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Wiltshire Safeguarding Adults Board

Annual Report 2014 – 2015

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Table on ContentsForward ............................................................................................................ 3

1. Introduction ........................................................................................................... 5

2. The National and Local Context .............................................................................

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3. Key Achievements from the WSAB Business Plan ............................................... 8

4. Monitoring and Quality Assurance Activity ......................................................... 11

5. Partner Reports ..................................................................................................... 18

5.1 Avon and Wiltshire Mental Health NHS Partnership Trust (AWP).................. 18

5.2 Community Rehabilitation Company (BGSW………………………………………………… 20

5.3 Carers Reference Group………………………………………………………………………………. 21

5.4 Great Western Hospitals NHS Foundation Trust………………………………..……….. 22

5.5 Healthwatch Wiltshire…………………………………………………………………….. …………. 24

5.6 NHS England, South Central Area Team…………………………………………………..….. 26

5.7 NHS Wiltshire CCG…………………………………………………………………………….……….. 27

5.8 Royal United Hospitals Bath NHS Foundation Trust…………………………..………… 29

5.9 Service User Reference Group………………………………………………………….….….…… 31

5.10 Salisbury NHS Foundation Trust…………………………………………………………..…….. 32

5.11 South Western Ambulance Service NHS Foundation Trust……………………….... 33

5.12 Wiltshire Care Partnership…………………………………………………………………..…….. 35

5.13 Wiltshire Council………………………………………………………………………………..………. 36

5.14 Wiltshire Fire and Rescue Service……………………………………………………………….. 39

5.15 Wiltshire Police……………………………………………………………………………………..…… 41

5.16 Public Health – Domestic Abuse…………………………………………………………………. 43

5.17 National Probation Service - Wilts and Glos Local Delivery Unit…………………. 47

6. Priorities for 2015-16………………………………………………………………………………………… 49

Appendix 1 Terms of Reference................................................................................... 51

Appendix 2 Board Membership & Attendance 2014-15............................................. 57

Appendix 3 Performance Report................................................................................. 58

Appendix 4 Strategic Plan 2015-17.............................................................................. 61

Appendix 5 Glossary of Terms ..................................................................................... 74

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Foreword

Welcome to the Annual Report of the Wiltshire Safeguarding Adults Board (WSAB) for 2014-15. The Board is a multi-agency partnership whose aim is to protect all adults in its area who have needs for care and support and who are experiencing, or at risk of, abuse or neglect from which they can’t protect themselves because of their needs. This report tells you about the work of the Board as it attempts to realise that aim: how we think we have worked successfully together over the past year, the things that continue to challenge us and the plans we have to take our work forward during the current year.

During a year of continuing change and financial pressures in public organisations, I have very much appreciated the continuing commitment of all partner organisations to the work of the WSAB. We have welcomed Healthwatch Wiltshire to membership of the Board, and I am pleased to report that we have new Chairs for our sub-groups that come from a range of WSAB member organisations.

The commitment is reflected in what, as always, is the most substantial part of this report – the contributions from each of the member agencies and our service user and carer reference groups that can be found in Section 5. These show an impressive level of organisational focus on safeguarding adults, expressed in a rich mix of past activities and future goals. Some are highly specialised individual projects, others build up the general systems that support good practice, and the essential collaborative nature of good safeguarding work is clear throughout. This work is illustrated with a number of case studies provided by partners.

It is good to be able to report a number of achievements during the year, which are set out in Section 3 and include:

It’s very good to be able to report that the Service User Reference Group, facilitated by Wiltshire and Swindon User Network (WSUN) has continued to be a lively and challenging forum for service user views, and they have contributed to this report.

I’m pleased to say that we now also have a Carer Reference Group (facilitated by Carer Support Wiltshire) on similar lines, which is providing valuable insights into carers’ experiences of safeguarding. They also send representatives to the main WSAB meetings.

We have prepared for the implementation of the Care Act 2014, which put safeguarding adults, including the work of the WSAB, on a statutory footing for the first time. We have updated our Terms of Reference, analysed our current approach against the expectations of the Act and its accompanying guidance, and identified the further implementation work we need to do in our Strategic Plan for this year.

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Work has started on delivery of the Action Plan in response to the Serious Case Review carried out in 2014. Other authorities who had placements in the care homes involved expressed appreciation of the information we sent them about the outcome of the review and are acting on the recommendations in their own areas.

All partners audited their own safeguarding activities against an agreed set of goals, and then challenged each other in discussions, sharing good practice and supporting others in achieving improvement. Agreed actions will be reviewed this year and another full audit completed in 2016.

Action on the 2015 – 16 Strategic Plan is already underway with a wide range of actions to try and address the challenges we face and deliver on our overall priorities for the year which are:

The implementation and monitoring of the practice changes required by the Care Act 2014 with its focus on Making Safeguarding Personal

Renewing the training programme to reflect changed expectations in safeguarding and work with partners to enable all the required training, both generic and specialist (e.g. Prevent, Modern Slavery) to take place with a manageable impact on work patterns

Refresh the performance reporting arrangements to include a focus on outcomes for the people about whom safeguarding concerns are raised

Implement the agreed communications strategy to support awareness raising and good information sharing across all Wiltshire’s communities, including updated web-based information

Develop the Board’s preventative strategy through a task and finish group

Continue to manage and respond to the greatly increased Deprivation of Liberty Safeguards (DoLS) work

This is my final report as the Independent Chair of the WSAB as my contract ends, and a new Chair will pick up the implementation of the Board’s future plans. My sincere thanks to all the members of the Wiltshire Safeguarding Board over the last five years for their commitment to the Board’s work during a period when their own roles have been busier than ever and subject to continued change and financial pressures. I am also grateful to the council’s officers who have provided support to the Board.

I wish the WSAB well in continuing to develop their vital work to improve the wellbeing and safety of Wiltshire’s citizens during times that continue to be very complex and challenging.

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Independent Chair, Wiltshire Safeguarding Adults BoardJuly 2015

1. Introduction1.1. The Wiltshire Safeguarding Adults Board (WSAB), as from 1st April 2015, is a

statutory body established by the Care Act 2014. Its main objective is to protect all adults in its area who have needs for care and support and who are experiencing, or at risk of, abuse or neglect from which they can’t protect themselves because of their needs. During the year under review in this report the WSAB was still operating as a voluntary partnership supported by national guidance but with the same broad objective.

1.2. The Board is a partnership of statutory and non-statutory organisations and, while they all share responsibility for safeguarding adults at risk, the local authority, Wiltshire Council, has the lead responsibility. The Board fulfils its purpose in two main ways:

co-ordinating the work of its member agencies to determine shared policy, facilitate joint training, raise public awareness and monitor and review the quality of services relating to safeguarding adults in Wiltshire

ensuring that all agencies work together to minimise the risk of abuse to adults at risk of harm, and to protect and empower those people effectively when abuse has occurred or may have occurred

1.3. You can find the full Terms of Reference to which the Board now works at Appendix 1 of this report.

Reporting 2014-15

1.4. This report outlines the work we have done and the actions we have carried out in 2014-15 to ensure the safety of adults at risk in Wiltshire. Details include:

progress with the shared priorities we set ourselves for the year

contributions from each WSAB member about their own safeguarding work

data about our performance

a summary of training carried out

our priorities for 2015-16

1.5. The report will be sent to:

the Corporate Directors and leader of Wiltshire Council the Police and Crime Commissioner and the Chief Constable Healthwatch Wiltshire the Chair of the Health and Wellbeing Board

1.6. It will also be distributed in the following ways:

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WSAB members will ensure the report is received by their relevant senior leadership bodies

it will be placed on the Wiltshire Council website http://www.yourcareyoursupportwiltshire.org.uk/safeguarding/adults-public-information.aspx

The Health Select Committee will have the opportunity to discuss it It will be reported to the Health and Wellbeing Board

2. The National and Local ContextNational

2.1. A major element of the national context, the coming into force of the Care Act 2014, has already been mentioned in the Introduction. The changes to safeguarding work that are made in the Care Act are part of a wider law that creates a single modern legal framework for adult care and support. A central theme of the Act is to emphasise that the purpose of adult care and support is to help people achieve the outcomes that matter to them in life, and that this must be done by focussing consistently on the needs and goals of the person concerned – a “person centred” approach.

2.2. This therefore also applies to safeguarding, and the Act reflects the work done through the Making Safeguarding Personal programme in recent years to ensure that safeguarding work seeks the views of the person concerned from start to finish and focuses on the outcomes they want to achieve. Making sure this is implemented across all the agencies involved will be one of the key tasks of the current year.

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Case Study - Self-neglect and safeguarding

The Care Act places increased emphasis on the way in which self-neglect may have safeguarding implications. One of the more common aspects of self-neglect which come to services’ attention is “hoarding” and this case study from the Fire and Rescue Service (FRS) illustrates the complex issues involved.

A referral to the FRS was made by a Supported Living Advisor (SLA) about a tenant living in a block of flats who was hoarding, and the SLA was concerned about the fire risk to him and to other tenants. The FRS officer visited and found extreme conditions in the flat which was cluttered with all kinds of items so that no rooms except the toilet could be used normally. The tenant has complex mental health needs.

Despite a series of visits to offer safety advice and support, along with the SLA, in reducing the level of clutter in the flat, very little progress was made and the fire safety and general welfare and health problems remained. It became clear that the solution was more likely to lie in addressing the tenant’s psychological health than in continued advice and support of a practical kind.

FRS observation is that this is a typical case which may be long-term and where success is not about complete clearance of the hoarding, but making the individual as safe as possible, working with other agencies and the person concerned.

2.3. A national change that came into effect in 2014 is the major reorganisation of the Probation Service under the “Transforming Rehabilitation” agenda. This has disbanded the local Probation Trusts and separated probation work between: the National Probation Service (NPS), that works with high risk offenders

released into the community 21 Community Rehabilitation Companies (CRC) country wide that manage

low and medium risk offenders.

2.4. Wiltshire comes within the South West and South Central Division of the NPS, and the Bristol, Gloucestershire, Somerset and Wiltshire CRC area. Following a procurement process, the contract for the CRC in this area was awarded to Working Links, which is a well-established company delivering welfare, employment, rehabilitation and consultancy services. Both arms of the Probation Service are now represented on the WSAB.

2.5. A decision of the Supreme Court about how the Deprivation of Liberty Safeguards (DoLS) associated to the Mental Capacity Act should be applied has created an enormous increase in applications for DoLS assessments nationally. This has affected Wiltshire and created significant pressures on the team providing these assessments.

Local

2.6. Several specific local issues also affect the work of the WSAB and safeguarding adults generally.

2.7. The well documented national recruitment crisis in health services is clearly having and equal impact on Wiltshire, where all parts of the health and social care sector are reporting severe difficulties in recruiting and retaining care staff. There are particular concerns about persistent shortages of nursing staff and health care assistants, as well as extensive gaps in capacity for carers.

2.8. These pressures, coinciding with the increasing demand for services for individuals with high levels of need, inevitably affect providers’ ability to maintain consistently safe, quality staff levels at all times. WSAB has acknowledged the threat posed by this situation within its Risk Register, and both Wiltshire Council and NHS Wiltshire CCG will be working actively with the whole of Wiltshire’s health and social care sector in 2015-16 to address these challenges through a new multi-agency Action Workforce Group.

2.9. Another local factor is the redeployment of a large number of service personnel to Wiltshire. Good arrangements to manage this are in place but

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the WSAB needs to be alert for any potential impact on safeguarding services.

2.10. The national plan following the Winterbourne View Hospital Serious Case Review, set targets for people with complex needs, including behaviour that challenges, to be accommodated in their home area. There is therefore growth in specialist care and support settings in Wiltshire that have been established in response to these individual needs.

2.11. Overall, therefore, the WSAB and the services that it is responsible for overseeing are operating in a complex and changing environment.

3. Key Achievements from the WSAB Business PlanThe WSAB Business Plan for 2014-15 has been reviewed to reflect the work completed during the last year, and a new Strategic Plan has been created for 2015-17. Our achievements in relation to the priorities we set ourselves for 2014-15 are shown below.

Take the necessary action to implement the Care Act 2014

After a full discussion about the Act at our December meeting, a small working group checked the action we needed to take. This was short term, so we had the key points in place in April, and longer term as we change day to day practice. We have new Terms of Reference and an updated policy in place, and our Strategic Plan

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Case Study – Safeguarding and Mental CapacityPatient P, who was known to have arthritis and a learning disability was admitted to the RUH with abdominal and knee pain. The ward contacted the RUH Adult Safeguarding Team as patient P disclosed that her partner, and main carer, had assaulted her. There was evidence of multiple bruising and patient P was extremely distressed. The Safeguarding team made an alert to Wiltshire Social Work department in the RUH. The partner was arrested and interviewed by the police. The partner was seen on a subsequent occasion by the police and the outcome of this visit did not affect the safeguarding process. Patient P was assessed by the Mental Health Liaison Team and had a formal capacity assessment in relation to her decision about where to go when discharged. It was deemed that, on balance of probability, patient P did not have the mental capacity to make that decision. As safeguarding for patient P was part of the discharge planning decision making, the ward held a Best Interest meeting to review all options for discharge and patient P’s choice was represented by an Independent Mental Capacity Advocate (IMCA). Patient P was able to express a wish to return home. The safeguarding processes continued alongside the discharge planning as it was decided that patient P would return home with a package of care and initial support from the Neighbourhood Team to support her personal care needs and monitor the home situation. There continued to be concerns on discharge and patient P remained under safeguarding in the community.

shows how we will make further changes.

Develop and start to implement the Action Plan arising from the Serious Case Review

This review concerned a small residential service and was reported to the WSAB in June 2014. It made recommendations about things we could learn from the case to improve services for the future. We finalised the Action Plan in the autumn and actions on it are well underway.

Implement the quality assurance and performance management system

All our partner organisations carried out an audit of their safeguarding arrangements. We discussed the outcomes so that partners could learn from each other and we could see our overall strengths and identify the gaps we needed to fill.

We have also agreed our overall quality assurance and performance framework and it is being implemented now.

Maintain work with the Service User Safeguarding Reference Group and continue to develop its role

The Reference Group has continued to meet throughout the year, giving plenty of feedback to the Board on the issues we have been dealing with. One member gave a presentation and led a discussion at our development session in September. The group has contributed its views to this report (see Section 5.)

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Investigate in more detail the reasons for the increased number of alerts and referrals

This priority was added later in the year in response to discussion at the Health Select Committee, so the work is not yet complete.

Develop work with Carers to involve them appropriately in the work of the Board

We’re pleased to report that, following initial discussions, Carers decided they would like to establish a Reference Group for the WSAB and this has been meeting regularly since December. In addition to the Reference Group discussion, two members of the group attend the Board to represent Carers’ views in any of the discussions.

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“This is what we want to tell you…”

“This is how it is for us…”

Case Study - Carer Support and Safeguarding

A carer visited the office to speak to a support worker regarding her concerns for her adult daughter’s welfare. The daughter has Asperger’s Syndrome and is a vulnerable adult. The carer was concerned that her daughter was staying in a flat with a man who was being abusive and controlling to the daughter. The carer was very upset and had not heard from her daughter for a while. The last time the carer had heard from her daughter, the daughter had given a clear example of exploitative behaviour.

The support worker enabled the carer to speak to the police by phone, which led to the police speaking to both the daughter and her boyfriend. Communication improved between the daughter and her mother, but recently the carer came back into the office with renewed concerns.

However, she wanted to be able to talk to a support worker without the possibility of a referral to the police if there appeared to be a safeguarding issue. She was advised that this was not possible as we have a legal requirement to report any safeguarding concerns and offered the alternative of a referral to the Samaritans for a confidential discussion when she felt unable to manage.

A support work plan was developed that includes: Supporting the carer to establish improved communication between the daughter, her

boyfriend and the carer, so that the carer can feel more assured about her daughter’s situation.

Signposting the carer to SPLITZ for advice on managing the relationship with her daughter, if she is in an abusive relationship.

The availability of CSW’s counselling service

4. Monitoring and Quality Assurance Activity4.1. Significant Cases

As noted in the 2013-14 Annual Report a Serious Case Review was completed in 2014. This review concerned several adults with a dual diagnosis of learning disability and psychiatric disorder living in a small residential service, one of whom died in 2013 as a result of ill-health that might have been exacerbated by the way her mental health problems had been treated. Investigation of this person’s care and a further safeguarding alert about another resident triggered a broader examination of the care offered in this service. This found that the service was not generally working to national models of good practice in relation to challenging needs and the safeguarding team worked with the provider agency to put an action plan together to improve the service.

The WSAB agreed at its meeting in June 2013 to carry out a Serious Case Review and Professor Hilary Brown was commissioned to lead the review. Her report was considered and accepted by the WSAB in June 2014 and an Action Plan in response to the recommendations completed in the autumn.

The main finding of the review was that no one had acted from malice towards the users of this service, nor had any service wilfully neglected the service users. No single individual or service provider was seen as having acted so far outside the bounds of accepted practice that they warranted a finding of wilful neglect to be made against them or one of causing significant harm. The Panel did, however, confirm the shortcomings found by the original safeguarding investigation in the care approach of the service. It also found failures in the way the services and the different professionals worked together.

The review made 43 detailed recommendations which range in their scope from actions to be taken by local teams in relation to individual cases, through wider organisational policy and procedural issues to points that would need national attention by professional bodies. The WSAB accepted the recommendations and approved an Action Plan in response. The Executive Summary of the review and the Action Plan have been published on the Council’s website and implementation of the Action Plan will be monitored throughout the year.

4.2. Self Assessment Audit

In late 2014 the WSAB carried out a self-assessment audit across each of its members. This asked each organisation to assess itself against a range of

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Case Study - Carer Support and Safeguarding

A carer visited the office to speak to a support worker regarding her concerns for her adult daughter’s welfare. The daughter has Asperger’s Syndrome and is a vulnerable adult. The carer was concerned that her daughter was staying in a flat with a man who was being abusive and controlling to the daughter. The carer was very upset and had not heard from her daughter for a while. The last time the carer had heard from her daughter, the daughter had given a clear example of exploitative behaviour.

The support worker enabled the carer to speak to the police by phone, which led to the police speaking to both the daughter and her boyfriend. Communication improved between the daughter and her mother, but recently the carer came back into the office with renewed concerns.

However, she wanted to be able to talk to a support worker without the possibility of a referral to the police if there appeared to be a safeguarding issue. She was advised that this was not possible as we have a legal requirement to report any safeguarding concerns and offered the alternative of a referral to the Samaritans for a confidential discussion when she felt unable to manage.

A support work plan was developed that includes: Supporting the carer to establish improved communication between the daughter, her

boyfriend and the carer, so that the carer can feel more assured about her daughter’s situation.

Signposting the carer to SPLITZ for advice on managing the relationship with her daughter, if she is in an abusive relationship.

The availability of CSW’s counselling service

questions related to each of the national Safeguarding Principles.1 Their findings were then discussed with other members for shared learning, challenge and to identify any areas where the Board should be taking collective action.

WSAB members all found it a useful exercise, with the opportunity to recognise their own and others’ good practice, use others’ experience or ideas to improve their own service and build strong relationships across the Board. The areas identified for the Board itself to take action are shown below.

These need to be prioritised and linked into the Strategic Plan.

4.3. Scrutiny of data

Number of Alerts

There has been a 38% increase in the number of Alerts. In the previous financial year we received an average of 193 Alerts per month; in 2014/15 this increased to 267. This has been caused by a combination of improved recording, a rise in the level of reporting individual cases by care agencies (care homes and domiciliary agencies) and a greater awareness of safeguarding vulnerable adult issues in the wider community. Of the 3,201 Alerts in 2014/15, almost three quarters (2,330) were ‘screened out’ (deemed as not needing further investigation) at the triage stage.

1 These are included in the WSAB Terms of Reference and are: Empowerment, Prevention, Protection, Proportionality, Partnership working and Accountability

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Develop public information Establish ways to develop and support training for all medical staff Offer organisations a short presentation for Boards/top teams as a

refresher on safeguarding and briefing on the Care Act Be quicker to recognise and respond to national issues and reports Share Mental Capacity Act and Deprivation of Liberty Safeguarding

systems and materials across organisations Develop partnership working further, including multi-disciplinary work on

individual cases Improve the referral form to meet current needs Develop ways for the Board to assure itself about partner performance on

issues like response to poor practice, whistle blowing and physical restraint

ABUSE ALERTS - Two-year Alert comparison, month-by-month:

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

167 155 167

214

164 163

224 228204 200

220 208206 215

269289

263 261

323293

261242

260

319

Alerts by monthApr 13 - Mar 14 : 2,314 alertsApr 14 - Mar 15 : 3,201 alerts

2013-2014 2014-2015 2013-2014 Average 2014-2015 Average

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Conversion rate from alerts to ESM

Although the number of alerts has increased, the conversion rate has remained constant

Wiltshire total2013/14

Wiltshire total2014/15

Numbers of Alerts 2,314 3,201

Number of Early Strategy Meetings (ESM) held

651 912

Percentage of Alerts leading to an ESM

28% 28%

Sources of Alerts

Sources of Alerts come from a wide spectrum of professionals and society. Alerts for care homes and domiciliary care agencies were double the previous year, indicating greater awareness of importance of safeguarding issues.

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Deprivation of Liberty Safeguards (DOLS)Individuals aged 18 + in care homes or hospitals registered under Health & Social Care Act 2008 (Pathway 1) or in supported living / live in care / Shared Lives arrangements (Pathway 2) identified as lacking capacity to consent to remain and at risk of being deprived of their liberty in order to protect them from harm.

Application is made by the Managing Authority (hospital or care home manager) to Supervisory Body (local authority).

The Local authority must provide Best Interest Assessor (BIA) to decide whether

- a deprivation of liberty is taking place- it is in the person’s best interests- It is in order to protect the person from harm and- It is a proportionate response

Acid Test

Supreme Court case of Chester & Cheshire West (2014) lowered the threshold for deprivation of liberty. There are now three questions to consider:

1. Does the person have capacity to make their own decisions about where they should be accommodated for the purpose of care and treatment? If not, then consider the ‘acid test’ set out in 2. and 3:

2. Are they subject to continuous supervision and control AND3. Are they free to leave

This change in the law broadened the eligibility criteria for people being deprived of their liberty in a residential setting.

The table below illustrates the number of requests for authorisations that came into the DoLS service on an annual basis prior to the Supreme Court ruling in May 2014

YearApplications

madeAuthorizations

given2011/12 153 702012/13 154 602013/14 153 70

The graph below illustrates the number of assessments requests the council received and the number of assessments completed in each month following the Supreme Court ruling in May. The graph illustrates the immediate increase in requests.

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Apr-14

May-14

Jun-14Jul-1

4

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

0

50

100

150

200

250

33

130

170158

109

131 123

206

130

208

157146

Number of Applications

Number of Assessments

Current number of assessments on the waiting list 1300

20 Social Workers in locality teams have been trained as Best Interest Assessors and it was envisaged that they would be able to undertake one assessment a week which in effect would have cleared that back log of assessments by the end of the year. In addition independent assessors would still be used for out of county and hospital assessments and there would be 2 seconded BIAS to the DoLS Service who could then complete the new assessments as they came in. With the pressures on the community and hospital social work teams only 32 assessments have been completed by the newly trained and existing BIAS.

How has the DoLS Service been strengthened to cope with the increase in requests for authorisations?

Prior to May 2014 the DoLS service was part of the SAMCAT with the DoLS Lead managed by the SAMCAT Manager. With the vast increase in work and team members the MCA DoLS team now sits separately to SAMCAT following the creation of an MCA DoLS Team Manager post last January.

Wiltshire Council has now received a grant of £194.460 from the department of health to help the council manage the vast increase in work generated by the change in eligibility following the Supreme Court ruling. The council will need to report back to the DoH by the 1st July on how this money will be spent.

A grant proposal was agreed and the DoLS service will now be increased to included 2 new seniors SW to complete BIA assessments, a lead post and an additional Admin post. There has also been agreement for 2 additional 1 year fixed term contract BIA posts to be advertised. 1 BIA will also join the team in August on secondment for 6 months. The team will therefore have increased by 7 members. As rough guide a BIA can be expected to complete 4 assessments a week which equates to approx 100 to 110 assessments to be completed each month. In order to keep pace with the number of assessments coming in and clear the back log the trained BIAs in operational teams will still need to be released to

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complete assessments as regularly as possible. Alternatively the DoLS team will need a further increase in staffing

4.4. Training

Training is, as ever, an important part of ensuring quality services. The chart below shows the range of training offered and levels of take-up during 2014-15. The Learning and Development sub-group is now fully updating their approach to the oversight of the training programme, which is reflected in the Strategic Plan for 2015-17.

COURSE TITLE TARGET GROUP COURSES NUMBER ATTENDED

Social care induction programme – Common Induction Standard 6. Principles of safeguarding in health and social care

New social care workers in Wiltshire Council

3 76

Safeguarding awareness – e learning package; meets requirements of National Capability Framework for Safeguarding Adults (NCF) for staff group A - responsibility to contribute to safeguarding adults

Any role in public services in Wiltshire; also available to service users, carers & volunteers

-

1475

Staff group A (NCF) – responsibility to contribute to safeguarding adults

Direct care staff in registered/regulated services – independent sector

- 00

Staff group A (NCF) – responsibility to contribute to safeguarding adults

Direct care staff in registered/regulated services - council

- 00

Staff group B (NCF) – Considerable professional & organisational responsibility for safeguarding adults

Managers and senior workers in registered/regulated services – independent sector & council

13 250

1 day Foundation course to get Investigating Officers up and running in the role

New Investigating Officers 2 24

3 day Investigating Officers course covering adult protection legislation,

Investigating Officers4 44

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procedures and processes Best Interest Assessor Experienced Social

Workers 2 34

Half day update & CPD session Experienced Investigating Officers 0 00

1.5 day course to develop knowledge and skills in the Investigating Manager role

New Investigating Managers 2 12

Half day update & CPD session Investigating Managers (also attended by Police, NHS & advocacy service)

2 41

WSAB Development Half day session – learning from experience: service user-led discussion; case studies.

WSAB members

1 13

4.5. Risk Register

The Board has continued to review its Risk Register at each meeting and amend it as necessary to reflect changing pressures.

5. Partner ReportsIn this section all the partner organisations on the WSAB have provided a summary of their safeguarding activities through the year, their approach to training and identified their priorities for 2015-16. The service user and carer reference groups have also provided reports giving their perspective on the work of the Board.

Overall, the reports show a strong understanding of and commitment to safeguarding adults work, with appropriate diversity across the range of organisations involved, but also with common themes emerging in both the achievements and in this year’s priorities.

Common areas of achievement in 2014-15 include:

Preparation for the Care Act in updating and revision of policy and procedures and awareness raising across staff groups

Strengthening of staff levels in safeguarding functions in a number of partners Improvements in recording systems and guidance for staff about recording Strengthened training programmes

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Audit and quality assurance activities of various sorts Responding to a continuing growing workload, both in general safeguarding

activity and the impact of the DoLS changes (see above)

Common priorities for the current year include:

Care Act implementation and ensuring the person-centred approach gets fully embedded in practice

Continuing to manage the increased activity levels Maintaining specialist safeguarding staff levels Support to the front line, including ensuring that front line delivery is not

affected by organisational changes, which continue in a number of organisations

Continuing to contribute to the work of the WSAB and its sub-groups Various collaborative initiatives both on specific projects and in general

safeguarding work

5.1. Avon and Wiltshire Mental Health NHS Partnership Trust (AWP)

How does your organisation fulfil its role in safeguarding adults from abuse in Wiltshire?

Avon and Wiltshire Mental Health Partnership NHS Trust is a specialist mental health NHS provider delivering a wide range of primary and secondary services across the geographical areas of Wiltshire, Swindon, South Gloucestershire, Bristol, North Somerset and Bath & North East Somerset, and tertiary services on a regional level. AWP fulfils its role in safeguarding through: Its management arrangements: at Trust level, the Director of Nursing and

Quality and the Head of Safeguarding have responsibility for both adult and children’s safeguarding; at local level, the Wiltshire Clinical Director is the senior manager with responsibility for safeguarding practice in the locality.

A Safeguarding Management Group that meets bi-monthly and reports to the Trust Executive team and Board with key partners including local and corporate leads, professional leads and service user representation. The Wiltshire Clinical Director is the clinical director representative for this group.

Regular reports about safeguarding from Localities to the Trust on a rolling monthly basis (i.e. each area approximately 9 monthly), including assurance and performance reporting, any service and action plans about safeguarding, as well as setting out challenges to safeguarding in the locality.

A range of other local governance arrangements: Quality and Standards meetings, Training arrangements, Performance and Business meetings and partnership discussions.

An annual safeguarding report to the Board from the Head of Safeguarding/ Named professionals/Executive Lead.

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Senior participation in WSAB sub-groups

What have been your key achievements in 2014 – 15? Establishment of a short life working group with local authority colleagues to

consider the implementation of the Care Act 2014 and changes required in regard to safeguarding

Review and amendment of the Trust Safeguarding Adults Policy and Guidance to reflect Care Act and statutory guidance and good practice

Review and amendment of service user / carer safeguarding leaflets The development and launch of Trust Safeguarding Adults ELearning module Introduction of a Trust wide system to use the improved functionality of RiO in

the safeguarding adult modules to improve recording, including the collection and reporting of outcomes for people subject to safeguarding.

Development of bespoke Rio eLearning modules to support staff The first annual audit of staff knowledge of Safeguarding Adults, Mental

Capacity Act (MCA) and Deprivation of Liberty (DoLS). Overall, findings demonstrated staff have a good understanding of their duties and responsibilities to safeguarding adults.

To support practitioners as well as supervisors to embed effective safeguarding supervision in clinical/management supervision a safeguarding supervision template was developed

The Trust Safeguarding Team developed guidance to further improve staff understanding of safeguarding recording and adverse incident reporting

Safeguarding content on the intranet and internet have been refreshed with simplified pathways to access key content

How do you ensure all your staff are appropriately trained about safeguarding adults?

Safeguarding Adults training is included in the Trust’s statutory /mandatory training matrix and an additional e-learning course was introduced to improve training rates. Rates for Level 1 and 2 training in 2014/15 were up 18% as compared to 2013/14, with 490 staff trained.

A further review of safeguarding adults E Learning modules will ensure the training is updated to reflect changes made by the Care Act 2014 as well as meeting DH and Bournemouth standards.

Staff can access Wiltshire Council’s multi agency training to support their delivery of safeguarding in practice

What are the challenges that inform your priorities for the year 2015-16? Achieving increased AWP representation on appropriate safeguarding

meetings and subgroups Demonstrating that outcomes from training are delivered in practice

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To manage increased demand for safeguarding activity, including safeguarding cases management and enhanced governance activity with safeguarding partnerships and commissioners

Achieving a Named professional who can lead on safeguarding locally. Achieving consistent compliance in relation to using Team and locality

registers

5.2. Bristol, Glos, Somerset and Wiltshire Community Rehabilitation Company


Bristol Gloucestershire Somerset & Wiltshire Community Rehabilitation Company (BGSW) works with low and medium risk of harm offenders in prison and the community. The Head of Wiltshire Local Delivery Unit has responsibility for all Safeguarding and represents the CRC on the WSAB. Two middle managers have operational responsibility to ensure the needs of all vulnerable service users are assessed and individualised support offered.

What have been your key achievements in 2014 – 15?

BGSW has continued to work with SEQOL on an “Understanding Autism” project; this involved staff training/awareness raising and clinical supervision offered to Offender Managers to discuss individual cases. This project won the Autism Great Practice Award at the National Learning Disabilities and Autism Awards ceremony in May 2015.


All operational staff receive information about Adult Safeguarding at induction. We have a rolling programme of more comprehensive training that all staff are expected to attend every 3 years.

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Case Study – Offender Management A male service user (Case A) presented significant challenges to partner agencies with issues around mental health, substance abuse and homelessness. His offender manager made a referral to the Adult Safeguarding Team. High risk meetings were held and Police, Adult Services and Probation worked closely together to identify a strategy to minimise the risk he presented. SEQOL via the Understanding Autism project have given advice to his offender manager around effective ways to talk to him and helpful language to use.

Case A is now abstinent from alcohol and in stable accommodation.

An important role in protecting Vulnerable Adults is the work we do with both perpetrators and victims of Domestic violence. New 2 day training on this area of work is currently being offered to all operational staff receive

What are the challenges that inform your priorities for the year 2015-16?

The probation service has experienced fundamental changes in the past 12 months under the Transforming Rehabilitation agenda. Our key priority during this period is to ensure front line service delivery is not affected.

In March 2015 a Criminal Justice Joint Inspection of the treatment of offenders with learning disabilities within the Criminal Justice System was published: A priority for the next year will be to ensure learning from that is embedded in practice.

5.3. Carers’ Reference Group

The purpose for establishing the group was to identify carer issues of safeguarding ‘in reality’.

The core membership of twenty represents a wide cross section of carers in a variety of different caring roles. Members can bring their experiences to inform the Board in order to make the safeguarding process easier and safer. The group want to be involved in making the safeguarding procedures in Wiltshire work effectively - ensuring carers know how the system works and that it is easily accessed. Two elected members of the group attend the quarterly Board meeting of the WSAB.

Already from the initial three meetings, topics have been identified which are particularly relevant to carers’ roles and responsibilities:

Clearer information in terms of relevant contact numbers for advice and crises Advice and information on the new Wiltshire website portal – this should be

the only place people need to go to access everything they need (a ‘one stop shop’)

Easy access to appropriate leaflets for ALL Good communication between statutory and voluntary agencies Training and awareness on safeguarding issues Separating the safeguarding issues and addressing the impact they have on

both the carer and the person they care for

Some experiences highlighted by carers demonstrate the need for:

Appropriate discharge from hospital with proper support plan in place Appropriate accommodation for the cared for person, where staff are

properly trained to meet particular care needs Respecting independence and providing a person-centred approach

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Understanding the risks posed for direct payment users who live independently of other family members

Effective out-of-hours help Provision of appropriate services and equipment to make the caring role safer

– e.g. adequate mental health services, quick access to equipment and physiotherapy services, medication advice, skilled and trained domiciliary care support, guidance on nutrition and feeding, legal and financial advice

Prevention of carer fatigue and stress by access to regular respite and emotional support

Bringing together the many different organisations involved so that they work more collaboratively to provide a holistic response

5.4. Great Western Hospital NHS Trust


The Great Western Hospitals NHS Foundation Trust (GWH) provides acute hospital services (at the Great Western Hospital) and community health services across Wiltshire. The Trust fulfils its role in safeguarding through:

its management arrangements: the Chief Nurse is the Trust Executive lead for safeguarding, with operational leadership from the Divisional Director of Nursing for acute based care and a Head of Locality for community services who provide Trust representation at Safeguarding Adult Boards in Swindon and Wiltshire respectively

its Safeguarding Adults at Risk Team which includes Safeguarding Adults at Risk Facilitators both for the Acute Hospital site and for Community Services and is supported by a Mental Health Act and Safeguarding Adults at Risk Administrator who coordinates centralised recording and reporting

Trust staff support to three Safeguarding Board sub groups a number of strategic and operational groups to ensure the appropriate

governance of the Safeguarding Adults agenda e.g. A bi-monthly multi-professional Safeguarding Adults Forum (SAF) chaired

by the Chief Nurse. A bi-monthly Mental Health Act/Mental Capacity Act committee which

reports to the Trust board Learning Disability forum Dementia strategy group

Specifically within the community division – Harm Free Care Focus Group chaired by the Patient Safety and Quality

Lead Patient Safety and Quality Committee chaired by the Director of

Community Services

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What have been your key achievements in 2014 – 15? Annual Safeguarding Forum held in July with positive feedback from all

attendees. Further development of internal reporting and will provide reports to the

safeguarding Adults Forum (SAF). Strengthened links with the lead agency to improve collaborative working and

appropriate participation at all levels of the safeguarding process. The Community Division held a clinically led multi-professional Harm free care

workshop, which led to the formation of the Harm Free Care Focus Group that will oversee, amongst other things, the investigation of serious incidents and a new Improvement Plan that will monitor achievement of all actions required as a result of a serious incident.

Recruitment to both the acute and the community adult safeguarding facilitator roles.


The Face to face Trust induction for all new starters includes basic awareness of Safeguarding Adults

All new clinical staff receive face to face basic awareness training on the Mental Capacity Act and Deprivation of Liberty Safeguards.

All staff with any direct contact with patients must attend a 3 yearly face to face ‘Vulnerable People’s’ day which includes Safeguarding Adults and Children, MCA, DoLS, Domestic Violence and person centred care with Dementia and Learning Disability patients including reasonable adjustments. (MCA is moving to training tracker).

Community clinical staff attend an enhanced face to face community induction programme which includes practice based training re consent and application of the Mental Capacity Act (2005).

Bespoke sessions on a range of subjects related to safeguarding for groups of staff or individuals are provided by the community and acute safeguarding facilitators following identification of learning need from multi-agency or internal investigations of serious incidents

Trust training statistics related to safeguarding are reported quarterly and monitored at the Trust Board.


Implementation of the new safeguarding responsibilities and duties under the Care Act (2014).

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To further develop internal assurance that the Trust has robust and compliant processes. This will include identification of gaps and learning needs. The Trust safeguarding audit schedule will provide the evidence to drive forward any changes required.

The need to make safeguarding and MCA everyone’s business. The Training strategy will be developed on the basis of the golden thread principle with the development of a model of ‘influencers’ throughout the Trust and targeted training and development focused on staff or staff groups identified through, for example, complaints or serious incident reporting as requiring support.

Recognition that the application and priorities in relation to MCA are different in the community and hospital settings.

There is a need stimulate interest, awareness and learning need (the golden thread principle) through consultation with staff.

A community ‘kick-off’ MCA awareness month is planned for September.

5.5. Healthwatch Wiltshire


Healthwatch Wiltshire is the only organisation with a statutory duty to speak up for local people on health and social care. We also have a role in monitoring the quality of local services. These tasks are strongly connected to Safeguarding, and Healthwatch Wiltshire took up a place on the WSAB in 2014. Beyond this we fulfil our responsibilities by:

supporting communities to fulfil the government’s vision that they should be ‘the eyes and ears of safeguarding, speaking up for people who may not be able to protect themselves’

engagement work in local communities where we talk to people who are using health and care services

working closely with local charities and voluntary sector organisations to learn about the experiences of their members and service users

Immediately referring on any safeguarding (or potential safeguarding) concerns

taking a proactive role in monitoring the quality of local services identifying any trends or areas for concern from the issues raised to us by

local people and working closely with the local provider for NHS Complaints Advocacy so that anonymised information can be shared.


In 2014 Healthwatch Wiltshire established a working group, including its lay volunteers, to develop the policy and operating procedures for the powers Healthwatch has to ‘Enter and View’ health and care services to talk to people about their experiences of using those services. This was

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followed by training and pilot visits to care homes, facilitated by Wiltshire Care Partnership, and final revisions to the policy and procedures. Healthwatch Wiltshire is now in a position to deliver its Enter and View function when it is required.

Healthwatch Wiltshire attends the NHS England Area Team Quality Surveillance Group which brings together commissioners and the Care Quality Commission to share intelligence about the quality of services. Healthwatch Wiltshire was instrumental in the establishment of a local equivalent group which started meeting in 2015.

Healthwatch Wiltshire carried out a significant piece of work on NHS complaints in 2014. This fed into national work led by Healthwatch England. The project in Wiltshire was designed to understand people’s experience of making a complaint or raising a concern as well as desktop research of the Acute Trust’s information about complaints. The final report was taken to the Wiltshire Health and Wellbeing Board with a number of recommendations which were approved.


During 2014 we revised our safeguarding adults policy and procedure followed by comprehensive training for all volunteers, staff, and board members. During 2015 the staff team had a development day which included a session on safeguarding which was delivered by a Safeguarding Manager at Wiltshire Council.


Healthwatch Wiltshire’s priorities for 2014-16 are informed by what local people have told us is important to them and our statutory duties and are:

Dementia Information and signposting Complaints Integration of health and care for older people (Better Care) Quality of services

5.6. NHS England – South Central Area Team


NHS England South Central is working to the “Safeguarding Vulnerable people in the NHS - Accountability and Assurance” guidance which described the roles and responsibilities of various bodies in the reformed health system. As the wider

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context for safeguarding continues to change it is important that safeguarding roles remain clear, and therefore the guidance is currently being refreshed.

The Safeguarding function sits within the Nursing Directorate; we hold an oversight role across the BaNES, Gloucestershire, Swindon and Wiltshire Clinical Commissioning Groups (BSGW) NHS System. The Directorate has worked to ensure that:

safeguarding has become embedded in all aspects of the Area team’s work – some examples of the Area team’s work are below. Safeguarding is a key element when ensuring the quality of services, patient safety and patient experience.

safeguarding is included in all Clinical Commissioning Groups business plans funding is available for Named GP / other professional model in line with

recommendations in the NHS safeguarding vulnerable people Assurance and accountability framework

we work closely with CCG Directors of Nursing and Safeguarding Leads to identify safeguarding themes, key areas of concerns have included:

Care in Care Homes Embedding MCA Child Sexual Exploitation Quality and safety in out of area placements Quality and safety of learning disability services

In addition NHS England convenes the Quality Surveillance Group which meets bi-monthly and enables the South Central team, Commissioners, Regulators, Local Authorities and local Healthwatch to provide robust surveillance of our healthcare providers, Safeguarding information, themes and trends are shared at this meeting.

We also investigate serious Incidents, complaints and safeguarding alerts as information is reported into the Area team from all health service providers (Primary and secondary care providers, prison health care, dental services, pharmacies, optometry services, Clinical Commissioning Groups) as well as safeguarding alerts from social care and complaints from patients/families.


Completion of the Safeguarding audit of GP’s across the area. Secured monies and agreed model defines BSGW CCG’s and NHS England will

work together to secure the provision of advice, support and training for Primary Care Services with regard to the safeguarding of adults and children; this includes the role of the Named GP/Named Professional

Commissioned NDTi to undertake a review and develop a plan to Improve the quality of services to patients who lack mental capacity, and their families,

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We have provided bespoke training for our Nursing and Medical colleagues directly involved in safeguarding

We have provided specialist training opportunities for CCG safeguarding Leads in investigation methods


Realigning safeguarding resources post re organisations (merger of two area teams)

Securing capacity to lead on safeguarding in BSGW (advert currently out) Ensuring Primary Care staff receive Adult Safeguarding Training Embedding MCA in Primary care practice

5.7. NHS Wiltshire Clinical Commissioning Group


During its second year of work NHS Wiltshire Clinical Commissioning Group (CCG) has made much progress to strengthen safeguarding adults arrangements across the health services commissioned by the organisation. This is shown in clear governance and accountability arrangements that comply with the expectation of the national framework for safeguarding vulnerable people:

the CCG Board is responsible for the overall safeguarding of vulnerable people for whom they commission services

the Chief Officer is accountable and responsible for ensuring the CCG’s contributions to safeguarding and promoting the welfare of vulnerable people are discharged effectively

the Director of Quality and Patient Safety, as executive lead for safeguarding, shares this responsibility

the Associate Director Quality (Safeguarding Children and Adults) has strategic responsibility and represents the CCG on Wiltshire’s Safeguarding Adults Board (WSAB)

the Head of Safeguarding Adults and Mental Capacity Act lead is accountable to the Associate Director and represents the CCG on WSAB sub-groups and task groups and works collaboratively across the health and social care economy

Reduced capacity due to staff absence has affected progress in relation to the contribution made to the work of the WSAB and sub groups for the latter part of 14/15.

What are your Key Achievements in 2014-15?

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Quality & Performance management has been strengthened in the following ways:

Safeguarding Adults is a standing agenda item on the NHS Wiltshire CCG Quality and Clinical Governance Committee. Quarterly reports to this committee provide detailed updates.

The CCG carries out a programme of announced and unannounced Quality Assurance Visits throughout the year which include adult safeguarding, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Safeguarding Adults activity is an agenda item at each quarterly Clinical Quality Review Meeting (CQRM) between the CCG and commissioned health providers and any outstanding concerns are addressed via the contract and performance meetings.

The process to align NHS Wiltshire CCG serious incident processes with adult safeguarding investigations has been progressed during 14/15. This has led to the most appropriate health professionals contributing to local authority (LA) safeguarding investigations. The head of adult safeguarding provides advice to the LA about appropriate management of health concerns and involves health professionals within health providers to appropriate investigate concerns raised via the LA safeguarding team. This process prepared the way for implementing the Care Act guidance on managing individual cases and has ensured effective shared learning across the health and social care system

Contract management in relation to safeguarding has been maintained and improved including bi-monthly meetings of the Head of Adult Safeguarding and the Associate Director with safeguarding leads from the main providers to develop practice and learn from cases to promote continuous improvement. The safeguarding team has also strengthened its quality schedule and standard assurance framework to reduce the risk of duplication for providers who have contracts with multiple CCGs. This schedule is in all health provider contracts. A set of metrics has been developed with a reporting framework to facilitate performance monitoring.

Deprivation of Liberty Safeguards (DoLS) work was supported by funding in March 2014 from NHS England to support recruitment in the CCG safeguarding team. This will allow safeguarding adults and MCA/DoLS training to be developed and delivered across primary care. The Head of adult safeguarding also worked collaboratively with the LA and health provider organisation to put in place advice and support to mitigate the impact of the Cheshire West judgement on DoLS.

The Local Quality Surveillance Group is now fully operational with appropriate membership. This forum provides an opportunity to discuss and link evidence of emerging quality and safety concerns across health and social care in order to establish an accurate picture of the care across the region.

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Key plans and objectives for 2015-16

Implement the recommendations from the Care Act. Recruit to posts within the CCG safeguarding team to develop and deliver a

programme of safeguarding, MCA and DoLS training to primary care. Sustain the progress to support frontline health care to be alert to

maltreatment and sub optimal practice. Ensure appropriate capacity in named professionals in health providers to ensure the ability to develop safeguarding competence and knowledge in the workforce, that they to know how to respond to a concern and this leads to continuous practice improvement.

Develop collaborative interagency working to effectively manage safeguarding investigations.

Contribute to the work of the WSAB and the sub groups.

5.8. Royal United Hospitals Bath NHS Trust


The Trust does this in a number of ways:

Director of Nursing and Midwifery is the Executive Lead for Adult Safeguarding supported by the Deputy Director of Nursing, Quality and Patient Safety.

Assurance relating to adult safeguarding, Mental Capacity and Deprivation of Liberty Safeguards is provided to the Trust Board by the Safeguarding Adults Forum, a multi-agency body, via the Operational Governance route.

The Trust continues to play an active role on the Wiltshire Safeguarding Adults Board through Executive level representation and is represented at the Quality Assurance sub group.

The adult safeguarding team (1.8 WTE registered nurses with the support of a 0.8 WTE administrator) has continued to develop the support for clinical staff raising concerns. The RUH team provides an immediate response for advice and support to all staff by being available via the bleep system. When the team receives an alert they review the patient and/or their medical records and gather initial information in line with local procedures. The team regularly undertakes case reviews to support safeguarding processes taking place in the community following care in the RUH, and represents the RUH at safeguarding strategy and planning meetings

What have been your key achievements in 2014-15?

The RUH is constantly working to improve the adult safeguarding service that it delivers. Achievements during 2014-15 have been:

Appointment of additional Safeguarding Nurse to manage significant increases in activity.

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Successful centralisation of the DoLS process including communication process between RUH and local authorities’ DoLS administration teams.

Compliant with training targets for the delivery of Adult Safeguarding Level 3; improving compliance for Level 1 and 2 including the launch of a Level 2 e-learning package and the development of a similar package at Level 1.

Established the Safeguarding Adults Network which aims to support practitioners by: ensuring lessons learnt from Safeguarding Adult Reviews or Serious Incidents is shared, discussed and disseminated; sharing examples of good practice; updating colleagues on organisation safeguarding priorities

Monitoring of adverse and serious incidents. Reviewed lessons learned from the investigation reports into offences

committed by Jimmy Savile in NHS hospitals, to strengthen safeguarding arrangements in the Trust.


Training is one of our challenges so the Adult Safeguarding Team have increased the Level 2 face to face training provision from 1 to 3 sessions per month and continue to deliver training at Level 2 on the Induction programme for clinical staff.

The Level 2 Adult Safeguarding e –learning programme has been developed by the Senior Nurse, Adult Safeguarding and was launched during March 2015. Development of Level 1 Adult Safeguarding e-learning programme began in March 2015.

Current delivery against the trajectory agreed with Commissioners means the Trust will achieve 90% compliance with Level 2 training Trust wide by October 2016. The compliance rate will continue to be monitored by the Safeguarding Adults Forum.


To meet training targets for level 2 Safeguarding Adults as per our agreed trajectory.

To review and build evidence for Care Quality Commission Fundamental Standards Outcome 13.

Work with Trust Head of Security in regards to restrictive practices Trust wide. Working closer with Named Nurse for Children and Named Midwife

particularly in relation to Domestic Violence. Establish PREVENT training programme in conjunction with children’s

safeguarding team and security to meet contract compliance targets for PREVENT awareness.

Compliance with Sections 42-46, Care Act Statutory Guidance 2014. Contribute to Making Safeguarding Personal initiatives in partnership with the

Local Authorities.

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Continue to raise awareness of Mental Capacity and Deprivation of Liberty Safeguards (DoLS).

5.9. Service User Reference Group

Wiltshire Users Safeguarding Reference Group is hosted and facilitated by the Wiltshire and Swindon Users Network. We are made up of adult care service users with a range of perspectives – with physical and sensory impairment, mental health service users, older people and people with learning difficulties. WSUN supports service users to attend the meetings including travel costs, transport and personal care.

We are now in our second year and meet regularly in between the Safeguarding Board Meetings. Margaret Sheather, Chair of the Safeguarding Board reports on items discussed at the main safe guarding meetings and service users have an opportunity to comment on any of the issues and raise concerns from their perspective.

The safeguarding board has appreciated and valued the input made by our group over the past year.

We would like to thank Margaret for her commitment to service user involvement during her term of office and we wish her well as she steps down. Members of the group have been involved in the recruitment of the new Chair of the Safeguarding board and look forward to working with that person to take the group forward.

5.10. Salisbury NHS Foundation Trust


Safeguarding adults is core business and central to clinical and professional practice for all staff

Director of Nursing is the Executive Board member with responsibility for Safeguarding

Deputy Director of Nursing represents the organization at the WSAB There is a Lead Nurse for Adult Safeguarding & the MCA We support staff to recognize the risk of & to identify abuse using the

multiagency policies & procedures We support multiagency working and information sharing We support/ lead safeguarding investigations related to the organization


Continued increased awareness of safeguarding adults within the organization

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Significant increase in urgent DoLS authorizations following the Supreme Court ruling of March 2014

Ability to electronically flag adults with an LD on the patient information system

9% decrease in hospital acquired grade 2 pressure ulcers, and 33% decrease in hospital acquired grade 3 & 4 pressure ulcers (6 down to 4)


All new staff have basic Safeguarding awareness at Induction All patient facing staff should complete Adult Safeguarding e-learning and this

is monitored with quarterly reporting All clinical staff should complete MCA eLearning and this is monitored with

quarterly reporting Specialty specific focused training covering Adult Safeguarding, MCA, DoLS,

Domestic Abuse PREVENT awareness & training has commenced, with 3 staff having

completed their WRAP training so cascade training can cover maximum staff


Increased workload from Adult Safeguarding, MCA & DoLS Increased training requirements to support staff relating to Adult

Safeguarding, MCA & DoLS Number of Urgent DoLS which lapse without completion of Best Interest

Assessments & Mental Health Assessments Care Act – unknown impact as yet Growth in PREVENT agenda

5.11 South Western Ambulance Services NHS Foundation Trust


SWAST is aligned to 28 Adult and Child Safeguarding Boards within its operational area. The trust tries to maintain relationships with all these organisations in the interests of fulfilling its responsibility to safeguard, but due to the complexity and unique range of coverage, an efficient and pragmatic approach needed to be agreed. The trust therefore continues to work with the Boards under a ‘memorandum of understanding’ agreement to maintain communication relationships with all Boards.

The Trust has strengthened its leadership of safeguarding and has robust Board reporting arrangements in place.

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Overall safeguarding in the Trust has been strengthened by: 8 of the 11 recommendations in the peer review achieved and 3 in

progress. 2 seconded posts were agreed in this year – a band 5 triager and a band 7

Named Professional. All SCR/DHR/chronology requests were responded to in a timely fashion. The safeguarding referral system is more sophisticated to produce quality

data. 25 safeguarding champions who are active across the trust area.

All Notice Boards in the North division stations have been updated in stations to reflect the new issues facing this agenda.

A successful SW Audit took place in Jan 2015.

The Safeguarding Service worked with Alcohol Anonymous (AA) to provide an awareness raising campaign across the trust area by use of leaflets posters etc and as a result the AA covered the Christmas and New Year period on the alcohol recovery bus.

The Head of Safeguarding has been elected as Chair of the National Ambulance safeguarding Group (NASG) this year which reports to QGARD.

The Child Death Review process and pack has been agreed so that all staff who attend a child death will be supported by the OO at the time of the incident in a formal process as the Form B notification will be completed at the time allowing for reflection and accurateness at the time.


A Safeguarding Training strategy has been agreed so all Board Members, Managers and staff are able to understand more effectively what is expected of them.

All frontline staff have been offered level 2 training in safeguarding with an overall attainment of 90% staff attendance.

All new 111 or 999 staff have had safeguarding training as part of their induction programme.

All 111/UCS staff have been offered level 2 training with an overall attainment of 99% preventing a CQUIN of £100k.

In total the Safeguarding Service has personally trained 724 staff across all service lines.

Prevent training has been agreed on the SME training for 2015-16

OOH GP’s remains a challenging area in which to achieve compliance due to the transience of this workforce. In order to mitigate this, any new recruits to

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this service are unable to start work unless they provide evidence of current safeguarding training (same strategy as applied to BLS/ALS).


Continue to ensure the completion of a centralised recording system for safeguarding training across all departments.

Review the current referral system to promote a more efficient system with input from IT

Work plan to be guided by NASG work plan and Savile Recommendations Embed the Prevent agenda Implications from the Care Act for the Trust Expansion of the Welfare agenda Consider a more resilient team by integrating more with the Governance

Structure Agree a Supervision Strategy for the trust Escalation Policy to be approved

5.12 Wiltshire Care Partnership


Wiltshire Care Partnership (WCP) is a member-led organisation whose role is to represent and support independent sector registered providers of residential, nursing and domiciliary care for older people and adults with disabilities in Wiltshire. The Board, staff and members of WCP work closely with commissioners within Wiltshire Council and NHS Wiltshire Clinical Commissioning Group (CCG) to achieve the provision of high quality, safe services.

WCP provides a valuable channel of communication about safeguarding and the work of the Wiltshire Safeguarding Adults Board (WSAB), facilitating the exchange of information and ideas and the sharing of best practice amongst our members. We act as a voice for care providers and make sure that their skill and expertise are used effectively to achieve positive outcomes. WCP’s agreed absolute priority is to support and lead all service providers in driving the delivery of quality safe care.


WCP has undertaken the following work over the past year to support good safeguarding practice:

Two workshops for care providers focused on the requirements of the new CQC regulatory framework, one of which explored in detail the expectations of the Key Lines of Enquiry including the question ‘Is it safe?’

A workshop for care providers on managing local authority safeguarding investigations and related employment law issues.

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Latest information circulated to members regarding: key messages from WSAB; how to access the Safeguarding Team for advice; guidance issued by Wiltshire Council, e.g. in relation to the DoLS and Mental Capacity Act and the Thresholds Framework Guidance Tool.

Participation by our Chair in national work led by the Registered Nursing Home Association, which is aiming to develop new guidance on investigating safeguarding alerts.

Promoting ‘My Home Life’ principles and standards to members. Membership of the Project Board for the Council’s new Quality Assurance

Team.


WCP works closely with the Wiltshire and Swindon Care Skills Partnership to ensure that care providers are aware of all the current training opportunities and to encourage take up. We have also actively promoted the ‘No Secrets’ guidance.


Both WCP members and Wiltshire Council are committed to working together in 2015-16 to explore how we can all improve operational practice in relation to safeguarding investigations, and share the learning from them more effectively. To this end WCP will be surveying members in 2015 about their experiences and suggestions for improving practice, and undertaking joint work with the Council and with the Wiltshire and Swindon Care Skills Partnership to consider and respond to the findings.

5.13 Wiltshire Council


Wiltshire Council, in addition to its general safeguarding role as a public authority, has the lead role for adult safeguarding and this has been reinforced in the Care Act 2014. It fulfils these roles in a number of ways:

Through its leadership and management arrangements, in which the Corporate Director is the safeguarding lead for Adults, strategic direction on a day to day basis lying with the Associate Director for Adult Care Commissioning, Safeguarding and Housing, and the Head of Adult Safeguarding and Quality Assurance leading the delivery of all safeguarding functions including support of the WSAB. The Cabinet Member for Public Health is the lead Member for adult safeguarding and a member of the Safeguarding Adults Board.

In its planning and priority setting:

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one of the Council’s three Business Plan priorities for 2013-17 is to ‘protect those who are most vulnerable’

one of the 12 key actions for the coming four years is to continue to improve our safeguarding services to protect the most vulnerable in our communities

the Council has, to date, taken full responsibility for the funding of the WSAB’s functions

by ensuring good links between Adults’ and Children’s Safeguarding: the relevant Associate Director is a member of both the WSAB and WSCB six-monthly Partnership Chairs’ meeting that includes the Chairs of the

Children & Young Peoples Trust Board and Community Safety Partnership Associate Directors and safeguarding leads in Children’s Services and Adult

Care meet quarterly to review cross-service, family and community issues by establishing and maintaining both the central Safeguarding Adults Mental

Capacity Act Team (SAMCAT)and effective safeguarding practice in the operation teams including ensuring working practices and recording schedules are kept up to date

by participating in leadership of the WSAB through the Head of Service’s chairing of the Policies & Procedures Sub Group


The central Safeguarding Adults Mental Capacity Act Team (SAMCAT) has responded to a very significant increase in referrals over the last year and now provides two triage officers on duty at all times. The team has been able to record emerging concerns about providers and feed these into the Quality Assurance Team and commissioning teams.

The close working links between SAMCAT, the Commissioning Team and the Quality Assurance Team have been clarified in a guidance document agreed by the WSAB. This closer working has achieved an increase in targeted preventative work and identification of emerging concerns which has reduced the number of situations that have required a Large Scale Investigation.

Following participation in the second phase of the Making Safeguarding Personal initiative, updated procedures have been put in place so that all operational teams now follow an outcome focused and person centred method of working with adults at risk to ensure the response to identified risks is proportionate. There will be an increase in the use of advocates who will support adults at risk who require that support in order to participate effectively in the safeguarding process.

The Quality Assurance Team has been established and has developed its role in working with care service providers to ensure that the quality of services delivered to the people of Wiltshire does not fall below what they have the

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right to expect. The team’s preventative and supportive role is an important complement to the investigative tasks of SAMCAT and the operational teams, including following up the effective implementation of action plans following large scale investigations. The early interventions by the Quality Assurance Team have been a factor in the reduction of Large Scale investigations over the year.

The Court of Protection Team has now put in place a triage system and follow clear eligibility criteria, concentrating on working with adults who are most at risk of financial abuse including urgent responses to safeguarding issues. Alternative providers are being procured to provide support with Appointeeship and less complex deputyship situations which will free up the main team to concentrate on the most urgent and complex situations.

The Mental Capacity Act/Deprivation of Liberty Safeguards service has had to respond to substantial pressures from a very significant increase in referrals for authorisations following the Supreme Court ruling in the Cheshire West case. This has included: A programme for training additional Best Interest Assessors, with 20

newly trained BIAs now qualified in operational teams. The use of a grant from the Department of Health to respond to the

increased workload for the recruitment 3 additional staff for the team. Adapted management structure to reflect the larger workload and

expanding team Close working between the MCA/DoLS Manager, the council legal

department and the relevant Heads of Service to ensure that Wiltshire is equipped to deal with the widening of the DoLS requirements to customers who live in the community

A programme of training has been delivered to all operational teams and a clear pathway for applying for an authorisation has been put in place

An action plan has been put in place to tackle the issue, common to all areas, of the back log of assessments for authorisations for customers in care homes and on hospital wards.


Induction for all new recruits in Adult Social Care teams includes: The d uty of care, Mental Capacity/DoLS safeguarding adults

Specific training is available for staff undertaking the roles of investigating manager and investigating officer. Investigating Officers – 1 day foundation course to get up and running in

this role; 3 days in depth training to be able to fulfil whole role; 2 hour CPD/update sessions run 4 times a year for Investigating Officers.

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Investigating Managers – 1 ½ day course; 3 hour CPD/update sessions run 3 – 4 times a year for Investigating Managers + police, health and advocacy colleagues.

Safeguarding training is provided in line with WSAB strategy for development of competence and national capability framework for safeguarding adults.

All staff receive training on MCA/DOLS either via e learning or face to face training according to their level of responsibility.

The council now has a Principal Social Worker who has provided the update training on DoLS to all teams, following Cheshire West/Surrey Supreme Court judgments. In addition there are DoLS forums run bi monthly by the MCA/ DoLS Team Manager.


To implement the changes brought in by the Care Act relating to safeguarding adults, particularly person-centred outcome-focused enquiries, changed eligibility, Safeguarding Adults Reviews and delegation of enquiry.

The need to respond to ongoing pressure in the DoLS service, including work arising from authorisations granted last year coming up for renewal and the inclusion in the requirements of people who live in their own homes who are affected by the Supreme Court ruling.

The development and resourcing of an adult Multi Agency Safeguarding Hub (MASH) similar to that in place for children’s safeguarding, to streamline the safeguarding process further and enable closer working at the earliest possible stage with the police and heath colleagues.

Continue to expand the role of the Quality Assurance Team to include more audits and review work on a regular basis with all providers and the development of a database, in conjunction with the Wiltshire Care Partnership, to capture current information about all providers.

Use a local peer review process to promote continued performance improvement in partnership with other local organisations.

5.14 Wiltshire Fire and Rescue Service


The Service not only recognises, and responds to, the risk from fire, road traffic collisions and other life threatening scenarios but across a broader range of themes associated with those who may be at risk from harm. It works with various organisations to support people aged over 65 and with domestic abuse agencies for those people that are at heightened risk of suffering harm, abuse, crime or neglect.

The Service will support people by offering the following services:

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Home Fire Safety Visits to reduce the risk from fire and identify other sources of vulnerability for onward referral to partner agencies

Work with other agencies to support the victims of domestic abuse

Offer advice on arson prevention around domestic and commercial premises

Conduct fuel poverty assessments and refer to central hubs who then signpost to other agencies, this is done through the Warm & Safe Wiltshire Partnership.

In accordance with its legal responsibilities, partnership arrangements and data sharing protocols we will share information to assist action by other agencies where the safeguarding of the vulnerable person is outside the scope and capabilities of the Service


2014-15 has seen the Service review our Safeguarding policy in a bid to ensure that the most effective procedures are in place to deal with any safeguarding concerns identified by our staff.

Our Incident Reduction Managers have worked tirelessly in following up concerns around vulnerabilities of people that we have come across in our daily activities. These range from the types of conditions people are living in to domestic violence cases where specific fire safety related advice and precautions are discussed.


Up until this year we were providing a structured training session to each and every staff member across the Service. That training is due to be recommenced during the latter part of this year to ensure all staff have received the training and to re-familiarise those staff members who have yet to receive the training. In addition to this, and as a result of a change in policy, we are now looking to secure training for key members of staff in levels 2 and 3 safeguarding.


The coming year will see Wiltshire and Dorset Fire & Rescue Services combine, which will require substantial work to align all policies and procedures, including Safeguarding Adults protocols, before the combination comes into effect on 1st April 2016.

Another piece of work on the horizon is that of a more proactive and targeted approach to identify and visit the most vulnerable members of our communities. This will potentially result in an increase in the quantity of safeguarding concerns that are identified by our staff.

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Case Study – Fire Safety and Safeguarding

A referral was received from a care staff member responsible for supporting two young men with learning difficulties to maintain independence in their own home. She was concerned about fire safety because the support had decreased from 24 to 18 hours a day meaning that the men were alone in the home for approximately 6 hours each day.

They had been instructed not to do any cooking or use the microwave during these hours, but this could not be monitored and there had been occasions when they had put themselves in danger with metal spoons being left in the microwave or a pan of eggs left

5.15 Wiltshire Police


Wiltshire Police is fully dedicated to preventing, investigating and detecting abuse against Vulnerable Adults. We have a dedicated Safeguarding Adults Investigation Team SAIT, which is made up of Detective Inspector, Detective Sergeant and 6 investigators. This team:

covers the whole of Swindon and Wiltshire, and investigates any significant abuse/risk of harm by carers, family, people in position of trust or fellow service users

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Case Study – Fire Safety and Safeguarding

A referral was received from a care staff member responsible for supporting two young men with learning difficulties to maintain independence in their own home. She was concerned about fire safety because the support had decreased from 24 to 18 hours a day meaning that the men were alone in the home for approximately 6 hours each day.

They had been instructed not to do any cooking or use the microwave during these hours, but this could not be monitored and there had been occasions when they had put themselves in danger with metal spoons being left in the microwave or a pan of eggs left

Actions:

A visit was carried out and safety advice given, but this did not resolve the problems about use of the cooker and microwave and the location of the fuse box. Advice was also given about night time routines, including turning computers and TVs off at night.

Outcomes:

The landlord agreed to move the fuse box to a more accessible location in a tamper proof cupboard so that it would be easier for the staff to switch off power.

The care provider was advised to purchase lockable plug covers so that the cooker and microwave could be isolated when they weren’t present.

The Social Worker was asked to get the smoke detectors linked directly to the lifeline call centre so that immediate action could be taken to respond to any incidents without relying on the occupants to identify the problem.

has a triage team based at County Hall, who are responsible for the receipt, review and allocation of all referrals, the strategy discussions held and they are the single point of contact prior to investigation

works closely with The Local Authority and partner agencies to provide a high quality of service and safeguarding.

Should a crime be committed against a Vulnerable Adult, but does not sit within our remit, then the victim will receive the same standard of investigation but by our uniform or CID colleagues, who are appropriately trained in joint investigations and Achieving Best Evidence.

As part of our commitment to protecting Vulnerable Adults, we form part of the core of the Safeguarding Adults Boards for both Swindon and Wiltshire.


As a SAIT team we have had a number of successful prosecutions against individuals for offences against Vulnerable Adults, which have been reported in local news.

In July 2014, we formed a triage team who are based at County Hall. As stated above they are responsible for the receipt, review and allocation of all referrals. The strategy discussions held, and they are the single point of contact prior to investigation. This has allowed a more effective and streamlined approach to the initial process. Partner agencies now have a single point of contact, and deadline/timescales are being met more efficiently.

As an organisation we have embraced the Care Act 2014. Our policies have been fully scrutinised and amended where necessary. Our website has been updated, training sent out through e-briefs and internal communications. The Force training department is now providing this as part of Probationer and CID training.


Training is always ongoing within Wiltshire Police. We have a number of ways in which this is done, which have all been adopted in the past year.

SAIT staff have attended uniform officers daily briefings to give an input on SAIT, and responsibilities, and what THEIR responsibilities are as attending officers.

The Three Strands of Vulnerability poster is in every Police Station and Operational Office across the County.

Firstpoint site has been updated to reflect the Care Act 2014, SAIT contact details plus links to Care Act, Mental Health Act, Mental Capacity Act, Swindon and Wiltshire Safeguarding Adults Policy etc

Discussions held with Horizon Team regarding their responsibility with vulnerable victims of crime, Making Safeguarding Personal and Care Act 2014.

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All probationer officers and detectives are now trained in Joint Investigation and Achieving Best Evidence

Any changes to law/policy/updates etc are included in the Force’s weekly e-brief which is sent by email and also accessible through Firstpoint.

SAIT staff attend all Investigating Officer and Investigating Manager workshops. This is to ensure training/updates/cases are shared between both.

We have attended outside seminars, presentations, training where possible.


Wiltshire Police are dedicated to continuing to provide a high level of service and improving any areas of work as necessary. This is a continuous process that is directed and supported by both the Chief Constable and Police & Crime Commissioner.

5.16 Public Health - Supporting Domestic Abuse

The overarching governance for Domestic Abuse (DA) reduction is cited within the Wiltshire Community Safety Partnership. Domestic Abuse has been identified as a priority within the Community Safety Strategic Assessment linked to (the JSA).

The responsibility for delivery and implementation of the current Pan County Domestic Abuse Strategy sits with the Joint WCSP and WSCB DA reduction sub group. This sub group is chaired by the Public Health Consultant lead for DA. Additionally, this area of business overviews the safeguarding arrangements for the Wiltshire Multi-Agency Risk Assessment Conference (MARAC), supports the commissioning of specialist support services for victims of DA, as well as monitor the implementation and compliance against the actions identified from the commissioned Domestic Homicide Reviews in Wiltshire.

Wiltshire adopted MARACs in July 2007, although not on a statutory footing they are recommended by the Home Office as good practice to facilitate a multi-agency response to high risk domestic abuse. It provides a forum for sharing information and taking action that will reduce harm. The primary focus of the MARAC is to safeguard the adult victim. The MARAC will make links to other fora to safeguard children, as well as manage the behaviour of the perpetrator. MARACs are outcome focused. Attendance is by key agencies from the statutory and voluntary sector to produce co-ordinated action plans.

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In 2014-15, the Wiltshire MARAC has continued to witness an increase in the volume of referrals being received into its safeguarding arrangements to support victims and their families at greatest risk of DA in the county. There were 424 high risk referrals received during 2014-15, which is a further 13% (+56) increase on 2013-14; of which 20% were repeat victims. 575 children were recorded in the household at the time of a high risk referral to MARAC. Wiltshire has continued to record higher than the national average for Partner Agency referrals, with 40% recorded in 2014-15, this is reflective of the multi-agency rolling training programme for MARAC, risk assessment and referral pathways.

2014-15 North/West Wiltshire

East/South Wiltshire

WILTSHIRE

Referrals received 243 181 424

Repeat Victims 48 (19.7%) 36 (1938%) 83 (19.6%)

Children in household 334 241 575

Anti Social Behaviour Update

The anti-social behaviour risk assessment conference (ASBRAC) is a multi-agency meeting that reviews ASB cases in a holistic approach. ASBRAC utilises a wide range of partners including Police, Housing Providers, Schools, YOT, Victim Support, Children & Families, Adult Social Care and Mental Health to name a few. The outcomes of the conference include supporting victims through emotional and practical assistance. As well as offering to perpetrators supportive interventions, informal enforcement measures and in the most extreme of cases court based action to prevent their ASB.

April 2014-March 2015:North South Total

Cases 47 63 110Victims 87 156 243Offenders 86 218 132

MAPPA

MAPPA is a mechanism through which agencies can better discharge statutory responsibilities and protect the public in a co-ordinated manner in respect of sexual (category 1) or violent (category 2) offenders, within the community, including those due for release from prisons or discharge from the mental health act and youths. Some of the cases referred from duty to cooperate agencies such as health, adult care and children’s services would include Category 3 offenders.

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The operation of MAPPA relies on component bodies working through an agreed process with MAPPA eligible offenders, making provision as needed for particular groups, subject to regulation and review. Offenders are managed at one of 3 levels depending on the extent of agency involvement needed and the number of different agencies involved.

During the period of 1/4/14-31/3/15, the number of Level 2 MAPPA meetings held was136. There were 6 Level 3 meetings held. Some of the meetings will have related to the same individual by way of reviewing risk management plans and ensuring all actions were completed by agencies involved in the overall management of the case. The average number of cases subject to MAPPA at any one time during this period was 30.

Snapshot on 3/6/15 for MAPPA eligible cases MAPPA Category In the community In HMP Totals:

Category 1 551 149 700

Category 2 135 230 365

Category 3 6 3 9

TOTALS: 692 382 1074

PreventThe threat we face from terrorism is real, and the Prevent strategy recognises that we can’t arrest our way out of the problem. The Prevent Strategy therefore aims to stop people becoming terrorists or supporting terrorism.The focus of Prevent is on the significant threat posed by international terrorism and those in the UK who are inspired by it. But it is also concerned with reducing threats, risks and vulnerabilities posed by domestic extremists such as those from the far right and far left, extreme animal rights activists and those involved in Northern Irish related terrorism. Prevent is supported by three objectives:

Responding to the ideological challenge of terrorism and the threat we face from those who promote it (ideology).

Preventing people from being drawn into terrorism and ensure that they are given appropriate advice and support (individuals).

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Working with sectors and institutions where there are risks of radicalisation which we need to address (institutions).

Prevent is not a Police programme. It needs the involvement of local authorities and a wide range of other organisations.

Safeguarding Children and Vulnerable Adults from Radicalisation and Involvement in Terrorism

Vulnerable people, including children, young people and vulnerable adults can be exploited by people who seek to involve them in terrorism or activity in support of terrorism. There is agreement across the Wiltshire Community Safety partnership and wider partners is that this is a safeguarding issue. There is a multi-agency approach to protect people at risk from radicalisation which is called ‘Channel’. This approach uses existing collaboration between local authorities, statutory partners (such as the education and health sectors, social services, children and youth services and offender management services), the police and the local community to:

Identify individuals at risk of radicalisation or involvement in terrorism. Assess the nature and extent of that risk. Develop the most appropriate support plan for the individuals concerned.

Channel is about safeguarding children and adults from being drawn into involvement in terrorism. It is about early intervention to address vulnerabilities, and divert people from harm.

Alcohol

Alcohol problems are widespread across the UK. Whilst it is difficult to accurately record levels of alcohol consumption and drinking behaviours; it is estimated there are over 4,200 dependent drinkers (aged 18 – 75 years) in Wiltshire. Further estimates14 suggest there are over 132,000 people in Wiltshire classified as drinking at ‘increasing’ or ‘higher’ risk levels. Wiltshire also has a greater proportion of higher risk drinkers (6%) as compared to the south west average of 4.7%.

The Alcohol Strategy 2014-2018 has been published in Wiltshire and sets out an approach for tackling alcohol consumption through four themes:

Prevent adults and young people from harming themselves and others by improving knowledge about the risks of hazardous drinking. Intervene by providing better services to help people who have problems as a result of alcohol misuse, as well as their families or carers.

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Take enforcement action against those committing alcohol related crime and anti-social behaviour. Provide effective rehabilitation programmes for those within the criminal justice system.

in the period 2012-13 in Wiltshire, we know that 1,246 people were admitted to hospital for an alcohol specific condition.14 119 people in Wiltshire also died from chronic liver disease in the period 2010-12.14 Numbers of alcohol specific in-patient hospital admissions for individuals aged under 18 in Wiltshire has remained relatively static with 67 alcohol related admissions in 2011-12 (as compared to 74 in 2010-11 and 59 in 2009-10)

2012-13 Wiltshire Police data shows 2,163 alcohol related arrests were recorded in the county. A large proportion of the arrests occurred in Salisbury; with the top 3 offence types being assault, drink driving and drunk and disorderly. 27 sexual offence alcohol related arrests were shown19.

Although alcohol related domestic abuse crimes in Wiltshire have decreased from a peak in August 2010; alcohol related domestic abuse crime in Wiltshire increased by 2.7% in the 12 month period recorded (2012-13). There were 1,234 domestic abuse crimes recorded in Wiltshire between August 2012 and July 2013. These figures should be considered as a ‘proxy indicator’ for the volume of domestic abuse related crime where alcohol has been involved.

During 2012-13, 544 adults were in alcohol treatment in Wiltshire, with a further 233 adults in drug treatment who cited additional problematic alcohol use

The UK, has seen a 25% increase in liver disease between 2001 and 2009; with hospital admissions for liver disease (including alcoholic liver disease) continuing to rise. It is estimated that the annual cost of alcohol harm to the NHS in England is £3.5bn2 (2009/10 prices).

Alcohol misuse also imposes wider harms and costs on society; such as crime and disorder, social and family breakdown and sickness absence. Estimated costs3 of alcohol misuse and crime in England are £11 billion per year (2010-11 costs) with the costs of alcohol related lost productivity in the UK of £7.3 billion per year (2009-10 costs). These costs also place additional burden and demand upon public services across a wide range of sectors; including health, social care, criminal justice, public protection and environmental services.

As such, the need to address alcohol related harm has gathered significant momentum in recent years; with publication in March 2012 of HM Government’s Alcohol Strategy; which seeks to “reshape the approach to alcohol and reduce the number of people drinking to excess”.

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Addressing alcohol related harm is therefore complex and requires a long-term and structured approach. This refreshed and updated alcohol strategy for Wiltshire is informed and directed by national and local policy drivers, alongside statutory and regulatory frameworks.

5.17 National Probation Service - Wilts and Glos Local Delivery Unit


The National Probation Service (NPS) is committed to reducing re-offending, preventing victims and protecting the public. The NPS engages in partnership working to safeguard adults with the aim of preventing abuse and harm to adults and preventing victims. The NPS acts to safeguard adults by engaging in several forms of partnership working including:

Operational: Making a referral to the local authority where NPS staff have concerns that an adult is experiencing or is at risk of experiencing abuse or neglect, including financial abuse, and is unable to protect oneself from that abuse or neglect

Strategic: Attending and engaging in local Safeguarding Adults Boards (SABs) and relevant sub-groups of the SAB. Through attendance, take advantage of training opportunities and share lessons learnt from Safeguarding Adult Reviews and other serious case reviews.

What have been your key achievements in 2014-15?

Prior to the formation of the NPS, the legacy Probation Trusts each had individual policies and strategies in place in relation to partnership working for safeguarding adults. This means that there has been variety in the way that each NPS Local Delivery Unit (LDU) attends and participates in local SABs. Probation has been undergoing a major transformation programme. In Wiltshire LDU the changes have been significant and required much hard work to implement re-organisation whilst striving to maintain business as usual in terms of effective partnership working. A National Partnership Framework has been produced and this will helpfully shape our involvement locally in Wiltshire.


From a national perspective, the NPS is currently developing national training resources for all staff in relation to Safeguarding Adults.

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From a local perspective, where an LDU of an NPS Division is a member of a local SAB, the SAB will be a resource for additional training provision in relation to adult safeguarding.

What are the challenges that inform your priorities for the year 2015-16

The National Probation Service is committed to the following actions and leaders in the Wiltshire and Gloucestershire LDU will be reporting back on them as of our work with Wiltshire SAB evolves: Cooperation with the local authority, in the exercise of their functions relevant to

care and support including those to protect adults. An appropriate grade manager should be involved in board business. If asked to be involved in a Safeguarding Adults Review, the LDU must participate

as directed, including the dissemination of findings throughout the organisation. As a member of a local SAB, to ensure that all staff in the LDU and Division who

attend the SAB have the relevant pre-requisite skills and knowledge. As a member of a local SAB, all staff should be aware of the requirements of the

local Information Sharing Protocol and know their responsibilities under this.

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6. Priorities for 2015-16







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Appendix 1

TERMS OF REFERENCE

Statement of PurposeThe Wiltshire Safeguarding Adults Board (WSAB) is a statutory body established by the Care Act 20142. Its main objective is to protect all adults in its area who have needs for care and support and who are experiencing, or at risk of, abuse or neglect against which they are unable to protect themselves because of their needs. The WSAB aims to fulfil its purpose by:

Co-ordinating the work of its member agencies to determine shared policy, facilitate joint training, raise public awareness and monitor and review the quality of services relating to safeguarding adults in Wiltshire

ensuring that all agencies work together to minimise the risk of abuse to adults at risk of harm and to protect and empower those people effectively when abuse has occurred or may have occurred

PrinciplesThe Board will achieve its role by implementing the principles of adult safeguarding3, which are shown below along with the impact their implementation should have for adults the Board seeks to protect.

2 Care Act 2014, Part 1, Sections 42 and 433 Care and Support Statutory Guidance, DH 2014

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Empowerment – People being supported and encouraged to make their own decisions and giving informed consent.“I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”Prevention – It is better to take action before harm occurs“I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”Proportionality – The least intrusive response appropriate to the risk presented.“I am sure that the professionals will work in my interest, as I see then and then will only get involved as much as needed.”Protection – Support and representation for those in greatest need.“I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent that I want”.Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.“I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.”Accountability – Accountability and transparency in delivering safeguarding.“I understand the role of everyone involved in my life and so do they.”

The work of the Board is also underpinned by other general sets of principles which will be applied in all its work:

Nolan ‘seven principles of public life’ Caldicott Principles Data Protection Act 1998 Equality Act 2010 Human Rights Act 1998

The WSAB supports the rights of all adults to equality of opportunity, to retain their independence, wellbeing and choice and to be able to live their lives free from abuse, neglect and discrimination. It values diversity and will seek to promote equal access and equal opportunities irrespective of race, culture, sex, sexual orientation, disability, age, religion or belief, marriage/ civil partnership and pregnancy /maternity.

TasksThe WSAB will:

Publish a strategic plan each financial year that sets out how it will meet its main objective and what its members will do to achieve this. The plan will be developed with local community involvement and in consultation with Healthwatch Wiltshire

Publish an annual report detailing what the WSAB has done during the year, both collectively and through its members, to implement its strategic plan. The report will also detail the findings of any Safeguarding Adults Review completed during the year and any subsequent action. The report will be presented to the Cabinet of the Council, its equivalent in each member agency of the Board and Health and Wellbeing Board.

Conduct any Safeguarding Adults Review as required by Section 44 of the Care Act 20144

Lead and promote the responsibility for safeguarding across all agencies and stakeholders, and ensure clear leadership and accountability are in place throughout all the organisations represented on the WSAB,

ensure the multi-agency safeguarding policy is based on current national policy, national and regional guidance and reflects developing best practice

develop and update operational multi-agency procedures and protocols, including information sharing, to protect people at risk of harm

Establish quality assurance arrangements:o to collect and analyse relevant data to increase the WSAB’s understanding of the

prevalence of abuse and neglect in its areao to monitor implementation of the policy and the quality of safeguarding services

across Wiltshireo identify and address resource shortfalls where these ariseo use self-assessment, audit and peer review as appropriate

develop preventative strategies that aim to reduce instances of abuse and neglect in Wiltshire

Involve service users and carers and adopt an inclusive approach to the work of the WSAB

Ensure a multi agency training strategy is in place for all workers in all sectors who have contact with adults at risk and receiving regular reports on its delivery and effectiveness

4 See Appendix x for details of Section 4452

Promote awareness of Safeguarding issues and disseminate accessible information about the work of the WSAB via a comprehensive communications strategy aimed at ensuring that abuse is recognised, reported and immediate action taken wherever it arises.

Ensuring effective engagement of safeguarding adults work with the safeguarding of children, domestic violence, bullying hate crime, MAPPA processes and wider work on community safety and public protection including the Prevent programme.

Membership The Care Act 2014 provides for three core members of the board - the local authority, the police and the clinical commissioning group – and for the local SAB to agree which organisations should also be members of the Board.

The membership of the WSAB consists of senior representatives from key organisations in Wiltshire, with authority and responsibility for Safeguarding Adults from the partner agencies as shown below. The representative (and their deputy) must be able to:

Make decisions on behalf of their organisation Hold their organisation to account Commit their organisation on policy and practice developments Commit resources in their organisation to support the work of the WSAB

Representatives of wider groups such as independent providers, service users and carers must have access to appropriate networks to communicate information to and from the Board.

Wiltshire Council Cabinet Member Associate Director, Adult Care Commissioning,

Safeguarding & Housing Head of Service, Safeguarding and Quality

AssuranceCCG Wiltshire Associate Director of Quality, Safeguarding Children

& AdultsNHS England Patient Experience Manager

Avon and Wiltshire Mental Health Partnership NHS Trust

Clinical Director, Wiltshire

Salisbury Hospital NHS Foundation Trust Deputy Director of Nursing

Royal United Hospitals Bath Deputy Director of Nursing, Quality & Patient Safety

Great Western Hospital Foundation NHS Trust

Head of Locality (Sarum)

NHS Community Services Via GWH Representative

Wiltshire Police Head of Public Protection Department

Residential and nursing care provider representative

As nominated by Wiltshire Care Partnership

South West Ambulance Service NHS Foundation Trust

Safeguarding Manager

Wiltshire Fire & Rescue Service Station Commander

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National Probation Service Assistant Chief Officer

Working Links (Probation Community Rehabilitation Company)

Assistant Chief Officer

Healthwatch Wiltshire Chief Executive

Care Quality Commission (CQC) Compliance Manager - Annual attendance

Domiciliary Care provider representative As nominated by Wiltshire Care Partnership

Learning Disability provider representative

As nominated by Wiltshire Care Partnership

Carer Representation As nominated by the Carers’ Reference Group

Service User Representation Through the Service Users’ Reference Group

Community Safety Partnership Consultant, Public Health and Public Protection

The Compliance Manager from the Care Quality Commission attends annually and the Wiltshire Council Corporate Director is an associate member, receiving all papers and attending as appropriate.

The Board has reciprocal representation arrangements with the Safeguarding Children’s Board.

Other organisational representatives or specialist leads may be invited for reports of specific interest to them.

ChairThe Chair of the Board is an independent person appointed for a three year term through procurement by Wiltshire Council.

The Deputy Chair is appointed by the Board from nominations from Board members.

Structure, Accountability and NetworksThe WSAB will meet not less than four times a year, with additional meetings as necessary. It will set time aside each year for a half day workshop to review its achievements, assess performance and effectiveness and consider future priorities.

The quorum for meetings will be one third of the usual membership providing the Council, one of the other core members5 and one other partner organisation is represented.

Lack of attendance will hinder the strategic development of the inter-agency arrangements for safeguarding adults. For this reason Board members are expected to attend two out of the four main meetings; substitutions are permissible, but should be by named, regular substitutes. A register of attendance is kept and will form part of the Annual Report.

Sub-groupsThe Board has three standing sub-groups which are responsible to the Board and take forward the Business Plan priorities:

5 Core members prescribed by the Care Act 2014 are the Council, the CCG and the Police54

Policy and Procedures (joint with Swindon SAB)

Learning and Development

Quality Assurance

Task GroupsThe Board may establish task and finish groups for specific, time-limited work.

AccountabilityThe WSAB has a reporting line to the Wiltshire Health and Wellbeing Board. It is accountable for its work to its constituent organisations and its members are individually accountable both to their own organisations and to the WSAB for the following roles and responsibilities:

Contributing to the effectiveness of the WSAB in the achievement of its main objective and the delivery of the tasks listed in section 3

Disseminating information to their own organisation and related agencies Participation in development, training and learning activities Contributing to the Annual Report as agreed by the WSAB, including a statement of their

contribution to the Strategic Plan. Making appropriate resources available to the Board and its sub-groups and task groups.

NetworksThe Board will maintain links with other multi agency bodies as follows:

People and Communities Board (Health and Wellbeing Board and Community Safety Partnership functions included)

Community Safety Partnership Children’s Safeguarding Board CCG Board Quality Surveillance Group Overview and Scrutiny Committee

Complaints ProcedureComplaints about Safeguarding Adults work should be addressed as follows:

1. Complaints about safeguarding case investigations should be addressed to the Associate Director for Adult Care Commissioning & Housing, Wiltshire Council who will respond through the Council’s complaints procedure.

2. Complaints about the decisions or actions of the WSAB should be addressed to the Chair (via the WSAB Business Support Officer at Wiltshire Council) who will work with the Council’s complaints section to ensure a response is made through the Council’s complaints procedure.

3. Complaints about the actions and decisions of individual WSAB members and their nominating organisations should be addressed to the relevant organisation which will respond through their own complaints procedure.

4. Complaints about the actions and decisions of the Independent Chair should be addressed to the Corporate Director at Wiltshire Council.

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ReviewThese Terms of Reference will be reviewed at the same time as the Board’s Safeguarding Policy and Procedures.

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Appendix 2 - Board Membership and Attendance 2014-15

Organization Designated Member June2014

Sept2014

Sept 2014Dev Day

Dec2014

Mar2015

Independent Chair Margaret Sheather Wiltshire Council DCS

James Cawley

Wiltshire Council Safer Communities

Naji Darwish (to Dec 2014)Tracy Daszkiewicz (from March 2015)

A A A

Wiltshire Council Commissioning

Phil Shire (to Sept 2014)Heather Alleyne (from Dec 2014)

Wiltshire Council Cabinet Member

Cllr Keith Humphries Ap-R Ap-R A

Wiltshire Care Partnership Matthew Airey Ap-R

Wiltshire PoliceSupt Caroline Evely D/Supt Craig Holden (from Dec 2014)

Ap-R

CCG Wiltshire

Karen Littlewood Teresa Blay (from Sept 2014)Karen Littlewood (from March 2015)

NHS England Kevin Elliott A A Ap-R A

Great Western Ambulance Service

Sarah Thompson A

Great Western Hospital Robert Nicholls Maddy Ferrari (from Sept 2014) Ap-R

RUH Bath Mary Lewis A Ap-R

Salisbury NHS Foundation Trust

Fiona Hyett A A A A

AWPJulie Hankin (to June 2014)Dr Liz Hardwick Dec 2014Dr Toby Sutcliffe (From March 2015)

AP-R

National Probation Service Mark Scully n/a A A A A

Community Rehabilitation Company (Wiltshire)

Liz Hickey A A A

Wiltshire Fire & Rescue Service

Damien Bence A A A A A

Healthwatch Wiltshire(joined Sept 2014)

Emma Cooper n/a

Domiciliary Care Providers Assn (from Sept 2014)

Darren Fowler n/a

CQC (annual only) Justine Button A A

Carers in Wiltshire Reference Group(from March 2015)

Kate GrantCraig Greaves-Lord n/a n/a n/a n/a

A – Apologies AP-R – Apologies but sent replacement

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Appendix 3 - Performance Report

Place of alleged abuse

Most alleged abuse took place in the vulnerable adult's own home; 46% in 2013/14 rising to 50% the following year. Cases proceeding beyond the Alert stage are dominated by those where the alleged abuse took place in the vulnerable adult’s own home, 47% in 2014/15 and 42% the previous year.

Type of abuse by setting

There was an increase in abuse that occurred in the homes of adults at risk, this was due to a heightened awareness of when to raise and alert by these providers and also as the result of a large scale investigation involving a domiciliary provider who was part of the Help to live at Home provision.

Relationship of the alleged perpetrator to the vulnerable adult

During 2014/15 calendar year, in 27% of cases investigated the alleged perpetrator (AP) was a relative, friend or neighbour. As a ratio this was a decrease in the previous year’s rate (32%), although the numbers increased in 2014/15 to 221 cases (out of 820 concluded investigations) from 197 out of 613 in the previous year.

Domiciliary care and self-directed support staff however, comprised 18% (111) of APs in 2013 and 26% (212) the following year. The proportion of Care home staff having accusations brought against them rose during this reporting period to 192 (23% of all concluded cases) from 164 (27%) previously.

Location of the alleged abuse

Care homes and the vulnerable adults’ own home dominate where abuse is alleged to have taken place, with own home averaging 47% across the 2 years and care homes averaging 37%. All other locations are similar in their proportions over the 2 year period.

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Hospital AP's Home Day Centre/Service

Edu/Trg/Work Estb

Care Home Own Home Public Place

28 394 0

232273

3742 30 18 1

289

402

38

Location of alleged abuse 2013/20142014/2015

Type of abuse

It is interesting to note the numbers of types of abuse and broadly similar ratios across the 2 time periods as shown below. Financial abuse has dropped as a percentage of types of abuse; perhaps an indicator of the improved national economy. The percentage of neglect has increased by half over the previous year. Institutional abuse has almost tripled due to issues experienced by Helped to Live at Home agencies:

Financial; 125; 12%

Institutional; 56; 5%

Neglect; 410; 38%

Physical; 245; 23%

Emotional / Psychological; 202; 19% Sexual; 41; 4%

2014/2015

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LARGE SCALE INVESTIGATIONS

Wiltshire Council is, naturally, aware of the number of customers for whom it commissions services but Help to Live at Home agencies (also known as Domiciliary Care agencies) also assist people who are self-funding, funded by the local CCGs or other local authorities bordering Wiltshire. It is therefore not possible to know how many customers these agencies have on their books as this is commercially sensitive. Additionally, as they have many customers, the numbers vary day-by-day.

During 2014/2015 SAMCAT instigated 8 Large Scale Investigations (abbreviated to LSI). Five of these Investigations involved 127 residents. This can be said with confidence as the number of beds in care homes is known and so these are in addition to the 3,201 individual case alerts above. The type of alleged abuse tends to be more a case of a lack of training or procedures that are either lacking or need updating:

Financial/Material; 5; 3%

Neglect/Omission ; 30; 19%

Institutional; 122; 78%

Large scale/whole home investigations

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Appendix 4 - Strategic Plan 2015-17

Wiltshire Safeguarding Adults Board

Strategic Plan 2015-17

61

Wiltshire Safeguarding Adults BoardThe Wiltshire Safeguarding Adults Board (WSAB) is a statutory body established by the Care Act 2014. Its main objective is to protect all adults in its area who have needs for care and support and who are experiencing, or at risk of, abuse or neglect against which they are unable to protect themselves because of their needs. The WSAB aims to fulfil its purpose by:

Co-ordinating the work of its member agencies to determine shared policy, facilitate joint training, raise public awareness and monitor and review the quality of services relating to safeguarding adults in Wiltshire

ensuring that all agencies work together to minimise the risk of abuse to adults at risk of harm and to protect and empower those people effectively when abuse has occurred or may have occurred

The Strategic Plan The WSAB is required to publish a strategic plan each financial year that sets out how it will meet the main objective described above and what its members will do to achieve this. Our plan is focussed on 5 main outcomes that we think will enable us to meet that objective and they are shown below.

Outcome 1 Prevention & Early Intervention: a pro-active approach reduces risks and promotes safe services whilst ensuring independence, choice and control.

Outcome 2 Responsibility & Accountability: There is a multi-agency approach for people who need safeguarding support

Outcome 3 Access & Involvement: People are aware of what to do if they suspect or experience abuse; Local practice and the commissioning of services and support are informed by feedback and satisfaction levels of those who have had experience of the safeguarding process

Outcome 4 Responding to Abuse & Neglect: People in need of safeguarding support feel safer and further harm is prevented

Outcome 5 Training & Professional Development: Staff are aware of policies & procedures, their practice safeguards adults and promotes understanding of harm

Our Objectives62

Each main outcome is supported by several objectives and linked actions. The objectives may be:

Responses to new developments, whether in legislation, policy or local circumstances

Focused on maintaining and improving our existing work

All of the actions should contribute to the Board’s overall effectiveness in its main statutory task and many will also contribute to our priorities for this year which are:







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Outcome 1. Prevention & Early Intervention: a pro-active approach reduces risks and promotes safe services whilst ensuring independence, choice and control.

Key Objective Actions required to address / meet the objective By When Lead Responsibility

1.1 Develop preventative strategies that aim to reduce instances of abuse and neglect in Wiltshire:

have an overview of how prevention is taking place

how this work ties in with the HWB, QSG, CSP and CQC’s stated approach and practice

Establish a task and finish group to review current relevant prevention activities and develop proposals for the Board’s role in preventative strategies.

Scoping report to Board from task group

Final report including proposals for monitoring impact

March ’15

September ’15

March ’16

Heather Alleyne

Outcome Activities are in place to reduce instances of abuse and neglect

1.2 Safeguarding is integrated into all contractual processes with clear expectations and reporting requirements to prevent harm, neglect and abuse

Monitor this through the follow up on the self-assessment audit. Autumn ’15 QA Sub-group/ Head of Service

Outcome Assurance that commissioning arrangements are effectively promoting safe, good quality care and identifying risk.

1.3 Performance Management systems are effective and include indication of the potential for vulnerability and

Consolidate the Board’s performance and Quality Assurance framework as a whole, and in relation to prevention: i) Confirm how learning events (our own and other SABs’) are applied

more systematically and inform Board discussions; avoiding

Quarterly reports

By December ’15

WSAB/QA Sub-group

Report from QA sub-group

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intervention duplication but ensure shared knowledge

ii) Establish whether/ how people who may be at risk of harm can be identified and appropriate intervention offered. Integrate this work with the action in 1.1 above.

As 1.1

Outcome The Board’s QA and Performance discussions address prevention as well as responses to harm

1.4 Policies and procedures are in place to prevent unsuitable people from working with adults at risk

Monitor this through the self-assessment audit and follow up. Autumn annually. QA sub-group

Outcome Risks are reduced by strong recruitment practice

1.5 Steps are taken to prevent or reduce risk of abuse within service settings

i) Distribute new awareness raising materials to all service settings and follow up their use of them (See also 2.4.i)

ii) Promote relevant training available to staff within service settings and any new guidance available through SCIE

iii) Monitor this through the self-assessment audit and follow up

WSAB

L & D Sub-group

QA sub-group

Outcome Organisations’ ability to prevent or reduce risk is improved.

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Outcome 2. Responsibility & Accountability: There is a multi-agency approach for people who need safeguarding support


2.1 There is a multi-agency Safeguarding Adults Board (SAB) of senior level officers who provide strategic leadership and address- prevention of abuse and

neglect - promotion of wellbeing

and safety - effective response to

instances of abuse & neglect when they occur

i) Confirm membership of the Safeguarding Adults Board and its Sub-Groups in line with the requirements of the Care Act.

ii) Consider the use of the Memorandum of Understanding to strengthen partners’ shared accountability

iii) Annual report on attendance at the SAB by its members

iv) Confirm role, responsibility, authority and accountability for each agency is clear across all Board documents including review of sub-group Terms of Reference; address transitions; maintain clarity about decision-making. Preparatory work Board confirmation

v) Finalise arrangements for shared resourcing of the SAB, including a shared budget

April ’15

April ’15

September ’15

Mar – June ’15June ’15

WSAB

WSAB

Chair

MSWSAB

Outcome Safeguarding Board is fit for purpose and effective, meeting statutory requirements and sharing responsibilities for its range of work

2.2 There are robust and current Local Multi-Agency Policies & Procedures for safeguarding adults that are in accordance with statutory requirements

i) Update the joint Wiltshire and Swindon Safeguarding Policy and Procedures to ensure they are compliant with the Care Act 2014. Signed off by WSAB

ii) Receive proposals for establishing a Multi-agency Safeguarding Hub (MASH) for adults

March ’15

Sept ’15

WSAB

WSAB

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iii) Consider how Care Act expectations about self-neglect will be addressed

iv) Review thresholds framework guidance tool to strengthen early stage procedure for both triage and providers

v) Promote any new guidance and/or training for providers on responding to potential safeguarding incidents, including addressing employment issues

vi) Review implementation and effectiveness of new policy and

procedures

Sept ’15

TBC

March ’16

HA/JC

P & P sub-group

WSAB/WCP

WSAB based on report from P & P sub-group

Outcome Policy and procedures are compliant with the Care Act and Statutory Guidance and provide an accurate and effective tool for all who need to use them

2.3 Clear leadership and accountability structures are in place and visible throughout the relevant organisations

i) Relationships between WSAB, WSCB and HWB clarified

ii) Present WSAB annual report to Health and Wellbeing Board and Wiltshire Council Cabinet

iii) Annual Report presented to partner Boards

iv) Include partner organisation’s safeguarding adults accountability arrangements in self-assessment audit

April ’15

Autumn

December ’15

September-November ’16

Partnership Chairs’ meeting

Chair

Board members

All

Outcome Organisational accountability across the partnership is clear and reporting lines effective

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2.4 Professionals who in the course of their work come into contact with adults at risk and their carers are aware of their safeguarding responsibilities

i) Distribute new awareness raising materials to all relevant organisations and follow up their use of them.

ii) Promote the National Capabilities Framework, training available and the Board’s strategy for training and competence development

iii) Alert organisations to national information resources e.g. Social Care Institute for Excellence (SCIE)

When available.

By end of 2015

WSAB

L & D sub-group

Outcome Wider awareness of safeguarding adults across a wide range of employees

2.5 Strategic Plan Develop the WSAB strategic plan for 2016/17in consultation with Healthwatch Wiltshire including putting in place a plan to involve the community and including links with other relevant strategies.

i) Develop proposals

ii) Agreed by WSAB

June – Sept

Sept 2015

Task Group/ sub-groupWSAB

Outcome Strategic Plan firmly based in consultation and widely disseminated

2.6 Effective links with other networks

Review current links and discuss how to ensure they are effective and mutual

Implement agreed actions

June 2015

TBC

WSAB

Outcome Safeguarding activity is well-co-ordinated across the network and strong communications in place

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Outcome 3. Access & Involvement: People are aware of what to do if they suspect or experience abuse; Local practice and the commissioning of services and support are informed by feedback and satisfaction levels of those who have had experience of the safeguarding process


3.1 There is a comprehensive accessible public information and advice about keeping safe and what constitutes abuse of adults at risk

Implement Communications Strategy as agreed in September 2014i) Develop website content

ii) Confirm media protocol

iii) Develop and maintain good quality public information

Sept ’15 June ’15

Dec ’15

Chair/ CM/ Comms

WSAB

Chair/CM/ CommsOutcome Improved awareness for communities and adults at risk about safeguarding services and issues.

3.2 The involvement and feedback from patients, people using services and their carers is an integral part of the design, commissioning and delivery of safe services

i) Maintain and develop the service user reference group and carer reference group so that they can contribute effectively to these activities.

ii) Review service user and carer outcomes and involvement across the Board membership.

Ongoing

December ’15

Chair / CM

WSAB Agenda

Outcome Two-way communication well-established between the Board and services users and carers.3.3 The subject of the alleged abuse is the main focus of all actions and proceedings that arise during the course of any enquiries and/or investigations.

Implement next stage of the Making Safeguarding Personal project and the changed approach to making enquiries about safeguarding concerns set out in the Care Act Statutory Guidance.

Receive a report on the audit of safeguarding cases to demonstrate that MSP is being applied in all safeguarding investigations.

Review training requirements resulting from Making Safeguarding Personal (and duty of candour)

In place WSAB

Head of Service / QA Sub-group

L & D sub-group

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Outcome 3. Access & Involvement: People are aware of what to do if they suspect or experience abuse; Local practice and the commissioning of services and support are informed by feedback and satisfaction levels of those who have had experience of the safeguarding process


3.4 Reports of service user involvement and outcomes are a routine part of the Board’s Quality Assurance arrangements

i) Through this and other means ensure that service user outcomes are routinely identified, monitored and reported, including service user or carer stories directly communicated with the consent of the person concerned and whatever level of involvement they wish.

ii) Make case studies available from the perspective of people who have experience of the safeguarding process in order to support training, learning and development

6 monthly

By end of 2015

Chair/ Reference Groups

Learning and development sub-group

Outcome Safeguarding services are identifying and responding to service user wishes, and the WSAB can monitor this.

Outcome 4. Responding to Abuse & Neglect: People in need of safeguarding support feel safer and further harm is prevented


4.1 Prompt action is taken involving the person at risk throughout, in line with the principles and requirements of the Care Act 2014.

Discussion at Development Session to establish ways in which the impact of the changed approach of the Care Act can be monitored and evaluated so that the WSAB can receive appropriate QA reports on this key development.

September ’15 Chair

Outcome Successes and problems in quality of safeguarding response are identified and acted on.

70



4.2 If the mental capacity to make a specific decision relating to the safeguarding process cannot be assumed a Mental Capacity Assessment is undertaken as required by the Mental Capacity Act (MCA) 2005

i) Receive regular reports on MCA/ DoLS activity including: briefing on national policy and case law the continuing impact of the Supreme Court judgement how capacity assessments are used to support people’s

involvement in safeguarding enquiries

ii) Carry out planned audit of MCA assessments in the context of safeguarding. Agree timing and report of audit

Quarterly

TBC

Julie Blick/HA

Outcome Service users are supported effectively to give their views when involved in safeguarding processes

4.4 Adult Safeguarding Investigations are appropriately resourced and supported

i) Monitor the engagement and compliance of all partner agencies with the agreed safeguarding processes – method to be agreed.

ii) Respond to service user proposal that further follow up is needed after safeguarding investigation and action

September Development Session

Chair

Outcome Resource problems identified promptly and addressed appropriately.

4.5 Learn from Safeguarding Adults Review (SAR) findings and other relevant reviews

i) Monitor delivery of the Action Plan from the 2014 SCR

ii) Continue to monitor local actions in response to the SCR of Winterbourne View Hospital

iii) Receive reports on relevant reviews: see 1.3 (a) above

Quarterly reportsSix monthly

As agreed

HA/ WSAB

QA sub-group

71



Outcome Agreed plans are completed in service user interests and further learning implemented promptly

Outcome 5. Training & Professional Development: Staff are aware of policies & procedures, their practice safeguards adults and promotes understanding of harm


5.1 All staff and volunteers working with adults at risk have been appropriately trained according to their role

i) Prepare a ‘prospectus’ of training available in Wiltshire ii) Promote information about the National Capabilities Framework and

‘minimum standards’ for training

iii) Report on training available and uptake for the WSAB annual report

iv) Keep WSAB’s own training needs under review

v) Identify training requirements resulting from the Care Act and Making Safeguarding Personal

vi) Ensure safeguarding is a part of the induction for elected members

L & D Sub-group

L & D Sub-group

L & D Sub-group

L & D Sub-group

L & D Sub-group

Chair/ JC

Outcome All staff and volunteers can respond appropriately to adults at risk5.2. All staff and volunteers have the appropriate knowledge and competencies in relation to safeguarding adults

Refresh the WSAB’s Strategy for Competence Development:

a) Safeguarding adults training is competency based, in line with the National Capability Framework for Safeguarding Adults (2012)

Ongoing L & D sub-group

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Outcome 5. Training & Professional Development: Staff are aware of policies & procedures, their practice safeguards adults and promotes understanding of harm


b) Safeguarding adults training links to professional development and appraisal systems.

c) Safeguarding adults training is informed by local and national lessons learned

Ongoing

Ongoing

L & D sub-group

L & D sub-group

Outcome Training is kept current and linked to awareness raising about safeguarding adults and the Care Act

5.3 Staff know how to make people aware of their vulnerability to safeguarding risks (prevention) and understand how to signpost them to effective support

Learning and development subgroup to consider and recommend actions to the WSAB

By end of 2015 L & D sub-group

July 2015

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Appendix 5 - Glossary of Terms and Definitions

ADASS Association of Directors of Adult Social Services

APC Adult Protection Conference

APR Adult Protection Review

ASBRAC Anti Social Behaviour Risk Assessment Conference

AWP Avon Wiltshire Partnership

BIA Best Interest Assessor

CCG Clinical Commissioning Group

CQC Care Quality Commission

DBS Disclosure & Barring Service (formerly CRB)

DoLS Deprivation of Liberty Safeguards

DVPN Domestic Violence Protection Notice

DVPO Domestic Violence Protection Order

ESM Early Strategy Meeting

IMCA Independent Mental Capacity Advocate

IMR Investigating Managers Report

LSAB Local Safeguarding Adults Board

MAPPA Multi Agency Public Protection Arrangements

MARAC Multi Agency Risk Assessment Conference

MASH Multi-Agency Safeguarding Hub

MSP Making Safeguarding Personal

SAB Safeguarding Adults Board

SAIT Safeguarding Adults Investigating Team

SAMCAT Safeguarding Adults & Mental Capacity Act Team

SCR Serious Case Review

WSUN Wiltshire & Swindon Users Network

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