Safeguarding Whole

Family Annual Report

2015 - 2016

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Page 3 Forward

Page 4 Abbreviations

Page 5 Section 1 - Introduction

Page 6 Section 2 - Organisational Structure

Page 7 – 9 Section 3 - Safeguarding Team

Page 10 – 14

Section 4 - Statutory Duties

Page 15 – 19 Section 5 - National Picture / Local Context

Page 20 Section 6 – Assurance Frameworks

Page 21 – 22 Section 7 – Safeguarding Training and Staff Support

Page 23 – 24 Section 8 – Safeguarding Reviews and Audits

Page 25 Section 9 – Inspections in the Last Year 2015-16

Page 26 – 32 Section 10 – Progress Against 2015-16 Priorities/Objectives

Page 33 – 34 Section 11 – Priorities for the Coming Year

Page 35 Section 12 – Conclusion

Page 36 Section 13 – References, Links and Contact Details

CONTENTS

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Safeguarding touches everyone’s lives at some time, including the lives of the service users and staff of Leicestershire Partnership NHS Trust (LPT). Many of our service users have experienced abuse of some kind, or may be at risk of experiencing abuse either now or in the future. Few of these service users exist in isolation, which is why in 2016 LPT adopted a ‘Whole Family’ approach to safeguarding; this approach has been reflected throughout the report. This year’s Annual Report has been produced as a single Whole Family report as opposed to producing separate Adult, Children’s and Looked After Children Annual Reports as had happened in previous years. The safeguarding agenda grows year on year as we become more aware, through learning and shared experience, of the risk faced by the most vulnerable in our society. The year 2015-16 was no exception and saw key developments in safeguarding which have changed the landscape considerably, further embedding the responsibility of organisations and individuals to safeguard those at risk from harm. On the 1st April 2015 the Care Act 2014 was implemented. The Care Act places adult safeguarding on an equal statutory footing as children’s safeguarding and introduces additional requirements on Safeguarding Boards, partner agencies and health agencies related to safeguarding adults. The implications of the Care Act on our work in LPT are outlined in the report. LPT recognises the importance of supporting survivors of Domestic Violence and Abuse and has been an active and valued member of this Leicester, Leicestershire and Rutland (LLR) priority work stream, making changes to training and procedures in line with new legislation such as the law relating to coercive control introduced in 2015. Training and information for staff has been adapted in relation to Individual and organisational responsibilities with regard to reporting of Female Genital Mutilation (FGM). Likewise, LPT has continued to work towards improving health outcomes for Looked after Children (LAC) and supporting the Child Death Overview Process (CDOP). The PREVENT Statutory Duty was introduced in 2015, placing specific statutory obligations on health organisations and other partners to support the protection of individuals vulnerable to exploitation by extremist groups. LPT has a dedicated PREVENT Lead in post and in 2015-16 has been fully compliant with PREVENT Statutory duties. Department of Education guidance ‘Working Together to Safeguard Children’ was updated in 2015, outlining a number of key charges including changes to the criteria for conducting Serious Case Reviews (SCR). This has impacted on the number of SCR’s LPT have been involved in, and whilst this has an impact on resources, essential lessons have been learned and practice changes implemented to improve the experiences of those who use our services. This report provides an overview of the safeguarding agenda and demonstrates the breadth of LPT’s safeguarding responsibilities. With this in mind, particularly given the vulnerabilities of those we work with in LPT, we must focus on ‘Early Help’ in 2016-17 in order to prevent the extreme abusive situations we often see highlighted by the media, but unfortunately also occur locally. LPT is closely monitored in relation to safeguarding activity both internally and externally to ensure the organisation is compliant with statutory requirements placed upon health organisations. The assurance processes in place and monitoring arrangements are included. We hope you find the report useful and informative and if you have any feedback to enhance next year’s report then please contact the Safeguarding Team. Thank you. Rachel Garton, Trust Lead Safeguarding Adults & Children

FOREWARD

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ACPO Association of Police Officers

ADASS Association of Directors of Adult Social Services

ALS Action Learning Sets

CAMHS Child and Adolescent Mental Health Service

CCG Clinical Commissioning Group

CDOP Child Death Overview Process

CSE Child Sexual Exploitation

CTL Clinical Team Leader

DHR Domestic Homicide Review

DoLs Deprivation of Liberty Safeguards

FGM Female Genital Mutilation

FII Fabricated and Induced Illness

FYPC Families Young People & Children’s Services

GP General Practitioner

IHA Initial Health Assessment

IRO Independent Reviewing Officer

JSNA Joint Strategic Needs Assessment

LAC Looked After Children

LGA Local Government Agenda

LLR Leicester, Leicestershire & Rutland

LLR MAPP Leicester, Leicestershire & Rutland Multi-Agency Policies and Procedures

LLR MSP Leicester, Leicestershire & Rutland Making Safeguarding Personal

LPT Leicestershire Partnership NHS Trust

LSAB Local Safeguarding Adult Board

LSCB Local Safeguarding Children Board

LWA Living Without Abuse

MARAC Multi-Agency Risk Assessment Conference

MCA Mental Capacity Act

MSP Making Safeguarding Personal

NHS National Health Service

NSF National Service Framework

RHA Review Health Assessment

SCR Serious Case Review

SDQ Strength & Difficulties Questionnaire

UAAS Unaccompanied Asylum Seekers

UAVA United Against Violence and Abuse

WALL Women’s Aid Leicestershire Limited

WRAP Workshop to Raise Awareness About Prevent

ABBREVIATIONS

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Safeguarding of children and adults at risk in Leicester, Leicestershire and Rutland (LLR) is overseen by the Local Safeguarding Adults and Children's Boards (LSAB and LSCB). The Care Act (2014), The Children’s Act 2004 and Working Together to Safeguard Children (2015) require all Local Authority areas to have Safeguarding Boards. The Boards have key statutory functions in place to ensure the welfare of children and adults in LLR is promoted. A number of agencies are invited to be members of the Board. Other agencies have a statutory obligation to be members of the Safeguarding Boards; LPT is one such agency alongside the Police, Social Care and Education. The Head of Professional Practice and Education attends the Boards (4 in total across LLR) on behalf of the Chief Nurse/Deputy Chief Executive, Adrian Childs. There are a number of Sub-Groups of the Board which are attended by the Safeguarding Team members or senior clinical/operational staff. The Boards oversee all regulated safeguarding work across LLR including but not limited to training, policy development and Serious Case Reviews/ Safeguarding Adult Reviews. In addition to being part of and supporting the work of the Boards, LPT also provides assurance to the Boards on a quarterly basis regarding the activities undertaken by LPT to safeguard children and adults at risk. One method of assurance is by providing data to inform the agreed performance management framework. The framework is submitted to and scrutinised by the Board along with other partner’s data on a quarterly basis, helping to give a picture of how well we collectively safeguard and promote the welfare of the population of LLR. Themes and trends are monitored and areas for improvement acted upon or included in the following years key priorities for the Board. The Boards produce an Annual Business Plan and related Annual Reports. These plans and reports, along with other information about the Boards can be found on the LSCB and LSAB websites, links can be found at the end of the report. Further assurance relating to LPT’s compliance with the Care Act and Working Together is provided on a quarterly basis to our commissioners via a series of assurance frameworks. These assurance frameworks as well as internal and multi-agency audits are completed by the safeguarding teams with the support of the audit department and clinical teams. They are monitored via the safeguarding committee and cascaded to the safeguarding forums to ensure learning is shared throughout the organisation. Information and learning is cascaded via regular safeguarding newsletters and through up to date training packages. There had been an increase of serious case reviews (SCR) in 2015-16. SCR’s are commissioned by the Safeguarding Children’s Boards. LPT support all serious case reviews with involvement from safeguarding, clinical and operational teams. Domestic Homicide Reviews (DHR) are conducted by the safeguarding Adults Board on behalf of the Safer Leicestershire Partnership/ Community safety Partnership. LPT Services have often been involved with the subjects of the review and complete reports and support the full DHR process. Since the implementation of the Care Act 2015, Safeguarding Adult Reviews (SAR) are carried out when an adult dies or is seriously harmed and there are concerns about how agencies worked together. Again, LPT are often involved and support the SAR process. The Safeguarding Team provide training and support to staff. The Team can be contacted in a variety of ways. Examples of the work of the Team in 2015-16 is included, the report introduces the Team and who to contact for further information or safeguarding support.

SECTION 1 - INTRODUCTION

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SECTION 2 – ORGANISATIONAL STRUCTURE

Trust Board Chief Executive, Executive Directors, Non-Executive

Directors

Quality Assurance Committee

Safeguarding Committee Chief Nurse, Head of Professional Practice and Education, Trust Lead Safeguarding,

Named Doctors for Safeguarding, Divisional Representatives, Senior Human

Resources, Learning and Development representative

Families, Young People & Children

Safeguarding Group

Named Professionals, Service Managers, Specialist Nurses, CDOP Manager,

Designated Nurse for LAC

Community Health Service Safeguarding

Group Professional Lead Nurses, Named

Professionals, Service Managers, Clinical

Governance

Mental Health & Learning Disability

Safeguarding Group

Named Professionals, Service Managers, Professional Leads

Mental Capacity Act Forum

Named Professionals, Service Managers, Professional Leads

Clinical Areas

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Rachel Garton Trust Lead Safeguarding Adults & Children Safeguarding Children Professional & Clinical Safeguarding Children Governance, Lead Safeguarding Children: Performance & Assurance Officer:

Carolyn Corbett Carol Smith Safeguarding Children Named Nurses:

Sue Troy Sue Stephenson Claire Silcott Angela Brook-Lawson

Heather Baker Roma Boobyer

SECTION 3 – SAFEGUARDING TEAM

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Specialist Nurse Domestic Violence Child Death Review Manager

Sally Clare Lisa Hydes Safeguarding Looked After Children (LAC) Designated Nurse for Looked After Children:

Claire Turnbull Specialist LAC Nurses: Bernadette Payne Chris Etherington Angela Davies Jo Jackson Debbie Bromley Liz Sampson Claire Read Jo Brettle-West Helen White Safeguarding Adult Professional Lead Adult Safeguarding :

Rachel Bradley Specialist Nurse Specialist Nurse Prevent Lead Team Administrator Safeguarding Adults Safeguarding Adults

Sharon Hames Fran Oloto Leon Herbert

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Director FYPC Helen Thompson

Head of Service Group 2

Mark Roberts

Professional & Clinical Lead Safeguarding

Children Carolyn Corbett

Trust Lead Safeguarding Children & Adults

Rachel Garton

Professional Lead Adult Safeguarding

Rachel Bradley

Prevent Lead Leon Herbert

Specialist Nurses Safeguarding

Adults

Team Administrator

Head of Professional Practice & Education

Safeguarding Children Named

Nurses

Child Death Review Manager

Lisa Hydes

Specialist Nurse Domestic Violence

Sally Clare

Designated Nurse for LAC Claire Turnbull

Head of Service Group 1

Adam McKeown

Safeguarding Governance, Performance & Assurance

Officer Carol Smith

Specialist LAC Nurses

Safeguarding

Management Structure

Safeguarding Named Doctors

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Safeguarding Children LPT is committed to discharging in full its duties under Section 11 of the Children Act (2004). This places a statutory duty on key people and bodies to make arrangements to safeguard and promote the welfare of children. Working Together to Safeguard Children: A Guide to Inter-Agency Working to Safeguard and Promote the Welfare of Children was updated and published in March 2015 and continues to reinforce that:- 1. The action we take to promote the welfare of children and protect them from harm - is everyone’s

responsibility. Everyone who comes into contact with children and families has a role to play. 2. Safeguarding and promoting the welfare of children is defined for the purposes of the guidance as:-

Protecting children from maltreatment;

Preventing impairment of children’s health or development;

Ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and

Taking action to enable all children to have the best outcomes. During 2015-16 LPT policies, guidance and training programmes were updated to reflect amendments to Working Together. NHS Commissioners require all NHS organisations to demonstrate how they meet, or are working towards the Markers of Good Practice, which are based on the National Service Framework (NSF) for Safeguarding Children, Young People and Maternity Services (2003:2004) Standard 5. The Markers of Good Practice is the annual performance management tool used to measure organisational progress against best practice standards. LPT complied fully with these standards in 2015/16. The Safeguarding Children’s Board also commissions the Section 11 Audit, measuring compliance with organisations responsibilities under the Children’s Act. This audit is carried out annually. LPT complied fully in 2015-16 with the Section 11 Audit. Looked After Children Promoting the health and well-being of looked after children: Statutory Guidance for local authorities, clinical commissioning groups and NHS England (Department of Health, Department of Education 2015). This document is the first point of reference for services working with LAC and describes how local authorities and health agencies carry out their duties in accordance with a number of pieces of legislation:– The Children Act 1989, 2004 The 2006 NHS Act (amended 2012) Care planning and placement and case review regulations The statutory guidance is formally issued to local authorities, CCG’s and NHS England. However, the guidance clearly relates to Designated and Named professionals, GP’s, dentists, optometrists, pharmacists and professionals in education, care leaver services, Health Visiting and School Nursing. It clarifies the responsibilities of professionals and support staff working with Looked After Children, young people and those leaving care.

SECTION 4 – STATUTORY DUTIES

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Looked after children: knowledge and skills and competencies of health care staff. Intercollegiate role framework. (Royal College of General Practitioners, Royal College of Nurses, Royal College of Paediatricians and Child Health 2015) A specific framework outlining the key roles, training, knowledge and skills required to work with LAC.

LAC Specialist Nurses fulfil the training requirements of the Guidance and their training is continuously updated by professional development sessions.

Health Visitors undertaking RHA for 0–4 year old LAC undergo 3 year LAC training.

There is s LAC/HV to support HV staff in undertaking RHA.

The LAC Practice Guidance of LPT revised 2015 outlines the responsibilities of HV and SN and where to find support in the Trust.

LAC Specialist Nurses have a good understanding of the role of partner agencies and link with the Local Authority and virtual school staff.

In 2015-16 preparations were made for specific CSE Nurses to support the Trust coming into post in Summer 2016.

NICE Guidance Quality Standard 31 (2013) This standard draws on existing guidance to provide an underpinning, comprehensive set of recommendations to support the measurement of improvement.

Overview of this document applies to the Health Needs Assessment for the County and Rutland which is overseen by the Strategic LAC Health Meeting.

The Specialist LAC Nurses now undertake the Leaving Care Health Summary since July 2015 on all care leavers to comply with the transition from child to adult services.

RHA audit has a specific focus on emotional well-being. NICE Guidance PH 28 (refreshed 2015) This guidance reflects recent changes in legislation since its original publication in 2010. It includes guidance on supporting to LAC to access health and mental health services. NICE Guidance: Children’s Attachment NG 26 (2015) This document provides guidance on supporting attachment for children and young people who are adopted from care, in care or at high risk of entering care. Safeguarding Named Doctor Support Significant support is provided to the Trust by 8 Named or Designated Doctors, supported by the community paediatric medical team who carry out safeguarding medicals for abuse or neglect, conduct weekly safeguarding peer reviews, compile safeguarding reports, provide advice to the primary care teams and staff within LPT, liaise with other agencies. Looked after Children medicals are also carried out by LPT paediatricians. Named Doctors also provide training on Social Services investigator courses and provide medical input into Serious Case Reviews, in addition to supporting the strategic development of all areas of the safeguarding agenda across the organisation and the wider partnership. Safeguarding Adults A number of key documents were published in 2014-2015 which continue to influence the adult safeguarding agenda through 2015-2016. The Care Act 2014 Safeguarding Provisions Clauses 42-48 of the Care Act provide the statutory framework for protecting adults from abuse and neglect. The safeguarding provisions include:-

New duty for local authorities to carry out enquiries (or cause others to) where it suspects an adult is at risk of abuse or neglect.

Local Safeguarding Adults Boards to carry out safeguarding adults reviews into cases where someone who experienced abuse or neglect died or was seriously harmed and there are concerns about how authorities acted, to ensure lessons are learned.

Requirement for all areas to establish a Safeguarding Adults Board to bring together the local authority, NHS and police to coordinate activity to protect adults from abuse and neglect.

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All organisations who are involved in adult safeguarding need to reflect the statutory guidance and good practice guidance that have been developed. The Care Act 2014 Statutory Guidance was published on 24th October 2014. In addition to providing a fundamental reform of the adult social care and support system, the Care Act creates a legal framework for key organisations and individuals with responsibilities for adult safeguarding to agree how they must work together and what roles they must play to keep adults at risk safe. http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted https://www.gov.uk/government/publications/care-act-statutory-guidance The Adult Safeguarding Improvement Tool 2015 is based on the Adult Safeguarding Standards, was refreshed in March 2015. Developed in Partnership by the Association of Police Officers (ACPO), Association of Directors of Adult Social Care Services (ADASS), Local Government Association (LGA), NHS Confederation and NHS Clinical Commissioners the document sets out key areas of focus, which have been used in numerous peer reviews, peer challenge and as a means of self-assessment. The characteristics of a well-performing and ambitious partnership are described, particularly in relation to the three key partners in safeguarding adults - the council, NHS and Police. http://www.local.gov.uk/documents/10180/6869714/Adult+safeguarding+improvement+tool.pdf/dd2f25ff-8532-41c1-85ed-b0bcbb2c9cfa There are 4 main themes of the tool along with how LPT are achieving these are outlined below:- Outcomes for, and the experiences of, people who use services

There is a shared approach to outcomes between the Council, NHS, Police and other partners so that we all know what difference we are making.

Outcomes are consistent, regardless of how old people are, whatever their disability or mental health problems are.

The public (including under-represented groups and adults at risk of abuse and neglect), is aware of Adult Safeguarding issues and how to raise concerns.

People experiencing safeguarding services are treated sensitively and with dignity and respect.

Advocacy is available and used appropriately for people who are (or may have been) experiencing abuse, including independent advocates for Mental Capacity (IMCA), Domestic Abuse (IDVA) and Mental Health (IMHA).

Leadership, Strategy and Working Together

There are clear and agreed structures, accountabilities, roles and responsibilities at member and officer leadership level for Adult Safeguarding.

Senior officers/managers (in the council, NHS and Police), key Councillors and Non-Executive Board members, Police and Crime Commissioners communicate to their organisations how Adult Safeguarding contributes to the well-being of individuals and communities.

Partners contribute human and financial resources to the SAB to enable it to function effectively.

Commissioning, Service Delivery and Effective Practice

Quality in health and social care services is managed across the NHS, Council and CQC (with links to Quality Surveillance Groups) so that abuse and neglect is prevented.

The public, voluntary sector, all council and partner staff are clear what abuse is and how to respond to it. People are clear what a safeguarding alert is.

Performance and Resource Management

Local workforce and training plans provide people with the right skills for Adult Safeguarding.

All staff have regular supervision that facilitates good decision-making support and an appraisal scheme that operates at all levels and which addresses development and performance

Making Safeguarding Personal (MSP) began in 2009 and continues to be motivated by the need to understand what works well in supporting adults at risk of harm and abuse. It is a programme led by the Local Government Association (LGA) Safeguarding Adults Programme and by the Association of Directors of Adult Social Services (ADASS).

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Making Safeguarding Personal involves:-

Ensuring the response by organisations to safeguarding concerns will be as individual as the person or situation.

Ensuring the safeguarding process is person-led not service-led.

Any safeguarding enquiries are outcome-focused.

Engaging people in conversations about their safety.

Enhancing involvement of the person.

Enabling choice and control by the person.

Improving the person’s quality of life.

Improving the person’s wellbeing and safety.

Providing a proportionate response.

Making Safeguarding Personal has gained widespread momentum and has picked up pace across LLR. It follows the edict of ‘no decision about me without me’ and means that the adult, their families and carers are working together with agencies to find the right solutions to keep people safe and support them in making informed choices. For LPT the MSP programme means changes to the way we make enquires into allegations of abuse needs to change to become more service user focused as opposed to being driven by organisational outcomes. MSP places the victim at the centre of the enquiry. LPT need sot ensure moving forward that processes, policies and procedures reflect the MSP principles. This work will be completed by 31st March 2017. https://www.adass.org.uk/making-safeguarding-personal-publicaitons/ The Mental Capacity Act (MCA) aims to empower people to make decisions for themselves as much as possible and to protect people who may not be able to take some decisions. The MCA is supported by a Code of Practice and health staff members are specially highlighted as a category of professionals who are required to have regard to this code of practice. The interdependencies between MCA and safeguarding can only be addressed if staff members are fully aware of their responsibilities. The Deprivation of Liberty (DoLs) Safeguards within the MCA provides a legal protective framework for those vulnerable/at risk people who are deprived of their liberty and not detained under the Mental Health Act 2005. The safeguards apply to people in hospitals and homes (whether privately or publicly funded) and their purpose is to prevent decisions being made which deprive vulnerable people of their liberty. In the event of it being necessary to deprive a person of their liberty, the safeguards give them rights to representation, appeal and for any authorisation to be monitored and reviewed. To date LPT have complied with all guidance as discussed and have achieved the following:-

Production of Adult safeguarding, MCA and DOLS policies and procedures.

Guidance for staff and partners (including such tools as flow charts).

Partnerships with Local Authorities and Police and other health organisations (UHL).

Representation at LSAB Board and meetings.

Establishment of a Trustwide MCA Clinical Forum

Reports on MCA activity such as training.

Participation in Serious Case Reviews, Domestic Homicide Reviews, Serious Untoward Incidents, Mental Health Inquiries, Coroners reports.

Continued operation of LPT adult safeguarding advice line.

Facilitation of Level 1 and Level 2 Adult Safeguarding, MCA and DOLS training packages.

Quarterly LPT Staff Briefing.

Embedding Care Act 2014 and participating in Section 42 enquiries with Local Authorities.

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Child Death Overview Process (CDOP) The duties undertaken by the LLR Child Death Overview Panel are as outlined in Chapter 5 of Working Together to Safeguard Children (2015). The child death overview process has been established within LLR since February 2009. Working Together to Safeguard Children (2006) outlined the duties of the Local Safeguarding Children’s Board (LSCB) to undertake a review of any child death resident within their area. Working Together to Safeguard Children (2010) re-emphasised the need to ensure a process is in place to undertake this work (sec 7.25). This process continues to be underpinned by the new Working Together to Safeguarding Children (2015). LPT is commissioned provide and co-ordinate the CDOP process and LPT Named Nurses undertake scene visits for unexpected child deaths. The Child Death overview manager is employed by the Local Safeguarding Children’s Board however is hosted with LPT and works closely with the Safeguarding Children’s Team. The CDOP Manager supports all CDOP reviews and supports learning across all partner organisations in LLR. The remit of the child death overview process is to co-ordinate a systematic review into the death of any child between 0 and 18 years of age (the review does not include stillbirth notifications) and identify emerging trends and themes, working alongside public health and partner agencies. All notifications are received by the Child Death Review Manager who will co-ordinate the initial response. The work of the Child Death Review Manager is supported by the Child Death Overview Panel Secretary. Within LPT there is a Team of 4 Safeguarding Children Named Nurses who contributes to rotational cover for unexpected deaths (2 nurses have recently joined the team due to existing vacancies and will undertake this role in due course). The Named Nurse role (for CDOP) has recently been reviewed and as a result the Named Nurse will hold the case until it has been to panel. It is hoped that this will provide families with a greater understanding of the CDOP process, provide continuity and allow them (should they wish to) to participate in the review. The Named Nurses provide cover during office hours (9:00am–5:00pm) Monday to Friday (excluding Bank Holidays). In addition there is a Sudden Unexpected Death in Children (SUDIC) Doctor who provides medical advice in relation to the notifications received and chairs subsequent case discussions before presenting the case to panel. Further information about the CDOP process and details about current developments, information can be found in the CDOP Annual Report (along with the LLR Child Death 6 year review) which has been undertaken. This information is available on the LSCB website. Prevent Prevent is part of the UK Government’s Counter Terrorism Strategy, aiming to protect those who are vulnerable to exploitation/radicalisation from those who seek to recruit people to support their cause. Examples are: IS/Daesh Al-Qaeda influenced groups, far right extremists, environmental extremists and animal rights extremists all of which may include criminal acts or acts of terrorism. We as healthcare staff are well placed to recognise individuals, whether patients or staff, both adults and children, who may be vulnerable and therefore more susceptible to exploitation by extremists or terrorists. It is fundamental to our ‘duty of care’ and falls within our safeguarding responsibilities and as such every member of staff has a role to play in protecting and supporting vulnerable individuals who pass through our care. It has been a key year for the Trust’s Prevent Strategy with policy, process, and resources being embedded. A significant number of staff have received WRAP (Workshop to Raise Awareness About Prevent) training & awareness across the organisation; putting the Trust in a strong position in line with introduction of the Prevent Statutory Duty which comes under the Counter-Terrorism and Security Act 2015 and NHS Standard Contract requirements. LPT continues to move forward this agenda with a dedicated Prevent Lead providing specialist strategic and operational support across the multi-agency partnership and safeguarding support to patients and staff across the Trust.

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Safeguarding Children The Children Act 1989 (DH 1991) reflects the philosophy that the welfare of the child is paramount and since Lord Laming’s Inquiry into the death of Victoria Climbie (2003) there has been a significant shift away from the narrow child protection ideology towards the wider concept of safeguarding children. Safeguarding children is a multi-agency approach that aims to improve outcomes for children by preventative early intervention and protection of children suffering or at risk of significant harm. To ensure children receive early support and protection all practitioners working with children and adults need to be aware of the constantly evolving perpetrator activities that present a risk to a child’s safety and well-being. During 2015-16 and progressing into 2016-17 some of the key national and local priorities includes:- Child Sexual Exploitation (CSE) Continued emphasis has been placed on child sexual exploitation over the last year with LPT contributing to a Joint Agency Targeted CSE Inspection. Locally, a multi-agency CSE Hub has been developed and funding secured to recruit CSE Specialist Nurses to the CSE Hub. Female Genital Mutilation (FGM) From 31st October 2015 Section 5B of the Female Genital Mutilation Act (2003) introduced a mandatory reporting duty which requires regulated health and social care professionals and teachers in England and Wales to report “known” cases of FGM in Under 18s. During 2015 LPT developed an FGM flowchart to ensure practitioners followed the correct referral route. FGM Enhanced Dataset From the 1st October 2015 certain organisations (General Practice, Mental Health Trusts and Acute Trusts since 1 July 2015) are required to have regard to the FGM enhanced dataset standard which relates to adult females as well as children. Data collected is sent to the Health and Social Care Information Centre (HSCIC). Data is then analysed and published in aggregate form. Signs of Safety Approach All LLR (including LPT) frontline health practitioners in Leicestershire have contributed to the use of the Signs of Safety approach during Local Authority led safeguarding children meetings. This approach focusses on agencies working collaboratively and in partnership with families and children to assess risk and develop action plans that increase safety and reduce the risk to children by focusing on the strengths, resources and networks within the family (Bunn 2013). Safeguarding Children Key Priorities Leicester, Leicestershire and Rutland local Safeguarding Children Boards identified key safeguarding priorities which reflect high profile national safeguarding issues. LPT adopted these key priorities and expanded them to include prevent underpinned by the Whole Family approach. The posters illustrated below were circulated to all LPT staff during 2015-16.

SECTION 5 – NATIONAL PICTURE / LOCAL CONTEXT

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Looked After Children Children and young people achieve better health outcomes living in consistent and stable environments where their individual needs are addressed. This is usually with their family of origin within their local community. Where it is not possible for a child or young person to remain with their birth family due to their safety and welfare needs not being met they may need to come into an alternative safe and stable placement where they can get appropriate support. When a child or young person becomes a Looked After Child (LAC) the Local Authority take on the role of the corporate parent. The Local Authority with the support of partner agencies including health should ensure they demonstrate the care given by any good parent and offer support, guidance and resources until that child or young person ceases to be LAC or makes the transition into adulthood. Nationally in 2016 the LAC population was 70,440 this has increased year on year since 2008.

Increase in LAC is 1% compared to 31st March 2015.

Increase in LAC is 5% since 31st March 2012. The1% increase reflects a large increase in unaccompanied asylum seekers who became LAC – 1,470. The increase in LAC was 970. More boys than girls were taken into care during 2015-16, 56% male and 44% female. National ethnicity is shown below, however ethnicity data is not available for LLR:-

75% White

9% Mixed ethnicity

7% Black/black British

5% Asian/Asian British

3% Other Regional data for LAC year ending 31st March 2016:-

Leicester – 645

Leicestershire – 479

Rutland - 40 The majority of children and young people come into care due to abuse and neglect (61%), family dysfunction accounts for 16% other reasons include reasons of disability and additional needs.

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Looked After Children have many of the same health risks and problems as their peers, the extent of these risks are often exacerbated due to their experiences of poverty, abuse and neglect. These children and young people are more likely to have more mental health problems and a greater proportion of children looked after have special educational needs. The numbers of Looked after Children and Young People have increased across Leicester, Leicestershire & Rutland (LLR) as a whole in 2015-16. There has been a substantial increase in Leicester City from 543 in March 2015 to 641 in March 2016 an increase of 18%. Figures for Leicestershire have remained broadly similar to last year, 489 in March 2015 and 471 in March 2016 and Rutland show a decrease from 49 in March 2015 to 38 in March 2016. Since 2010 the total figures for LAC across LLR have increased from 837 to 1,149 an increase of 37%. Leicester City had a higher rate of LAC in 2015 at 70 per 10,000 children compared to the national average of 60. The counties have a lower than average rate of LAC at 35 for Leicestershire and 43 for Rutland. Foster placements account for the residency of LAC in 77.1% of cases in Leicester City, 69.9% in Leicestershire and 75.8% in Rutland similar to the national 75% average. LAC placed in residential care, hostels or secure units vary from an average of higher levels of 10.5% in Leicester, 9.5% in Leicestershire and currently 0% in Rutland; the average nationally is 9.4%. Local resources:-

LPT LAC Practice Guidance 2015

Neonatal Pathway including LAC

Pre-Adoptive Pathway – trial April 2016

Hearing the Voice of LAC proposal University of Leicester The Strategic Looked after Children Health Group There is a well established Strategic Looked after Children Health meeting which takes place bi-monthly chaired by the Designated Nurse (employed by LPT) where LAC representatives from Leicester City, Leicestershire County and Rutland County meet to review progress on meeting the health recommendations of the Statutory Guidance. The representatives include the Designated Nurse for LAC, the Designated and named Doctor for LAC, an Independent Reviewing Officer (IRO), Public Health, and Service Managers for LAC, a commissioning representative from the Clinical Commissioning Group (CCG), a Child and Adolescent Mental Health specialist (CAMHS), Children’s Social Care and Early Help and a Safeguarding representative from the acute hospital service. The meeting addresses any new issues affecting the health and well-being of LAC and ensures the responsibilities outlined in the statutory guidance are being met and evidenced. Safeguarding Adults The government’s policy on safeguarding adults was set out in May 2011 and re-issued in 2013, when 6 principles were identified for local authorities, housing, health, the police and other agencies to follow and use for monitoring safeguarding arrangements:-

Empowerment

Prevention

Proportionality

Protection

Partnership

Accountability

The National Health Service (NHS) has a duty to ensure that the 6 principles are applied by all staff to ensure that safe and high quality care and support is delivered. The statutory safeguarding duties have been clarified through a number of national documents and the impact of the new Care Act (2015) requirements has generated a wide array of policy requirements and guidance in support of these new responsibilities.

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The Criminal Justice and Courts Act 2015 came into force 13th April 2015 (applying to offences committed after this date) and includes both individual care workers and provider organisations in offences of ill treatment or wilful neglect. This care provider offence can be committed by a range of organisations, by hospitals or by partnerships, e.g. a GP partnership.

The Serious Crime Act 2015 makes a number of distinct changes to the criminal law protecting girls from female genital mutilation and strengthening the protection afforded to victims of domestic abuse.

Domestic Violence, Crime and Victims Act 2004 (updated in 2014) places a duty on Community Safety Partnerships to make arrangements for Domestic Homicide Reviews and health agencies are required to participate in these.

The Lampard Report (2015) was published in Feb 2015 relating to the Jimmy Savile Enquiry. This report provided independent oversight of the NHS and Department of Health investigations into the role and activities of Jimmy Savile in health organisations. The report focussed on the findings and conclusions of NHS investigations with the intention of strengthening patient care and safety. The common themes relevant to the wider NHS are related to security and access arrangements (including celebrities/VIPs), the role and management of volunteers and safeguarding arrangements.

Statutory guidance issued under section 29 of the Counter-Terrorism and Security Act (2015) came into force in February 2015 and created a new duty on certain bodies to have due regard to the need to prevent people from being drawn into terrorism. Key duties of the Act were also included in the 2015-16 NHS Standard Contract with requirements for a Prevent Lead, Policies and Procedures and compliance with the principles contained in the Government Prevent Strategy/Guidance Toolkit.

The Safer Leicester Partnership is linked closely with the LSAB with the objective to effectively manage safeguarding issues within all communities across Leicester City. It is made up of a range of agencies including NHS, Police, Fire and Rescue Service and Probation Services. The partnership commission’s specialist DV services for the people of Leicester, Leicestershire and Rutland. UAVA stands for United Against Violence and Abuse and is a consortium of three local specialist providers (Women’s Aid Leicestershire Ltd, FreeVA and Living Without Abuse). It aims to provide a simplified journey which can be accessed by anyone who has been affected by domestic abuse and or sexual violence. In March 2016 Leicester City developed ‘A Keep Safe Place’ scheme. The scheme identifies a temporary safe place a person can go to when they feel unsafe, vulnerable or upset with the idea being that staff at the venue are able to offer reassurance, offer the person a place to calm down and feel safe, offer support with making a call or to make a call on their behalf, to either a relative or relevant service and make an emergency call on the person’s behalf to the Police or for an Ambulance. During 2015, Leicester City Council established a steering group to take forward a local project to embed MSP and Leicestershire and Rutland Councils are also establishing similar groups with a view to combining to create one Leicester, Leicestershire & Rutland Making Safeguarding Personal (LLR MSP) Group of which LPT will be a member. Leicester, Leicestershire & Rutland Multi-Agency Policies and Procedures (LLR MAPP) is a resource reflecting the commitment of all organisations and practitioners in LLR to work together to safeguard adults experiencing or at risk of abuse or neglect. The MAPP is aimed at different agencies and individuals involved in safeguarding adults, including managers, professionals, volunteers and staff working in public, voluntary and private sector organisations. LPT are a member of the MAPP development group and contribute to development and oversight of all MAPP. Think Family was developed in order to provide a more unified approach to families experiencing Parental Mental Illness and promote joint working across services. One hundred frontline professionals from more than 20 different services from health (inclusive of LPT employees), education, social care and voluntary sector have been trained in this evidence based family intervention. The programme equips frontline professionals with family focused intervention skills and necessary knowledge and awareness regarding mental illness in the family. It also provides skills around the needs of children of parents with mental illness as well as skills enabling collaborative approach with partner agencies. LPT has made a positive contribution to the Think Family Multi-agency Training and Family Intervention. It has adopted the training package which consists of adapted Behavioural Family Therapy - Meriden Family Programme model of working with families affected by Parental Mental Illness.

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Domestic Violence and Multi-Agency Risk Assessment Conference (MARAC) Nationally, the Government continued its commitment to ending violence against women and girls (A Call to End Violence against Women and Girls – Government Action Plan 2014–2016). LPT continue to contribute to the MARACs across Leicester, Leicestershire & Rutland, recording 100% attendance during 2015-16. Domestic Violence services across Leicester, Leicestershire and Rutland (LLR) are now provided by United Against Violence and Abuse (UAVA). This new organisation replaced SAFE (City), Women’s Aid Leicestershire Limited (WALL) and Living Without Abuse (LWA). The independent domestic violence and sexual violence advisors (IDVAs and ISVAs) are also provided through UAVA. Coercive Control: On the 29th December 2015 a new domestic violence law came into effect which recognises that abuse is a complex and sustained pattern of behaviour intended to create fear. The offence of coercive control which carries a maximum penalty of 5 years imprisonment and a fine can be invoked if a victim suffers serious alarm or distress that impacts on their day-to-day activities, or if they fear violence will be used on at least two occasions.

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On 2nd July 2015 NHS England published Safeguarding Vulnerable People in the NHS- Accountability and Assurance Framework. This document updated and replaced the Safeguarding Vulnerable people in the reformed NHS – Accountability and Assurance framework, issued by the NHS commissioning board in March 2013. The framework outlines the requirements for commissioners to support providers to discharge their statuary duties to safeguarding children and adults as outlined in documents such as the Care Act, Working together, Mental Capacity Act and the PREVENT Statutory duty (not exhaustive). Within the Framework commissioners of health services have a duty to ensure that health providers provide care compliant with their safeguarding duties. In order to support providers, the designated safeguarding nurses, employed by CCG’s, for LLR developed three assurance frameworks: The Safeguarding Adults Assurance Framework; The Markers of Good Practice and the Mental Capacity Act Checklist. These frameworks are completed annually by LPT and include a self-assessment rating of full compliance, partial compliance or not compliant in across a range of areas including but not limited to policy and procedure, training, safeguarding governance structures, recruitment and service user/carer involvement. In 2015-16 LPT were rated as fully compliant for children’s safeguarding with the exception of the process for sign off of Serious Case Review Reports. This area was rated as partially compliant. This has since been rectified with a flowchart for the sign off of SCRs being produced and signed off by the safeguarding committee in 2015. LPT were rated and fully or partially compliant for all areas of adult safeguarding. Action plans have been developed for areas of partial compliance and these are monitored internally and externally. Action plans were reviewed at quarterly meetings with the designated nurses to ensure full compliance is reached and areas of full compliance are maintained. Action plans are also monitored via divisional safeguarding forums and exceptions reported to the safeguarding committee. In 2015-16 changes were made to the MCA training based on feedback following the completion of the frameworks. The training was increased and a successful bid was made to secure increased one of funding to improve MCA training in 2016-17, policies and procedures were updated to reflect the Care Act. All staff who are employed by the Trust now have a clear outline of their responsibility to comply with MCA standards as this is contained in their job descriptions. Work began to increase service user and carer involvement in safeguarding practice. Further work is needed in relation to involvement and MCA and service user involvement; this is reflected in the priorities for 2016-17 outlined later in the report. Moving forward into 2016-17 work is underway with commissioners to produce a single assurance framework which combines the Safeguarding Adults Assurance Framework and the Markers of Good Practice. Progress will be outlined in the 2016-17 Annual Report.

SECTION 6 – ASSURANCE FRAMEWORKS

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Safeguarding Training During 2014 the trust wide Safeguarding Education and Training Strategy was revised for both children and adult safeguarding programs and a further review will take place in 2016-17. The Education Strategy provides the framework for safeguarding training relevant to all staff working for LPT and it meets both national and local competency framework requirements. Children The Safeguarding Children Team delivers face to face Level 2 & Level 3 safeguarding children training to LPT staff. Compliance data as of the 31st March 2016 is illustrated in the table below:-

Safeguarding

Children Level 2 Update: 3 years

Safeguarding Children Level 3

Update: 3 years

Adult Mental Health & Learning Disabilities Services Community Health Services (CHS) Enabling (Corp) Family Young People & Children (FYPC) Hosted Services GRAND TOTAL

86.4% 91.2%

The Safeguarding Children Team also delivers Fabricated and Induced Illness (FII) training as part of the LSCB multi-agency training programme. Adults Safeguarding Level 1 Alert is included on LPT core mandatory training for all staff. This is repeated every 3 years and is delivered via classroom by the organisations trainers. The content of the safeguarding training is reviewed annually by the Adult Safeguarding Team. On a monthly basis LPT provide approximately 120 places across the adult service areas for a full day Safeguarding Level 2 Alert and Refer training programme. It is delivered via classroom is repeated every 3 years. The classroom delivery is part of a training package that incorporates Level 2 Children’s Safeguarding, Prevent, MAPPA, Domestic Violence and MCA and DoLS mandatory training. There is also collaboration with Leicestershire Police who delivers training with the LPT Prevent Lead and training in relation to the role of the Police Adult Referral Desk. LPT Adult Safeguarding Team has been successful in being awarded bid money of £17,500 through NHS England. The bid included using the money to fund bespoke training in MCA and DoLS for senior managers and matrons and for the MCA Champions across LPT. A priority for 2016/17 is to provide Safeguarding Children Level 3 training to adult service staff. As of 31st March 2016

Level Organisation Area Current Compliance

Adult Safeguarding All staff 83.3%

Adult Safeguarding Substantive Staff Only 88.6%

Mental Capacity Act Substantive Staff Only 86.7%

SECTION 7 – SAFEGUARDING TRAINING AND STAFF SUPPORT

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Between 2015-16 a total of 708 LPT staff completed Prevent WRAP training. There was also a total of 6987 LPT staff who completed Prevent Basic Awareness training via Induction & Core Mandatory training. Safeguarding Advice Lines The Safeguarding Children Advice Line is open between the hours of 12 midday-4:00pm (Monday-Friday). Outside of these hours practitioners are advised to contact their Team Leader/Manager for advice. The Safeguarding Children Advice Line is a well-used resource across LPT and is constantly evolving its delivery and data collection processes. The number of calls dealt with by the Safeguarding Children Team on the Advice Line during 2015-16 are shown below:-

Quarter 1 – 356 Quarter 2 – 381 Quarter 3 – 387 Quarter 4 – 370 Total Calls – 1,494

The Adult Safeguarding Advice Line is open between the hours of 12:00noon-2:00pm. An answerphone is available outside of these times. There were 894 referrals made to the Adult Safeguarding Team for April 2015-March 2016. Staff Support and Supervision LPT is committed to ensuring staff have access to safeguarding children supervision in order to safeguard and promote the welfare of children and young people. All staff within LPT can request safeguarding supervision from the Named Nurses Safeguarding Children Team. Within Families, Young People and Children’s services a structured safeguarding supervision process is available to staff which includes 1:1 supervision or Action Learning Sets facilitated by Safeguarding Children Named Nurses or Peer Supervisors who have received specific safeguarding supervision training. Health Visitors and School Nurses are required to attend safeguarding supervision a minimum of three monthly as per National Guidance. Within Adult Services across LPT the Specialist Safeguarding Nurses meet regularly with matrons and senior managers to discuss themes and trends and specific safeguarding concerns. There is also provision of ‘drop in’ style sessions facilitated by the nurses for all staff to access and discuss safeguarding concerns. Moving forward through 2016 this will be expanded with a plan of phased and monitored safeguarding clinical support which will increase clinical visibility of safeguarding staff and embed learning into practice. Discussions are underway with the learning and development team around highlighting safeguarding supervision alongside clinical supervision and giving it equal prominence.

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Safeguarding Reviews Safeguarding Children Within safeguarding children practice local serious case reviews and national enquires are conducted following the death of or significant injuries to children. These reviews have been the driving force in policy development and the identification of interventions that are considered best practice to safeguard children. During 2015/2016 a number of Serious Case Reviews (SCRs) and Alternative Reviews were commissioned by the two Local Safeguarding Children Boards across Leicester, Leicestershire and Rutland. Recommendations from these SCRs:-

Neglect – Across all agencies improvement is required to assess and respond to children at risk of or suffering neglect. The related action is the development of a LSCB multi-agency neglect strategy, procedure and toolkit. LPT participated in the development of the procedure and toolkit.

Injuries to pre-mobile babies - Improvement is required in agency responses to the identification of injuries to pre-mobile babies. The associated action is the development of a LSCB multi-agency pre-mobile baby protocol again; LPT participated in the development of this.

Professional disagreements and escalation of concerns. There was a lack of challenge regarding agency decisions and concerns were not escalated within and between agencies. The related action is to update and strengthen the LSCB multi-agency Resolving Practitioner Disagreements and Escalation of Concerns procedure.

Looked After Children SCR Child B Final Report January 2015 – Looked after Child in Pre-Adoptive Placement Recommendations and lessons learned for Health:-

LAC Practice Guidance makes the responsibilities to pre adoptive parents and LAC explicit. This has been achieved by making amendments to LPT practice guidance.

Team Leader / Clinical Team Leader (CTL) presentation need to update on pre adoptive placements and best practice – this has bene achieved by making the required amendments.

Health Visitors should understand their responsibilities in relation to Looked after Children and their legal status. The training provided to Health Visiting in relation to LAC has been revised and the legal status of pre-adoptive children is now explicit in practice guidance.

RHA quality is audited by the Specialist LAC Service and specific questions are related to the LAC status of the child, the legal status of the child and the status of the parent.

Multiagency work has taken place with children’s social care adoption services to undertake a pilot offering additional health support to pre adoptive parents from the health visiting team. This is a 6 month pilot from April 2016; the outcomes will be included in the annual report for 2016-2017.

Safeguarding Adults Leicestershire Partnership NHS Trust (LPT) service users have been involved in Domestic Homicide Reviews (DHR) and Safeguarding Adult Reviews this annual year. The Trust has also conducted a safeguarding audit to measure staffs understanding of safeguarding and areas of competence/confidence. The key learnings, recommendations and good practice areas emerging from these reviews and audit are:

SECTION 8 – SAFEGUARDING REVIEWS AND AUDITS

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Recommendations for LPT from recent DHR

LSAB to seek assurance that single agency domestic abuse training does not focus purely on abuse within intimate partner relationships and that learning from this DHR is incorporated into domestic abuse training.

For there to be national and regional guidance regarding the management of historical or non-recent allegations of abuse.

For routine enquires regarding domestic abuse to be embedded within substance misuse services, in particular alcohol misuse services, given the link between domestic abuse and alcohol.

Recurrent themes from other DHRs

A recent DHR report highlighted staff lack of confidence in exploring issues of domestic violence with patients and the lack of awareness and knowledge around the use of the Domestic Abuse, Stalking and Harassment and Honour Based Violence (DASH 2009) Risk Identification Checklist. DASH training is available to staff on an ongoing basis, as is support from staff via the children’s safeguarding team and Specialist Nurse for Domestic Violence and Abuse employed by LPT.

Areas of Good Practice for LPT from DHRs

In one of the DHRs that LPT contributed in, the author could not identify any recommendations in this IMR from LPT. There has been no identified root cause for this incident. The IMR findings found that this incident from an LPT perspective could not have been predicted as the victim was not in LPT care at time of incident and was under the care of his GP.

The care and treatment the victim received from LPT was in line with risk assessments and Trust policies and procedures.

The author was impressed with the record keeping, risk assessments and referrals to other agencies from inpatient and community practitioners’ mental health practitioners’ rom LPT.

There was robust information sharing between LPT and GP on discharge. There was also evidence of cross county information sharing between agencies.

Safeguarding Audits LPT Annual Safeguarding Audit

The key messages from the last Trust Wide Safeguarding Audit indicated that 100% of respondents knew who to contact if they had concerns that a child or vulnerable adult is being abused. This is an excellent result that we must strive to emulate year on year.

Good basic understanding of safeguarding, MCA/DoLS, MAPPA and PREVENT is also evident.

However, greater understanding of the more complex areas of MCA/DoLS is needed.

Also greater need for emphasis on the principles of Think Family would benefit safeguarding practice across LPT to ensure staff are supportive of all family members and the impact on family circumstances as opposed to focus solely on one family member.

Support and supervision is necessary for staff to effectively safeguard those they care for and despite this being an area of high importance, there are inconsistencies across the Trust in relation to the implementation of safeguarding supervision. Understanding the quality of supervision and addressing inconsistencies is a priority for 2016-17.

Moving forward into 2016/17 a full multi-agency audit program is being developed for both children’s and adults services, led by the corresponding safeguarding boards. The internal safeguarding audit is also being reviewed with a new internal audit plan being considered to focus on specific themes pulled out from 2015/16. Outcomes of which will be reported in 2016-17 Annual Report.

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CQC Full Compliance Visit In March 2015 the CQC inspected LPT. The CQC recognised good practice in some areas of safeguarding. However, expressed some concern in relation to how we evidence implementation of the principles of mental capacity as outlined in the Mental Capacity Act. Following the visit an action plan was developed addressing areas for improvement and improvements continued to be implemented. In the action plan we agreed to:- We will offer time limited MCA/DOLS training specifically for team managers/matrons to ensure requirements are fully understood. Bespoke training sessions to also be offered based on results of monthly safeguarding audit. Funding has since been secured for this training and a draft plan to deliver the training has bene produced with the aim of sin off at the Safeguarding Committee Nov 2016 Review of existing MCA/DOLS training to ensure fit for purpose- this has also been addressed via the additional funding. We will ensure that developments implemented in one directorate are shared Trust wide through strong attendance from safeguarding and appropriate directorate reps at the MCA Clinical Forum. We will ensure the safeguarding agenda is monitored and implemented by committing to Senior Divisional leadership representation at the Trust Wide Safeguarding Committee. - Partially complete. Directorate representation at the MCA forum has improved and work is underway to strengthen the divisional links with the committee. Regula divisional reports to the committee as proposed along with monitoring of divisional risk is proposed and will be a priority in 2016-17. We will complete and submit a proposal for a Specific MCA/DOLS Development Lead to deliver training, audit, practice development around MCA/DOLS and provide advice/support to teams. The necessity for DoLS applications to be scrutinised and one central point across the directorate could also be addressed via this role. Essentially the work required to implement DoLs procedures to the required standard in the medium to long term cannot be managed within the safeguarding team or divisions due to the increasing safeguarding agenda. A safeguarding Adults professional Lead has been appointed to the safeguarding team; this role incorporates specific responsibilities related to the implementation of MCA/ DoLS. A proportion of the money acquired for MCA/DoLS development has been ring fenced to develop a centralised system for the collection of DoLS data. A plan will be in place by the end of Q2 2016-17with the Trusts Ulysses system the preferred option. This will allow oversight of DoLS by the Adult Safeguarding Team enabling the team to identify where additional support may be necessary. Child Sexual Exploitation Joint Agency Inspection (CQC, OFSTED, Her Majesty’s Police Inspectorate) – September 2015 LPT contributed to a joint agency pilot inspection which involved a multi-agency review of CSE casefiles held by each agency. School Nursing and LAC nursing involvement was considered by the CQC inspectors to be good. CQC Review of safeguarding children arrangements in Leicester City, February 2016 (awaiting publication) LPT casefiles for 9 children who had been referred to Children’s Social Care by LPT School Nurses, Health Visitors and CAMHS were reviewed as part of the Leicester City CCG CQC inspection. The CQC inspection also reviewed the involvement of LPT Adult Mental Health Services in relation to these 9 cases. LPT are awaiting the publication of the final CQC report.

SECTION 9 – INSPECTIONS IN THE LAST YEAR 2015-16

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Safeguarding Children Priority 1 Safeguarding Children Team to receive training on the Mental Capacity Act (MCA) 2005.

Mental Capacity Act training attended April 2015.

Priority 2 The new Professional Lead once appointed, to work with other Professional Leads within the Division ensuring all professional groups are aware of their safeguarding responsibilities and to provide collective/collaborative support across the FYPC Division.

Professional & Clinical Lead appointed December 2015.

SECTION 10 – PROGRESS AGAINST 2015-16 PRIORITIES

Safeguarding Achievements in 2015-16

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Priority 3 Development & roll out of the Peer Supervision Model/Pathway to Health Visitors and School Nurses.

April-June 2015 new & existing Peer Supervisors provided with full day training in the use of Action

Learning Sets (ALS).

ALS Safeguarding Supervision Model rolled out to Health Visitors & School Nurses during July 2015.

Priority 4 Strengthen working relationship with the Adult Safeguarding Team through events such as Time Out sessions & joint meetings.

LPT Safeguarding Adult & Children’s Education Group commenced February 2016.

Priority 5 Undertake a comprehensive review of the Safeguarding Children Advice Line to identify and develop alternative sources of support for staff and ensure they are able to make confident decision using their professional judgement.

Safeguarding Children Advice Line Standard Operating Guidance was reviewed and updated to include

sign posting to alternative sources of information.

Safeguarding Children Advice Line Standard Operating Guidance adopted and circulated in October

2015.

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Priority 6 To keep up to date with the changing Female Genital Mutilation (FGM) agenda and equip practitioners to work in line with National and local guidelines.

LPT FGM decision making flowchart developed and circulated to staff in May 2016.

This FGM Flowchart has been included in the updated Safeguarding Children Practice Guidance (2016)

and the Responding to Domestic Violence/Abuse Experienced by Clients Policy 2016.

Priority 7 Improve the quality and analysis of safeguarding children data.

In collaboration with Leicester, Leicestershire & Rutland Local Safeguarding Children Boards LPT Safeguarding Children data has been continually revised to enhance analysis and promote the development of better outcomes for children and obtain the voice of the child. Performance management reports have been developed and are presented to the Safeguarding Board on a quarterly basis.

Priority 8 The Child Death Review Manager and Named Nurses will review the support that is offered to parents and families, in order to strengthen the current pathway.

Standard Operating Guidance for the Support of Families (by the Named Nurses for Safeguarding)

Following the Unexpected Death of a Child developed and published December 2015.

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Looked After Children Priority 1 Improve the timeliness of Initial Health Assessments (IHA) and Review Health Assessments (RHA).

Improvements to the IHA consent and communication coupled with monthly multiagency scrutiny of data has vastly improved timeliness and meeting the national 28 day target across LLR.

RHA audit is more specific and demonstrates improved quality and access to services for LAC.

Priority 2 Make progress on the recommendations of the SCR of a LAC dying in pre adoptive care.

The LAC Service Health Visitor/LAC Nurse initiated a County of Leicestershire 6 month pilot for pre-adoptive parents to be offered additional health support. This will operate between April and October 2016 and be evaluated for the potential of roll out.

RHA audit includes a specific question on pre adoptive placements.

Work with the local authority to develop a pre adoptive health pathway being piloted 2016-17.

Developed training of adoptive and pre adoptive parents on how to access health services being piloted 2016-17.

Priority 3 Improve the notification process for out of area children who are looked after.

Quarterly meetings chaired by an LSCB officer with all 3 local authorities on the movement of LAC.

Monthly data sharing between LLR and health on LAC moving between Local Authorities. Health Administrators update the System1 electronic health record and task Health Visitors and LAC Nurses about changes in placements.

Revision of the East Midlands protocol.

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Priority 4 Better evidence of the voice of the looked after child and young person.

Listen into Action project with LAC across LLR where they made recommendations on the delivery of health assessments and feedback on health input of the LAC Nurses.

University of Leicester research project on the voice of LAC on health services being started 2016-17.

A LAC Nurse attends every Child in Care Council across LLR.

Priority 5 Demonstrate improved services for LAC utilising effective and targeted multiagency working.

Smoking cessation service for LAC available in Residential Homes and extended to Foster care placements and carers.

Development of CSE Specialist posts to work in the CSE Hub from summer 2016.

Recording of Strength & Difficulties Questionnaire (SDQ) to integrate with RHA’s from April 2016.

Leaving health care summaries / health passports being offered to all care leavers in 2015. Safeguarding Adults Priority 1 Work in partnership with other agencies to progress the LSAB business objectives for 2014-2015.

LPT were represented at key LSAB meetings and forums across 2014-2015.

LPT supported and will continue to support LSAB policy development, safeguarding adult reviews and domestic homicide reviews.

LPT have contributed to the development of LSAB business plans for both City and County for 2014-2015 and form part of the sub groups driving the work forward.

LPT have developed an adults and children’s shadow action plan of the LSAB key priorities to guide our work moving forward.

Priority 2 Sustain compliance across LPT for alerters and alert and refer safeguarding adult training.

Safeguarding adults training across LPT is 83.5% as of 1st July 2016. A training flash report is prepared for the LPT Safeguarding Committee every 2 months.

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Priority 3 Audit staff knowledge of Mental Capacity Act within MHSOP services and Community Hospitals and progress required actions.

A series of audit questions relating to staff understanding of MCA and DoLS was included in the 2015 annual safeguarding audit. This will act as a benchmark for future training needs in relation to MCA and DoLS.

All staff have been made aware of the implications of the new case law including consultants from both the Mental Health and the Community Health Services Division.

Practice Workshops were commissioned through two law firms, Capsticks and Mills & Reeve to deliver practice implications of the ruling around MHA and the MCA legal frameworks.

MHA/MCA forums were developed across MHSOP with band 6’s and 7’s to support and empower their knowledge and competency.

Bespoke training for MHSOP and AMH/LD were commissioned from an independent trainer to complete practice scenarios for both medical and nursing staff.

An MCA/DoLS/MHA interface flowchart was developed to support practice.

Champions group for MCA and DoLS have been set up across CHS and has now amalgamated to include AMH/LD.

Induction workbook for new medical staff has been strengthened around the MCA and DoLS.

Priority 4 Provide DASH domestic violence risk assessment tool training to targeted services.

Although not categorised as mandatory training, Domestic Violence and Abuse training has been very well attended with staff who attend receiving training in the use of DASH RIC (2009).

Priority 5 Launch the LPT PREVENT policy and raise the awareness of how it is applied in practice.

The Trust PREVENT policy has been in place since September 2014 and will be reviewed in July 2016.

The policy is available via the safeguarding pages on the intranet.

The policy is shared across our multi-agency partners and regional PREVENT network.

Data pertaining to the number of staff who have accessed training in the past year and the number of referrals made by LPT in relation to vulnerable people at risk of radicalisation by extremist groups has been reported to the safeguarding committee on a bi-monthly basis.

Priority 6 Embed MAPPA training as part of the full safeguarding programme from May 2014 onwards.

MAPPA training now forms part of the full day safeguarding training programme.

A MAPPA briefing has been made available to staff attending trust induction.

Bespoke MAPPA sessions have been carried out in CHS division and training is also being rolled out to medical staff in 2015.

Priority 7 Develop further the work to integrate the Adult and Children’s Safeguarding Teams.

The adults and children’s safeguarding teams continue to foster strengthened links and combined approaches to safeguarding activity. In 2015 a proposal to commence a joint project of clinical support visits which will see adult and children’s team members jointly visiting clinical areas was produced and has been agreed. The aim of the visits is to increase focus on supporting clinical teams to ensure they meet CQC fundamental standards relating to safeguarding.

The safeguarding training package has been reviewed and a proposal has been made for both adult and children’s nurses supporting the delivery of the training days.

The integrated forum has been commenced and after review will be rolled out across 2016-2017.

Annual Report is now combined.

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Priority 8 Continue to work with the LSAB in developing a meaningful performance management framework, which captures the outcomes of safeguarding activity and demonstrates we are keeping people safe. The LSAB Performance Management framework has been developed. This is completed on a quarterly basis and scrutinised by the Safeguarding Boards Safeguarding effectiveness groups and reviewed by the Safeguarding Boards.

Priority 9 Monitor with the support of divisions application of the MCA and DoLS.

CHS, AMH and LD services have a system to capture the use of MCA and DOLS applications. There is an ongoing plan to progress this further with the use of funding from a bid awarded and will see the use of electronic database to capture required data.

Priority 10 To lead the mental health joint priority with LSAB. The Safeguarding Adult Professional Lead was identified to carry out this work, which is now underway and part of the 2016-17 Safeguarding Adult’s Board Business Plan. Progress will be reported in the 2016-17 LSAB Annual Report.

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Priorities have been considered against the LSCB/LSAB Business Plans, the Safeguarding Annual Audit reports following inspections and learning from Serious Incidents. Our priorities for 2016-17 are outlined below. Trust Wide

Development of a robust internal and external audit plan and confirm reporting arrangements to the LPT Safeguarding Committee.

Embed the Whole family approach across the organisation and ensure that the voice of the child or adult is heard and acted upon. Promote the ‘Whole Family’ agenda widely across services

Ensure divisional reporting into and representation at the safeguarding committee is consistent and highlights divisional risk which may impact of the welfare of service users and families

Provide a quarterly report to the safeguarding committee and commissioners regarding the number of allegations against staff reported to the Safeguarding Team, including LADO referrals.

Improve integrated clinical support related to safeguarding for all clinical areas of the Trust.

Develop a MCA case note audit to test out areas of improvement following 2015-16 audit and inspection.

Develop a program of opportunities for clinical/operational staff to develop in safeguarding, such as shadowing, supporting safeguarding investigation and processes in order to increase confidence and competence and begin to support succession planning.

Ensure strong safeguarding links within clinical procedures such as AWOL, Health and Safety, seclusion and physical interventions.

Develop further work to integrate the Adult and Children’s Safeguarding Teams.

Commission and implement improved safeguarding adult database which enables streamlined retrieval of data for evidence of activity and outcomes.

Safeguarding Children

Evaluation of Safeguarding Children Supervision Action Learning Sets to be conducted to ensure that the supervision structure meets the needs of staff, and to inform the implementation of Action Learning Sets across other children’s services.

A 6 month Health Visitor secondment into Leicester City Early Help Team to support partnership working and the use of Liquid Logic.

The Safeguarding Children’s Team to re-locate to County Hall to enhance working relationships with LPT Safeguarding Adult Team, Leicestershire & Rutland LSCB and Leicestershire Children’s Social Care.

The Safeguarding Children’s Team will contribute to the multi-agency development and embed the Neglect Strategy, Procedure & Toolkit into practice.

The Safeguarding Children’s Team will contribute to the multi-agency development of pre-mobile baby protocol.

FYPC will develop an action plan to ensure all staff who could potentially be involved with children who are in transition from children services to adult services attend Mental Capacity Act (MCA) training.

The Safeguarding Children’s Team will undertake an audit in conjunction with the Clinical Governance Team on Health Visitor record keeping and learning following Serious Case Reviews and Serious Incidents.

Looked After Children • Ensure ongoing compliance and improved performance in line with the statutory guidance with a

continued focus on the IHA and RHA national target times. • To consider when published, the outcomes and recommendations of the city Joint Strategic Needs

assessment JSNA. • To continue to address the recommendations outlined in the 2015 Health Needs Assessment (HNA) for

LAC from Leicestershire and Rutland Public Health Department.

SECTION 11 – PRIORITIES FOR THE COMING YEAR

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• Improve partnership working to ensure that the pathway planning process identifies health needs early, in order to inform the leaving care health summary.

• Developing a multi-agency meaningful response to the Strengths and Difficulties Questionnaire to ensure that emotional/mental health needs are identified early and appropriate services are offered in response.

• To know the health needs of our looked after children via electronic data systems (to capture for example specific details such as drug and alcohol misuse and teenage pregnancy, currently not captured). Thus enabling monitoring of the health of LAC and the impact of health services.

• Ensure that the health needs of Looked After Children are accurately highlighted within the Joint Strategic Needs assessment (JSNA) currently underway.

• Ensure children and young people placed out of area have their health needs identified and addressed accordingly. The Designated Nurse monitors the impact of the health assessments and health care through individual audit using a national audit tool.

• Embed the role of the Child Sexual Exploitation (CSE) Nurse into the CSE Hub and monitor agreed objectives; providing a bridge for CSE clients into health services, provide health assessments, provide training to front line staff, provide health intelligence to the CSE Hub.

Safeguarding Adults

Support the LSAB/LSCB engagement and participation strategy by actively seeking involvement of service users in safeguarding practice and development.

Develop support materials for service users who may have experienced historical abuse and, guidance for staff who may be working with those individuals.

Embed MSP within Section 42 enquiries across LPT services. Secure assurance of positive impact for service users.

Recruitment of Safeguarding Adult Team Administrator.

Ensure that thresholds for Safeguarding Adult Alerts are appropriate, understood and consistently applied across LPT and that referrals are made to local authorities in line with policy and procedure.

Agree the training plan for enhanced MCA training for key senior staff.

Implement the plan for a centralised system to monitor DoLS.

Develop a system to monitor the quality of clinical supervision related to safeguarding within adult

services.

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During 2015-16 the Trust has taken forward a number of developments to strengthen safeguarding arrangements across LPT. Locally and nationally there has been a large increase in adult safeguarding activity. This activity trend has the potential to continue over the coming years. The independent inquiry examining historical child sex abuse in England and Wales will have significant implications for the vulnerable adults we care for, who may have suffered abuse as a child. It is essential that our staff are able to support people effected in a manner commensurate with the ‘Making Safeguarding Personal Agenda’, whilst also ensuring that staff working in adult services fulfil their responsibilities to any children who may be at risk following none recent abuse disclosures. This balance can be challenging for staff. The Safeguarding Team will prioritise ensuring adequate support is in place for staff in these situations. Children’s safeguarding agenda has grown and is expected to continue to grow. LPT has demonstrated an improvement in the safeguarding of children through the engagement and actions taken from lessons learned from findings of serious case reviews. We acknowledge that there is significant amount of work to complete to ensure that the ‘whole family approach’ is embedded and routine practice across all of our services. This is a priority for 2016–2017. The report has provided an overview of the safeguarding agenda and the breadth of work we are involved with, as well as the achievements from 2015–2016. Due to the crucial role of safeguarding in maintaining the safety of vulnerable people, the area comes under a lot of necessary scrutiny. It is therefore essential that LPT’s safeguarding work is monitored and meets specific standards. This report provides assurance that staff are working hard to maintain safety and acknowledges the need for continued development to ensure best outcomes for those we care for. With thanks to all of the Safeguarding Team for their support and contributions to this report and to LPT staff for their ongoing commitment to the safeguarding agenda.

SECTION 12 – CONCLUSION

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Leicester Safeguarding Children Board http://www.lcitylscb.org/ Leicestershire & Rutland Safeguarding Children Board http://lrsb.org.uk/children Leicester City Adult Safeguarding Board http://www.leicester.gov.uk/health-and-social-care/adult-social-care/what-support-do-you-need/staying-safe-and-avoiding-harm/safeguarding-adults-board Leicestershire and Rutland Safeguarding Adults Board http://lrsb.org.uk/adults Care Act 2014 http://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf Children Act 2004 http://www.legislation.gov.uk/ukpga/2004/31/pdfs/ukpga_20040031_en.pdf Department of Health National Service Framework for Children, Young People and Maternity Services Core Standards https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/199952/National_Service_Framework_for_Children_Young_People_and_Maternity_Services_-_Core_Standards.pdf NHS England Safeguarding Vulnerable People in the NHS – Accountability and Assurance Framework https://www.england.nhs.uk/wp-content/uploads/2015/07/safeguarding-accountability-assurance-framework.pdf HMG (2015) Working Together to Safeguard Children; A guide to inter-agency working to safeguard and promote the welfare of children https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/419595/Working_Together_to_Safeguard_Children.pdf Useful Contact Details Safeguarding Children Advice Line - 0116 295 8977 The Advice Line is open between 12 midday-4:00pm (Monday-Friday) Outside of these hours practitioners are advised to contact their Team Leader/Manager for advice. Safeguarding Adult Advice Line - 0116 295 7261 Monday-Friday between 12 midday-2:00pm An answerphone is available outside of these times - Administrator contact number 0116 295 0862

SECTION 13 – REFERENCES, LINKS AND CONTACT DETAILS