessments undertaken highlighting an additional demand in this area.

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OLDER PEOPLE AND PEOPLE WITH A PHYSICAL DISABILITY AND/OR SENSORY DISABILITY

Introduction

This year’s reports describe a challenging environment for staff in services for older people and those with physical and sensory disabilities (OPDSI). The overarching impression is of services that are under pressure from a range of demands, some of which are familiar, but others which emanate from the attempts to modernise and redesign health and social care. Notwithstanding these challenges, there are very clear messages that staff are coping and are committed to improving service delivery.

One of the most striking aspects of this year’s reports is the very small number of issues which Trusts have felt necessary to escalate to either Directorate or Corporate Risk Registers. Physical and Sensory Disability identifies virtually no significant matters which fall into these categories. This should not be interpreted as the manifestation of a less challenging professional environment, but rather of the confidence and ability of the workforce to respond to service change.

1. Key Challenges

1.1 Resources Resource constraint is one of the most consistent themes found in the reports. Ironically it does not relate to an absence of additional funding, but the fact that this money is provided in order to advance a range of initiatives to meet demographic demand through a number of new approaches, which in turn highlights the need for social care to review its role and associated governance arrangements. 1.2 Care Management The most striking example of this are the references made in each report to reviews/audit/re-evaluation of the application of Care Management Guidance as outlined in DHSSPS Care Management HSC ECCU/1/2010 Circular. It appears to be primarily a by-product of the continued development of integrated team working

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and the associated challenge of progressing single assessment arrangements through the implementation of Northern Ireland Single Assessment Tool (NISAT) and increased expectations regarding personalised budgets/self-directed support. The accountability meetings with Trusts did not indicate any desire to move away from or revise the 2010 guidance, and reinforced its continued viability. It will be important to follow up with individual Trusts the outcomes of their review/audit exercises and the implications it might have on workforce planning and deployment. 1.3 Governance A significant by-product of these developments has been the continuing emphasis on improving professional governance arrangements. There is a great degree of similarity in the way Trusts have ensured appropriate supervisory and accountability particularly within integrated team structures. This is both reassuring and necessary in order to preserve professional integrity and focus within social care. 1.4 Supervision A range of supervision audits are cited throughout the reports and across programmes and it is clear that Trusts are placing a great deal of emphasis on this pivotal method of ensuring high standards of professional practice and service delivery. Compliance rates are reassuringly high and need to be maintained and improved. 1.5 Caseload Weighting The associated issue of what should be considered appropriate caseload size and case mix continues to be reported with frustrating regularity in older people’s services, and reassuring regularity in PDSI services. The latter is reported with apparent satisfaction in terms of its ability to manage caseload pressures appropriately. The former finds expression in the expectation of a possible regional solution as part of the roll out of the Regional Social Work Strategy. This should be considered as one of the priority areas for attention as an action plan is developed to take forward this work.

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1.6 Statistics/Information

The statistical accuracy problems that affected previous DSF reports has been addressed in a number of reports. Trusts have revised and improved data collection systems and the outcomes of this are evident this year in terms of improved quality. Further work is indicated in relation to a number of the PDSI returns and should be a priority for local follow up during the year.

1.7 Audit

A wide range of audit activity is described by all Trusts but what remains unclear is the extent to which this activity has improved practice on the ground. Some further insight into how learning from audit is disseminated and improves practice and the ‘user experience’ would be helpful in future reports.

1.8 Carer Support Last year’s summary report was critical of the efforts being made to improve the promotion and uptake of carers’ assessments. The work of the Regional Carers Strategy Implementation Group and impact of the Departmental audit of the implementation of a number of carer related reviews/action plans appears to have had some impact in increasing the uptake assessments to between 44-66% from an average of 37% in 2011/12. 1.9 Safeguarding One area of activity which has been strongly highlighted in this year’s reports is the increased profile of safeguarding activity and the very significant way in which it is re-defining the efforts of many social care and health professionals. Whilst it is no longer seen as the primary responsibility of social workers and police officers, social work is still viewed as the lead safeguarding profession within Trusts. Incremental investment is assisting in the re-definition of staff inputs to safeguarding and helping to fundamentally reshape how Trusts respond to this challenge. The move towards replicating a version of the Child Care Gateway model in adult services is a positive development but further investment is likely to be necessary to address the scale of pressures identified in the DSF reports. A crucial requirement in the next year will be the production of new regional procedures and guidance by DHSSPS.

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1.10 Direct Payments Another service area which has been commented on in recent DSF analysis has been the development of Direct Payments. The number of people availing of them in both programmes of care appears to have levelled off in the past year. An obvious impediment to this has been the legal judgement by Lord Justice Girvan which raised a number of issues about the applicability of this method of procuring care for those who lack capacity to manage resources. The vehicle which has been put in place through the Office of Care and Protection, the Short Procedure Order, designed to facilitate transition to more soundly based arrangements has impacted on a number of individuals in both programmes. After a slow start the processing of cases has now attained a sense of momentum. Progress must continue to be monitored to deliver on targets within a reasonable timescale for all concerned. 1.11 Hospital Social Work

Hospital Social Work (HSW) has featured more prominently this year because of the regional focus and consequent media attention on pressures on accident and emergency departments and delayed discharges. Whilst this has created pressures on many professionals a major challenge has been in managing unrealistic expectations of the social work role and capacity in resolving these issues. This must also be viewed in the context of the volume of referrals which hospital social work teams are dealing with each year. In response to the undoubted pressures felt within HSW, there are positive reports in the DSF of new working arrangements (weekend working and flexible hours) being rolled out, an approach that is in keeping with an ethos of innovation and change.

2. Programme Specific Issues

2.1 Re-ablement

All Trusts highlight re-ablement as a key component of their service reform programme in older peoples services but the reports, with the possible exception of BHSCT, give little indication of the impact on social care delivery even though there have already been strong indications of the need to refocus domiciliary

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care service inputs in alignment with the strong therapy-focussed investment. To date it has raised issues about staff grading, assessment (interface with NISAT) and the development of community and voluntary services. This approach to care has the potential to change how we use domiciliary care and how we meet future need.

2.2 Dementia Services

Service pressures vary as Trusts respond in different ways to local need and the challenges of the Dementia Strategy. For example, BHSCT has approached matters from a ‘rehabilitation and accommodation’ perspective: Commissioning twenty community placement beds across three nursing homes; developing a new model for inpatient care on the Knockbracken site, and developing Supported Housing schemes for people with dementia. This is similar to the SEHSCT approach where a 24 apartment supported living facility has been opened in Downpatrick, comprising one and two bedroomed apartments. WHSCT reports alcohol related dementia care as its significant pressure area, NHSCT is struggling to meet the increasing demands of its dementia population post hospital discharge and is now meeting need via additional commissioning of intensive domiciliary care packages. Best professional practice and training underpins some approaches; SHSCT has developed a person centred tool for all commissioned services with Trust Home Care and Day Care applications. This will improve the communication between the person with dementia and the provider. In SEHSCT a vocational strategy for social care staff has been developed with an action plan for progressing the Qualifications and Credit Framework for social care (QCF) over the next three years. 2.3 NISAT

As with re-ablement, the reports reinforce the importance of good quality assessment at the core of the social work role. Staff still appear to struggle with the perceived additional requirements being placed on their time by the Northern Ireland Single Assessment Tool (NISAT). It is however slowly becoming more accepted as the regional tool of choice although the issue of, at

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times, limited commitment from other professional groups is a continuing source of complaint. The successful submission of the Business Case for eNISAT, the electronic enabler, is yet another step on the road to the goal of community information systems. Social work is well placed to both lead and benefit from these developments.

2.4 Services for Acquired Brain Injury/Progressive Illnesses

The most consistent priority and challenge for Physical Disability services is the lack of appropriate responses for a small but challenging sub group of service users with acquired brain injury, associated challenging behaviours and other progressive illnesses such as Multiple Sclerosis, Motor Neurone Disease and Huntington’s disease. Trusts have clearly tried to address some of this need through innovative and opportunistic developments, and their efforts should be acknowledged, but the need has not been addressed to any meaningful degree in recent years. There is a strong case to be made for adopting a much more focussed and concerted approach to moving this matter forward. 2.5 People with co-existing conditions such as disability, mental health needs, alcohol dependency

A number of Trusts have again raised this issue. BHSCT has entered into partnership working with Northern Ireland Association for Mental Health (NIAMH) to address this need. Whilst this issue is reported via physical disability services, the issue has wider resonances at a Trust and regional level in terms of supporting the development of a more ‘joined up’ assessment and care pathway approach. NISAT has the potential to deliver much of this, but cannot be a proxy for good professional practice and core engagement and assessment skills.

2.6 Emergency Planning

The reporting year represented quite a busy year regarding Emergency Support Centres. All Trusts have reported on this issue, some in more detail than others. Only BHSCT has flagged up resource implications, as it has done in previous DSF reports.

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3. Analysis of individual Trust Reports:

3.1 BHSCT

The Trust notes that tensions between service demand, capacity, resources and increasing public expectations have created a difficult environment during the reporting period. The Trust reports increased caseloads and challenges emanating from areas such as hospital discharge, direct payments and care management.

3.1.1 Key Issues and Service Pressures

Hospital Discharge – pressures are reported here not just in terms of capacity and resources, but also in terms of associated workforce issues and the challenge of providing a sustainable service via trained and skilled practitioners.

Care Management Reviews – the issue reported is wider than just ‘care management’ and relates to the wider issue of caseload pressures and the challenges of providing regular client and care package reviews.

Direct Payments – Applications to the Office of Care and Protection for Short Procedure Orders are being progressed and are placing additional demands upon staff time.

3.1.2 Risk Issues and Governance

‘Safe and effective discharge from hospital’ is recorded as a ‘high risk’ area in the Trust risk register. The Trust has taken a broad ‘whole systems’ approach to this problem, seeking to deal with the issue by developing more flexible, modern domiciliary care approaches to need and improving access to community placements. The Trust’s difficulty with carrying out care management reviews within care placements (also rated as a ‘high risk’) will require a similar focus because the minimum service standard of an annual review of care is an important safeguard for many clients.

3.1.3 Professional and Workforce Issues

Workforce development and support is a theme that runs throughout this year’s report. The strong focus upon caseload management, caseload weighting tools and the Business Service Organisation (BSO) supervision audit and action plans acknowledges the importance of staff as an organisational ‘asset’.

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The Trust notes that increased activity levels in relation to Safeguarding, carer assessments, Direct Payments and NISAT impact significantly on workload and professional time. The review of the Social Care Workforce should deliver valuable outcomes in terms of workforce skill mix planning.

The Trust reports the development of a ‘generic’ job description in the context of responding to recruitment difficulties. More information on this specific issue, the proposed job description and the wider recruitment difficulties reported will be required by the Board.

3.2 NHSCT

The NHSCT report is satisfactory with several key challenges and issues carried forward from last year.

3.2.1 Key Issues and Service Pressures

This has been another very challenging year for the Trust, the key issues being the significant efficiency savings required and pressures due to increasing demands upon services.

The number of complaints has increased across most Directorates regarding service access linked to resource constraints.

3.2.2 Risk and Governance Issues

There is non-compliance with the DHSSPS Minimum Standards within Residential EMI Units due to the structure and layout of the buildings. This also applies to the physical environment in the generic Residential Care Homes and Day Care Centres across the Trust.

The increased number of Failure to Comply notices issued by RQIA on Residential and Nursing Homes has impacted on the workload of staff carrying out care assessments, placement reviews and safeguarding.

Discussion between the Trust and RQIA continues regarding the training requirements for domiciliary care staff to ensure compliance with the DHSSPS Standards for the Control and Administration of Medicines in Domiciliary Care settings.

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3.2.3 Professional/ Workforce Issues

Due to financial constraints, high levels of sick leave and vacancy controls, there is a difficulty in releasing staff for training which impacts on their opportunities for continuous professional development (CPD).

3.3 SHSCT

3.3.1 Key Issues and Service Pressures

According to data returned, there were 320 Article 15 Payments, having been none in 2012. This issue will require further examination.

A significant increase in referrals to Memory Service is noted, but not the demographic or service trends that might account for this. At the same time, vacancy controls on the recruitment of two Social Work staff are in place. The Trust needs to consider how it balances capacity and demand.

3.3.2 Risk and Governance Issues

There has been a lot of Trust audit activity but the report provides little detail on outcomes/findings.

The report refers to introduction of Short Procedure Order following the Judicial Review regarding Direct Payments, but the report does not indicate how it is implementing the DHSSPS Circular or the number of applications to Office of Care and Protection or Orders granted.

The problem of backlog in annual reviews in residential and nursing homes is reported for the third year. The rate of compliance is dropping; 78.6% in nursing (87% in 2012) and 78.4 in residential (85% in 2012). This is clearly a priority area for attention.

3.3.3 Professional/ Workforce issues

The establishment of a Permanent Placement Team was highlighted as a breakthrough in 2012, but there is no reference in this year’s report.

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There are references to vacancy controls but clarification is required about the impact of these and any other reason for loss of capacity.

3.4 SEHSCT

The Older Person’s section of the DSF Report is positive, balanced and captures the key issues.

3.4.1 Key Issues and Service Pressures

Hospital Social Work – this continues to be challenged in dealing with higher volumes of referrals (an increase of 13%) of greater complexity and a growth in the use of intermediate care beds by more than 50% to 356.

Adult Safeguarding – the Trust reports a 38% increase in referrals from 400 to 553 with a resultant 71% increase in investigations from 285 to 488. The impact upon staff time and workload is not directly referenced but can be assumed to be significant.

Continuing Health Care - this is an increasing challenge for the service with 23 requests for review of funding. SEHSCT have requested regional guidance from DHSSPSNI to clarify the legal context of any action

3.4.2 Risk Issues and Governance

Hospital Social Work - NISAT and time pressures and constraints, and the use of email as means of communication about discharges are flagged up as emerging risk issues. Complex discharges actioned within 48 hours of being declared medically fit dropped by 500 and Trust comment on this would be valuable.

Independent Sector (quality assurance) is potentially an important issue. The Trust does not feel it is sufficiently aware of quality of care concerns, this has been placed on the Directorate Risk Register.

3.5 WHSCT 3.5.1 Key Issues and Service Pressures

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Workloads have increased (partly due to demographics) however; this is being addressed by the social work governance group which is examining caseload weighting models.

Increased activity in Adult Safeguarding with resulting impact upon staff workload.

The development of community service indicators that suggest that the social work service (older people) in the WHSCT area is more expensive than elsewhere resulting in the need to identify efficiencies.

3.5.2 Risk Issues and Governance

A range of audits and re-audits have been undertaken within the past year as recommended in the last full Trust, HSCB DSF meeting (June 2012). Each audit has made recommendations for improvements in practice and service and appropriate action taken as necessary.

The implementation of NISAT is described as challenging. Despite being a multidisciplinary assessment tool, the Trust reports that the majority of assessments are being carried out by social work staff.

Progress is reported in the offer and acceptance of carers’ assessments. In the re-audit of carers assessments referred to above, it was noted that there was no identifiable carer in 43% of newly referred cases.

3.5.3 Professional Workforce Issues

Team health checks have been introduced within the programme. These will measure social work activity and help to identify key performance indicators. Details of progress are being shared with HSCB on an ongoing basis.

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ADULT SAFEGUARDING

BELFAST TRUST

1. Leadership and Partnership Working The Trust, Local Area Safeguarding Partnership (LASP) has developed a range of positive working relationships and partnerships. In some instances for example the Domestic Violence Partnership, the Trust has built on existing structures. In other cases, the Trust has forged new relationships such as the Police and Community Safety Partnerships. The amount of energy and skill required to progress these partnerships cannot be overestimated. The Trust also very effectively represents regional adult safeguarding on the Non-Government Organisations Engagement group on Human trafficking. All these partnerships appear to be functioning well, and to be furthering awareness and support to adult safeguarding activities.

2. Public Awareness and Prevention The Trust has played a significant part in progressing both the review of the “Protocol for the Joint Investigation of Alleged or Suspected Cases of the Abuse of Vulnerable Adults” and the development of new operational policies and procedures.

3. Protection The Trust has implemented a new electronic recording system for adult safeguarding referrals. This has now been rolled out, either electronically or on hard copy for those practitioners who do not have access to the central recording system. This has significantly improved the gathering and collation of activity information. The Trust has also completed a major re-structuring of adult safeguarding arrangements which has included the creation of a Trust-wide Adult Safeguarding Gateway Team. Work will

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be required in 2013- 14 to ensure that the Mental health Programme of Care is fully integrated into this system.

4. Governance The Trust has a clear governance structure in place for adult safeguarding activities and the work of the LASP. The recently completed audit of referrals to the new Gateway Team contains some significant learning and should be shared on a regional basis. The Trust and Local area Safeguarding partnership (LASP) has also established a mechanism to take forward recommendations contained in the RQIA overview Report.

5. User Experience The Trust has also significant experience of working alongside service users, which led directly to the publication of leaflets for all users. The workshop programme for service users that has been developed is also an example of good practice that should be shared with other LASPs.

6. Training and Practice Development The Trust has a busy programme of training in relation to adult safeguarding, ranging across a variety of professional and work roles. The Trust/LASP made creative use of the availability of non-recurrent funding to support training of staff in advanced court room skills.

7. Activity The Trust notes an overall increase in referrals from 1189 in 2011/12 to 2054 in 2012/13, an increase of approximately 72%. This compares to a regional increase of approximately 59% for the same period. The figures recorded in the LASP report do not always tally with the figures submitted to the HSCB on a regular basis for example in Physical Health and Disability where the quarterly data return records a total of 266 referrals, but the LASP report records only 199. The majority of referrals are from the Learning Disability

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Programme of Care, which may be a reflection both of the RQIA Review and the fact that the regional specialist hospital sits within the Trust boundaries. The most common form of abuse alleged was physical abuse, followed by financial abuse.

Older People: During the reporting period there has been a significant increase of 58% in the volume of referrals. Of these, just 10% were managed under the Joint Protocol. The challenges involved in passing work to core services where there is a scarcity of social work practitioners and the implications for adult safeguarding investigations are also noted. The development of the communication information system (CIS) should greatly assist data collection and management.

Mental Health: Within the Mental Health Programme, there has been an increase in referrals of approximately 18%. Some of this increased activity may be attributable to the RQIA review of safeguarding arrangements, but this is still at the lower end of increased activity levels across the region. However, of these referrals, 42% were managed under the Joint Protocol arrangements, with most also proceeding to achieving best evidence (ABE). It should be noted that these are likely to be the most serious cases.

Learning Disability: Within the reporting period, there was an increase in referrals of approximately 96%. Some of this increase may be due to the impact of the recent RQIA review as well as a growing awareness of adult safeguarding amongst practitioners. The majority of referrals were received from a hospital setting. The Trust correctly makes reference to the pressures that can arise in such environments and which may trigger some instances of physical abuse. While each incident requires a safeguarding response, more work is required on a regional level to ensure that only relevant cases are referred under the Joint Protocol. In the reporting period only 12% of referrals were managed under the Joint Protocol, with a total of 8% proceeding to ABE.

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Physical Health and Disability: The report in relation to this Programme of Care is a significant improvement on the contribution to last year’s report. The increase in the number of referrals is noted (93%), as are the Trust’s concerns in relation to maintaining a Human Rights based approach to individual service users.

NORTHERN TRUST

1. Leadership and Partnership Working The Report highlights a number of examples of good partnership working across a range of organisational boundaries. The partnership with Multi Agency Risk Assessment Conference (MARAC) arrangements is particularly strong in the Northern Trust area. The Report also highlights good practice in relation to the development of leadership on adult safeguarding in the acute sector. Adult Safeguarding has been closely involved in the establishment of the Sexual Assault Referral Centre on the Antrim Hospital site. The level and number of referrals to adult safeguarding from this new resource will need careful monitoring.

2. Public Awareness and Prevention The Trust and Local Adult Safeguarding partnership (LASP) has a very pro-active approach to the prevention agenda, and has built on an inclusive, community development approach very successfully over the last year. In particular the community information sessions have been very productive. This approach should be shared with other Trusts/LASPs.

3. Protection The report highlights that not only has the volume of referrals increased in the last year, but that the complexity of referrals and the issues raised through investigations, has also increased significantly. The Trust also notes the challenges of working across Trust boundaries and the need for clarity in

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relation to lead roles and responsibilities. The Trust has made significant progress in engaging with colleagues in acute care settings, and this work should be shared with other Trust areas.

4. Governance The Trust has clear governance arrangements and structures in place. However, further clarity on the reporting and accountability arrangements for the new Band 7 Designated Officers following completion of the service re-engineering project would be helpful.

5. User Experience The community information sessions piloted by the Trust have provided safe environments for service users to express their views and opinions on adult safeguarding arrangements this has led directly, to the request for consideration of a single Helpline for the region.

6. Training and Practice Development The Trust has a clear programme of training for adult safeguarding that appears appropriate for the range of roles and responsibilities.

7. Activity The Report highlights an overall increase in the number of referrals to adult safeguarding services and the number of Care and Protection plans put in place. However, the figures presented in the report do not tally with the quarterly returns submitted by the Trust, and this needs resolved as quickly as possible. This should be supported through the full implementation of the SOSCARE adult protection module. The Trust has a consistently high level of referrals that lead to Care and Protection Plans (range = 71-88%) The inclusion of the category “Mental Health for Older People” reflects how the Northern Trust organises its services, but makes comparisons with other Trusts who do not record information in this way, more difficult.

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Older People: If the figures for Older People Programme of Care and the category “Mental Health for Older People” are brought together, there has been a significant increase in the number of referrals and Care and Protection Plans in relation to people over the age of 65.

Mental Health: There has been a significant increase in the number of adult safeguarding cases within this Programme of Care. This may, in part, be attributable to the recent RQIA inspection of adult safeguarding arrangements in mental health and learning disability hospitals.

Learning Disability: There has been an increase in the number of referrals to adult safeguarding. This has included a number of extremely complex investigations. Nevertheless, the referral rate in this Trust is the lowest in the region.

Physical Health and Disability: This section of the report is quite brief and more detailed analysis of activity would have been helpful.

SOUTHERN TRUST

1. Leadership and Partnership Working The Local Adult Safeguarding Partnership is developing a range of very different and interesting partnerships. While the Trust is building on many existing arrangements, the amount of time and energy required to progress these should not be underestimated. The work in relation to Multi Agency Risk Assessment Conference (MARAC) and Public Protection Arrangements Northern Ireland (PPANI) arrangements is particularly striking. The work with Black and minority ethnic (BME) groups has the potential to be a model for other Trusts to copy.

2. Public Awareness and Prevention This is a difficult area to measure as many of the outcomes will only become obvious over time. There are some examples of good practice in this section of the report,

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particularly in relation to joint working with the PSNI. The development of a community adult services directory also reflects a positive and creative view of Care and Protection Planning as well as prevention activities.

3. Access to Adult Safeguarding Services The Trust/LASP has done o a lot of work over the last year to ensure better access to adult safeguarding services. The Trust is to be commended for its work in relation to PPANI arrangements and the forensic mental health and learning disability team. Again, this has the potential to be a model for best practice and should be disseminated and shared beyond the Trust.

4. Effective Interventions The Trust’s skill and commitment to a number of extremely complex investigations involving, in particular allegations of financial abuse is to be noted and commended. The HSCB would wish to work with the Trust to find a way of ensuring that the learning from these investigations is shared as widely as possible.

5. User Experience It is positive to see the experience of users of adult safeguarding services being included in user feedback exercises, and also to see that it is included in core Trust business and processes.

6. Training and Practice Development The adult safeguarding training calendar appears very busy, with significant numbers of staff receiving training that appears appropriate to their work role. The training initiative targeting GPs is a very positive development.

7. Activity The Report highlights a significant increase in activity in 2012/13 across all Programmes of Care, with referrals rising by approximately 69% on last year. Only 33% of these

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referrals result in a Care and Protection Plan being implemented. This is the lowest percentage across the Trusts, and further work is required by the HSCB and Trust to understand this variation. It is interesting to note that the percentage increase in rates of referral is not the same as the percentage increase in either investigations or Care and Protection Plans.

Older People: Within this Programme of Care there has been an increase of 37% in referrals, 50% in investigations and 46% increase in the number of Care and Protection plans implemented. There is a need to understand why there was a 65% increase in the number of allegations or suspicions of psychological or emotional abuse over the reporting period.

Acute Services: There has been a significant increase in recorded activity from this Programme of care. However, in common with all Trusts, further work is required to raise awareness of adult safeguarding in the acute sector and to ensure appropriate case finding and onward referral.

Mental Health: There has been a significant increase in referrals from this Programme of care which may be attributable to the recent RQIA inspection. Referrals have increased by over 200%, investigations by 185% and the number of Care and Protection Plans by 256%

Learning Disability: In the reporting period there was an increase in referrals of 71%, and an increase of 60% in the number of Care and Protection Plans implemented. The increase in the number of investigations appears unusual at only 18%.

Physical Disability/Sensory Impairment: There was an increase in referrals of 77% compared to last year, but the number of Care and Protection Plans as a proportion of overall referrals dropped on the previous year’s activity, which requires some further scrutiny.

SOUTH EASTERN TRUST

1. Leadership and Partnership Working The Trust and Local area safeguarding partnership (LASP)

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has developed very effective partnership working arrangements with Lisburn Council. This experience should be shared with other LASPs to encourage greater participation from local councils across the region. The Report evaluates the effectiveness of a number of partnership arrangements and suggests how this aspect of the LASP can be progressed in the coming year.

2. Public Awareness and Prevention The Trust has engaged in a range of awareness-raising activities, both for targeted groups such as staff in care homes, and the general public. It is encouraging to see adult safeguarding included in the general Older People’s Survey as this will not only raise awareness of the issue but may also act as an effective case finding tool. It is disappointing to note that Trust colleagues in Finance and other Directorates did not avail of training in relation to adult safeguarding. This is an issue that will also be addressed on a regional basis in 2013 /14.

3. Protection The Report highlights issues of abuse occurring in regulated services and facilities. A mechanism for taking this forward has been developed and it will be important to share any evaluation of the “Care Checklist” initiative more widely.

4. Governance SET Safety and Quality Adult Safeguarding Sub-Committee has been effective in ensuring that a corporate response to adult safeguarding has developed within the Trust. The Trust has undertaken a review of adult safeguarding in Adult Learning and Physical Disability Programmes of Care and has used the findings to inform practice. Again, it would be useful to share this learning more widely.

5. User Experience The Trust has a range of mechanisms in place to engage with service users, and it is encouraging to note that these are available to adult safeguarding. As the Trust rolls forward the

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action in regard to a more formal evaluation of user experiences, it will be important to share the findings as widely as possible. The Report highlights the importance of the provision of information on adult safeguarding being available in alternative formats. The HSCB would welcome the opportunity to work with the trust on this in the year ahead.

6. Training and Practice Development The Report notes a high level of training activity across all LASP partner organisations.

7. Activity The Trust/LASP notes an increase in overall activity of approximately 45%, with particular increase in relation to the Mental health Programme of Care.

Older People: There has been a steady increase in the rate of referrals from this Programme of care, increasing by 38% over the reporting period, with the number of Care and Protection Plans put in place increasing by 50%. There has also been a significant increase in the number of cases involving the Joint Protocol for Investigation.

Mental Health: Activity in this Programme of Care has increased by 203% on the same period last year. This may be a reflection of the awareness-raising activities targeting this area of work, as well as the impact of the recent RQIA review of safeguarding in mental health and learning disability facilities. The increase in the number of Care and Protection Plans put in place (279) is slightly higher than the increase in the referral rate:

Learning Disability: The Trust reports a decrease in the number of referrals in relation to adult safeguarding of approximately 3%, but notes that the level of complexity has increased. This is an unusual return both within the Trust and across the region, and further work is required to understand this pattern of work.

Physical Health and Disability: The report indicates a small increase in referrals and a reduction in the number of Care and Protection plans.

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Acute Hospital Social Work/Intermediate Care: The Report notes a significant increase in activity in relation to acute and intermediate care. While this is to be welcomed, it should also be noted that this is from a very low baseline.

WESTERN TRUST

1. Leadership and Partnership Working In the last year, the Trust/LASP has provided strong leadership on adult safeguarding across all sectors. Unfortunately sometimes the operational demands made on specialist practitioners have meant that the LASP has not been able to capitalise on some of the strategic opportunities this has created. Nevertheless, the Trust/LASP has developed effective partnerships with, amongst others MARACs and PPANI. The approach taken by the Trust/LASP to these investigations has a strong Human Rights focus and the learning that has arisen from this approach should be shared more widely The effect of additional investment in 2013 -14 and 2014 – 15 should allow for a more strategic approach, but will require monitoring.

2. Public Awareness and Prevention For the second year running the Trust and Local area safeguarding partnership (LASP) has centred awareness-raising activities around World Elder Abuse Day in June, which appears to have been very successful. The emphasis on a community development approach is very welcome and the Trust is to be commended for the work done in this area.

3. Protection In relation to Joint Protocol investigations, the report notes that both the Trust and the PSNI are experiencing challenges in relation to the retention and utilisation of appropriately trained staff. The Trust should consider if there are other effective ways to support staff in these roles and encourage others to undertake the training.

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The Trust and Local area safeguarding partnership (LASP) has been proactive in identifying and investigating significant and complex cases which will have a significant effect on regional policies and procedures and should be shared as widely as possible.

4. Governance There is a clear line of accountability for adult safeguarding activity through Practitioner Fora, the Adult Safeguarding Forum and the Quality and Standards Sub-Committee to the Trust Governance Committee. The Trust/LASP has undertaken 2 internal audits on the screening of referrals and ABE activity. The findings will be of interest to other Trust areas.

5. User Experience See below.

6. Training and Practice Development The Trust Local area safeguarding partnership (LASP) has worked hard to engage service users in training events on adult safeguarding. This has been very positively evaluated by participants and should be shared with other Trusts/LASPs.

7. Activity While the number of referrals to Trust adult safeguarding services remains low when compared to the other 4 Trusts, the level of complexity within investigations continues to increase. The referral figures in the DSF report (654) do not tally with the activity data returned to NIASP on a quarterly basis (506). This should be resolved as soon as possible, as well as being addressed through full implementation of the SOSCARE adult protection module.

Older People: This Programme of Care has seen the greatest increase in the number of referrals, an increase of 132 or approximately 94%. While some of

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this can be explained by the number of inappropriate referrals being screened out, nonetheless there has been a significant increase in activity. This is posing particular challenges for a dispersed workforce.

Mental Health: The number of referrals to adult safeguarding from this Programme of Care remains low at only 50. This is perhaps surprising given the recent RQIA inspection of adult safeguarding arrangements in Mental Health and Learning Disability facilities which would have been expected to lead to at least a temporary increase in referrals, as it seems to have elsewhere.

Learning Disability: This Programme of Care has undoubtedly seen an increase both in the number and complexity of referrals, many of which are the subject of intense media scrutiny. However the quarterly returns to the HSCB and NIASP and the activity data in the Local area safeguarding partnership (LASP) report note very different levels of activity (HSCB/NIASP return notes 155 referrals, the Local area safeguarding partnership (LASP) report notes 306). This is a particular difficulty in view of the PfG commitments and the requirement to provide quarterly information to the DHSSPS. It is difficult to comment further until this position is clarified.

Physical Health and Disability: The number of referrals to this Programme of Care remains low as evidenced by the quarterly HSCB, NIASP returns. The commentary in this section of the report does not refer to activity levels and requires more detail.

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CONCLUSION

This overview of the delegated statutory functions reports submitted by each of the Trusts brings together the main and substantive issues with regard to how Trusts are discharging their delegated statutory functions.

The process for monitoring and reporting on these functions is now well established and includes regular monitoring meetings with Trusts and an annual meeting between HSCB and all Trust Directors responsible for delivery of those services under the scheme of delegation. The regional Governance Forum continues to address any matters related to reporting arrangements and the statistical returns.

The report identifies key issues that need to be progressed in 13/14 and these will be incorporated into the work of the Children’s Services Improvement Board.