SHROPSHIRE AND TELFORD & WREKIN VULNERABLE ADULT ... · Telford & Wrekin Council As joint chair of...

Shropshire Council and Telford & Wrekin Council 1 – Safeguarding Adults Annual Report 2008-2009

SHROPSHIRE AND TELFORD & WREKIN

VULNERABLE ADULT SAFEGUARDING BOARD

ANNUAL REPORT

2008/09


Contents

Page

1 Forewords 3

2 Summary of Achievements and Work over last 12 12 months

3 Training 14

4 Public Awareness and Prevention 16

5 Activity and Performance 17

6 Priorities for 2009/10 22 Appendices 1 Safeguarding Board Terms of Reference 24

2 Sub analysis by local authority/agency area of training 28 3 Sub analysis by local authority of activity & performance 31 4 Regional Comparisons (when available) 35 5 Outcomes from Independent Sector Adult 36

Protection Plans


1. Forewords The following forewords highlight the achievements and work that has been undertaken by the partner agencies over the last twelve months. Telford & Wrekin Council As joint chair of the board the Council completing the reconstitution of Vulnerable Adult Safeguarding Board and Terms of Reference was a key achievement in 2008/09. The move to a Safeguarding Board will drive the embedding of an increased focus on partnership working and accountability and ensure a clear and consistent emphasis on prevention, investigation and response. The governance arrangements for the Board within the Council have also been reviewed and confirmed and it will report to the Health & Well Being Partnership Board with Scrutiny and the portfolio’s Delivery Board also receiving the annual report. Active involvement of managers and staff in MAPPA and MARAC arrangements at all levels has continued throughout the year Each portfolio within the Council has a lead officer in relation to safeguarding issues and a Corporate Safeguarding Group (covering both Children & Adults) has been established, chaired by the Chief Executive. A Governance Group has also been established within the portfolio chaired by the Corporate Director. A dedicated vulnerable adult’s team provides advice and guidance across the council in relation to vulnerable adults as well as co-ordinating the VA investigation process. Additional resources were identified to significantly increase the capacity of this team during the year. This was to recognise the ongoing significant increase in referrals and also to allow the team to develop its preventative function. It is recognised that a key element of safeguarding prevention is through awareness. Training is provided for all relevant staff of the Council and partner organisations. In 2008/09 the numbers trained increased significantly by 26%. Adult protection training is provided at two levels, one for those who work specifically with vulnerable adults and another at a general awareness level. General awareness training is mandatory for all staff within the portfolio regardless of their role. Similarly relevant staff within all other portfolios are also provided with awareness training. A file audit policy has been introduced. This ensures that service user records clearly demonstrate decisions made, by whom and when as well as having a clear risk assessment. Revised risk assessment paperwork has also been introduced. The Cabinet members and Corporate Director, alongside other managers participate in periodic case file audits. An audit was also undertaken during the year to verify that all teams have up to date copies of the Multi Agency Vulnerable Adult Protection Policy.


The Council’s learning outcome approach has also been widened in order to mainstream this approach to learning and service improvement with the introduction of an Unexplained Death and Untoward incident policy. In 2009/10 the focus will be on the preventative agenda with the launch of a poster and easy read leaflet. The outcome of the review of “No Secrets” is eagerly anticipated with the hope that it will take forward adult safeguarding and nationally give it the status and priority it deserves. Karen Kalinowski Head of Performance & Standards Adult and Consumer Care Telford & Wrekin Council


Shropshire County As set out in my Co-Chairs forward on behalf of Telford and Wrekin Council, one of the major achievements of the Board during 2008 / 09 was a focusing of the work of the Board to not only consider and oversee issues relating into Adult Protection but to also extend and develop the Board’s role in relation to the broader Adult Safeguarding agenda. The review of the Board’s terms of reference and associated support has provided real clarity on the way forward and ensured appropriate engagement and ownership from all key strategic partners. During 2008 / 09, Shropshire County Council strengthened its processes and infrastructure linked to the reporting and management of Adult Protection referrals, integrating the information within its social care records system. This has resulted in a real time availability of the information relating to each case, has assisted in robust performance monitoring and management as well as contributing to an overall strengthening of governance. With the creation of the new unitary council (Shropshire Council) which has brought together a number of services that previously were the responsibility of District and Borough Councils, work was undertaken to ensure the new Council had an accurate awareness and understanding of the Adult Protection and overarching Safeguarding arrangements within these services and work was done to prepare the new structures to ensure a seamless transition. The inclusion of services such as housing and leisure into the Directorate has presented interesting opportunities for further enhancing the Adult Safeguarding agenda and further work will continue to consolidate and build on this during 2009 / 10. The role of Partners in the Adult Protection agenda has never been stronger as evidenced by the increased training of non-Council staff either within the voluntary sector or the NHS. The Health Overview and Scrutiny Committee reviewed during 2009 the arrangements within the NHS relating to Adult Protection Training and concluded significant progress had been made. The importance of ensuring robust resources are available to support Adult Protection has resulted in the creation of a head of Adult Safeguarding position within the Community Services Directorate and work is currently underway to recruit to that position. This post will provide a valuable resource to strengthening all aspects of the Adult Safeguarding agenda. The inclusion of specific Adult Protection performance indicators linked to key areas within the overarching policy was subject to significant development during 2009 / 10 and these performance indicators now report sustained improvement in both the responsiveness to referrals as well as ensuring the outcomes result in a reduction in risk. Work is currently underway and will be completed during early 2009 / 10 on an additional file audit process which includes member engagement and involvement. Shropshire Council believes it has undertaken continuous and sustained improvement in its Adult Protection and latterly Adult Safeguarding agendas, work that it will continue to develop and build on during 2009 / 10. Stephen Chandler Assistant Director, Adult Social Care Shropshire Council


Shrewsbury & Telford Hospitals Trust The Director of Corporate Services is the executive lead for Adult Protection and coordinated the appointment of an Adult Protection Lead in March 2009, strengthening the Trust’s commitment to Adult Protection across the Trust. Mandatory training for all staff in Adult Protection awareness has been incorporated into the statutory training programme being introduced at the end of 2009. In the interim an Adult Protection introduction session has been developed in partnership with local Adult Protection agencies that raises the profile of adult protection within the Trust and strongly emphasises the absolute responsibility for recognising abuse or suspected abuse and taking necessary action. These sessions have been delivered to multi-professional clinical staff across both sites. The training sessions stress that early recognition is vital to safeguard the patient and others who may be at risk. The Trust is also developing an e-learning package for staff in partnership with other agencies following a successful bid for funding to the West Midlands Health Authority. Guidance and support is available to all Trust staff throughout the referral and investigation process. Advice and support is given to vulnerable adults, carers and families in a sensitive manner. The Trust has provided an information pack for every ward and department, which includes leaflets on the implications of the Mental Capacity Act (including capacity assessment and best interest checklists), Deprivation of Liberty Safeguards advice and Adult Protection in line with national and local guidance. This information was also sent to all consultants and is available to every staff member on the hospital intranet and is issued to junior doctors on induction. The Trust has seen a significant rise in the number of cases being referred to Adult Protection following the improved awareness and support offered to staff and has developed a much closer working relationship with other involved agencies particularly the Local Adult Protection Groups and Social Services. Julia Buckley Corporate Management Director Shropshire and Telford Hospital Trust


Shropshire County PCT & NHS Telford & Wrekin Awareness of Vulnerable Adult Safeguarding procedures and referral processes have improved within PCT provided health services throughout 08/09. This has resulted from an increase in uptake of training at all levels, involvement in some complex, high profile cases, the links to MCA and DoLS and increased recognition of the health responsibility with regard to potential neglect or acts of omission. Both PCTs have taken these responsibilities very seriously with regard to the collection of clinical safety indicators that may provide early indicators of areas of need. These include the collection of data on all pressure ulcers being treated in service on a monthly basis from Grade 2 and above. In addition an all wounds audit was undertaken and an action plan developed from the recommendations. In T&W PCT the role of the Tissue Viability technician is being developed to monitor and resolve risks in the community including nursing homes, whilst utilising incidents as a means of learning to prevent recurrence. A Pressure Ulcer Prevention and Management policy has been developed in order to improve risk assessment and monitoring for those most at risk across the whole health economy, with staff training the bedrock of prevention and management of pressure ulcers. Training for SCPCT Professional Executive Committee and Board was undertaken by the Vulnerable Adult Safeguarding Manager in April 2009. SCPCT developed guidance for the use of the Multi-agency Adult Protection Policy to comply with stating our staff’s responsibilities explicitly and contributed to the development of the assessment tool for determining neglect in the development of a pressure ulcer. Similarly in T&W managers have undergone training in adult protection and the law to support staff in every day working. The principles of vulnerable adult protection are incorporated into many aspects of mandatory training, such as record keeping. The Vulnerable Adult Safeguarding Board can play an important role in coordinating the collection of data to drive service development and enhance our action planning in this important aspect of healthcare provision. Denise Williamson Kevin Moore Shropshire County PCT NHS Telford & Wrekin


West Mercia Police Constabulary West Mercia is the fourth largest geographic police area in England and Wales. The force area is divided into five divisions, which match the boundaries of our local authorities. Protecting vulnerable people is a key strategic priority for the force in the 2009/10 policing plan. Enhancing the safety and security of vulnerable people through taking a pro-active collaborative approach to deal with incidents is a key priority for West Mercia Police. Communities within West Mercia experience low levels of crime. This success has been achieved through West Mercia's investment in record numbers of police officers and staff and the development of effective working partnerships with our local authority partners, our communities and other criminal justice agencies. In July 2009 West Mercia Police intend to appoint a new Detective Inspector within the Headquarters Strategic Public Protection Department that has a dedicated role for vulnerable adults. The force exists to protect people from harm.

This takes many forms including arresting criminals, providing advice, saving people in an emergency, policing public events, protecting vulnerable people from dangerous individuals, tackling anti-social behaviour and helping people rebuild their lives.

If we serve and protect people well we will be making the difference.

Policing changes lives. Our aim is to ensure that crime remains low, make unsafe places feel safe, meet the needs of our communities and act in a caring and considerate way. This will result in a stronger and safer West Mercia.

Everyone who is part of the force – front line officers, police staff, special constables and volunteers – has an important role to play in achieving this goal.

Our values define the standards that govern our behaviour and actions not only towards the communities we serve but also within the force. Every member of staff will:

• Act with honesty, fairness and respect in serving our communities and the people within them

• Take pride in working within an organisation dedicated to protecting people and upholding the law

• Always take responsibility; their contribution makes a valued difference

D.I. Shane Lewis West Mercia Constabulary


Shropshire Partners in Care Shropshire Partners in Care (SPIC) is committed to the protection of vulnerable adults within the independent adult health and social care sector. Shropshire Partners in Care:

• Works closely with partners including Shropshire Council and Telford and Wrekin Council, actively participating on the Vulnerable Adult Safeguarding Board.

• Contributes to consultations including the review of No Secrets and the Dementia Strategy consultation.

• Facilitates workshops, Seminars and presentations including, Dignity and Quality Seminar, Mental Capacity Act – Deprivation of Liberty Safeguards and a workshop on Do Not Resuscitate Policies. A template Do Not Resuscitate Policy for the Independent Sector which complies with the Mental Capacity Act is now under development.

• Organises an event each year with Shropshire and Telford and Wrekin Council to mark World Elder Abuse Awareness Day. WEAAD events aim to raise awareness of the abuse of vulnerable adults both within the independent sector and amongst the general public. Previous events include a tandem parachute jump, white water rafting with staff from a residential care home taking part, a night of entertainment at the Shrewsbury Town Football Club and this year a curry and karaoke event in Shrewsbury. These events have been attended and sponsored by organizations from the independent sector.

• Works on development projects with the Adult Protection Teams from Shropshire and Telford and Wrekin Councils. Projects have included developing and piloting a Non Statutory Sector Disciplinary Policy and Procedure for the independent sector. This was formally launched through a workshop at the Action on Elder Abuse National Conference 2009.

• Represents the independent sector on working groups set up by the Adult Protection Teams for Shropshire and Telford and Wrekin Council.

• Has been involved in developing and delivering an adult protection training session for service users with a learning disability. The first pilot session ‘Keeping Yourself Safe, Understanding and Reporting Abuse’ has been delivered in Shropshire. A second pilot session will take place in August 2009.

• Delivers adult protection training including Adult Protection Awareness Training and Adult Protection for Provider Managers training through Joint Training for Adult and Community Health Shropshire Council and Adult and Consumer Care, Telford and Wrekin Council. The training is delivered to a joint audience which includes the independent sector (training figures included in report).

• Employs two Adult Protection Training and Development Workers in Shropshire and Telford and Wrekin who deliver training, support Managers to develop action plans and keep members up to date with Adult Protection and Safeguarding developments.


Will continue to work on development projects in 2009/10, this will include developing a Non Statutory Sector Whistleblowing Policy for the Independent sector Mike Donkin Chief Executive Shropshire Partners in Care


South Staffordshire and Shropshire Healthcare NHS Foundation Trust

South Staffordshire and Shropshire Healthcare NHS Foundation Trust continue to maintain and promote its commitment to the county-wide policy and procedures, and the effective understanding and application of the procedures. The Trust has representation on the Shropshire, Telford and Wrekin Safeguarding Vulnerable Adults joint committee which is held quarterly and remains committed to the work of the joint committee. Training One of the key priorities for the Trust this last year has been awareness training of frontline staff and other key staff including the Trust Board who have also received awareness training. The Trust is committed to the protection of vulnerable adults and sees awareness training as fundamental in this process. The Trust currently has several senior staff who are trainers. The trainers have partially met the increasing demand for awareness training. Awareness training remains part of the mandatory training requirement for staff who work in key areas. The compliance with the mandatory training is monitored by the board. A review of how best to continue to meet this increasing demand for awareness training is now needed. Recording and Reporting In common with other Health Organisations there is a need to review how the reporting of safeguarding vulnerable adults (SVA) concerns fits in with the Trusts SUI processes. This requires a focus on how information systems can work together without duplication for staff whilst ensuring no essential information or alerts are lost. This can be achieved by continuing to foster a culture of good professional practice, ensuring that the protection of our service users remains paramount. Leadership The Director with responsibility for Safeguarding Vulnerable Adults is the Director for Quality and Professional Practice. The Trust is working to strengthen its internal Safeguarding Vulnerable Adult leadership arrangements and is working with partners to develop a more robust local and strategic approach. Safeguarding Vulnerable Adults has been identified as a key area within supervision sessions, and a standing agenda item within team meetings. Gill Foster Service Manager Mental Health Telford and Wrekin


2. Summary Of Achievements/ Work over the last 12 months Much of the detail of the work and achievements undertaken by the Board and its partner agencies is described in the preceding forewords. This section highlights some of those actions and in particular those of a generic nature: Development of a Safeguarding Board The Vulnerable Adult Protection Committee has developed into The Vulnerable Adult’s Safeguarding Board with new terms of reference. Membership has been reviewed and there is greater involvement at a higher level from partner agencies across the two council areas. The board continues to recognise the importance of continuing Adult Protection work as part of the wider Safeguarding agenda. Some positive work was undertaken on the development of The Safeguarding Strategy with key partners attending an away day session and forming some small working groups to focus on specific areas. However this has been delayed due to awaiting national guidance in response to The Department of Health’s review of “No Secrets”. This work will be on-going in 2009/10. Adult Protection Referrals and Investigations The Multi-Agency Adult Protection Policy has been in operation since the 24th October 2001. Since the launch of the Policy, both Shropshire and Telford & Wrekin have continued to experience significant annual increases in the number of adult protection referrals. Between 2004/05 and 2008/09 there has been an increase in investigations of 226% for Shropshire and 251% for Telford & Wrekin. Over the previous twelve months, the number of Adult Protection Investigations for both authorities has continued to increase. Between 07/08 and 08/09 the increase in investigations for Shropshire has increased by 11% (399 referrals in total during the year) and has increased in Telford and Wrekin by 32% (375 referrals in total during the year). In addition 2008/09 saw a significant increase in the complexity of referrals across all the primary client groups. The increase in referrals has had a significant impact on joint working with the police for both authorities. Many investigations have been complex and time consuming. Capacity & Resources Following a review of adult protection services Telford & Wrekin have significantly increased the size of their Adult Protection Team recruiting additional administrative staff and a Senior Practitioner to Chair Adult protection meetings and provide specialist advice and guidance.


The development of a vulnerable adults specialist post across the acute hospitals; Princess Royal and Royal Shrewsbury has enabled a better and closer working relationship with both local authorities. Training More training was provided in 2008/09 across all agencies than previously. Shropshire and Telford & Wrekin now deliver the same training modules across the area. There is also other training being developed and delivered on a pan area basis. The Safeguarding board will continue to develop this multi-agency approach to training in 09/10 and include training in its strategy and plan. Deprivation of Liberty Safeguards (DoLs) DoLs has been successfully implemented across both local authority areas. The ongoing implementation will be monitored by the Board in 2009/10. No Secrets Review Consultation The Board prepared a coordinated response to the No Secrets Review consultation through two workshop sessions which were attended by all key members of the Board. As well as ensuring a co-ordinated response on behalf of the Board the workshops will form a useful basis to take forward the outcome of the review. Serious Case Review In 2008/09 the first Serious Case Review was initiated. The review was referred by Telford & Wrekin Council. The review will be completed in the first quarter of 2009/10. As this is the first review to be undertaken, the Board recognised it as being a key test of the policy and process. A learning outcome meeting will held at it’s conclusion to review and consider how well the process worked and whether any changes are required to the process Pressure Ulcer Prevention and Management Policy A policy has been developed for application across the whole Health economy Pilot Awareness Training for ALD Service Users A comprehensive awareness training programme ‘Keeping Yourself Safe, Understanding and Reporting Abuse’ was piloted in Shropshire by Shropshire Council and Shropshire Partners in Care trainers with support from Taking Part, Shropshire. This will be further piloted in 2009/10.


3. Training The training strategy and training plans: The well established adult protection training programme has continued this year with the two authorities, Health and the Care Workforce Development Partnership working together to co-ordinate training across the statutory and independent sectors. The training is comprehensive and tailored to meet all levels of need from basis awareness to investigation skills and requirements. The figures below reflect training in the financial year 2008-09.

Module Shropshire Telford SATH Total Adult Protection Awareness

919 441

1360

Adult Protection for Provider Managers

57 26

83

Interviewing and Investigation

6 23

29

Adult Protection and the Law

8 26

34

Interviewing Vulnerable Victims and Witnesses

0 19

19

Chairing Adult Protection Meetings

7 0

7

Adult Protection Awareness for Service Users

12 0

12

Implementing a Disciplinary Policy & Procedure in the Independent Sector

13 0

13

The Role of the Investigating Worker

5 26

31

SaTH Adult Protection Introduction

170 170

SATH Adult Protection 185 185

Total 1027 561 355 1939


Both authorities are committed to training in partnership with other agencies. The range of agencies and amount of people accessing this training continues to be encouraging and has increased significantly over the previous year.

Agency/ Sector Shropshire Telford SaTH Total

Acute 11 3 355 369 Foundation Trust 21 5 26 PCT 155 45 200 Local Authority 135 263 398 Independent and Voluntary Sector (inc housing)

701 245

946

Total 1023 561 355 1939

The increase in demand for the training (in particular Adult Protection Awareness) since new services joined relevant portfolios/directorates in both authorities will require a review of our approach which ensures everyone in a relevant role continues to receive appropriate training and information in a timely fashion. A review of training provision across all partner agencies will be undertaken in 2009/10 Staff have also received training as part of the implementation of both the Mental Health Act and Mental Capacity Act which will contribute to the broader safeguarding agenda. The process of conversion form Approved Social Worker to Approved Mental Health Practitioner (AMHP) has gone well in the area and resulted in the first AMHPs from a non social work background. Both Local Authorities and Health have supported a number of people to become Best Interests Assessors to ensure compliance with the deprivation of liberties safeguards. SaTH are developing an e-learning package which will significantly enhance the range and accessibility of training available.


4. Public Awareness & Prevention The focus of The Vulnerable Adult Protection Committee and Local Authorities has traditionally been to respond to allegations of abuse and protect vulnerable adults. The development of the Vulnerable Adults Safeguarding Board will create better opportunities to focus even more on awareness and prevention in the future. Work undertaken in 2008/09 includes: The training and development posts with Shropshire Partners in Care, funded by the local authorities, continue to raise awareness in the independent sector about adult protection. The posts include supporting Provider Managers with the development and implementation of action plans to reduce the risk of abuse in the work place. Evaluations from Registered Managers who have undertaken this training and completed actions plans have been positive. There are some excellent examples of proactive work undertaken as a result of the training illustrated in appendix 5. The development of a Standardised Disciplinary Policy that could be adopted by the independent sector as good practice has been completed. The Policy was launched at the Shropshire Partners in Care (SPIC) conference in September 2008. The Policy and all paperwork are listed as good practice on the Action on Elder Abuse website. Training has been offered to support the Independent sector with its use. The policy and its implementation will be reviewed in October 09. World Elder Abuse Awareness Day has now become an annual event and has built on the previous event of 2006/07. A joint event was organised by both councils and Shropshire Partners in Care at Shrewsbury Football Ground. This event was well attended and raised considerable funds for Action on Elder Abuse as well as raising overall awareness in the local communities. Members of The Adult Protection Team in Telford & Wrekin visited Cartlidge House, a care home for the elderly on World Action on Elder Abuse day. They were involved in raising awareness with vulnerable adults living there by using art, discussion and other activities. There was a significant increase in awareness training provided and undertaken across all sectors in 2008/09. (see training section) Development of a Pressure Ulcer Prevention and Management Policy was completed By Shropshire County PCT, Telford & Wrekin NHS and the Clinical Nurse Advisor (Independent Sector).


5. Activity and Performance Data

Individual data for Shropshire Council and Telford & Wrekin Council can be seen in Appendix 3

Total Referrals 2005 - 2009

0

100

200

300

400

500

600

700

800

900

Fre

qu

en

cy

Number of Referrals 382 501 643 774

of which Concluded in Period 181 417 466 605

05/06 06/07 07/08 08/09

It is clear that the number of safeguarding cases has increased dramatically over the 4 year period, more than doubling in this time period. Shropshire has seen an increase of 11% more cases this year compared to last year. Telford has seen an increase of 32% more case this year compared to last year. Shropshire received 399 referrals in 08/09 and Telford & Wrekin received 375 referrals in 08/09. That is a rise of 40 and 91 respectively on last year’s figures.

The increase has inevitably affected the capacity of the Social Care teams and specialist Police officers who deal with Adult Protection investigations to meet the time scales as set out in the procedures. Despite the increase in referrals and the continuing good working relationships between the Police and Social Care teams proven investigations are still not being undertaken through the Criminal Justice System and resulting in convictions. The West Midlands Regional Adult Protection Managers group (hosted by Shropshire Council) compare investigation figures on a yearly basis. The figures are not yet available but will be included in Appendix 4 when they are.


Referrals by Type of Alleged Abuse 2005 – 2009 Type Of Abuse 05/06 06/07 07/08 08/09

Physical Abuse 88 129 185 254 Sexual Abuse 31 35 53 55 Financial/ Material Abuse 92 134 157 191 Neglect/ Acts of Omission 38 95 177 208 Psychological Abuse 33 46 68 86 Institutional Abuse 7 16 20 17

Discriminatory Abuse 0 4 3 3 Not Stated 2 21 0 3 Of which, number of Multiple Abuse

0 29 72 57

The decrease of ‘Not Stated’ from 2006/07 demonstrates improved recording and investigating of Alleged Abuse. Physical abuse still remains as the main type of abuse and continues to increase rapidly. This is closely followed by neglect and financial abuse. Source of Referral 2008 – 2009

0 20 40 60 80 100 120 140 160 180 200 220 240

Housing

Police

Vulnerable Adult

Care Quality Commission

Other

Vulnerable Adults Family and

Friend/ Neighbour

NHS

Social Care - Other

Social Care - Residential Care

Staff

Social Care - Social Worker/

Care Manager

During 2008-2009, 70% of referrals were made by Social Care staff. This includes Social Workers and Residential Care staff. NHS staff were then responsible for about 10% of all referrals. This was closely followed by Friends, Family and Neighbours of the Vulnerable Adult.


Relationship of Alleged Abuser

0 50 100 150 200 250 300

Neighbour

Volunteer

Other (specify)

Stranger

Institution

Not known

Friend

Other client

Family member

Paid staff

Frequency

05/06 06/07 07/08 08/09

2008-2009 has seen a 39% increase in referrals where the Alleged Abuser is a Family Member and a 100% increase where the Alleged Abuser is a Friend. These two categories of Alleged Abuser have increased year on year over the last 4 years along with Other Clients. Paid Staff are still the Alleged Abuser in the majority of Referrals but this has reduced slightly during 2008-2009. Referral by Team

Over the past 2 years, referrals have been fairly consistent from each team except Mental Health. From the detail in Appendix 3 it is clear that referrals from Mental Health this year has dropped in both Shropshire and Telford & Wrekin. Data for

07/08

49%

30%

12%

9%Older People

Learning Disability

Physical Disability/Sensory ImpairmentMental Health

08/09

51%

30%

14% 5%


2009/10 will be closely monitored to see if this trend continues and investigated further if necessary. Case Conclusions

0

50

100

150

200

250

300

05/06 06/07 07/08 08/09

Fre

qu

en

cy

Proven/admitted

Likely

Unlikely

Disproved

Unknown

Over the last 4 years there has been a significant change in Case Conclusions. The middle of the road outcomes of Likely or Unlikely have generally decreased, with the definitive Outcomes of Proven or Disproved sharply increasing. This reflects the hard work of the teams in investigating all the allegations fully to ensure a solid conclusion can be reached. Outcome by Team

0

50

100

150

200

250

300

350

05/06 06/07 07/08 08/09 05/06 06/07 07/08 08/09 05/06 06/07 07/08 08/09 05/06 06/07 07/08 08/09

MH Disability ALD OP

Fre

qu

en

cy

Proven/admitted Likely Unlikely Disproved Unknown


This demonstrates the extra workload on the different teams, and demonstrates the increase in Cases where the allegations are Proven or Disproved.


6. Priorities for 2009/10 Areas of work for 2008/09 include: Safeguarding Strategy and Plan The VASB Safeguarding strategy to span Shropshire and Telford & Wrekin will need to be developed in 09/10. All board and partner agencies will need to be involved in the development and implementation of an action plan which sets out clear priorities for work to be undertaken regarding the protection of vulnerable adults. Training and development The Training strategy and plan for both local authorities will be reviewed. A multi agency working group will be co-ordinated by the VASB that will develop a multi agency strategy and plan, and identify and co-ordinate resources for learning and development. Adult Protection Investigations

A review of resources available to carry out investigations to ensure these are focussed effectively, dependent on the nature and complexity of the investigation will be carried out. In 2009/10 this will specifically include a review of the implications of the increase in referrals around financial abuse. Prevention and awareness

• Pressure ulcer thresholds for referral:

The implementation of using the assessment tool to assess whether neglect has been part of the development of a pressure ulcer. This work will be expanded to include thresholds for when pressure ulcers should be referred into the process.

• Medication thresholds for referral:

A review to look at options for the development of thresholds for determining when medication errors should be referred into the process.

• Cross Agency Review of Prevention Activities against ADASS National Framework of Standards

• The Telford & Wrekin the information leaflet will be reviewed and an “Easy Read” version developed. A safeguarding poster will be produced for use in key public places e.g. libraries, GP surgeries, Leisure Centres etc. The leaflet and poster will be adopted on an area wide basis (Shropshire and Telford & Wrekin).

• Review of performance data and implications for the policy and procedure.


Engagement with Service Users and Families Options to build routine engagement and feedback on the process to be developed for incorporation within the policy Integration with related work streams In 2009/10 this will focus on Community Safety Deprivation of Liberties Safeguards (DoLS) Monitor ongoing implementation.


Appendix 1

Vulnerable Adult Safeguarding Board for Shropshire and Telford & Wrekin TERMS OF REFERENCE Aims 1. The Board will promote inter-agency collaboration in Safeguarding work within

the Shropshire and Telford & Wrekin area (‘the area’). 2. Recognising that the two local authorities have responsibilities for the co-

ordination of adult safeguarding work within their respective parts of the area, the Board will provide a forum for debate and for the development of strategy about vulnerable adult safeguarding.

3. The Board will regularly review progress against the safeguarding strategy and any associated action plans.

4. The Board will oversee the development of policies and procedures, which

specify how agencies will respond and co-operate in dealing with adult safeguarding concerns and referrals.

5. The Board will maintain a collective and developing awareness of best practice

within the area of vulnerable adult safeguarding nationally, serious case reviews and of examples of systemic and institutional failures. The Board will proactively address any issues arising as a consequence.

Objectives 6. To ensure the protection of vulnerable adults in the local area from all forms of

abuse, whether by commission or omission. 7. To develop on a multidisciplinary basis, the means by which vulnerable adults

can be safeguarded and protected from avoidable harm. 8. To adopt and sustain a reflective learning approach to adult safeguarding,

across the professional system. 9. Ensure that learning outcomes result in change and improvement. 10. To identify gaps in service and options to address them. Values 11. Commitment to the reduction and ultimately to the eradication of all forms of

abuse of vulnerable adults and to encourage a zero tolerance culture in respect of all forms of abuse.

12. Belief in the value and dignity of all and recognition of the right of individuals

to choose.


13. Recognition of a wide range of inequalities which render some citizens

particularly vulnerable to abuse and a commitment to action which minimise the impact of such inequalities.

14. Ensure individuals have access to services that will protect them from harm 15. To ensure a proportionate response to issues and incidents of potential

abuse. Membership 15. The Board will be composed of representatives of the following statutory

agencies, operating in the area. The Board will operate inclusively, so that no relevant agency is precluded from membership. In addition to regular attendance by the following statutory organisations, representatives of other agencies will be invited to attend the Board where relevant.

Statutory Organisations Other possible members

• Shropshire Council *

• Telford & Wrekin Council *

• West Mercia Police

• Crown Prosecution Service

• Probation Service

• Shropshire County PCT

• Telford & Wrekin PCT

• Shrewsbury & Telford Hospital Trust

• South Staffordshire & Shropshire Mental Health Trust

• Care Quality Commission

• Prison Service

• Provider Organisations

• Residential and domiciliary care provider association (SPIC)

• Children’s Safeguarding Boards for Shropshire and Telford & Wrekin

• Service user/patient organisations

• Carers organisations (CVS)

* Representation from Adult Social Services, Housing and Legal Services

16 All organisations will provide a named representative and deputy and commit

to maintaining a minimum 80% attendance. Representatives will be at a senior level from partner organisations sufficient to enable them to commit to decisions of the Board on their organisations behalf as required and appropriate.

17. The Board will additionally maintain strong working links with local strategic

partnerships, especially with regard to work streams on Community Safety. 18. Links will also be made as required with HM Coroner, the Office of the Public


Guardian, Courts, Fire Service and the Ambulance Service. The HM Coroner will receive copy of the minutes as a matter of course.

Reporting 19. As the Board has no executive function, any recommendations which it

makes should be submitted promptly for endorsement to the appropriate management group/board in the relevant organisations as agreed by the Board.

20 The Board will produce an annual report on safeguarding activity during the

previous financial year. The Board will specify the required content of the report, within the terms set out in the joint policy and procedures, and seek input from the agencies represented on the Board.

21. The annual report will be presented by members of the Board to their

respective boards – management groups as listed in Appendix ?? 22. The Board will receive quarterly updates in relation to the performance and

quality of services being delivered across the two local authorities. This ensures that the Board maintains a strategic overview with key themes and trends being identified and addressed via the safeguarding strategy and supporting action plan.

23. The Board will be responsible for commissioning and receiving independent

investigations for serious case reviews. Board Meetings 24. The Board will meet quarterly with the responsibility for arranging a venue,

making housekeeping arrangements and the provision for secretarial support alternating between the two local authorities on an agreed basis.

25. The Adult Protection Manager (SCc), and the Principal Officer Adult

Protection (T&WC) and the Adult Protection Trainer (SPIC) will attend Board meetings in the capacity of professional and technical advisors.

26. Papers for consideration by the Board need to be provided in good time to

ensure circulation with the agenda which will be distributed a week before the meeting.

27. Papers tabled at the meeting or verbal presentations on matters requiring

detailed consideration will be permitted by exception only and with express approval of the Chair.

28. Guest speakers will attend the Board by prior arrangement or at the invitation

of the joint chairs.


The Board’s Work 29. Each member of the Board is responsible on behalf of the agency s/he

represents for bringing to the Board issues and developments in the area of adult safeguarding which will require, or would benefit from an inter-agency perspective.

30. The Board will formally register matters of local, regional and national

interest, in the field of adult safeguarding, and will formally record a view on what response it needs to make.

31. Although some decisions can be reached on the basis of plenary discussions

at Board meetings, the Board will also form subgroups from among its membership to undertake specified tasks. The Board will appoint a lead for each such group, and specify a date for reporting back and any interim updating arrangements.

32. In order for a formal decision/recommendation to be made by the Board,

eight of the member agencies must be present. If this is not the case, the decision/recommendation will be deferred until the next meeting of the Board. At least one member of the relevant local authorities and health must be present.

These Terms of Reference will be subject to review by the Board on an annual basis.


Appendix 2a

Training Analysis by Council Area, Course and Agency - Telford & Wrekin Council Telford & Wrekin

Acute Foundation Trust PCT Local Authority

Independent and Voluntary Sector (inc housing) Total

Adult Protection Awareness 3 1 42 179 216 441

Adult Protection for Provider Managers 2

24 26


1

21 1 23

Adult Protection and the Law 1 1 21 3 26

Interviewing Vulnerable Victims and Witnesses 2 2 14 1 19

The Role of the Investigating Worker 26 26

Total 3 5 45 263 245 561


Appendix 2b Training Analysis by Council Area, Course and Agency – Shropshire Council Shropshire County

Acute Foundation Trust PCT

Local Authority

Independent and Voluntary Sector (inc housing) Total

Adult Protection Awareness 11 21 147 96 644 919

Adult Protection for Provider Managers 8 7

42 57


6 6

Adult Protection and the Law 8 8

Chairing Adult Protection Meetings 7 7

Adult Protection Awareness for Service Users 12 12

Implementing a Disciplinary Policy & Procedure in the Independent Sector 13 13

The Role of the Investigating Worker 5 5 Total 11 21 155 141 699 1027


Appendix 2c

Training Analysis – Shropshire and Telford Hospitals (SaTH) Adult Protection Introduction course 2009:

� 170 members of staff (on site sessions with Helen Hampson, Adult Protection Lead)

� Statutory training commences at the end of the year Adult Protection course 2008/09:

� 42 Medical Staff � 143 Mental Capacity Medical Staff

Adult Protection Referrals since March 2009:

� 35 referrals in total � 8 made against the Trust � The Trust has made 23 referrals � 3 made by Social Services (not against the Trust)


Appendix 3a

Safeguarding Statistics for Shropshire Council Total Adult Population (18+): 230,200 Total Referrals 07/08: 399 Referrals per thousand population: 1.73 History of Referrals 05/06 06/07 07/08 08/09 Number of referrals 202 248 359 399 Number of concluded cases in 12 months

99 190 219 343

Number of cases going to court Not Counted

Not Counted

Not Counted

2

Number of cases with a successful prosecution/formal caution

0 10 12 7

No. of institutions investigated 1 8 16 16 Referrals by Type of Alleged Abuse 05/06 06/07 07/08 08/09

Physical 62 86 115 158 Psychological 20 13 27 24

Financial 63 61 75 90

Not stated 0 16 0 0

Institutional 1 8 16 16

Sexual 25 17 39 33

Neglect 32 53 100 114

Discriminatory 0 2 3 3

Of which, Multiple 0 Not Counted

Not Counted

Not Counted

Relationship of Alleged Abuser 05/06 06/07 07/08 08/09 Paid staff 68 122 163 141

Volunteer 0 0 1 0

Family member5 70 68 56 92

Other client 11 20 76 64

Neighbour6 7 6 8 0

Institution 1 8 16 22

Friend 7 15 10 30

Stranger 7 5 5 11

Other (specify) 27 10 27 5

Not known 4 2 13 19


Case Closure Reasons 05/06 06/07 07/08 08/09 Proven/admitted 33 65 79 163 Likely 18 45 40 34

Unlikely 19 41 25 0

Disproved 16 32 46 87

Unknown 11 7 29 59

Closure Reason by Team Proven/

admitted Likely Unlikely Disproved Unknown

05/06 6 3 5 0 0

06/07 15 14 10 9 0

07/08 31 4 8 6 5

ALD

08/09 103 9 0 23 15

05/06 17 12 12 13 7

06/07 42 25 25 20 4

07/08 35 23 12 31 17

OP

08/09 41 14 0 44 29

05/06 4 1 1 0 3

06/07 3 1 4 2 3

07/08 4 6 1 3 2

MH

08/09 4 1 0 2 6

05/06 6 1 0 3 1

06/07 4 3 2 1 0

07/08 8 6 4 6 5

Disability

08/09 15 10 0 18 9

05/06 0 1 1 0 0

06/07 1 2 0 0 0

07/08 1 1 0 0 0

Others

08/09 0 0 0 0 0

Referrals by Team 05/06 06/07 07/08 08/09

Older People 131 144 154 155

Learning Disability 38 60 134 155

Physical Disability/sensory impairment

16 19 42 70

Mental Health 19 20 26 18

Not known 0 0 0 0


Appendix 3b Safeguarding Statistics for Telford & Wrekin Council

Total Adult Population (18+): 123,300 Total Referrals 07/08: 375 Referrals per thousand population: 3.04 History of Referrals 05/06 06/07 07/08 08/09 Number of referrals 180 253 284 375 Number of concluded cases in 12 months

82 227 247 262

Number of cases going to court 1 0 1 Number of cases with a successful prosecution/formal caution

1 0 2 6

No. of institutions investigated 6 8 4 1 Referrals by Type of Alleged Abuse 05/06 06/07 07/08 08/09 Physical 26 43 70 96 Psychological 13 33 41 62

Financial 29 73 82 101

Not stated 2 5 0 3

Institutional 6 8 4 1

Sexual 6 18 14 22

Neglect 6 42 77 94

Discriminatory 0 2 0 0

Of which, Multiple 0 29 72 57

Relationship of Alleged Abuser 05/06 06/07 07/08 08/09

Paid staff 34 59 99 103 Volunteer 0 0 1 4

Family member5 24 75 109 137

Other client 3 22 22 59

Neighbour6 4 14 3 0

Institution 6 8 4 13

Friend 4 6 14 18

Stranger 6 21 12 11

Other (specify) 1 11 12 8

Not known 6 37 12 23


Case Closure Reasons 05/06 06/07 07/08 08/09 Proven/admitted 19 44 90 110 Likely 30 67 43 33 Unlikely 14 43 22 66

Disproved 22 22 76 94 Unknown 0 51 16 0

Closure Reason by Team Proven/

admitted Likely Unlikely Disproved Unknown

05/06 7 6 1 5 0

06/07 9 12 11 8 17

07/08 21 4 2 19 3

ALD

08/09 24 11 15 19 0

05/06 10 20 10 14 0

06/07 31 39 29 13 23

07/08 52 28 14 49 10

OP

08/09 74 16 36 67 0

05/06 2 1 0 0 0

06/07 2 9 2 1 9

07/08 11 6 4 5 0

MH

08/09 4 4 2 2 0

05/06 0 2 2 3 0

06/07 2 7 1 0 2

07/08 6 5 2 3 3

Disability

08/09 8 2 12 6 0

05/06 0 1 1 0 0

06/07 0 0 0 0 0

07/08 0 0 0 0 0

Others

08/09 0 0 1 0 0

Referrals by Team 05/06 06/07 07/08 08/09

Older People 54 144 161 235

Learning Disability 18 57 56 81

Physical Disability/sensory impairment

6 12 33 37

Mental Health 3 23 34 23

Not known 1 0 0 1


Appendix 4 REGIONAL BENCHMARKING DATA 08/09

Total Referrals

Referrals per 100,00

population

Investigations Completed

Cases going to Court

Successful prosecutions/

cautions

Institutions Investigated

Shropshire Council 399 1.73 219 2 7 16

Coventry Council

Worcestershire Council

Telford & Wrekin Council 375 3.04 262 6 1

Stoke on Trent Council

Wolverhampton City Council


Appendix 5

Outcomes from Adult Protection Action Plans

Adult Protection action plans are produced by Managers following attendance on the Adult Protection for Provider Managers training. Karen Littleford and Stephanie Holden (Adult Protection Training and Development Workers, Shropshire Partners in Care) then visit the workplace to support and document the actions implemented. The following are a selection of action plan outcomes from 2008/09.

� One Manager (supporting people with learning difficulties) had ensured that all service-users files contained a profile of each medication prescribed, including potential side effects. They worked closely with the local pharmacist who trained all staff. When a new medication was prescribed the pharmacist came to talk to the staff about its benefits, side-effects and consequences of non administration, enabling staff to feel more confident about administering medication and reducing risks of non administration.

� In one domiciliary organisation the Manager ensured that all staff had

a copy of a flowchart illustrating how to make an Adult Protection Referral. Scenarios were now discussed at staff meetings so that workers were aware of Adult Protection issues and were able to discuss and voice concerns. Adult Protection was promoted as a positive process to keep service-users safe, staff are encouraged to be autonomous completing their own referral forms and are supported to attend level 2 meetings.

� One Manager dealt with a staffing issue that could have impacted on

service users (attitude of a care worker) by using an Improvement Note. This form was introduced to the Manager during the training and it formally identifies the required changes and timescale. This resulted in a change in the behaviour of the worker and the home has now received comments about an improved atmosphere from relatives.

� One organisation has started to access training available from

Shropshire Partners in Care following the action plan visit; all training was previously delivered by watching a DVD. The first training accessed was Infection Control staff were able to actively participate in the training.

� A Manager has sent all staff through the Adult Protection Awareness

Training; this training had previously not taken place within the home. Prior to the staff attending the full awareness session the manager requested a workshop to look at staff responsibilities related to adult protection as an introduction to the subject. A workshop entitled Safeguarding and Your Role was therefore delivered by the Adult Protection Training and Development Worker for Shropshire.


� Following attendance on the training course an organisation signed up to participate in the Disciplinary Policy and Procedure Pilot scheme with Shropshire Partners in Care and the Adult Protection Team, Shropshire Council. This involved implementing the policy in the workplace giving regular feed back on it’s effectiveness in order to develop the work.

� A Manager introduced unannounced observations in the workplace to

achieve consistent work practice and address any work practice issues; this would be formally recorded and followed up in staff supervision. They developed a template to record the visits on based on one provided through the action plan visit.

� Capacity Implementation Officer and the Adult Protection Training and

Development Worker.

� One organisation has planned a staff conference for September 2009 to look at Mental Capacity, Deprivation of Liberty Safeguards and Adult Protection with input from the Mental Capacity Implementation Officer and the Adult Protection Training and Development Worker.

� One organisation had revised their supervision forms to have adult

protection and whistleblowing as standard agenda items. They now formally record the discussion and supervisee and supervisor now have signed copies.

SHROPSHIRE AND TELFORD & WREKIN VULNERABLE ADULT ... · Telford & Wrekin Council As joint chair of...

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