safeguarding (adult) trust report 2014-15 · april 2015. the trust already had a safeguarding...

1 An Associated University Hospital of

Brighton and Sussex Medical School

TRUST BOARD IN PUBLIC

Date: 29th October 2015 Agenda Item:2.4

REPORT TITLE: Safeguarding Adults: Annual Report 2014/15

EXECUTIVE SPONSOR: Fiona Allsop, Chief Nurse

REPORT AUTHOR:

Fiona Crimmins & Julie Chivers,

Adult Safeguarding Leads

REPORT DISCUSSED PREVIOUSLY: (name of sub-committee/group & date)

Safety and Quality Committee – 06/08/15

Action Required:

Approval () Discussion () Assurance ()

Summary of Key Issues

The Annual Report for Adult Safeguarding enables the Board to review activity

across the Trust in relation to the Boards Statutory compliance with the Mental Capacity Act 2005 and the Care Act 2014 to provide assurance that the Trust is adhering to current legislation. Areas discussed to evidence that compliance include:

Enhancement of Adult Safeguarding Team reflective of the service needs Activity trends

An analysis of the data collected during this time period and

compared to previous years

Evidence of actions as a result of national regulatory changes and safeguarding reviews

Key achievements and challenges throughout the year and future developments.

Changes to the DOLS as a result of the Cheshire and Surrey Rulings in 2014

CQC Report August 2014 for Safeguarding Adults

Key issues to note are:

The number of alerts has risen for the third consecutive year

The increase in DoLs referrals following changes to legislation

50.35% of staff has received training during the last 3 years.

Introduction of the Care Act 2014 on 01/04/2015.



Relationship to Trust Strategic Objectives & Assurance Framework:

SO1: Safe -Deliver safe services and be in the top 20% against our peers

SO3: Caring – Ensure patients are cared for and feel cared about SO4: Responsive – Become the secondary care provider and employer of choice for

the catchment populations of Surrey & Sussex

Corporate Impact Assessment:

Legal and regulatory implications Yes

Financial implications Yes

Patient Experience/Engagement Yes

Risk & Performance Management Yes

NHS Constitution/Equality & Diversity/Communication

Yes

Attachments:

Nil



Safeguarding Adults Annual Report

2014/15 Executive Summary

With the introduction of the Care Act 2014 on the 1st April 2015, Adult Safeguarding is now

statute in law. The bulk of the specific safeguarding duties and powers are set out in Section

14 of the Act. This has given Adult Safeguarding an equal footing to its counterpart in

Safeguarding Children so that both services mirror each other. As outlined in the Act some

measures had to be in place by the 1st April 2015. The Trust already had a Safeguarding

Adults Board (SAB) in place, have signed up to an Information Sharing Agreement between

agencies and assigned the role of Designated Adult Safeguarding Manager (DASM) to the

existing Safeguarding Leads.

During 2014/15 the Safeguarding Team a total of 271 Adult Safeguarding Alerts were raised,

34 of which were raised about the Trust of which only 1 case was substantiated. This was

regarding pressure damage and staff communication with the patients family. The number

of alerts has risen this year on lasts years’ total of 251 alerts. This demonstrates a

continuous improving awareness and understanding of the Trust safeguarding processes

and procedures and highlights the staff confidence in raising concerns in a transparent and

open manner. This allows an environment where staff understand the importance of learning

from incidents and alerts as actions are implemented following investigations carried out

within the Trust, this may involve feedback to the teams involved and changes to practice.

Following the Supreme Court Ruling on Deprivation of Liberty Safeguards (DoLS) in March

2014, there has been a sharp increase to the number of DoLS applications made by the

Trust in 2014/15. During 2013/14, 11 DoLS applications were made, this increased to 53

applications for 2014/15. The Trust has met with external partners from the Surrey

Deprivation of Liberty Team and the Clinical Commissioning Group to ensure

implementation of this ruling with actions monitored via the adult safeguarding action plan.



Following the Trust’s CQC inspection there were no concerns raised regarding safeguarding

adults procedures within the Trust. However, the Trust was advised to review the Mental

Capacity training provided for staff. The Safeguarding Team have added this to the action

plan and have implemented ward based MCA training since the Autumn 2014.

1.1 Introduction

This report aims to provide assurance to the Board that there are robust arrangements in

place to ensure Adult Safeguarding is fully integrated into the Trust’s systems and meets the

required regulations and standards.

The Care Act 2014 has now been successfully introduced to law and came into force on the

01st

April 2015, meaning that ‘No Secrets’, Department of Health, 2000 is no longer in

place as guidance. However, it must be considered that the timeframe this report covers

falls under the “No Secrets” guidance.

The information contained in this report comprises from the period from 01st

April 2014 to

the 31st

March 2015 in respect of the following:

Adult Safeguarding Team

Activity

An analysis of the data collected during this time period and compared to previous years

Key achievements and challenges throughout the year and future developments.

The Safeguarding Adults Team continues to work closely with external agencies, in

particular with both Sussex and Surrey Social Care Teams and police.



2. The Adult Safeguarding Team

2.1 The Adult Safeguarding Team Structure at Surrey & Sussex Healthcare NHS Trust

Role Name & Job Title

Executive Lead Fiona Allsop, Chief Nurse

Strategic Lead Victoria Daley, Deputy Chief Nurse

Operational Lead Julie Chivers, Adult Safeguarding Lead

Fiona Crimmins, Adult Safeguarding

Lead Named Doctor Virach Phongsathorn, Chief of Medicine

Administration Support Laura Lewis, Administration Support

2.2 Executive Lead for Safeguarding Adults

Within the Trust, the Chief Nurse holds the overall responsibility for Safeguarding Adults.

The Chief Nurse is responsible for providing professional support for initiatives concerned

with the nursing practice in relation to Safeguarding Adults at risk of harm. She ensures

the Trust is committed to the provision of high quality care and continuous improvement of

standards through clinical governance and adherence to the National Frameworks and other

nation policy initiatives relating to Safeguarding.

2.3 Strategic Lead for Safeguarding Adults

The Deputy Chief Nurse is the Strategic Lead for Safeguarding Adults. The Deputy Chief

Nurse has Safeguarding Adults Board Level responsibility for Safeguarding Adults and is

responsible for ensuring that systems and processes are in place. She is an active

member of both Surrey and Sussex Adult Safeguarding Boards.

2.4 Operational Lead for Adult Safeguarding

In 2014 the role was expanded to cover five days a week to ensure that teams across all

Clinical Divisions and Non-Clinical Services had access to safeguarding advice. The

Safeguarding Adults Lead has responsibility to develop, monitor and enhance systems

and structures to support



Safeguarding process (e.g. procedures, monitoring activity & provide training). The role acts

as a local expert and offers support and advice to individuals and departments in their

engagement and implementation of the Mental Capacity Act 2005 and the Deprivation of

Liberty Safeguards 2007. The Team works closely with external partner agencies namely,

Social Services for both Surrey and Sussex and is the main point of contact for outside

agencies. The Operational Lead receives external supervision from the Sussex Designated

Nurse for Safeguarding Adults.

2.5 The Named Doctor for Safeguarding Adults

The Named Doctor for Safeguarding Adults is an advisory role held by the Chief of Medicine.

He assists the Safeguarding Team during investigations on request and when required

attends Strategy Meetings and Case Conferences as a Trust Representative.

2.6 Safeguarding Administration Support

The Safeguarding Team Administration Support has been in place since August 2013. This

is a joint role between the Safeguarding Adults & Safeguarding Children’s Team.

2.7 Adult Safeguarding Trust Committee

The Adult Safeguarding Trust Committee is held on a bi-monthly basis. This is chaired by

the Executive Lead for Safeguarding, Fiona Allsop. The meeting is attended by

representatives by Clinical Divisions, Surrey and Sussex Social Services, the Clinical

Commissioning Groups, Surrey Police, Learning Disabilities, Tissue Viability Nurse and

Matrons. This meeting reports to Patient Safety and Clinical Risk Committee.

2.8 Key Staff working with the Adult Safeguarding Team

Role Name

Tissue Viability Nurse Louise Evans

Learning

Disability Surrey

Liaison Nurse for Sarah Lalljee



Learning Disability Liaison Nurse

for Sussex

Christine Mazak / Jackie Haffenden

Matrons Surgical / Medical & WAC Divisions

Human Resources Business Partners Surgical / Medical & WAC Divisions

Falls Prevention Lead Frances Fernando

Quality & Risk Katharine Horner / Kim Rayment

Dementia Consultant Nurse Steven Adams

Compliments & Complaints Department Nicola Murray

Named Nurse for Safeguarding Children Sally Stimpson / Vicky Abbott

Specialist Midwife for

Safeguarding Children

Salli Alihodzic

3. Safeguarding Referrals at Surrey & Sussex Healthcare NHS Trust

3.1 Background

The Trust has a public Safeguarding Declaration in place stating that Surrey & Sussex

Healthcare NHS Trust is committed to protecting those most vulnerable in our

community. The Trust’s safeguarding policies are aligned with the Surrey Safeguarding

Multiagency Procedures.

In 2014/15 the Safeguarding Leads continued to focus on concerns and safeguarding alerts

that have been raised either by the community or the Trust regarding patients under the

care of Surrey & Sussex Healthcare NHS Trust. The Safeguarding Team meet with Surrey

Social Services on a weekly basis to discuss the alerts received and what action has been

taken as a result. This has proved to be an essential process as it fosters joint working with

the Trust’s partner agencies, thus ensuring management of information and enabling

meeting strict timescales for investigatory reports and actions that are given to the Trust

following Safeguarding procedures. All investigations and required actions with timescales

are added to a Safeguarding Action Plan which is reviewed regularly by the Safeguarding



Team. The Safeguarding Action Plan is also a standing item on the Trust’s Adult

Safeguarding Committee agenda which takes place every second month and is chaired

by the Chief Nurse. Lessons learned following investigations and changes to practice

within the Trust are also highlighted and discussed at the Safeguarding Meeting.

3.2 Activity

From April 2014 to March 2015, a total of 271 Adult Safeguarding Alerts were raised. None

of these have been reported as a serious incident (SI). Neglect continues to be the main

concern raised with a total of 144 alerts raised regarding this type of abuse, this is only

slightly less for the previous year (151 in 2013/14).

Below is a graph showing obvious comparisons over the last two years:

Broken down, 237 alerts were raised by Surrey & Sussex Healthcare NHS Trust regarding

concerns in the Community, this has increased on last year’s figure of 214. A further 34

alerts, (a decrease from 37 in 2013/14), were raised regarding care patients received

whilst being a patient in the Trust with just 1 case being substantiated. Of the 34, 16 were

raised internally; this has decreased from last year’s total of 22.

Total Number of Alerts 50

40

30

20

10

0

2013

2014



The police were involved in 37 of all 271 alerts raised with 9 of these being cases involving

the Trust (6 in 2013/14). Of the nine cases involving the Trust, one remains an open case

with the police. This case involves both an agency member of staff and a Trust Bank Nurse

Assistant. Of the cases referred to the Police for criminal investigation, none were

allegations made against substantive members of staff.

There has been a decrease on the previous year regarding alleged neglect within the Trust,

with only 15 concerns raised (23:2013/14). Alerts raised regarding physical assault have

increased from 10 in 2013/2014 to 13 for this year. There were 3 allegations of sexual

assault within the last year, these allegations were investigated by the police and the

Trust and proven to be unsubstantiated, this has slightly increased on last year where

there were 2 allegations of a similar nature. Lastly, there were 3 concerns raised

regarding emotional abuse, this is a similar to the previous time period, (2:2013/14).

During 2014/15, one case within the Surgical Division was substantiated on two parts and

partially substantiated on one part. This was regarding pressure damage, delay in provision

of pressure relieving equipment’s and staff interaction and communication with a patient’s

family. An action plan with recommendations was put in place following the Case

Conference. The Trust implemented training facilitated by the Tissue Viability Nurse around

skin integrity and the Matron worked in partnership with the Ward Manager to improve

communication. This was done by the introduction of a robust strategy within the ward

regarding information sharing with patient relatives, friends and carers.

A Review Case Conference took place in October 2014 for a case that had been open since

May 2012. Due to the complexities of this case, the Trust requested the assistance of

the Surrey Designated Nurse for Safeguarding Adults to carry out the investigation. This

case was substantiated however, since 2012, the Trust has introduced a number of

initiatives, including comfort rounds and the doctors rounds on Fridays, this ensures

improved communication regarding patients care and needs are met within an acceptable

time frame.



As expected, the Medical Directorate raised the most concerns during 2014/15. The

Emergency Department referred almost 50% (136) of all alerts made for this period.

One case from the Emergency Department remains open from the previous year, this

is due to go to Coroners Court in June 2015.

Overall there have been more safeguarding raised, demonstrating an increased reporting

culture within the organisation. The Adult Safeguarding Team have proactively enhanced

working relationships and communication with Trust staff in order to continue raising

awareness of this area.

3.3 Deprivation of Liberty Safeguards (DoLS).

DoLS applications must only be made as a result of Mental Capacity Act compliance and a

best interest’s decision. That is why the safeguards have been created: to ensure that

any decision to deprive someone of their liberty is made following defined processes and in

consultation with specific authorities as outlined in DOLS Code of Practice (Mental

Capacity Act 2005).

However, since the introduction of the Supreme Court ruling which was handed down on

the 19th

March 2014 regarding two cases, “P v Cheshire West and Chester Council” and

“P and Q v Surrey County Council”, the thresholds of what constitutes deprivation of

liberty have lowered dramatically. As a direct consequence of this ruling, the number of

Deprivation of Liberty Safeguards (DoLS) applications within the Trust has risen

considerably within this time period.

During 2014/15 there were a total of 53 DoLS applications from the Trust to both counties.

This can be broken down as Surrey, 26 applications made from the Trust and 27 for

Sussex. Due to the increased activity the pressures on the DoLS Teams in both counties

has been overwhelming for them resulting in a high percentage of patients not being

reviewed by the DoLs team within the legal timescales laid down. In 2013 there were 112

applications in the Surrey County; in 2014-2015 this had increased to 3,500. It is widely

acknowledged by both counties that there is, and will continue to be an escalation of



applications and the gap in the service will potentially widen. At present there are 35

part time best interests assessors in Surrey who carry out assessments in addition to

their substantive roles and duties. Surrey County have been granted funding of £500,000

to recruit additional full time best interest assessors, however for reasons that remain

unclear, are finding these posts difficult to recruit to resulting in escalating pressure on the

DoLS teams.

This can be further demonstrated by the activity within the Trust in 2014-2015. Of the 26

urgent applications made to the Surrey DoLs team, 11 remained outstanding, 10 had been

withdrawn, 4 were authorised and 1 was not authorised. Sussex DoLs Team have been

unable to provide a breakdown of these figures due to their workload pressures but it is

likely a similar picture would be presented. In contrast in 2013/14, only 11 Deprivations of

Liberty Safeguards (DoLS) urgent authorisations were requested by the Trust for patients.

All were assessed with 7 of the 11 applications upheld.

The Trust, however, must continue to adhere to this ruling and to apply for DoLS

authorisation for our patients who fall within the given criteria.* (Please see appendix A –

DoLS Ruling). The Trust must remain mindful that it does not make speculative applications

for DoLS as a result of this judgement, and patients are not subjected to unnecessary or

avoidable assessments which can be unsettling for them and their families.

As described above, the DoLS Teams within Surrey & Sussex remain stretched to capacity.

The Safeguarding Team will continue to adhere to the CQC regulations and inform them of

the DoLS activity within the Trust prior to assessment by a DoLS team. The CQC are aware

of the challenges regarding DoLS across the country and are happy to accept

notifications prior to assessments.

.3.1. Who does this new ruling apply to?

There are two key questions to ask? – the two step acid

test. Is the patient under continuous supervision and

control? AND

Is the patient free to leave?



It is now clear that if a patient lacks the capacity to consent to their arrangements and is

subject both to continuous supervision and control and are not free to leave, they

are deprived of their liberty.

Professionals must remember that the deprivation of liberty authorisations and Court of

Protection orders under the DoLS in the Mental Capacity Act 2005 are rooted in the principles

of that Act. DoLS exists to provide protection to individuals – to safeguard these individuals

when a deprivation of liberty is an unavoidable part of a best interests care plan.

Individuals who are identified as potentially deprived of their liberty must be considered on a

case-by-case basis and all appropriate steps taken to remove the risk of a deprivation of

liberty where possible.

Given the patient population that are served by the Trust, a significant proportion

of patients now fulfil the criteria e.g.

Patients who require continual 1:1 nursing care will require some form of safeguard

where they lack capacity to consent to this regime. This will include those patients for

instance with cognitive impairment who are at risk of falls (but who are not objecting

as such at being in hospital). The hospital would need to apply to the local authority

for a Deprivation of Liberty authorisation (unless the Mental Health Act was

applicable)

Patients who, though compliant with their care and therefore have no restrictions in

place, would not be allowed to leave the hospital without agreement from hospital

teams (as they would be at significant risk) would also need a form of safeguard. As

before the hospital would need to apply to the local authority for a Deprivation of

Liberty authorisation (unless the Mental Health act was applicable)

Patients who are in ITU under constant 1:1 nursing and who have not “consented” to

their care and treatment (e.g. planned operations where the patient has consented to

the risk of ITU treatment) may well be judged to be deprived of their liberty. As before

the hospital would need to apply to the local authority for a Deprivation of Liberty

authorisation (unless the Mental Health Act was applicable).



There is a legal view that in the worst case scenario it could be that all patients not

deemed free to leave the hospital would need some form of legal safeguard.

The Adult Safeguarding Team have embraced the challenge of ensuring that they are

engaging effectively with the nursing teams to address the learning and development

needs of staff on this contentious issue. The mandatory training has been revised and

updated to discuss fully the implications of the Supreme Court Ruling. Bespoke ward

based training sessions have also commenced during the last six months which have been

hugely beneficial to both the staff and the Safeguarding Team as a greater understanding

is being developed of this often complex ruling. This individual ward training will continue

to be rolled out across all departments during the coming year.

An MCA and DoLS Training day has been arranged for 27th

July 2015 which is be led

by an outside specialist speaker on the subject, who has been commissioned by NHS

England to raise the profile and understanding of MCA & DoLS. The Safeguarding Team

will then be in position to facilitate the training day themselves for the future on a rolling

programme to ensure there is continuous awareness throughout the Trust. These initiatives

for the year ahead will ensure a robust training programme is in place providing necessary

knowledge staff are required to have in relation to Deprivation of Liberty Safeguards.

3.4 The Savile Inquiry

Following the publication of the report, recommendations were made requesting all NHS

organisations to carry out a review of safeguarding procedures in place within their

individual organisations. On receipt of the published recommendations, Surrey & Sussex

Healthcare NHS Trust carried out a self-assessment will be submitted to the TDA, CCG’s

and Local Safeguarding Boards. From undertaking the self-assessment the Trust is assured

that safeguarding has a robust system in place in relation to some of the

recommendations made.

There are a number of areas that remain a work in progress, these have been added to

the Safeguarding Action Plan which is reviewed regularly. There are three areas work to be

completed:



The management of visiting celebrities, VIP’s and other official persons to the Trust.

The implementation of a trust-wide policy setting out access by patients and visitors

to the internet, to social networks and other social media activities such as blogs

and Twitter is managed and where necessary restricted

Ensure there are robust policies and procedures in place in relation to the

assessment and management of the risks to their brand and reputation, including as

a result of their association with celebrities and major donors, and whether their risk

registers adequately reflect this

3.5 The Care Quality Commission Report August 2014

In May 2014, the CQC carried out an inspection of Surrey & Sussex Healthcare NHS

Trust. The report was published in August 2014 with an overall rating as Good. There

were no concerns raised regarding safeguarding adults procedures within the Trust. The

report states that support for patients with Learning Disabilities or mental health

problems is readily available. It also states that patients were observed to be treated with

respect and their privacy and dignity were protected. There are robust systems in place for

monitoring safety and reporting incidents.

The CQC have advised that the Trust should review the training provided to clinical staff on

the Mental Capacity Act to ensure that all staff understand the relevance of this in relation

to their role. The Safeguarding Team have addressed this with a plan in place and training

is now being rolled out together with our first MCA and DoLS Training Day in July 2015.

4. The Care Act 2014

The Care Act 2014 came into effect on 1st

April 2015, putting Adult Safeguarding on a

statutory footing in line with Children’s Safeguarding. The Act has replaced the ‘No Secrets

‘guidance and sets out the legal requirements that the Trust to adhere to. Over the last year,

the Safeguarding Team have worked closely with both Surrey and Sussex Social Care

Teams to ensure that the Trust were fully compliant with the necessary regulations and a

smooth transition into a new way of working. The Safeguarding Team developed an Action



Plan to support the implementation.

As part of the Adult Safeguarding Boards for both counties, the Trust has signed up to a

locally agreed Information Sharing Policy. This involved liaison with departments within

the Trust including Information Governance, Legal Affairs and the Communications Team.

The fundamental shift however revolves around professional practice that puts the adult,

their wishes and their desired outcomes at the centre of safeguarding enquiries. It is about

making safeguarding a personalised experience, aiming to achieve the outcomes identified

by adults at risk of harm or abuse, rather than a person being taken through a process. It

is of paramount importance that this cultural change of thinking be articulated via training

and development to ensure that our staff are able, in reality, to change the way they

approach adult safeguarding within the Trust.

5. Training

5.1 Overview

Training continues to be an essential factor of the safeguarding agenda as it allows the team

to raise awareness, explore and evaluate practice within the Trust. The training session

on the MAST programme continues to be well evaluated by both the clinical and non

clinical teams. Involvement in the Doctors, Medical Students and Maternity training also

continues. Following CQC Trust report, the Safeguarding Team has facilitated some ward

based bespoke training in the medical directorate. This has proven to be an invaluable

exercise as it has given small groups an opportunity to reflect on practice in their area. It

has also provided the Safeguarding Team with an insight into what the training needs are at

ward level.

The reintroduction of establishing Safeguarding Link Nurses on the wards is essential to

our initiatives and this action is currently in progress. This is of particular importance at this

time as following the implementation of the Care Act 2014 on 01/04/2015 as the Trust is

now legally bound to act and share information in relation to safeguarding concerns.

Winterbourne, the Francis Report, the Savile Enquiry and Lampard’s investigation, continue



also to shape the Safeguarding Agenda. This is supported by Jeremy Hunt, Secretary of

State for Health’s introduction of a duty of candour throughout the NHS. Duty of

Candour has been introduced to the Trust incidents reporting system, the Safeguarding

Team are alerted if any incidents are reported that may have a safeguarding element. The

Safeguarding Team highlights the process of how to raise concerns, being open and

whistle blowing during each training session.

5.2 Training Figures for April 2014- March 2015

All staff are required to attend adult safeguarding training every three years. Based

on the figures received from the Training and Education Department, this gives an

overall percentage of 50.4 % of staff have received training during this 3 year period (April

2012 – March 2015).

The annual figure for the last year is calculated on the total staff head count for March

2015 which was 3768. From the numbers received from the Training Department, it

shows that overall 2060 members of staff have had Adult Safeguarding Training for this

period. This equates to 54.7 % of staff. Please see a further breakdown in the table

below:

Staff Group Total Staff Trained

Trust Headcount % Trained

Add Prof Scientific and Technical 55 78 70.51

Additional Clinical Services 434 699 62.09

Administrative and Clerical 308 719 42.84

Allied Health Professionals 102 168 60.71

Estates and Ancillary 190 320 59.38

Healthcare Scientists 40 90 44.44

Medical and Dental 242 536 45.15

Nursing and Midwifery Registered 689 1154 59.71

Students 0 4 0.00

Grand Total 2060 3768 54.7%

The Trust had set the Safeguarding training target at 85% compliance for all staff. The

Safeguarding Team continue to aspire to the set target. This has been added to the



Safeguarding Action Plan and the Safeguarding Team have met with the Training and

Education Department to discuss and plan for the training for this coming year. External

factors such as increasing room capacity for delegates will continue to be addressed

as this issue remains a challenge in improving compliance.

5.3 Prevent and CHANNEL

Prevent and CHANNEL are high on the national agenda. The Trust has the

HEALTHWRAP workshop in place which runs on a monthly basis for small groups of

staff. The workshop is facilitated by two Trust HEALTHWRAP trainers; it has been well

received with excellent feedback.

The Home Office and the Department of Health provided strict guidelines on how Prevent

training should be facilitated. This has recently changed, allowing the Safeguarding Team

to include Prevent awareness to the Safeguarding Adults training on the MAST

programme, thus highlighting the importance of Prevent to wider audience throughout the

Trust. It should be noted that the Crawley/Gatwick locality is a priority area and greater

level of awareness is built into the training delivery and generally across the organisation.

Prevent training is to become statutory in July 2015 meaning all staff must attend a one

off training session. This will be rolled out by the Safeguarding Team as the Trusts covers a

priority area as outlined by the Government.

6. Policies

6.1 Safeguarding Polices

The Safeguarding Adults, Management of Allegations and Intimate Care policies are in

place. The Safeguarding policy is currently being updated to incorporate the changes to

practice as a result of The Care Act 2014. These policies are discussed at all training

sessions, to ensure staff know how to access and use them in practice.



6.2 Supporting Policies

Over the last year, the Safeguarding Team have assisted with the Mittens Policy and the

Safer Holding Policy. The DBS referral guidance has also been incorporated into the

Disciplinary policy at the request of the Safeguarding Team.

6.3 Future Policies

Earlier this year, the Safeguarding Team met with a police officer from the Surrey MASH

(Multi Agency Safeguarding Hub) to discuss MARAC (Multi Agency Risk Assessment

Conference) referrals for domestic abuse. The Safeguarding Team plan to meet with

Safeguarding peers from other Trusts across Surrey County where this referral pathway has

already been introduced. The Care Act 2014 has highlighted domestic abuse falls within

Adult Safeguarding criteria. The Team hope to work closely with the Emergency

Department to ensure a Trust policy is introduced to ensure this this method of referral for

domestic abuse is followed.

The NHS Policy now states that there should be separate Safeguarding and Mental

Capacity Policies, the Safeguarding Team will work toward introducing this during 2015/16

period.

7. Independent Mental Capacity Advocate (IMCA) & Advocacy

7.1 IMCA

Where a person has been deemed to lack capacity or has substantial difficulty in being

involved in their care, the Trust must follow the Best Interests Principle. An IMCA must be

instructed if there is no other appropriate person available. Whenever possible the

Safeguarding Team attends any Best Interests meetings with IMCA involvement.

There were 28 referrals to KAG (Kingston Advocacy Group) during this year. The service

continues to be used regularly throughout the Trust, in particular in the Medical Division

and the Special Dentistry Unit.



7.2 Advocacy

Effective safeguarding is about promotion of an adults rights as well as protecting physical

safety, taking action against occurrence or prevention of reoccurrence of abuse or neglect.

This can enable an Adult to understand and recognise risk and know what actions to take or

request others to carry out actions on their behalf.

With the introduction of the Care Act 2014, if there is no advocate already in place, the

Local Authority (LA) must arrange, where necessary, for an independent advocate to

support and represent an adult who is the subject of a safeguarding enquiry or a

Safeguarding Adult Review (SAR).

The Trust must involve Adults in decisions made about them and their care and support

or a safeguarding enquiry or SAR. No matter how complex a person’s needs, staff are

required to involve the patient, to help them express their wishes and feelings, to support

them to weigh up options and to make their own decisions.

If an enquiry needs to start urgently, it can begin without an advocate being in place

however an advocate must be appointed as soon as possible. All staff must know how

to request an advocate and understand the role of an advocate.

Potentially, in April 2016, Advocacy will be offered to

All patients regardless of capacity

Patient Carers

Children approaching transition point to Adult Services

Adults who are subject to a safeguarding enquiry or Safeguarding Adults Review

(SAR) However, the introduction of this is subject to development, consultation and

parliamentary process.

8. Learning Disabilities

The LDLN (Learning Disability Liaison Nurses) play a vital role within the Trust, ensuring

that both patients and staff are supported when challenging situations arise. Their

assistance facilitates better experiences for patients with learning disabilities (LD). Sarah

Lalljee has taken up the position of learning disability liaison nurse at East Surrey for Surrey

patient and Christine Mazek has been covering maternity leave for Jaqueline Haffenden for



Sussex.

There has been a total of 161 referrals made to the Liaison Team, this can be broken down

by County:

Surrey, 73 referrals and Sussex, 88 referrals.

There were a total number of 19 Safeguarding alerts raised that involved a patient that had

a learning disability, this has decreased on last year’s figure of 23. Of these 19 alerts, 2

were raised against the Trust, one from each county and both raised externally to the Trust.

Recent data suggests that East Surrey Hospital have significantly higher rates of

admission of people with Learning Disabilities than any other acute hospital in Surrey. This

is in keeping with the fact that there is a larger population of people with learning

disabilities who live in the Trust’s catchment area. As a result the Learning Disability

Liaison Service receive a high number of referrals however we know that more people

access the hospital than we see therefore we are keen to increase the referral rates to

the service and ensure accurate data collection. In order to meet this demand the Learning

Disability Liaison Team has made a recommendation to the Surrey CCG collaborative to

increase the current commissioning.

A recent evaluation of the Surrey Learning Disability Liaison Service identified that a

significant amount of liaison nurse time was spent on providing Mental Capacity Act

(MCA) advice and support.

The Safeguarding team are aiming to commence monthly meetings with the Link Nurse to

discuss any safeguarding concerns on their wards or departments and promote this new way

of working around Adult Safeguarding. We plan to rotate each month with the Learning

Disabilities Team as we feel this will be beneficial to all parties involved and encourage

working together with different specialities.



9. External Meetings

9.1 Surrey

As the Trust geographically falls within Surrey boarders, the Trust follows Surrey

Safeguarding Multi agency procedures. The Surrey Adult Safeguarding Board invites the

Trust to send a representative from the Adult Safeguarding Team to attend the quarterly

meetings. The Strategic Lead attends this meeting with an Operational Lead as a

representative in her absence.

9.2 Sussex

The Sussex Adult Safeguarding Board invites the Trust to send a representative from the

Adult Safeguarding Team to attend the quarterly meetings. The Strategic Lead attends

this meeting with an Operational Lead as a representative in her absence.

9.3 Implementation of the Care Act 2014

Over the last six months, the Safeguarding Team have attended a number of meetings

across both counties in preparation of the new legislation which came into effect on the

01st

April 2015.

9.4 Training and Peer Meetings

As the Safeguarding Team now have more than one whole time equivalent in place, the

Team aspire to attend further external meetings and training as will not detract from the

service provided.

10. Serious Case Review

10.1 Sussex

The Trust was invited to assist with gathering information for a serious case review(SCR)

for Sussex during the high profile investigation into Orchid View Nursing Home. Following

the publication of the SCR, 34 recommendations were made. Whilst none were directly

applicable to the acute setting, the organisation has a part to play in the identification of

potential risks to patients admitted from nursing homes in the local area.



11. Audit

11.1 The Adult Safeguarding Team has an audit plan in place. This will be rolled out in the coming year.

12. DBS

12.1 Changes to the DBS

The DBS came into effect in 2012 following the joining of the CRB and the ISA. Under

the Safeguarding Vulnerable Adults Groups Act 2006, the Trust is placed with the legal

requirement to refer any person who has:

Harmed or poses a risk of harm to the a child or vulnerable adult

Satisfied the harm test: or

Received a caution or conviction for a relevant offence.

Following any safeguarding investigation involving a member of Trust staff, the

Safeguarding Adults Lead works in partnership with the Trusts HR Business

Partners to ensure that any member of staff or volunteer who falls within any of the

above criteria is referred to the DBS. This will be done in conjunction with the

introduction of the role of the Designated Adult Safeguarding Manager (DASM).

13. Priorities for 2014-2015

13.1 The Team have three areas of priority for the coming year, these are outlined below:

Training

This is an ongoing priority for the Safeguarding Team and the Trust, particularly in light of

the implementation of the Care Act 2014 on 01/04/2015. The Act has made Adult

Safeguarding statute in law and heralds a new way of working. The Safeguarding Team

will highlight the introduction of this and the changes that have occurred within Adult

Safeguarding ensuring compliance across the Trust.



Training will continue to highlight and promote the importance of the Mental Capacity

Assessments and Best Interests Process and ensure clear guidance is in place and

accessible for all staff. Further training days are already in the process of being rolled out

with a view to have MCA & DoLS training days on a continuous programme for the year

ahead.

MCA & Consent training has been introduced to the Consultant Training Programme for

the coming year. To assist with this, the Safeguarding Team will continue to work in

partnership with the Learning Disabilities Liaison Team in highlighting the importance of the

Mental Capacity Assessments and Best Interests process.

The Team will continue with ward based training and being visible in the clinical areas

thus highlighting the profile of the Adult Safeguarding Team.

Deprivation of Liberty Safeguards (DoLS)

Due to the recent change in the threshold for Deprivation of Liberty Safeguards applications,

the Safeguarding Team must ensure that there is a robust reporting system in place and

support for staff completing the application. This will include clear guidance and support for

staff. The creation and publication of an information leaflet for patients and their carers

regarding DoLS.

Risk & Compliance

The Team plan to roll out a robust audit programme for the Adult Safeguarding Team in

relation to DoLS applications and concerns raised.

The Team will continue to develop strong links between the Complaints and Patient Safety

& Risk Departments to ensure that safeguarding is considered at all times when

investigating a complaint or a patient safety issue.

The Safeguarding Team will continue to work closely with the Tissue Viability Nurse to

raise awareness regarding pressure area care.



The Safeguarding Team will continue to raise awareness around Domestic Abuse and

introduce direct links with the local MARAC (Multi Agency Risk Assessment Conference).

The Safeguarding Team to continue to raise awareness around Female Genital Mutilation

and assist to ensure that a robust reporting system is in place.

With the Trust migrating to NHS.net later this year, the Safeguarding Team plan to move

to electronic reporting of concerns, this will ensure immediate notification to both Social

Care and the Safeguarding Team enabling a timely and appropriate response.

14. Conclusion

The Safeguarding Team will continue to work towards ensuring that across the Trust

Safeguarding Adults remains everyone’s business. The level of activity and referrals made

to the Safeguarding Team continues to indicate that staff are concerned about real or

potential abuse of adults and are aware of how to report this and escalate their concerns.

Following on from the learning recommendations relating to the one substantiated case of

neglect against the Trust regarding pressure care, timely provision of appropriate

equipment and staff communication issues, the ward implemented the following series of

measures. Increased specialist training around tissue viability care, twice daily handovers

with key personnel at patient’s bedside, a robust information sharing strategy involving

patient’s relatives, a three minute response time to call bells and the introduction of a tool

to assess pain relief for patients with dementia and/or cognitive impairement. These

ongoing ward care standards by all staff will be displayed on ward and staff areas will be

assessed by their on-going appraisal process and also part of the assurance that this work

is successful will be feedback via Friends and Family tests.

The introduction the new Care Act 2014 has made a fundamental shift in approach toward

adult safeguarding, as it puts the Adult and their wishes and experiences at the centre of

any concern or enquiry. In the coming year, the Safeguarding Team will embrace this

and focus on highlighting the cultural changes that are taking place within Adult



Safeguarding.

The lowering of the Deprivation of Liberty Safeguards (DoLS) thresholds and a greater

understanding of this legislation through continuous training and presence of the

Safeguarding Team on the wards and departments will continue to produce increasing

levels of DoLS applications.

The Team is committed to continue to raise awareness across the Trust so that all staff

recognises the signs of abuse or potential abuse. Work will continue with both internal

and external agencies to create a climate in which abuse of adults is not tolerated.

The Trust Board is asked to receive this report and to continue to give its full support to

the Safeguarding Adults agenda.



Appendix A BRIEFING SHEET FOR HOSPITALS – The “Acid Test”

Deprivation of Liberty after Cheshire West

How to decide whether it is likely that a deprivation of liberty is occurring and when to make a

referral to the DoLS Team

The requirement for the Deprivation of Liberty Safeguards remain the same

There are still 6 requirements which need to be met

1. 18 and over

2. Suffering from a mental disorder

3. Lacking capacity for the decision to be accommodated in the hospital or care home

4. No decision previously made to refuse treatment or care, or conflict relating to this such

as LPA

5. Not ineligible for DoLS

6. The person needs to be deprived of liberty, in their best interests.

The difficulty comes in working out whether a situation in a hospital or care home amounts to a

deprivation of liberty.

The Supreme Court has now confirmed that here are two key questions to ask – the ‘acid test’:

(1) Is the person subject to continuous supervision and control? (All three aspects are

necessary)

AND

(2) Is the person free to leave? (The person may not be saying this or acting on it but the

issue is about how staff would react if the person did try to leave).

So this now means that if a person is subject both to continuous supervision and control

and not free to leave they are deprived of their liberty.

The following factors are no longer relevant to this:

(1) the person’s compliance or lack of objection;

(2) the relative normality of the placement and

(3) the reason or purpose behind a particular placement.



REMEMBER

The Deprivation of Liberty Safeguards applies in hospitals and care homes but this criterion to

decide what a deprivation of liberty is applies in any setting.

safeguarding (adult) trust report 2014-15 · april 2015. the trust already had a safeguarding...

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