Leeds City Council Adults Safeguarding City... · Caroline Baria, Service Director, Adult Social...

Leeds City Council Adults Safeguarding Peer Challenge Report December 2014

Final

1

Table of contents

Executive Summary .................................................. 2

Report ...................................................................... 3

Leadership, Strategy and Working Together ............ 5

Outcomes ................................................................. 9

People’s experience of safeguarding ...................... 11

Commissioning ....................................................... 14

Effective Practice and Service Delivery .................. 17

Performance and Resource Management .............. 21

Case File Audit ................. ……………………………24

Your scope questions and our response ................ 26

Key Messages ........................................................ 27

Appendix 1 – Standards for Adult Safeguarding – Revised December 2014

Leeds City Council Adult Safeguarding Peer Challenge Report 2

Executive Summary

Leeds City Council requested that the Local Government Association undertake an Adult Safeguarding Peer Challenge at the Council and with partners. The work was commissioned by outgoing DASS Sandie Keane and was taken up by Interim DASS Dennis Holmes who was the client for this work. He was seeking an external view on the effectiveness of Leeds safeguarding adults arrangements which included adult safeguarding practice. The Council intends to use the findings of this peer challenge as a marker on its improvement journey. The specific scope of the work was:

How effective are Leeds safeguarding adults arrangements. 1. How effective are the Safeguarding Adults Board and related partnership arrangements? 2. How effective is our joint work at an operational level, both between organisations and within organisations? 3. Are we ready for the Care Act? 4. How well are we delivering Personalisation? 5. Do we focus on what adults at risk want as outcomes? How well do we seek feedback from users, carers and communities on people’s experience of safeguarding? 6. Are there any areas of practice where we need to improve?

After due consideration of the documents and information read the people seen and spoke with and the places visited the peer challenge team assessed that there are many positive things to the adult safeguarding work at Leeds City Council. All the staff that the peer challenge team met across all organisations were clearly committed to adult safeguarding and passionate about its importance. This is a real strength. The City has very positive preventative arrangements to reduce demand in communities which is embedded across the work of the authority. There is evidence of a good standard of social work practice with clients involved in safeguarding decisions and strong advocacy services.

The team also communicated some key messages to the Safeguarding Adults Board (SAB) which were that the drive and commitment of staff across all agencies is clear and that the SAB needs to define its governance and function, develop clear priorities and take on board the concerns of all partners whilst also reviewing the role of the Partnership Support Unit (PSU). It should implement recommendations, debate and agree the quality of care and safeguarding thresholds whilst also seeking ways to change the safeguarding processes so they promote innovation whilst developing the quality of the partnership relationships. Lastly the SAB was urged to continue on its improvement journey and accelerate progress and resolve key issues quickly.

The report includes detailed comment across the headings of the Standards for Adult Safeguarding as well as specific answers to the scoping questions posed to help Leeds City Council, the SAB and partners to continue to develop and improve.


Report Background

1. Leeds City Council requested that the Local Government Association undertake an Adult Safeguarding Peer Challenge at the Council and with partners. The work was commissioned by outgoing DASS Sandie Keane and taken up by Interim DASS Dennis Holmes who was the client for this work. He was seeking an external view on the quality, processes and procedures of Adult Safeguarding which in part included adult safeguarding practice. The Council intends to use the findings of this peer challenge as a marker on its improvement journey. The specific scope of the work was:

How effective are Leeds safeguarding adults arrangements 1. How effective are the Safeguarding Adults Board and related partnership arrangements? 2. How effective is our joint work at an operational level, both between organisations and within organisations? 3. Are we ready for the Care Act? 4. How well are we delivering Personalisation? 5. Do we focus on what adults at risk want as outcomes? How well do we seek feedback from users, carers and communities on people’s experience of safeguarding? 6. Are there any areas of practice where we need to improve?

2. A peer challenge is designed to help an authority and its partners assess current achievements, areas for development and capacity to change. The peer challenge is not an inspection. Instead it offers a supportive approach, undertaken by friends – albeit ‘critical friends’. It aims to help an organisation identify its current strengths, as much as what it needs to improve. But it should also provide it with a basis for further improvement.

3. The benchmark for this peer challenge was the revised and updated version of the Standards for Adult Safeguarding (Appendix 1). These were used as headings in the feedback with an addition of the scoping questions outlined above. The headline themes were therefore:

Outcomes for, and the experiences of, people who use services

Leadership, Strategy and Working Together

Commissioning, Service Delivery and Effective Practice

Performance and Resource Management

4. The members of the peer challenge team were:

Mick Connell, Director of Adults and Communities, Leicestershire County Council

Angie Bean (Labour), Cabinet Member for Adult Social Care, London Borough of Waltham Forest

Verena Cooper, Adult Safeguarding Lead Nurse, Dorset Clinical Commissioning Group


Caroline Baria, Service Director, Adult Social Care and Health, Nottinghamshire County Council

Rachael Roberts, Service Manager, Mental Health, Substance Misuse, Safeguarding, Portsmouth City Council

Detective Sergeant Tessa Adams, Thames Valley Police

Clare Forman, Principal Adviser Adults Safeguarding, Local Government Association

Marcus Coulson/Judith Hurcombe, Local Government Association.

5. The team was on-site from 24th – 28th November 2014. The programme for the on-site phase included activities designed to enable members of the team to meet and talk to a range of internal and external stakeholders. These activities included:

interviews and discussions with councillors, officers and partners

focus groups with managers, practitioners, frontline staff and people using services / carers

reading documents provided by the Council, including a self-assessment of progress, strengths and areas for improvement

A comprehensive review of a select number of case files

6. The peer challenge team would like to thank staff, people using services, carers, partners, commissioned providers and councillors for their open and constructive responses during the challenge process. The team was made welcome and would in particular like to thank Dennis Holmes the Interim Director of Adult Social Services and Hilary Paxton, Head of Safeguarding Adults for their invaluable assistance in planning and undertaking this review.

7. Our feedback to the Council on the last day of the challenge gave an overview of the key messages. This report builds on the initial findings and gives a detailed account of the challenge.

8. ‘No Secrets’ (DoH 2000) provides the statutory framework and guidance for adult safeguarding. This defines ‘a vulnerable adult’ as ‘a person who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation’. The previous Government published a review of No Secrets with the following key messages for safeguarding:

safeguarding must be empowering (listening to the victim’s voice)

everyone must help empower individuals so they can retain control and make their choices

safeguarding adults is not like child protection – vulnerable adults need to be able to make informed choices

participation / representation of people who lack capacity and the use of the Mental Capacity Act are important.

The Care Act will soon put safeguarding adults on a statutory footing. Safeguarding remains a complex area of work and case law continues to test the basis on which it is undertaken.



Strengths

Good level of awareness reflected in the self-assessment

Alignment across the 3 boards (ASB/LSCB/Safer Leeds)

Excellent political support for safeguarding

Good working relationships and a great willingness to work together moving forward

The cross-council approach ensures staff are equipped to raise concerns about safeguarding across all departments

Cross-city approaches to prevention and making safeguarding everyone’s business

Recognition of the need for change (SAB/LSAPBSU/Care Act)

Active effort to improve the effectiveness of the SAB

Areas for consideration

SAB governance – fitness for purpose going forward, including sub-groups

SAB requires more focus, needs clearly defined aims and key priorities

Roles and responsibilities of the Chair need clarification with appropriate resourcing

Roles and responsibilities are not clear – revisit function, responsibility and accountability of each agency

Cultural shift is needed, develop a more collective approach – ownership, engagement, challenge, debate

Develop more understanding of each others’ drivers and issues

Raise the visibility and profile of the SAB

Use the Protocol on the relationships between Leeds Safeguarding Children Board, Leeds Adults Safeguarding Board, Safer Leeds Executive, the Children’s and Families Trust Board and Leeds Health and Well-Being Board to strengthen relationships between the Boards.

9. The self-assessment written prior to this adult safeguarding peer challenge had a clear narrative and readable style. There was a good level of self-awareness reflected in the self-assessment as the team found themselves agreeing with many aspects of the document and the assertions made in it. As peer challenge is partly an exercise in organisational self-awareness this was a very good place from which to start.


10. There is clear alignment of policies and procedures across the Safeguarding Adults Board, the Local Safeguarding Children’s Board (LSCB) and the Safer Leeds (Community Safety) Board. There is also a shared understanding of what is important and how to achieve it amongst the staff and partners represented on these Boards which bodes well for delivering effective outcomes.

11. Amongst the politicians there is unequivocal political support for safeguarding from the Leader of the Council, the Portfolio Holder for Adult Social Care and the rest of the political membership. Safeguarding is seen as important and relevant to the business of Leeds City Council and the people who live and work there.

12. The peer challenge team read, heard and saw good working relationships between staff and partners at all levels in relation to safeguarding and a great willingness to work together moving forward. This enables challenges to be more easily overcome in the future.

13. Leeds City Council has a clearly articulated and enacted cross-council approach to adult safeguarding which ensures staff are equipped to raise concerns about safeguarding across all departments. Each directorate has a safeguarding lead officer, it is their role to disseminate information into their directorates, and also to be the first point of contact for any safeguarding concerns. This group meets bi-monthly and sets objectives each year. There is a corporate training programme which is delivered to all staff and it is expected that all staff will repeat this training every three years. There is a system in place to check this is happening for all staff. As a result of this approach the knowledge of safeguarding appears embedded across the Council and staff have permission to raise alerts and deal with it when they encounter it. This is impressive.

14. The approach to adult safeguarding described above is evident in organisations across the City which allows prevention to be delivered and makes safeguarding everyone’s business. A good example of this is the publicly accessible multi-agency safeguarding hub in the centre of the City which encourages engagement with police and other agencies on safeguarding matters.

15. The Safeguarding Adults Board (SAB) recognises that it needs to improve its performance and tackle future challenges by working together better as well as with other Boards. This recognition of the need for change is evidenced by the request for this peer challenge as well as the impending changes required for the Care Act and the Leeds Safeguarding Adults Partnership Support Unit. Discussions have taken place to air the options available, policies have been amended and plans created to change structures and practice to address this changing landscape which felt appropriate and positive to the peer challenge team.

16. There is on-going activity and effort to improve the effectiveness of the SAB. This was evidenced by the re-establishment of the performance subgroup, with reviews of the chair’s role and clearer outcomes and objectives being set. The independent LSAPBSU has been subjected to a review to assess its current effectiveness and to determine different ways of working in the future.

17. There is an opportunity to revise the governance of the SAB to ensure it is fit for purpose going forward, this review should include the structure and function of


the sub-groups. Board papers are often late, and it is not always clear about why papers are going to the Board, and there are suggestions that there are too many items on the agenda. Some partners raised concerns that the Board then rushes through the business without giving time and thought to key issues, nor spending sufficient time debating and developing Board views. This has been recognised and objectives have been set for the subgroup, to identify key messages that need to be considered at Board level.

18. To be fully effective the SAB requires more focus, needs clearly defined aims and key priorities. The priorities of the Board are not clear to everyone and it is difficult to identify the most important things facing the City on safeguarding. This is reflected in the Business Plan which has a more detailed rather than strategic ‘big picture’ focus.

19. The roles and responsibilities of the Chair need clarification with appropriate resourcing. Further discussion is needed about the degree of support required by the Chair. Consideration also needs to be given to whether sufficient days per annum are allocated to the role of the Chair, given the scale and importance of the role across the City.

20. The roles and responsibilities of partner agencies on the SAB are not clear, the peer challenge team recommend that you revisit the function, responsibility and accountability of each agency to ensure they understand their role on the SAB. Each partner organisation needs to ensure they have appropriate safeguarding structures in place and ensure that they resource them sufficiently. This would be the case for all partners not just those whose status becomes statutory in April 2015.

21. A cultural shift is needed on the SAB to develop a more collective approach which would be evidenced by a shared ownership and engagement of the issues and clear constructive challenge to diverse views as they are discussed in honest debate. This would allow for differences of opinion to be clarified through increased trust to deliver effective outcomes. Time needs to be allowed for the Board to have debates about some of the big issues. There is enthusiasm from partners to work together but there is a need to understand the roles and responsibilities going forward. Currently not all external partners are fully signed up to a collective approach and as a result, some partners feel that not all voices are heard, nor is everyone confident that they can influence the agenda.

22. There is the opportunity for the SAB to engage in some development work where there is more understanding of each others’ drivers and issues as the Board moves towards statutory status. For example a question for discussion could be “Do Board members have a good understanding of the incident reporting systems in other organisations?” this would seek to prevent duplication and maximise resources. The peer challenge team believe the Board could benefit from everyone having greater understanding of the functions and roles of both the Clinical Commissioning Groups (CCG) and NHS Providers. This is important because there is a challenging agenda ahead and investment now should help to ensure that the person is at the centre of the Board’s focus on delivery.


23. We recommend that you raise the visibility and profile of the SAB as currently it does not have the profile it deserves given its responsibility and function. Although it is as important, it does not have the same visibility or profile of the Local Safeguarding Children’s Board (LSCB). Furthermore the Health and Well Being Board (HWB) in Leeds has had the benefit of an extensive board development programme which is regarded as being exemplary. There is the opportunity to explore what they did and how this could be adapted and applied to the SAB.

24. Further consideration needs to be given to how the Protocol on the relationships between Leeds Safeguarding Children Board, Leeds Adults Safeguarding Board, Safer Leeds Executive, the Children’s and Families Trust Board and Leeds Health and Well-Being Board can be used to strengthen relationships between the Boards.


Outcomes

Strengths

People are asked at the beginning of the process what they want as an outcome(s)

Neighbourhood networks are well established and reaching a wider group of vulnerable people

Good feedback from service users about outcomes being achieved

Good use of IMCA service to enable people to achieve their outcomes

Areas for Consideration

Need a clear narrative about what is meant by outcomes or an outcome-focused approach

Overall approach to safeguarding practice needs to be more outcome focused

Making Safeguarding Personal should be more than recording systems and data collection – it is about cultural shift, practice improvements and personalised approaches

Define what good looks like for safeguarding practice in Leeds

25. In the adult safeguarding process people are asked at the beginning of the process what they want as an outcome. This is a significant step in making them safe and the work being personalised to their needs.

26. The neighbourhood networks run by Leeds City Council are well established and are reaching a wider group of vulnerable people. From the evidence the peer challenge team saw these networks promote early intervention by signposting residents to social enterprises and self-help groups. The early intervention is working as a preventative measure and helps to lower the risk of more residents reaching substantial or critical need faster than is necessary. The Council commissions preventative services for a large and diverse group of vulnerable people who may not meet Fair Access to Care Services (FACS) eligibility criteria but who nonetheless are being supported to live independently in their own homes.

27. The peer challenge team heard good feedback from service users about outcomes being achieved which is heartening and suggests that frontline practice is engaging those who use services in a personalised way. There was evidence that the Leeds Involving People (LIP) initiative was effective in ensuring service users’ and carers’ views were being heard and were informing practice. It was evident that service users understood what it was to be safe, but did not always understand what safeguarding actually was.


28. There is good use of the Independent Mental Capacity Advocacy (IMCA) service provided by Articulate Advocacy. The IMCA service has developed good links with care homes and supported living providers in relation to Deprivation of Liberty Safeguards. Staff are clearly aware of the availability of this service and are routinely accessing it for those vulnerable people who lack capacity. This ensures that vulnerable people’s views are being taken into consideration when care and support services are being commissioned on their behalf. The IMCA service supports and befriends the resident in order to counsel and monitor their progress and report any concerns to clinicians. This support was shown to be very satisfactory in achieving the desired outcomes agreed with clients.

29. The adults social care service needs a clearer narrative about what is meant by outcomes or an outcome-focused approach. Currently these appear to be rather abstract concepts and need to be brought to life for staff, so that they have a better understanding of what it is they are working towards and how they are expected to get there.

30. Whilst there is some good feedback from those who use services - and therefore practice by frontline staff - the challenge team felt the overall approach to safeguarding practice needs to be more consistently outcome focused, with less emphasis on process. Approaches for collating and measuring whether peoples’ needs have been met following a safeguarding intervention are not yet fully developed. In addition, there are examples from staff and from case file audits that people are being taken through the safeguarding process even when they had specifically said this is not what they wanted. To some extent this is because staff feel they have had to protect themselves or that they feel this is required of them, so there is room for improvement.

31. Making Safeguarding Personal should be more than recording systems and data collection – it is about cultural shift, practice improvements and personalised approaches. Staff need to be given permission to take a proportionate approach to safeguarding.

32. Define what good looks like for safeguarding practice in Leeds. This means developing a common language and aspiration for safeguarding across the City. Over the last three years there have been high numbers of domestic violence related homicides but these have not been formally reviewed collectively. This leads to concerns that lessons are not being learned from what went wrong and what could be improved or that knowledge is being transferred into practice. A solution the SAB could consider is to establish a domestic violence sub-group to meet quarterly to review a number of targeted cases.


People’s experiences of safeguarding

Strengths

Good service user engagement, e.g., Leeds Involving People

Access to services e.g., website, contact centre

Support for carers re safeguarding (Carers Leeds)

Service user representation on SAB

Well-developed advocacy services

Media campaign


Service user focus isn’t always reflected in experiences on the ground e.g., expectations are not always understood

Long and complex process, simplify so people only need to tell their story once and speed up resolution

People feel they are not kept informed of progress and the outcome

How do you know that you are achieving outcomes for people?

Mechanisms need to be developed to hear the voice and experiences of people

33. The peer challenge team saw and heard about good service user engagement across the work of adult social care, a good example was the Leeds Involving People (LIP) initiative which was a large consultation exercise and one where Leeds were able to collate the responses and evidence from feedback very well. The LIP is successfully engaging with a wide group of service users and carers and is providing a means for people’s views to be ascertained to help inform the Council when it is planning and developing its social care services.

34. Users, carers and staff have good access to services and information about services through the Leeds City Council website and the contact centre. The contact centre allows individuals to be placed on the correct pathway and users did highlight they felt they knew what it was to be safe, however members of some client groups some did not always understand what safeguarding was or how it could add to their safety.

35. Adult Social Care provides support for carers with regards to adult safeguarding through the Carers Leeds organisation. Carers told us that they felt supported and there are some good working relationships with evidence of commitment to both service users and those who support them. Carers also highlighted they felt they knew where to go if they had concerns, but again did not fully appreciate what safeguarding was or how it could add to their safety.


36. The SAB seeks to understand the service user experience through user representation on the Board. This provides good representation across all groups, although it is unclear whether they have the authority to speak collectively about the group or what processes they had to really gain an objective opinion.

37. Advocacy services for those who require it are well-developed through an effective commissioning process as a result of the LIP initiative which has informed the criteria required for the services from user input. Frontline staff are aware of the availability of these services and are accessing them to support service users. The use of these services will ensure that service users’ wishes are determined and represented when decisions are being made about their care and support provision.

38. A media campaign on the prevention of abuse took place during the summer of 2014. It used a wide range of methods to reach people across the City including buses, lamppost banners, social media and local radio. It was evaluated and shown to be successful in raising awareness of the need to prevent abuse across the City. A number of participants in the peer challenge told us they felt that the campaign was successful and should be continued and ongoing, although there were also some concerns that it focused too much on the older person, and greater benefits could have been achieved if partners were aware of it earlier.

39. Adult safeguarding is a clear priority at Leeds City Council that is set by elected members and senior staff and actioned through Council policies and the work of the SAB. However, it is not always clear how the service user focus and voice is reflected in the experiences on the ground, and it would appear that the expectations of safeguarding interventions are not always understood. There is a need for the Council and partner agencies to consider how they wish to engage with service users from both an awareness raising and safeguarding perspective.

40. The West Yorkshire Multi-Agency Safeguarding Policies and Procedures have been created to comprehensively capture the person’s experience and address all risks. However these are now seen as long and complex processes by both users and staff with some unintended consequences. Service users stated they need to keep repeating their story and experience to different professionals and this can be draining and create disillusionment for vulnerable people. There is a need to simplify the process so that people only need to tell their story once and thereby speed up resolution.

41. The peer challenge team heard feedback from those who have been through the safeguarding process that they feel they are not kept fully informed of progress and the outcomes of the work. Clients need to know what to expect and what happens as a result of the safeguarding interventions. More attention needs to be given to explaining to service users and carers what the safeguarding intervention will entail and that they will be informed of, or be included in determining, the outcomes of the safeguarding intervention.

42. As with most organisations involved in delivering safeguarding the focus can be upon effective and timely processes for staff and partners to follow. The peer challenge team believe there needs to be a clear focus on achieving outcomes


for people. One method of achieving this would be to conduct regular audits of multi-agency responses to cases of domestic abuse and vulnerable adults in need from initial alert to conclusion.

43. The self-assessment for this peer challenge identified that the mechanisms to hear the voice and experiences of people need to be developed. The peer challenge team agree with this view. The overall approach needs to be more systematic so that this information is more readily planned for and captured. There needs to be clarity about how these outcome are achieved, which could be through discovery interviews, facilitated focuses groups and by gaining timely feedback.


Commissioning

Strengths

Investment and commitment to community based (VCS) provision – preventative services/neighbourhood networks

Good level of services in place for carers

Quality assurance framework in place with care providers

Good joint commissioning between the Council and the police, especially re homelessness and prostitution

Good examples of joint commissioning in drug and alcohol abuse

Integrated health and social care services in place with vision and ambition for the future

CCG and Council financial contribution to safeguarding


Contracting needs to focus more on quality improvement to reduce numbers of safeguarding referrals – is the overlap too great?

Ensure safeguarding is not used as the vehicle to address poor quality of care

Visibility and professional challenge in primary care, e.g., lead safeguarding GP?

Greater collaboration between Adult Social Care and CCGs in safeguarding, and their need to work more effectively together to influence providers

Minimising the impact on safeguarding individuals, given the financial challenges

44. Leeds City Council illustrates its commitment to safeguarding through the investment and commitment to community based (Voluntary and Community Sector) provision, the preventative services and the neighbourhood networks.

45. There are good levels of service in place for carers through the Hub that deals efficiently with carers and their concerns and needs, signposting them to other services quickly and recording outcomes. This is as a result of the Council’s continued investment in carers’ support services. However due to overall budget pressure it is recognised that the level of funding allocated for carers’ services is subject to review.

46. There is a comprehensive quality assurance framework in place with care providers that provides successful monitoring. However, there remain a high number of concerns about the quality of care in relation to care homes and these concerns continue to be routed through as safeguarding referrals. The


Council has guidance in place on thresholds for safeguarding referrals but clarity is required about who is responsible for managing concerns about poor quality in care home placements and how these matters are being addressed and resolved. This should help reduce the high numbers of safeguarding referrals which relate to poor quality of care.

47. There is good joint commissioning between the Council and the police, especially in relation to the work on homelessness and prostitution.

48. There are good examples of joint commissioning in drug and alcohol abuse.

49. There are integrated health and social care services in place with a vision and ambition for the future. These teams are co-located with an emphasis on working together to prevent unnecessary hospital admissions and promote individuals wellbeing within the community.

50. The CCG and the Council make significant financial contributions to safeguarding. Concern was raised as to what this money actually funds and a recommendation would be to consider this in line with the PSU review.

51. The contracting process needs to focus more on quality improvement to reduce numbers of safeguarding referrals. The question the team grappled with but didn’t come to a conclusion on was ‘is the overlap too great’. It is suggested you revisit this to assure yourselves of your understanding. A degree of overlap may be required but there is a need to ensure that it is not too significant and that there is not too much duplication of effort which in turn wastes resources.

52. The team recommend that there is a drive to ensure safeguarding is not used as the vehicle to address poor quality of care, particularly the quality of care relating to care homes, as currently a high proportion of safeguarding cases are routed from care homes or providers. The processes of quality assurance and safeguarding whilst linked should be separate and seen to be so by those managing the systems. Safeguarding alerts that are generated from health care providers, need to be categorised as poor quality or safeguarding, and enquires should be made as to investigative work undertaken by the provider, which could inform the safeguarding process and reduce duplication and minimise use of unnecessary resources.

53. The peer challenge team suggest that there should be increased visibility and professional challenge in primary care, particularly due to the degree of pressure on primary care being experienced at the moment. A good example of this from practice elsewhere would be to have a General Practitioner who leads on adult safeguarding.

54. Generally whilst there is much good work there needs to be greater collaboration between Adult Social Care and the CCGs in safeguarding, and in particular they need to work more effectively together to influence NHS providers. This should ensure services being commissioned through NHS providers and Continuing Health Care are meeting quality requirements of national policy.

55. The local government sector is experiencing a severe reduction in its budget with some councils having had 40% cuts to date, and the range of cuts is


extending more widely across the public sector. In the Chancellor’s Autumn Statement it looks like this will continue. At this time of austerity the Council and its partners should be mindful of minimising the impact on the safeguarding of individuals given these financial challenges. These are difficult times for all partners, so ensure that safeguarding is all about people as you move forward together.


Effective Practice & Service Delivery

Strengths

MCA/DoLS & BIAs – robust processes and good practice

Development of the safeguarding hub between ASC & Police

Community hubs provide informal/low level support and signpost to community resources

Mental Health triage pilot – excellent initiative

SRMs – skilled, experienced and supportive resource for operational teams

Good training delivered for care providers

Responsive helpline

Committed staff across all organisations


Lack of clarity about taking vulnerable people through safeguarding process – disconnect between ASC and other agencies about managing risk

Safeguarding practice is process driven and risk averse

Personalisation practice is variable

Threshold criteria between safeguarding and quality need to be interpreted and applied consistently

Delays in convening case conferences need addressing as safeguarding process becomes lengthy and protracted

The future of the PSU following the review, including relationships with operational teams

Feedback loop to safeguarding alerters is missing

56. The peer challenge team spent time looking at the arrangements for the Mental Capacity Act and Deprivation of Liberty Safeguards (MCA/DoLS) and the related work with Best Interest Assessors (BIAs). The arrangements the peer team saw are well thought out with robust processes delivering positive outcomes and is notable practice.

57. The development of the safeguarding hub between Adult Social Care and the Police is a positive development and is one of the Council’s seven break-through projects. The arrangement would be further enhanced by health partners’ input and discussions are underway to develop this and to enable a broader family based approach to be developed.


58. The Leeds City Council Community Hubs provide informal and low level support through the well trained and motivated staff the team met and they provide useful signposting to community resources for those who use services. There is good evidence of higher reporting of issues from the Black and Minority Ethnic (BME) community within the ten new community hubs, showing that the partnership is responding to need.

59. The peer challenge team read, heard and saw the Mental Health street triage pilot in action which involves the mental health Crisis Team providing support to the police in relation to s.136 detentions and referrals – whereby a worker from the Crisis Team will go out with the Police to attend a potential s.136 and triage the situation on the street to see if it is appropriate. This was seen to be an excellent initiative which has streamlined resources whilst giving earlier appropriate signposting and helps to provide quick problem solving. This could be publicised further afield.

60. Safeguarding Risk Managers are seen by colleagues as a skilled, experienced and supportive resource for operational teams. They undertake a lot of risk management, provide guidance and co-ordinate case conferences.

61. There were examples of effective and well delivered training for care providers. The training and workforce sub-group on the SAB has recently had a new chair appointed and there is evidence that future training will be reviewed to meet the changing needs of the impending Care Act.

62. The helpline (for safeguarding) is seen as responsive and there are plans to improve the service by putting a social worker in place to deal with referrals quickly as part of a triage system.

63. All the staff that the peer challenge team met across all organisations were clearly committed to adult safeguarding and passionate about its importance. This is a real strength.

64. After due consideration of the pre-reading material and talking with participants whilst on-site there appeared to be a lack of clarity about taking vulnerable people through the safeguarding process, in that there is a disconnect between adult social care staff and the actions of other agencies about managing risk in the safeguarding process. The expectation of various agencies was that the Council should be safeguarding adults who are considered to be vulnerable but who don’t meet the Council’s eligibility criteria. This is complex but Adult Social Care should have a series of conversations with partner agencies in order to manage expectations and this should to be within the context of the Care Act, lifestyles, choices and capacity as well as the Council’s financial constraints.

65. The safeguarding adults practice is process driven and risk averse. Since the Commission for Social Care Inspection (CSCI) in 2008 where Leeds safeguarding of adults was deemed to be poor there has been a great deal of emphasis on ensuring adults in Leeds are safe, and undoubtedly in response to that inspection, that was the right thing to do. There is now a very strong compliance culture and strict adherence to policies and procedures, so that safety is at the forefront of culture, and social work practice has become very process driven, summarised by one observer as a “safeguarding sausage machine”. Another observer described safeguarding processes as cumbersome


with 80% of time spent looking backwards, with only 20% of the effort focused on planning to avoid or reduce risk going forwards. This means that opportunities for innovation and for staff to be more proactive are stifled, and that in some instances cited to the team, lengthy processes are followed irrespective of the aspirations of the client. Part of the solution will be to review current risk identification and management process this can be achieved through further collaborative working across partner agencies. There is something around asking what good looks like for the City of Leeds and how through collaborative working can this be achieved.

66. When considering the work of frontline staff it is the team’s judgement that personalisation practice is variable. There are some good examples but some approaches lack ambition, and not all partners are signed up to personal budgets and what they mean. There also appears to be a lack of understanding about the difference between using personalised approaches, such as in the assessment process, and the use of Direct Payments. In addition, further clarification is needed about the relationship between personalisation and safeguarding in that currently safeguarding cases are process driven rather than being outcomes focussed and informed by the person being safeguarded.

67. Threshold criteria between safeguarding and quality need to be interpreted and applied consistently. The safeguarding adults threshold criteria appear to be clear but the interpretation and application of the criteria can be subjective and variable. At Board level a debate is needed about the threshold and whether it is pitched at the right level, as well as the consequences of changing the criteria. Eligibility for social care is high so many people with medium levels of risk or need, don’t receive a service. In addition, it is unclear what thresholds operate for vulnerable adults who are the victims of anti-social behaviour or a crime, in accessing adult safeguarding.

68. Delays in convening case conferences need addressing as safeguarding process becomes lengthy and protracted. At present, all safeguarding case conferences are chaired by the three Independent Safeguarding and Risk Managers (ISRMs). There is no reason why the Safeguarding and Risk Managers (SRMs) located within the locality teams should not also be chairing these case conferences, although it is acknowledged that they would not be able to chair those case conferences where they have had an input because of potential conflict of interest. If the SRMs covered one another’s locality teams, they would equally be able to ensure independence and objectivity to the same levels as the ISRMs. The sharing of this task between the ISRMs and the SRMs would prevent unnecessary delay in the convening of case conferences.

69. The role of the PSU is not clear, and this is even reflected in the varying titles that people have for it, as it is also referred to as the Business Support Unit. Clarification of its role is needed going forward as is the need to become more outward looking. A clear mission statement or service specification would help. Within this, the Council needs to consider whether there is a need to have the three ISRMs located within the PSU in terms of added value. In some of the staff focus groups there was debate and confusion about the delineation of roles of the ISRMs and that of the locality SRMs. Prompt clarification of this issue would be beneficial.


70. The feedback loop to safeguarding alerters is missing and should be closed through a straightforward alteration to the system.


Performance & Resource Management

Strengths

Excellent multi-agency application of MCA/DoLS

Commitment to “learning lessons”

Significant investment in safeguarding from all agencies

Evidence of quality assurance, audits, and supervision

Capacity pressures identified and responded to

Evidence of significant investment into sub-groups to review and rejuvenate

Comprehensive data collection with emerging trend analysis


Develop a shared understanding about personalisation and a set of objectives across the partnership

Data capture needs to be broadened across the partners

Intelligence and analysis are required to answer the “so what” questions

Broadening opportunities to learn from lessons across the agencies

Opportunity to reshape PSU investment

Moving safeguarding from being process driven to outcome driven

Review the safeguarding quality assurance framework

Review information sharing agreements and systems

71. The peer challenge team were impressed with the multi-agency application of the Mental Capacity Act / Deprivation of Liberty Safeguards to such an extent that this is notable practice and could be publicised more widely. The Council has invested in Best Interest Assessor (BIA) training for a high number of social work practitioners and also health professionals including nurses and Occupational Therapists and in doing so, are in a position to meet the high increase in demand for BIAs arising from the Cheshire West judgement. Good practice in relation to Deprivation of Liberty Safeguards appears to be embedded in the operational teams and this is seen and managed as core business. The business support staff that are involved in the administration of DoLS are seen as the ‘lynch-pin’ in supporting and enabling best practice. The Council has a Best Practice Panel which, through the use of a ‘screening tool’ is able to ensure consistency of practice in Best Interest decision making. It was particularly impressive that all social workers had the opportunity to undergo the training very quickly and that the links with partners were excellent.


72. There was a clear commitment to ‘learning lessons’ in the practice of adult social care and safeguarding through the training and workforce group, however influence on how knowledge is transferred into practice needs to have additional consideration.

73. It was positive to see that in advance of the requirements of the Care Act there has been significant investment in safeguarding from all agencies in terms of both staffing and financial contributions.

74. The peer team saw evidence of quality assurance, audits, and supervision. The externally commissioned case file audits demonstrated a commitment to openness and independent scrutiny. The most recent audit of 2013/14 was comprehensive and made some clear recommendations. The challenge will be in taking the messages to the workforce. The Council has some internal resource committed to undertaking improvement work with front line managers and staff, following the latest audit, but there is a risk that the approach adopted if linked to a systems and compliance model would not engage staff sufficiently to create the desired improvements.

75. The adults social care service has recently recognised that there are capacity pressures for staff which have been identified and responded to.

76. There was evidence of significant investment in SAB sub-groups to review and rejuvenate policy and delivery.

77. There is comprehensive data collection with emerging trend analysis.

78. The peer challenge team recommend that the Council initiate the development of a shared understanding about personalisation and a resulting set of objectives across the partnership through which these can be enacted.

79. Data capture needs to be broadened across the partners and the performance framework needs evolving further to cover all agencies. An area for consideration could be to explore multi-agency action learning sets, as these could maximise the dissemination of learning from across the agencies.

80. Intelligence and analysis are required to answer the “so what” questions.

81. In order for the partnership to increase the effectiveness of its work some focus should be on broadening opportunities to learn from lessons across the agencies. This is particularly the case in relation to learning from Domestic Homicide Reviews and Serious Case Reviews and Children’s Serious Case Reviews. This would enable a consistent approach in practice around safeguarding being applied by partner agencies and across children’s and adults’ services.

82. There is the opportunity to reshape PSU investment. That partners contribute significant sums to the unit is a positive reflection on their commitment to the SAB, however, there should be greater clarity about the role and function of the unit, and what partners are expecting to receive as a result of that contribution as mentioned earlier in the report.


83. As is mentioned elsewhere in this report the Council and its partners should move safeguarding from being process driven to outcome driven. This means giving permission to social care staff to take a proportionate approach when determining how each safeguarding referral is to be addressed and identifying and agreeing the outcomes based on the views and wishes of the service user.

84. Review the safeguarding quality assurance framework to ensure it is truly fit for purpose with the demands of the Care Act, and that data that adds value is being captured, monitored and evaluated against the framework.

85. Review information sharing agreements and systems to ensure existing arrangements and systems are fit for purpose.


Case File Audit

The Case File Audit process completed in this adult social care peer challenge follows the methodology outlined in the LGA Guidance Manual for Adult Safeguarding Peer Challenges. The cases considered represented a mix of ages and include adults with mental health problems, people with learning and physical disabilities. A total of twenty-eight case record numbers were made available to the peer challenge team and fourteen were randomly selected, two from each category. The feedback given here is based on the files the peer challenge team have read and seen.

Strengths

Evidence that the vulnerable adult and family members/carers are involved in safeguarding investigations, and invited to conferences

Evidence that IMCAs are appointed where needed

Capacity is assessed and recorded and is decision-specific

Initial decisions are timely

Vulnerable adults are involved in agreeing what they want to see happen and how they will manage some of the risks themselves

Investigation reports from providers are timely

Evidence of good standard of social work practice


Conference report contains too much detail about process and what has been done, needs more space for analysis

Evidence that conferences are not always timely e.g., taking place a year after completion of the investigation

An example of an adult’s views being sought then ignored about whether an issue should have been taken through the safeguarding assessment

Evidence that relevant cases are not always discussed with health partners

Narrative response:

Fourteen case files were audited utilising the following criterial to assess the quality of safeguarding practice:

That the views of the vulnerable adult and their desired outcomes were sought and recorded

That the principles of the Mental Capacity Act were applied

That the rationale for decision making was clearly recorded, and there was evidence of management oversight


That where needed there was multi-agency involvement, and clear protection plans were put in place to manage risk

That processes were completed within required timescales.

The reviewers found that initially responses to concerns raised were prompt and that appropriate safeguards were put in place to manage any immediate risk identified. The audit evidenced good practice with front line staff engaging with the vulnerable adult and working alongside them to reduce risk. There was only one example were despite the vulnerable adult being assessed as having capacity and asking that their disclosure about their home life was not shared this was ignored and both a strategy meeting and case conference were held.

The vulnerable adult concerned and their family recognised there were some issues and they worked together to support the vulnerable adult to move into their own accommodation and be supported to access activities in the community. This was the outcome that the vulnerable adult wanted and the strategy meeting and conference were not required to achieve this.

The audit evidenced positive, cooperative relationships with providers where concerns were raised about their services. There was evidence that providers addressed risk effectively and that the outcome of provider led investigations were fed back to vulnerable adults and their families in a timely way.

Although the audit demonstrated practitioner focus on outcomes, investigation reports were not person centred. The majority were too detailed documenting too much of the investigation process. This led to them being too long and the focus on the person became lost.

There was evidence in all but one case of management oversight and the majority of management decisions had a clearly documented rationale. In some cases there was a delay in getting safeguarding investigation reports signed off. It was not clear if once signed these reports were routinely sent to the vulnerable adult, and other professionals involved, particularly where a safeguarding conference was not held. This may have contributed to feedback received during the review that outcomes were not always fed back. The audit evidenced good practice regarding appropriate use of IMCA's.

A more proportionate streamlined report format would support practitioners to effectively record their safeguarding interventions, focusing on outcomes and be accessible to the vulnerable adults involved.


Your scope and our answers

1. How effective are the Safeguarding Adults Board and related partnership arrangements?

Partnership is effective but feels a bit stuck on some key issues and needs to raise its game at a critical time. It is a good partnership but struggling with some key issues. You need more clarity at strategic and operational levels on thresholds, processes, understanding/process and priorities.

2. How effective is our joint work at an operational level, both between organisations and within organisations?

Practice is effective but improvements are needed to achieve greater coordination and an outcome focus. The new electronic system needs further adaptation to help you achieve an outcome focus.

3. Are we ready for the Care Act?

Good progress is being made on what you need to have in place by 1st April 2015 but you also need to look at the bigger picture. A cultural shift is required to achieve a personalised approach and greater clarity is needed around the interface between the Council and NHS partners, in relation to the specific requirements of the Care Act, so that you are confident all partners have an equal understanding of what is involved.

4. How well are we delivering Personalisation?

Personalised care is being delivered but you need to define what it means for Leeds – develop a strategic narrative and disseminate it. Some of the conversations are confused and there are mixed views and enthusiasm about developing direct payments and personalised budgets.

5. Do we focus on what adults at risk want as outcomes? How well do we seek feedback from users, carers and communities on people’s experience of safeguarding?

There is some positive evidence, but outcomes are not at the forefront. A more strategic approach across all partners is needed to evidence that outcomes are delivered in a different way, and that feedback is captured

6. Are there any areas of practice where we need to improve?

Visible good practice

Empower practitioners to move away from process and take a proportionate approach

Clarify the thresholds and reduce the overlap between quality and safeguarding

Coordination of the safeguarding process and investigations between the Council and NHS partners.


Key Messages

Drive and commitment of staff across all agencies is clear

Define SAB governance and function

Develop clear priorities for the SAB

Take the concerns of all partners on board

Review role of PSU and implement recommendations

Debate and agree quality of care and safeguarding thresholds

Don’t allow processes to restrict innovation

Continue to develop partnerships

Continue on your improvement journey but accelerate progress and resolve key issues quickly


Adult Safeguarding resources

1. LGA Adult Safeguarding resources web page http://www.local.gov.uk/web/guest/search/-/journal_content/56/10180/3877757/ARTICLE

2. Safeguarding Adults Board resources including the Independent Chairs Network, Governance arrangements of SABs and a framework to support improving effectiveness of SABs

http://www.local.gov.uk/web/guest/search/-/journal_content/56/10180/5650175/ARTICLE

3. LGA Adult Safeguarding Knowledge Hub Community of Practice – contains relevant documents and discussion threads

https://knowledgehub.local.gov.uk/home

4. LGA Report on Learning from Adult Safeguarding Peer Challenge http://www.local.gov.uk/web/guest/search/-/journal_content/56/10180/4036117/ARTICLE

5. Making links between adult safeguarding and domestic abuse http://www.local.gov.uk/web/guest/search/-/journal_content/56/10180/3973526/ARTICLE

6. Making Safeguarding Personal Guide 2014 – the guide is intended to support councils and their partners to develop outcomes-focused, person-centred safeguarding practice.

http://www.local.gov.uk/web/guest/publications/-/journal_content/56/10180/6098641/PUBLICATION

7. Social Care Institute for Excellence (SCIE) website pages on safeguarding.

http://www.scie.org.uk/adults/safeguarding/index.asp

Contact details

For more information about the Adult Safeguarding Peer Challenge at Leeds City Council please contact:

Marcus Coulson Programme Manager Local Government Association Email: [email protected] Tel: 07766 252 853

For more information on adults peer challenges and peer reviews or the work of the Local Government Association please see our website http://www.local.gov.uk/peer-challenges/-/journal_content/56/10180/3511083/ARTICLE



https://knowledgehub.local.gov.uk/home



http://www.local.gov.uk/web/guest/publications/-/journal_content/56/10180/6098641/PUBLICATION

http://www.scie.org.uk/adults/safeguarding/index.asp

mailto:[email protected]

http://www.local.gov.uk/peer-challenges/-/journal_content/56/10180/3511083/ARTICLE

http://www.local.gov.uk/peer-challenges/-/journal_content/56/10180/3511083/ARTICLE

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Appendix 1 – Standards for Adult Safeguarding – Revised December 2014

Overview There are four key themes for the standards, with a number of sub-headings as follows:

Themes Outcomes for, and the experiences of, people who use services


Commissioning, Service Delivery and Effective Practice

Performance and Resource Management

Elements 1. Outcomes 2. People’s experiences of safeguarding This theme looks at what difference to outcomes for people there has been in relation to Adult Safeguarding and the quality of experience of people who have used the services provided

3 Collective Leadership 4.Strategy 5 Local Safeguarding Board This theme looks at:

the overall vision for Adult Safeguarding

the strategy that is used to achieve that vision

how this is led

the role and performance of the Local Safeguarding Board

how all partners work together to ensure high quality services and outcomes

6. Commissioning 7. Service Delivery and effective practice This theme looks the role of commissioning in shaping services, and the effectiveness of service delivery and practice in securing better outcomes for people

8. Performance and resource management This theme looks at how the performance and resources of the service, including its people, are managed

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