westminster safeguarding adults board · 2009. 7. 13. · westminster city council › safeguarding...

Westminster Safeguarding Adults BoardAnnual Report 2008

adultservices_AR_290908_v2.indd 1 30/9/08 10:14:33

� WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008


WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008 �

ContentsNational context: No Secrets 2

Beyond No Secrets 3

Letter from the Chair of the Board 4

This year’s achievements 5

Westminster Safeguarding Adults board 5

Board sub group: Mental Capacity Act 2005 Local Implementation Group 5

Board sub group: Safeguarding Adults Policy and Procedures Review Network 6

Consistent application of the safeguarding adults policy and procedure 6

Safeguarding adults training and development 8

Working with partner agencies 10

Metropolitan Police 10

Central and North West London Foundation Trust 10

Westminster Primary Care Trust 11

Imperial College Healthcare NHS Trust 11

Supported housing, voluntary and independent sector 11

Prevention of abuse 12

Links to strategic partnerships: crime and disorder 12

Service users as key partners 12

Reporting and monitoring activity 13

Lessons learned this year 14

Assuring quality 14

Safeguarding developments 15

Last word 15

Appendices 1. Organisations attending training courses 16

2. Westminster Safeguarding Adults action plan 2008/09 16

3. Safeguarding vulnerable adults in Westminster 23

end-of-year monitoring report 2007/08

Glossary 32



National Context: No Secrets‘No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse’ was published in 2000 by the Department of Health. It responded to the findings of an investigation into systematic sexual, physical and emotional abuse, and neglect of people with learning disabilities, over a period of ten years at Longcare in Buckinghamshire.

No Secrets was the first coherent national policy statement to establish a single system, with clear lines of responsibility and accountability, to tackle the abuse of people made vulnerable by age, disability or poor physical or mental health. It is rooted in the Human Rights Act 1998 and upholds the right of all individuals, regardless of their circumstances, to live their lives free from violence and abuse.

No Secrets is based on the premise that some groups of adults experience a higher prevalence of abuse and neglect than the general population, and that they are also not easily able to access services to enable them to live safer lives.

No Secrets identifies five types of abuse. They are physical, sexual, emotional or psychological, financial and neglect. Institutional and discriminatory abuse have since been identified as additional types of abuse.

No Secrets identifies adult social services departments as the lead agencies in the investigation of abuse. It also places responsibility on all agencies working with adults who may be deemed to be vulnerable to have clear policies, procedures and systems for responding to allegations of abuse.

It places an obligation and responsibility on all health and social care agencies and the police, to co-operate with and participate in joint systems, including multi-agency forums, to protect vulnerable adults from abuse.

In Westminster, these responsibilities are taken very seriously and the work required to prevent and protect or safeguard vulnerable adults from abuse is led by the multi-agency Safeguarding Adults Board. This report outlines what the Board has achieved during the past year and its plans for the year ahead.



Beyond No SecretsSince the publication of No Secrets, which is currently under review, there have been a number of national developments which have significance for safeguarding adults work in Westminster.

In 2005, the Association of Directors of Social Services introduced a safeguarding adults best practice guide. The guide contains standards for the systems designed to protect adults made vulnerable by age, illness, disability or circumstances. It shifts the notion of vulnerability from the person themselves to the circumstances they find themselves in: “The concept of a vulnerable adult is replaced with an assessment of the risk posed by the abuse and neglect, to the quality of life of the individual adult concerned”. The Board has adopted the terminology of ‘safeguarding adults’ to replace ‘adult protection’ as this embraces a more robust approach to preventing as well as responding to abuse. It also uses the framework to guide and inform its key objectives and annual work plan.

Last year, a national survey was conducted by Action on Elder Abuse and funded by Comic Relief into the prevalence of abuse and neglect of older people. The report, published in June 2007, confirmed that one in 40 older people are experiencing mistreatment that occurred within a relationship of trust; family members, close friends and care workers. This statistic suggests that over 300 older people aged 65 to 74 experience abuse in Westminster. At present, less than a third of these people are coming forward to seek help so raising public awareness of safeguarding adults is a key priority for the coming year.

Staff in all agencies have been trained to work within the requirements of the Mental Capacity Act 2005, which came into force from April 2007. The Act enshrines five principles for decision-making, sets up independent mental capacity advocates, and strengthens the protection offered by the courts to people whose ability to make key decisions that impact on their well-being is impaired. In the year ahead, work will be carried out to assess the needs of people who may be deprived of liberty under the Act.

The Safeguarding Vulnerable Groups Act 2006, which will be enacted next year, introduces a vetting and barring scheme which will screen all staff working in health and social care, in the statutory and voluntary sector, for their suitability to work with children and vulnerable adults. It replaces the Protection of Vulnerable Adults (POVA) list.

The Domestic Violence Crime and Victims Act 2004 increased the protection, support and rights of victims and witnesses of domestic violence, including vulnerable adults who may be being abused by a family member. In Westminster, this work will be co-ordinated by the Multi-agency Risk Assessment Conference operational from September 2008.



Letter from the Chair of the BoardThe Westminster Safeguarding Adults Board is a multi-agency partnership responsible for leading and overseeing all strategic and operational inter-agency safeguarding adults work in Westminster, as required by No Secrets.

The Board is made up of representatives from all key statutory agencies, and from the independent and voluntary sector. Members of the Safeguarding Adults Board are sufficiently senior to represent their organisation and to make multi-agency agreements on behalf of their organisation.

This year, facing the challenge of delivering independence, well-being and choice, the Board has been determined to work together to strengthen the safeguarding adults systems within the City. We have been developing a network of safeguarding champions in all the statutory agencies and our third sector partner organisations. We are working with service users and carers as experts and care partners to raise awareness of abuse and promote dignity and respect in local services.

In general, Westminster residents are well served and protected from abuse and harm by the responsiveness and diligence of front-line staff and managers in all services. But we are not complacent and are committed to continuously improving our performance in this key area, and in raising public awareness of adult abuse to the same level of that of protecting children.

To this end, the Board commissioned an evaluation of its safeguarding activity, using case samples and interviews with key stakeholders. This has given us a position statement with regard to the effectiveness of its current systems and recommendations for improvement.

A key recommendation has already been met. Westminster City Council and Primary Care Trust have jointly funded a full-time safeguarding adults lead post. The post-holder is working with frontline staff in all agencies to develop their practice in the context of transformation of Adult Social Care, helping staff to meet the challenge of balancing risk and safeguarding with increased user choice, independence and self-directed care.

The safeguarding adults lead is developing an audit tool to help track cases more systematically. This will capture outcomes for service users and any learning from practice, inform the workforce development strategy and fine-tune safeguarding procedures.

By this time next year, we anticipate being able to strongly evidence the improvements we have made to the safety and well-being of Westminster’s most vulnerable residents, hopefully using their own testimony, as expert partners in safeguarding adults.

Zena DeaytonAssistant DirectorSocial Care Services



This year’s achievementsWestminster Safeguarding Adults BoardThe Safeguarding Adults Board has worked hard this year to strengthen its membership so that all key partner agencies are properly represented and that each member is able to champion safeguarding effectively within their organisation. Members have been working to ensure that their work on the Board is directly linked to the governance arrangements of their organisation. This is in line with standards 1 and 2 of the Association of Directors of Adult Social Services (ADASS) National Framework of Standards for best practice in safeguarding adults. Board members attended an away-day in April 2008, which provided the opportunity to reflect on their responsibilities and track the progress of key priorities.

The safeguarding adults work plan has been linked to the ADASS National Framework of Standards for the past two years. The 2007/08 plan was ambitious. Most of the tasks have been completed and it has served to demonstrate the need for more designated staff time to ensure all aspects of work are robust and safe.

Board sub-group: Mental Capacity Act 2005 Local Implementation Group The Westminster Local Implementation Group with representatives from key health, social care and voluntary organisations was set up in November 2006 as a sub-group of the Safeguarding Adults Board. The work of this group has ensured that the Mental Capacity Act has been publicised as widely as possible throughout the city, using websites and printed material. The training programme has been very successful in developing staff confidence and competence in all partner agencies to support decision-making and undertake mental capacity assessments.

The effectiveness of the training strategy is reflected in the number of appropriate referrals that have been made by Westminster to the Independent Mental Capacity Advocate service.

Westminster led the tendering and contract let process for the Independent Mental Capacity Advocate service across seven London boroughs to ensure that a specialised service could be provided for a range of client needs. The contractor providing the Independent Mental Capacity Advocate service is performing well across all seven boroughs.

Ongoing staff advice and guidance on specific cases continues to be provided by a Mental Capacity Act champions group, made up of staff representatives from adult social and health care teams.

The Local Implementation Group refreshed its terms of reference in March 2008. It will co-ordinate Westminster’s multi-agency response to the introduction of Deprivation of Liberty, building on the networks and strategies that have been so effective with the implementation of the Mental Capacity Act. A time-limited senior level post will be created to develop the systems required to support staff in all agencies to respond consistently, effectively and within the law.



Board Sub-Group: Safeguarding Adults Policy and Procedures Review Network The refreshed Westminster City Council multi-agency policy and procedures, first published in 2002, will be re-launched at a safeguarding adults conference in October 2008. The task has been more substantial than envisaged because of national developments in safeguarding adults.

Westminster is a member of the London Adult Protection Network, which is currently working with the Social Care Institute of Excellence and Care Services Improvement Partnership to develop a pan-London Safeguarding Adults Strategy. The strategy will be published in 2010. As with the London Safeguarding Children’s Strategy, it will remove the need for borough specific policy and procedures and facilitate inter-authority working. It will also simplify referral and response arrangements for provider agencies and Trusts including the police and the London Ambulance Service, who work across boroughs.

Consistent application of the Safeguarding Adults policy and procedureThe Safeguarding Board commissioned an evaluation to find out how well Westminster residents are protected from abuse by safeguarding adults systems. This report has provided qualitative data to supplement the prevalence data that is collected each year and reported to the Board at its quarterly meetings.

The evaluation adopted a whole system approach, using a representative sample of case studies, interviews and meetings with key stakeholders including staff, service users, carers and partner agencies.

The findings and recommendations of the report are listed below:1. There is commitment and willingness among practitioners and managers to undertake

safeguarding adults work.

2. Great importance is attached to the early alerting stage of the process and clarity of responsibility on the part of Safeguarding Managers.

3. Safeguarding managers and practitioners are open, willing and keen to improve and evolve their own practice and to see procedures updated and made clearer and more accessible.

4. There are examples of outstanding practice and tenaciousness which has resulted in positive outcomes for clients who have been protected from harm.

5. There are also examples of excellent practice in relation to vulnerable adults who make unwise decisions and choices. Practitioners are not complacent about these situations, nor complicit in service users coming to harm, but they are able to investigate, analyse and support service users’ wishes and rights to self determination in an exemplary way.



6. Multi-agency strategic ownership and oversight of safeguarding needs strengthening and the chair and members of the Board are working towards achieving this.

7. The lack of dedicated operational level resources to support safeguarding work (systematic case tracking; monitoring of practice and practice activity data; support for strategy and case conferencing activity) is felt by all. The appointment of a full-time safeguarding adults lead will help to overcome this.

8. There is a need to revisit and refresh thresholds, key definitions and procedures across the board to reflect recent shifts and to communicate key messages about expectations across the system. The policy review and training programme is well placed to deliver this.

9. The consistency of case recording needs to be improved across and within teams.

10. There appears to be a concentration of activity and effort at the initial stages and at points of referral with a tendency for activity, including review activity to tail off or be overlooked in recording.

11. Risk assessment and risk recording beyond alert and strategy decision stages need to be strengthened.

12. There are complex issues in relation to care providers, which encompass questions about thresholds and definitions, such as where does concern about good care end and concern about abusive or negligent care begin?

13. There is a lack of clarity about how safeguarding and staff disciplinary procedures separate and interact, particularly in provider settings.

The response of the board to the evaluation has been to take the following actions:appoint a full-time safeguarding adults leadappoint a full-time Deprivation of Liberty project workseek joint funding for a Safeguarding Adults Quality Assurance Officer to assist with case tracking and audit, and administering meetings and minute-takingreview the training and development programme and work with providers to identify the learning needs in relation to safeguarding adults and Dignity in Carecomplete and publish refreshed policy and procedures in October 2008design a publicity campaign to raise public awareness of safeguarding adultsdevelop a case tracking and care audit processorganise a safeguarding adults conference to demonstrate the commitment of key partners to safeguarding adults work at both strategic and operational levels of their agencyintroduce standard forms to record key decisions including assessment of risk or seriousness; referral forms; minutes of strategy meetings or discussions and case conferences and safeguarding plans

›››

›

››››

›


8 WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008

reintroduce practice forums for practitioners and Safeguarding Adults Managersdevelop sub-groups of the board to progress the key work streams such as case reviews, training and communicationsbuild safeguarding into all aspects of Transformation of Social Care workset up and publicise a designated safeguarding adults line and safe-haven fax to receive referrals from the public, the police, the London Ambulance Service and the Commission for Social care inspection. This is being widely publicised.

Safeguarding adults staff training and development Safeguarding adults work is complex and can only be done well by skilled and resourceful people. We are fortunate in Westminster to be able to attract and retain high calibre staff and are committed to supporting and developing them to do this challenging work.

This year, we have taken the opportunity to refresh the content of our development and training activities and our pool of trainers using an evidence-based assessment of training needs. New courses included Investigating Suspicions of Abuse and Financial and Material Abuse. Furthermore, the Service Manager has delivered a series of briefings to a variety of organisations.

We have made sure that safeguarding policy and procedures underpin all of the training relating to vulnerable adults eg Mental Capacity Act, HIV Awareness and Challenges to Mental Health in Later Life.

All Westminster social care providers were sent a questionnaire in May 2007, asking them to detail the percentage of staff that have received safeguarding training, by team, during the previous year. There was a 100% return rate and the questionnaire has been sent out again to gather data for 2007/08. The information is being used to analyse the providers’ training needs, to inform the commissioning priorities and plan with providers how best to address the gaps.

The safeguarding adults development and training programme is available to council staff and partner agencies in health, housing, MPS and the voluntary sector. Some training is provided by a reciprocal arrangement with Royal Borough of Kensington and Chelsea. Westminster City Council currently funds the programme, with contributions from the Royal Borough of Kensington and Chelsea and Westminster Primary Care Trust.

The core safeguarding adult modules are:protection of vulnerable adults - stage 1identifying and investigating financial and material abuse1

legal aspects of safeguarding adults, adult protection and riskdeveloping effective investigation skillsadult protection enquiry co-ordinator training – co-ordinating multi-agency responses to allegations of abuse.

� Thisisanewcourse.ThecoursewasdesignedanddeliveredbytwoAdultsServicesTeamManagerswithpresentationsfrom the Metropolitan Police, the Public Guardian’s Office and the Department for Work and Pensions.

››

››

›››››



In addition to the modules outlined above, the inter-agency programme offers a wide range of courses such as Mental Capacity Act, Living with Dementia, Capacity and Consent and Valuing Diversity. All of this training is underpinned by reference to the safeguarding adults multi-agency policy and procedures.

We will be updating our workforce plan and workforce development strategy, beginning with an away day for the Safeguarding Adults Board in April. The strategy will respond to the recommendations of the evaluation report and will be circulated to all key agencies for contributions and comments.

The number of people who attended training as part of the safeguarding adults programme 2007/2008 is outlined in the table below:

Training course Attendees

Protection of Vulnerable Adults (stage 1) 144

Investigating Suspicions of Abuse 26

Financial and Material Abuse 10

Legal Aspects of Safeguarding 13

Community Care Legislation 16

Risk Assessment (Legal Aspects) 10

Adult Protection Enquiry Co-ordinators (run jointly with the Royal Borough of Kensington and Chelsea)

3

Supported attendance at external conferences 2

Total 224

Complementary Development and Training

Capacity and consent 60

Mental Capacity Act briefings 707

Mental Capacity Act assessments 175

Total 942

Team briefings and contributions to training

Westminster Primary Care Trust (PCT)

Six teams and sessions in induction, refresher and domestic violence

129

Westminster City Council (WCC)

Six teams, three practice forums, providers conference, LDQ

102

Central North West London Foundation Trust (CNWL)

Three teams 47

St Mary’s Three teams 35

Independent Princess Grace Hospital Managers 8

Total 321

For a list of organisations who attended the courses, please see appendix 1



Working with partner agenciesMetropolitan PoliceSuccessful joint working with the police at an operational level has resulted in a key case being taken to court. Representation on the Safeguarding Adults Board has improved throughout the year and there is now increasing commitment from police colleagues to making clearer links between the Safeguarding Adults Board and the Crime and Disorder Reduction partnership.

From 1st April 2008, Westminster’s Public Protection desk has been dealing with the issues raised by the Safeguarding Children legislation and will undertake the Merlin referrals previously dealt with by child protection teams. It is envisaged that once the Public Protection Desk is fully functioning, its role will be expanded to take in vulnerable adults who are subject to police notice. Notification will be in the same way as with children and young people. The Public Protection desk is responsible for supporting all the public protection teams as well as providing ongoing analysis of referrals that will inform the domestic violence and race and hate intervention panels, the Multi-Agency Risk Assessment Conference (MARAC) and the Multi–Agency Public Protection Arrangements (MAPPA).

Adult Social Care Services have set up a single safeguarding adults line and safe-haven fax which will help expedite referrals and further facilitate joint working between council staff and the police.

The Metropolitan Police safeguarding adults policy will be launched this year. The launch will be backed by a training programme to ensure all police officers, from new recruits to senior officers, are aware of their safeguarding adult responsibilities.

Central and North West London Foundation TrustThe Westminster Adult Mental Health Service has recently appointed a mental health lead to work alongside the lead nurse and safeguarding adults lead, to drive forward the safeguarding adults agenda.

The mental health lead will translate the multi-agency policy into local procedures and standards to assist staff in identifying and managing the protection of vulnerable adults in their work areas.

She will also develop a monitoring process to ensure that standards are adhered to and that information is accurately captured and action taken within agreed timescales.

Systems will be developed to ensure that data on safeguarding adults cases in Westminster’s Adult Mental Health Service are fed back to the local authority and the Central and North West London Foundation Trust. There will be a mechanism in place for reflecting on cases for learning and developing best practice. This will allow for earlier detection of vulnerable service users which can feed into the care programme approach and clinical risk management of the user.

All serious incidents will automatically trigger a safeguarding strategy meeting. Information


WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008 11

from the strategy meeting will feed into the investigation of incidents and lead to an integrated action plan. This plan will be implemented by the Westminster Adult Mental Health Service’s clinical governance structure.

The safeguarding lead for mental health will be a member of this group and, with other colleagues, will be responsible for the local implementation and monitoring of the plan.

The lead will also chair a Safeguarding Steering Group for Mental Health with users and carers’ representation. This meeting will also feed into the Central and North West London Steering Group that includes representation from all five boroughs in partnership with the Trust.

Westminster Primary Care Trust (PCT)Westminster PCT’s board representative is the head of clinical governance. She has been an active member of the policy and procedures review group and ensures, through incident recording, that all safeguarding cases in the PCT are tracked, deliver outcomes, and that lessons are captured and learned.

The PCT has made a commitment to jointly fund the safeguarding adults lead post, the Deprivation of Liberty project manager post and make a financial contribution to the production and launch costs of the revised multi-agency policy and procedures. The training and development department of the PCT has made safeguarding adults a priority for frontline staff. The safeguarding module, incorporating safeguarding adults, children and domestic violence has been delivered by a team of five presenters. Induction training is run once a month for up to 20 staff and refreshers three times a month for up to 20 staff. This means that as many as 1,000 staff have been trained to recognise the abuse of children and adults and how to raise a safeguarding alert.

Imperial College Healthcare NHS Trust The lead Nurse Medicine (Elderly Care and Stroke) is working to strengthen the safeguarding component of Dignity in Care through training and briefing sessions for staff and to key development groups at St. Mary’s Hospital. The St. Mary’s care management team are receiving more safeguarding referrals, reflecting growing staff awareness and confidence in recognising abuse and knowing what to do if they have concerns. The Head of Nursing (Medicine Programme Group) for the newly formed Imperial Trust has been given overall lead safeguarding responsibility for the Trust. She is leading a group to review the Trust’s internal safeguarding policy and systems. Westminster and Hammersmith and Fulham are represented on this working group.

Supported housing providers, voluntary and independent sectorAn emerging theme from the evaluation report is the need to develop closer working around safeguarding adults with partners who deliver frontline services on behalf of the statutory services. There needs to be greater clarity of thresholds for action, joint risk-assessments,


1� WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008

better communication of decisions and clarity of roles and responsibilities, especially when staff are implicated in the abuse.

The contracts unit of the Adults Services Department of Westminster City Council has regular contact with all contracted services and is therefore pivotal in creating relationships with providers and contractors. This is through regular monitoring meetings which usually take place on a quarterly basis. There are also visits to service users as part of the monitoring of quality for some contracts. Safeguarding issues are discussed at quarterly monitoring meetings and actions are identified to ensure appropriate actions have been taken. Council officers are keen to improve monitoring and reporting of safeguarding adults’ issues, particularly in relation to home care, and to strengthen our partnerships.

A priority for the coming year is building a stronger framework for responding to establishments or agencies where there are serious concerns, linking up information, complaints, contract monitoring, care management, safeguarding leads, the Commission for Social Care Inspection, users carers and advocates, and from the organisation themselves.

Prevention of abusePreparatory work by the council and contracted organisations ensures that they have robust recruitment practices and undertake criminal record bureau checks for all staff working with vulnerable adults. They are prepared for the introduction of the vetting and barring scheme under the Safeguarding Vulnerable Groups Act 2006, which will replace the Protection of Vulnerable Adults scheme next year.

Links to strategic partnerships: crime and disorderThe city’s crime and disorder partnership is setting up a multi-agency risk assessment conference, an information-sharing framework for agencies working with victims of domestic violence. Since the introduction the Domestic Violence Crimes and Victims Act 2004, this includes vulnerable adults who may be being abused by a family member. The conference is about developing a strong multi-agency approach and response to domestic abuse, in order that each agency has a more comprehensive idea of what is occurring in a victim’s life and can respond accordingly.

The safeguarding adults lead has been asked to be a representative on the multi-agency risk assessment conference. Workshops have developed a common risk assessment model, a process for referring high risk cases and an information sharing protocol.

Service users as key partnersThe learning disability self-advocacy group, Our Choice, has launched and distributed an action against bullying accessible leaflet and a training package, which they have delivered to all staff attending Learning Disability Qualification training.

People with learning disabilities continue to be involved in the recruitment of staff working in the partnership and to share their expertise through presentations to various audiences across London.


WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008 1�

Westminster is developing a Choice and Control board to steer the transformation of social care. It is anticipated that members of this board, predominantly service users, will provide guidance on the management of risk and safeguarding in the context of self-directed care.

Reporting and monitoring activityA full report of safeguarding activity in Westminster this year is in Appendix 3. The comparison with last year’s figures shows a pleasing and steady increase in the number of alerts that are captured on SWIFT, with nine out of ten initial enquiries leading to a strategy meeting, and seven out of ten strategy meetings leading to a formal investigation.

This is the first full year that the data has been captured on SWIFT and although it is a time-consuming data entry process, the quality of data, including recording of outcomes, has undoubtedly improved.

The evaluation commissioned by the board this year has provided qualitative data to supplement the prevalence data and indicates where the systems supporting safeguarding adults work in Westminster need to be further strengthened.



Lessons learned this yearAssuring qualityThe methods we have used this year to reflect on safeguarding work in Westminster, to extract learning and to plan the coming years’ activities and priorities, are: external evaluation, case review and analysis of feedback, including complaints, from partner agencies, regulators, carers, users and front-line staff.

A case review of the successful prosecution of abusers of an older Westminster resident indicates that multi-agency co-operation and staff practices in Westminster compare favourably with the recommendations arising from the Margaret Panting Serious Case Review.

This included:correct assessment of risk through GP screening of those aged over 70 and listening to concerns of friends and neighbours timely use of the safeguarding adults process to plan and monitor safeguarding interventions including appropriate care packages respecting user choice whilst actively pursuing a safeguarding plan work across authorities when the service user left the city work with the police to persuade the Crown Prosecution Service to take the case to courtgood inter-authority and inter-agency communication sustained over two years by the Safeguarding Adults Manager demonstrating a model of best safeguarding practice.

This case predated the implementation of the Mental Capacity Act but staff demonstrated the application of the statutory principles in all decision-making with the service user.

This case and the case that was taken to the High Court provide two examples of the commitment of front-line staff in all agencies, supported by the resources of the council, to work together to seek and secure legal redress for vulnerable adults.

Other reviews of cases through practitioner forums have shown that there is a culture in Westminster of responsible vigilance and willingness to work with vulnerable adults who do not meet existing adult services’ criteria. There is a willingness to intervene early to prevent the escalation of risk and serious harm to these people. There is also a need to clarify who will respond to allegations of abuse of vulnerable adults placed in service within the city by another authority, and for self-funders. This is currently being done on a good-will basis and will be formalised this year.

The Westminster placement monitoring arrangements extend this vigilance to people who are placed out of borough. There have been a number of cases of abuse uncovered and actions taken to safeguard service users, working in partnership with safeguarding teams in host authorities outside of Westminster.

Feedback from regulators suggests that managers need safeguarding adults thresholds to be more clearly defined in order to enable staff to respond proportionately to allegations of abuse in regulated settings.

›

›

››››



Evidence of increasing numbers of alerts suggests that all the training programme and staff development activities in all partner agencies, and briefings to community groups, are raising staff and public awareness. A priority this year will be ensuring that all this work is properly recorded and that data is captured on SWIFT and electronic client records.

Safeguarding developments The strategic plan outlining the safeguarding adults priorities for the coming year is informed by all of the lessons learned throughout the year. See appendix 2 for further details.

The partner agencies of the board have acknowledged that national drivers are placing safeguarding adults centre stage in the transformation of adult services by appointing the Deprivation of Liberty Project Manager and safeguarding adults lead and one day of a team leader post in Westminster Adult Mental Health Service.

The board is implementing the recommendations of the evaluation report in the way outlined above.

Safeguarding will remain a priority in Westminster, whilst simplifying the point of referral for external agencies and members of the public, and increasing the capacity of the safeguarding team to support practice, track case progress and extract lessons learned.

Safeguarding is embedded into all the transformation of adult social care work being led by the council including the development of access and information; IT; case recording and outcome monitoring; and the development of self-directed care.

The increased capacity of the safeguarding team will enable even more effective partnership working with the police and health and give the council the capacity to build on existing work with service users and carers as expert partners. The board is focusing on achieving strategic buy-in to safeguarding adults at executive levels of all partner agencies in Westminster.

Last wordThe Safeguarding Adults Board wishes to thank everyone working in all health and social care organisations, housing and the police and criminal justice system, for their continuous and sustained work throughout the year; work that is helping vulnerable people in Westminster to exercise their choice and independence, free from harm or abuse by others.



Appendix 1

Organisations that attended training coursesAdult’s Services (Westminster)Age ConcernCarers Network WestminsterCNWL (MH Trust)CentrepointWestminster Centre for Independent LivingChinese Domiciliary Care TeamChurch Army City GuardiansConnexions at St. MartinsDeafblind UKDepaul TrustHousing 21Independent Mental Capacity Advocacy ServiceLife Opportunities TrustLondon CyreniansNacroOutlook Care GroupPenderells TrustPIPSt. Mary’s HospitalSt Mungo’s Thames Reach HousingWestminster Carers WestlinkWestminster Primary Care TrustWestminster SocietyWestminster MIND

Appendix 2

Westminster Safeguarding Adults action plan 2008/09


Appendix 2 Joint planning and capability

Standard 1: The partnership

Priorities Actions By whom By When

To ensure that the Westminster safeguarding adults (SGA) multi-agency partnership provides leadership and the framework for effective planning, implementation and monitoring of SGA work.

Forward plan developed against SGA standard and endorsed by all key partners.

SMSC to draft plan. Safeguarding Adults Board (SAB) to sign off

July 2008

Review Terms of Reference (TOR) and strengthen membership of SAB half-day facilitated workshop. Secure senior representation from all key partner agencies.

SAB May 2008

SGA Partnership linked to the Local Strategic Partnership via the Crime and Disorder Reduction Partnership.

SMSC and Assistant Director Social Care Services (ADSCS) to effect

Dec 2008

Organise a SGA conference to demonstrate the commitment of key partners to SGA work at both strategic and operational levels of their agency.

ADSCS, Training and Development (T&D) Adults Commissioner, SMSA

Oct 2008

SGA strategy is referenced in the local delivery plan.

SCA and ADSCS to effect Dec 2008

Standard 2: Partner organisations

Priorities Actions By whom? By when?

To ensure that each partner has a good understanding of its role in the work of safeguarding adults and make a clear commitment of resources appropriate to that role.

Increase Westminster City Council’s capacity to carry out its No Secrets lead responsibilities and offer support to partner organisations: Appoint a full-time Safeguarding Adults Lead (SAL)(joint-funded).

Appoint a full-time Deprivation of Liberty project work (joint-funded).

Seek joint funding for a Safeguarding Adults Quality Assurance Officer to assist with case tracking and audit, and administering meetings and minute-taking.

SMSA Chair of Local Implementation Group (LIG)

SMSA

July 2008 Aug 2008

Aug 2008



Prevention of abuse and neglect

Standard 3: In the community

Priorities Actions By whom? By When?

To ensure that every persons’ right to live a life free from abuse and neglect is actively promoted to the public by the Local Strategic Partnership, the safeguarding adults partnership, and its member organisations.

Develop a communication strategy to raise public awareness of abuse and the actions people can take to safeguard themselves and others.

Spring 2008

Develop stronger links with the Community Protection Directorate (CPD).

SMSA to liaise with CPD and explore joint work around safeguarding individuals and communities.

SMSA member of Multi Agency Risk Assessment Conference (MARAC).

SA Conference Borough Commander.

Sept 2008

Sept 2008

Oct 2008

Standard 4: Within service delivery


To work together with providers, commissioners and regulators to ensure that safeguards are in place so that adults who receive community care services are protected from abuse and neglect both in care settings and in their own homes.

Increase the number of safeguarding adults awareness raising sessions for partner agencies to eight per quarter.

T&D to audit training in partner agencies and to develop SGA workforce development plan.

From April 2008

Review the training and development programme and work with providers to identify the learning needs in relation to SGA and Dignity in Care.

T&D Adult Commissioning Manager.

Develop a case tracking and care audit process.Introduce standard forms to record key decisions including assessment of risk or seriousness; referral forms; minutes of strategy meetings or discussions and case conferences; safeguarding plans.

SAL July 2008

Hold quarterly reflective sessions for practitioners and SGA managers to develop and improve knowledge, skill and confidence in safeguarding work.

SAL to publish dates and venues to all relevant staff and to focus work around key issues flagged through casework.

From July 2008



Prevention of abuse and neglect (continued)

Standard 5: Training standards


To develop the Westminster safeguarding adults multi-agency workforce development and training strategy and ensure that it is properly resourced.

Set up T&D multi-agency sub-group of the board to develop SGA workforce development plan.

T&D Adult Commissioning Manager

Sept 2008

Include SGA in induction of all staff working with and caring for vulnerable adults in all partner agencies.

T&D Adult Commissioning ManagerSAB workforce development sub-group

Jan 2009

Review the training and development programme and work with providers to identify the learning needs in relation to SGA and Dignity in Care.

T&D Adult Commissioning Manager

Link SGA training programme including to staff SGA objectives and PDPs: mandatory training.

T&D Adult Commissioning MangerSAB workforce development sub-group

Sept 2008

Test the feasibility of E-Learning package for staff in all partner agencies.

SAB workforce development sub-group

Sept 2008

Work with the police to develop the investigators course – joint training with police and linked to ABE.

SAB workforce development sub-group

Sept 2008

Re-introduce practice forums for practitioners and SGA Managers.

SAL From April 2008

Explore setting up joint SGA fund with partner agencies.

Part of work to develop SGA workforce development plan

Sept 2008



Responding to abuse and neglect

Standard 6: Upholding human rights


To ensure that any action taken by organisations in the Westminster Safeguarding partnership to safeguard an adult should meet human rightsstandards and be proportionate to the perceived level of risk and seriousness.

Provide training and information to staff in partner organisations and raise public awareness of Deprivation of Liberty (Mental Capacity Act 2005).TOR of local Implementation group revised.Deprivation of Liberty (DOL) project worker appointed.DOL project scoped.Programme of briefings and training for assessors designed.Communication strategy regularly updated.Progress reported to LIG and SGA Board

LIG Chair LIG Chair DOLPMT&D Adult Commissioning Manager & DOLPM LIG Chair & DOLPM

April 2008 Aug 2008 Sept 2008Oct 2008

April 2008 April 2009

Standard 7: Joint systems

Priorities Actions By whom? By when

To ensure that the local multi-agency SGA policy and procedure describing the framework for responding to all adults who are or may be eligible for community care services and who may be at risk of abuse or neglect, are up-to-date and accessible.

Complete and publish refreshed policy and procedures in October 2008.Work with communication team re design, publication and launch of new policy/procedures.Launch at conference.Develop T&D programme. Develop accessible version and toolkits.

Safeguarding Adults Policy and Procedures Review Network (SAPPREN)

SMSA – Westminster City Council and the Royal Borough of Kensington and Chelsea

T&D Adult Commissioning Manager T&D Sub group of Board

Oct 2008

From April 2008Oct 2008

�0 WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008


Responding to abuse and neglect (continued)

Standard 8: Partner agency systems


To ensure that each partner agency has a set of internal guidelines, consistent with the Westminster multi-agency safeguarding adults policy and procedures, which set out the responsibilities of all workers to operate within it.

Work with Imperial to develop internal SA guidelines that ensure consistent response to and staff understanding of POVA.Provide SA briefings to staff teams. Imperial representative on SA management committee. Contribute to safeguarding adults work – training, policy development at St Mary’s/Imperial.

SMSA and SAL

SMSA and SAL

From April 2008

Sept 2008

Continue to work with CNWL to develop internal SGA guidelines for in-patient settings.

SAC from Westminster City Council and the Royal Borough of Kensington and Chelsea to work with senior CNWL managers.

From June 2007

Standard 9: Effective procedures


The multi-agency safeguarding adults procedures detail the following stages:alert, referral, decision, safeguarding assessment strategy, safeguardingassessment, safeguarding plan, review, recording and monitoring.

Teams to ensure SWIFT adult protection module is capturing all POVA activity. Review following findings from TIS pilot.

SAL July 2008

Build safeguarding adults into development plan of new CIS.

Director of Adult Social Services (DASS) & IT commissioner

Introduce case tracking and audit to test consistent application of procedures, to ascertain outcomes for the service users and to capture learning.

SAL Case review sub-group of the SGA Board

July 2008July 2008

WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008 �1


Access and involvement

Standard 10: Equal access to safeguarding services


To ensure that the safeguarding procedures are accessible to all adults covered by the policy.

Distribute accessible leaflet, Action Against Bullying.

May 2008

Set up a designated safeguarding adults line and safe-haven fax to receive referrals from the public, the police, London Ambulance Service and the Commission for Social care inspection. Publicise number through campaign including posters, leaflets, articles etc.

Vertex, Service Manager, North West Older People and Physical Disabilities (SMNWOP&PD), SMSA

SMSA and communications

1st Aug 20081st Aug 2008

Autumn 2008

Standard 11: Engaging citizens


To ensure that Westminster’s Safeguarding partnership includes service users as key partners in all aspects of its work.

Review of TOR of management committee to include plan to increase user involvement.

SMSA and SAL Autumn 2008

Building safeguarding into all aspects of Transformation of Social Care work.

ADSCS and SMSA From July 2008

Design a publicity campaign to raise public awareness of safeguarding adults.

SMSA and Communications From April 2008

�� WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008


Appendix 3

Safeguarding Vulnerable Adults in Westminster end-of-year monitoring report 2007/08IntroductionThis is the first full year that safeguarding adults monitoring information has been captured on the adult protection module on SWIFT. Since Adult Social Services staff have been using SWIFT (from January 2006), there has been a 27% increase in the numbers of abuse cases reported as can be seen by comparing activity in 2007/08 with 2006/07.

The Community Mental Health Teams do not routinely use SWIFT and there is under-reporting of adult protection activity in mental health, although this activity is captured through the Trust’s serious incident reporting.

The Trust is in the process of strengthening their adult protection/safeguarding adults reporting systems to better reflect the activity in this area. It is anticipated that the introduction of electronic client records and the dashboard will lead to further rises in number of safeguarding adults/adult protection cases recorded in 2008/09.


SummaryAlerts2 receivedThere were 151 alerts received in 2007/08, compared to 119 in 2006/07, an increase of 27%. The trend therefore is upwards but Westminster still records less adult protection alerts than most other London authorities.3 The table below shows the latest available comparative figures for London.

Council2005/06 Referrals

2006/07 Referrals

City of London 1 2

Merton 34 70

Kingston upon Thames 63 83

Richmond upon Thames 66 88

Bromley 95 103

Islington 170 103

Westminster 91 119

Hammersmith & Fulham 56 121

Havering 64 128

Hillingdon 108 128

Camden 61 141

Greenwich 38 144

Bexley 87 149

Brent 131 158

Haringey 87 158

Barnet 153 159

Waltham Forest 91 159

Barking & Dagenham 103 168

Redbridge 188 174

Lewisham 118 186

Harrow 164 187

Lambeth 126 189

Southwark 135 196

Hackney 9311 198

Newham 147 207

Croydon 117 233

Wandsworth 83 240

Sutton 48 243

Ealing 280 259

Hounslow 231 260

Enfield 251 281

Tower Hamlets 168 315

Kensington & Chelsea 254 369

� Thereisnoconsistencyof whatconstitutesanalertacrossLondonsoauthoritiesmaybecountingdifferentlyieatfirst point of contact or when the alert is confirmed as a safeguarding/POVA issue warranting a full enquiry.



Sixty nine percent of referrals during the year were from Adult Services teams (Older People and Disabilities); 23% were from the Learning Disabilities Partnership; 5% were from Community Mental Health teams; 3% were from the Joint Homelessness team, and 1% were not recorded.

Information about the alleged victimThe highest number of people experiencing abuse were aged over 65 (53%). One alert was for an alleged victim aged 17 at the time of referral.

Seventy four percent of alerts related to white people and 26% related to people from Black and Minority Ethnic (BME) communities; this compares to 24% of the local population being from BME communities. The proportion of people from BME communities subject to POVA alerts is therefore similar to the proportion in the local community.

Source of the referral and location of incidentTwenty percent of alerts this year came from provider agencies, mainly day care centres and residential/nursing care homes. Fourteen percent came from health, both in-patient and community services, and a further 9% came from carers, both family members and non-family members, usually paid carers.

Nearly half (48%) of alleged incidents occurred in the user’s home and a further third (29%) occurred in residential and nursing homes.

Types of alleged abusePhysical abuse was most common type of abuse reported in 2007/08, particularly for older people. The second most common type of abuse was financial/material.

About the alleged perpetratorLimited information was known or recorded about the alleged perpetrator. This year, 57% of the alleged abusers (where known) were men and 43% women.

Thirty one percent of alleged perpetrators (where known) were paid carers and 14% were the son or daughter of an older person.4 For 19% of incidents there was no relationship between the alleged perpetrator and the victim.

� TheActiononElderAbuseUKStudyof AbuseandNeglectinOlderPeopleprevalencestudy(June�007)showedthatnationallythereisunder-reportingof abuse.Thereportfoundthat�in40adultpeopleaged65-74experiencemistreatment within a relationship of trust ie family members, close friends and paid carers. In 2005 the Westminster populationaged65-74was��,��5.Thismeansasmanyas��5olderpeoplemaybeexperiencingmistreatment.Lessthanathirdarecomingtoourattention.

4 Thisisaworryingstatisticasthetrendforadultchildrentoremaininthefamilyhomeincreases.Abusebetweenadultfamily members constitutes a crime under the Domestic Violence, Crime and Victims Act 2004.

WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008 ��


Information gathering and outcome of enquiriesEighty seven percent of alerts identified the need for a strategy meeting compared to 83% last year. Two percent of allegations were withdrawn and for 7%, there was inadequate evidence to confirm whether the allegation was founded. Three percent of allegations were deemed unfounded and one person was not deemed to be a vulnerable adult.

Strategy meetingsA high proportion of strategy meetings (76%) identified the need for a formal investigation; 11% of allegations were either unfounded or withdrawn following a strategy meeting; and for 14% there was inadequate evidence to warrant a full enquiry. In one case, the person was not a vulnerable adult.

Case conferences and reviewsHalf of all cases reported went to case conference and a full list of outcomes of these case conferences is listed on page 31 of this report.

The tables opposite provide detailed information about activity during the year, including:numbers of referrals receivedservice users’ age, gender and ethnicitythe source of the referral/alertwhere the abuse took placetype of abuseinformation about the perpetratoroutcomes at key points in the POVA/Safeguarding process; information gathering, strategy meeting, investigation and case conference.

The information in this report will be complemented by an evaluation of safeguarding adults activity in Westminster that has been commissioned by the Director of Adult Services. The findings were reported to the Safeguarding Adults Board in June 2008.

›››››››



POVA referrals received

2007/08 2006/07

Team name No. % Team name No. %

OP/Dis North West 47 31% OP Marylebone 4 3%

OP/Dis North East 12 8% OP Paddington 12 10%

OP/Dis South 37 25% OP Victoria 12 10%

OP West End 10 8%

Disability North 4 3%

Disability South 9 8%

OP St. Mary’s 8 5% OP St. Mary’s 16 13%

Learning Disabilities 35 23% Learning Disabilities 44 37%

MH Paddington 3 2% MH Paddington 3 3%

MH Abbey Road 0 0% MH Abbey Road 2 2%

MH West End 0 0% MH West End 0 0%

MH Victoria 4 3% MH Victoria 2 2%

Substance Misuse 0 0% Substance Misuse 0 0%

JHT 4 3% JHT 1 1%

Total 150 100% Total 119 100%

Information about service users – age, gender and ethnicity

2007/08 2006/07

Age No. % No. %

Under 18* 1 1% 0 0

Under 65 69 46% 51 49%

65+ 80 53% 54 51%

Total 150 100% 105 100%

Unknown 1 14

*aged 17 at time of referral

2007/08 2006/07

Gender No. % No. %

Male 61 40% 50 45%

Female 90 60% 62 55%

Total 151 100% 112 100%

Unknown 7



Information about service users – age, gender and ethnicity (continued)

2007/08 2006/07

Ethnicity No. % No. %

White 109 74% 83 75%

Mixed 3 2% 1 1%

Black or Black British 16 11% 11 10%

Asian or Asian British 12 8% 6 5%

Other 8 5% 9 8%

Total 148 100% 110 100%

Not known 3 9

Source of referral

2007/08 2006/07

No. % No. %

Allocated worker 2 1% 0 0%

Anonymous 2 1% 0 0%

Carer (family member) 1 1% 0 0%

Carer (non-family member) 12 8% 0 0%

Community Health 9 6% 14 12%

Community Support and Rehabilitation Service 2 1% 0 0%

Provider agency 29 20% 49 41%

Family member (non-carer) 6 4% 5 4%

Friend 0 0% 5 4%

Hospital 12 8% 7 6%

Housing 4 3% 0 0%

Neighbour 0 0% 2 2%

Other 21 16% 25 21%

Other local authority social services 6 4% 0 0%

Partner 0 0% 2 2%

Physiotherapy 2 1% 0 0%

Police 4 3% 0 0%

Private agency 4 3% 0 0%

Scheme manager 2 1% 0 0%

Self-referral (party concerned) 11 8% 10 8%

Voluntary agency 5 3% 0 0%

Westminster City Council 12 8% 0 0%

Total 146 100% 119 100%

Not recorded 5 3%



Where did the incident take place?

2007/08 2006/07

No. % No. %

Day resource 5 4% 1 1%

Hospital 6 4% 4 3%

Nursing home 13 9% 7 6%

Other 11 8% 9 8%

Public place 8 6% 8 7%

Relative’s home 1 1% 2 2%

Residential home 29 21% 30 26%

User’s own home 68 47% 54 47%

Total 141 100% 115 100%

Unknown 10 4

Type of alleged abuse (includes main category and other categories)

2007/08 2006/07

Lear

ning

Dis

abili

ties

Men

tal H

ealth

(in

c JH

T)

Old

er P

eop

le/P

hysi

cal

Dis

abili

ties

Lear

ning

Dis

abili

ties

Men

tal H

ealth

(in

c JH

T)

Old

er P

eop

le

Phy

sica

l Dis

abili

ties

Physical 15 7 33 25 2 22 4

Neglect 5 23 5 0 5 2

Sexual 4 1 4 4 1 2 1

Institutional 1 2 1 1 12 0

Emotional/psychological 7 3 11 12 3 5 3

Financial/material 4 4 38 6 5 27 7

Discriminatory/hate crime 0 0 0 0 1 1 1



Information about the alleged perpetrator5

2007/08 2006/07

Gender No. % No. %

Male 33 57% 44 56%

Female 25 43% 35 44%

Total 58 100% 79 100%

2007/08 2006/07

Relationship to service user No. % No. %

Brother 2 2% 0 0%

Carer - non family member 3 3% 1 1%

Carer (paid) 31 31% 40 43%

Cohabitee 1 1% 0 0%

Son or daughter 14 14% 4 4%

Ex-cohabitee of mother 1 1% 0 0%

Family (other) 0 0% 6 7%

Friend 7 7% 11 12%

Grandson 1 1% 0 0%

Husband/wife/partner 11 11% 2 2%

Father/mother 1 1% 3 3%

Neighbour 4 4% 5 5%

No relationship 19 19% 0 0%

Residential/nursing home worker 3 3% 0 0%

Self 1 1% 0 0%

Sister in law 1 1% 0 0%

Other 0 0% 20 23%

Total 100 100% 92 100%

Outcomes at key points of POVA/Safeguarding process information gathering

2007/08 2006/07

No. % No. %

Allegation withdrawn - NFA 3 2% 2 2%

Inadequate evidence - NFA 10 7% 8 7%

Not a vulnerable adult 2 1% 6 5%

Strategy meeting required 125 87% 92 83%

Unfounded - NFA 4 3% 3 3%

Total 144 100% 111 100%

5 Limited information known or recorded about the perpetrator.



Strategy meeting

2007/08 2006/07

No. % No. %

Allegation unfounded NFA 9 7% 4 5%

Allegation withdrawn NFA 5 4% 1 1%

Formal investigation required 96 75% 56 73%

Inadequate evidence NFA 11 9% 13 17%

Not a vulnerable adult 6 5% 3 4%

Total 127 100% 77 100%

Formal investigationCase conference required 42

Further investigation required 6

Further strategy meeting required 3

No further action 21

Case conferences/reviews6

2007/08

Allegation disproved 6

Allegation likely on balance of probability 15

Allegation proved 7

Court proceedings 2

Criminal investigation 5

Disciplinary procedures 2

Insufficient evidence 11

Insufficient evidence to prosecute 1

Investigation not complete - Need CC review 10

No further action 3

Not recorded 7

Other 8

Safeguarding plan in place 9

Staff dismissed 2

Total 88

6 Therecanbemorethanoneoutcomeforacaseconference.

WestminsterCityCouncil›SafeguardingAdultsBoardAnnualReport�008 �1


GlossaryADASS Association of Directors of Adult Social Services

ADSCS Assistant Director Social Care Services

CNWL Central North West London Foundation Trust

CPA Care Planning Approach

CPD Community Protection Directorate

CSCI Commission for Social Care Inspection

CSIP Care Services Improvement Partnership

DASS Director of Adult Social Services

DOL Deprivation of Liberty

IMCA Independent Mental Capacity Advocate

LAPN London Adult Protection Network

LIG Local Implementation Group

MAPPA Multi–Agency Public Protection Arrangements

MARAC Multi-Agency Risk Assessment Conference

MCA Mental Capacity Act 2005

MPS Metropolitan Police Service

PCT Primary Care Trust

PPD Public Protection Desk

SAC Safeguarding Adults Co-ordinator

SAL Safeguarding Adults Lead

SAPPREN Safeguarding Adults Policy and Procedures Review Network

SCIE Social Care Institute of Excellence

SGA Safeguarding Adults

SMNWOP&PD Service Manager, North West Older People and Physical Disabilities

SUI Serious Untoward Incident

TOR Terms of Reference

WAMHS Westminster Adult Mental Health Service




Westminster City Hall, 64 Victoria Street, London, SW1E 6QPMain Switchboard 020 7641 6000 www.westminster.gov.uk

© Westminster City Council 2008


westminster safeguarding adults board · 2009. 7. 13. · westminster city council › safeguarding...

Documents