Issue - meetings

·         Report by the Safeguarding Adults Board Independent Chair

21.1     The Board considered a report on the East Sussex Safeguarding Adults Board Annual Report for 2017/18.

21.2     In response to questions from the Board the following key points were raised:

• The Safeguarding Adults Board is monitoring closely the increase in the number of incidents of abuse in residential care homes and mental health hospitals. The current view is that the increases are not yet statistically significant, especially because of the low baseline number of incidents. The Adult Social Care Department (ASC) is also working with the care sector to ensure staff are aware of safeguarding duties including through conducting safeguarding reviews. The completion of some of these safeguarding reviews conducted at individual care organisations may also explain some of the increase in reporting of safeguarding breaches as they have made staff more aware of the signs of abuse.
• The Board is due to launch a new self-neglect procedure to highlight to professionals the symptoms of self-neglect and provide pathways of support that they can offer to individuals. The Board is also continuing to promote awareness and details of the referral process to organisations and individuals who are more likely to come into contact with signs of self-neglect, such as hording.  e.g., the fire service, shop owners and carers.
• One of the challenges with benchmarking ASC data on abuse is that raising awareness of abuse leads to higher incidents of reporting. This makes it difficult to judge which local authority area is performing well. Consequently there is no national definition of the rate at which incidents of abuse should be reported. There is, however, regional and national networks that enable local authorities to discuss instances where particular safeguarding issues are increasing and compare best practice.

21.3     It was RESOLVED to note the report.

Report by the Director of Adult Social Care and Health.

16.1     George Kouridis, Head of Service, Adult Safeguarding, introduced the item and highlighted some of the key issues contained within the Safeguarding Adults Board (SAB) Annual Report.  This included: 

·           the four safeguarding adult review (SAR) referrals made in 2017-18; and

·           the key findings of the ADASS Peer Review of Safeguarding.  The review was undertaken in March 2018 and delivered an overall positive review of adult social care and found no issues with regard to Safeguarding Adults practice.   The one key area the review did identify for development relates to the ability of staff to take on appropriate levels of risk.  The review recommended therefore that the service should provide support and training which empowers staff in this respect.   As a result an Action Plan has been implemented which includes, for example, a new threshold decision making process guidance tool for partners and providers. 

16.2     The key points discussed by the Committee are summarized below:

·         Implementing the findings of SAR.   The Committee welcomed the overall positive situation described in the annual report.  Although further clarification was sought regarding the mechanisms the Department have in place to ensure learnings are acted upon.   The Committee also sought clarification regarding whether the Department believes it has sufficient resource available to successfully implement the findings of its SARs.   In response, the Committee were informed that training is key for the Department.  So, for example, the last referral to the SAB resulted in an ‘open discussion’ amongst staff regarding the issues. At a strategic level, the Department have a process for monitoring the implementation of the recommendations of a SAR.

·         Staffing Levels.   In response to a question about staff levels within the safeguarding team, the Director of Adult Social Care informed the Committee that an 8% reduction in staffing levels will have an impact across the Department.   The Department’s response to this is to re-focus its resources on key areas, such as safeguarding.   This response should also be seen in the context of the broader changes taking place across the Council, whereby resources for the most vulnerable are prioritised.   Within the context of adult social care, this re-prioritisation process may have an impact on, for example, how long people wait for an assessment.   The Director also noted that its peer review process is still relatively well-funded in terms of support to the SAB.  

·         Mental Health - responsibility for responding to a threatened suicide.   Councillor Ensor asked which agencies would be responsible for responding to and caring for an individual who was making threats in public to commit suicide.   In response, the Committee were informed that the NHS would ultimately be responsible, but that there would also potentially be an element of Adult Social Care involvement too.  

·         IndependentChair of the Safeguarding Adult Board.   In response to a question from the Committee, it was confirmed that the Chair of the Safeguarding Adult Board, Graham Bartlett, would normally be in attendance for this report.   However, Keith Hinkley, Director of Adult Social Care, confirmed Mr  ...  view the full minutes text for item 16

– Report by Safeguarding Adults Board Independent Chair

17.1     The Board considered the latest Safeguarding Adults Board Annual Report.

17.2     The Chair welcomed the announcement that £30,000 fines have been introduced for use on rogue landlords who are found guilty of operating illegal houses of multiple occupancy (HMOs). He said that this would be a positive step towards combating modern slavery.

17.3     The Board asked several questions and the following answers were provided:

·         The Community Safety Partnership draws together the different services available to children and young people to ensure that they are working together and utilising available commissioned services to their best effect. This is important given the reduction in available resources.  

·         Domestic abuse refers to physical, sexual or psychological abuse between adults who are either family members or intimate partners; it can take place anywhere, not just in the home. The locations of most types of abuse are recorded as part of the fulfilment of safeguarding duties, however, the locations of where incidents of domestic abuse take place are not currently recorded. This is, however, under review and the model used by Brighton & Hove City Council to target their services based on the location of instances of domestic abuse is being considered for East Sussex to help with targeted preventative work.

·         It was confirmed that the Safeguarding Adults Board peer review will be carried out during the 2017/18 financial year.

·         The reason why the Annual Report is published in September but reports on the outcome of the previous financial year is that there is a considerable amount of data that needs to be collated from multiple agencies.

17.3     The Board RESOLVED to note the Safeguarding Adults Board Annual Report.

14.1     The Chair of the Committee and the Chair of the Safeguarding Adults Board (SAB) paid tribute to the work of Angie Turner, former Head of Safeguarding, who had sadly passed away recently.

14.2     The Chair of the SAB introduced the Safeguarding Annual Report, highlighting the close work between agencies and an innovative pan-Sussex review of agencies’ capacity to undertake safeguarding which had been undertaken. He drew the committee’s attention to three key themes from the report:

i)             The completion of the first statutory Safeguarding Adults Review (SAR), which are required in cases where an adult has died within the local authority area, had care and support needs and where there is an indication that neglect or abuse played a role. The SAR report will be published in late October or early November and will include 23 recommendations covering seven areas.

ii)            The increase in the proportion of safeguarding enquiries related to domestic abuse (from 2% to 9%). The increase may be  a positive trend related  to work carried out through a multi-agency review and other awareness raising activity about the safeguarding aspects of domestic abuse. The audit undertaken identified many strengths and also areas for improvement. There has been significant work with primary care over the last year and there is now a named GP for safeguarding and piloting of a co-location worker from the domestic abuse Portal in Health and Social Care Connect.

iii)           The partnership protocol developed between the SAB, Local Safeguarding Children Board, Safer Communities Board and Health and Wellbeing Board in recognition that a number of priorities cut across these Boards. Its purpose is to clarify responsibility and accountability for various areas of work and it will be evaluated in a few months time, after 1 year in place.

14.3     The following additional points were made by the Director of Adult Social Care and Health in relation to the additional information on home care which had been requested by the committee:

·         There are home care representatives on the SAB and safeguarding awareness and training work does cover this sector. The SAB has recognised the particular vulnerability in relation to home care, which doesn’t have the same level of oversight in the home as other paid services.

·         There are three layers of assurance in relation to home care: 1) CQC regulates and rates the sector, including setting clear expectations in areas such as training and safeguarding 2) ESCC undertakes direct work with providers to support improvements in quality 3) the core safeguarding process, including awareness raising across all stakeholders and service users. Awareness raising ensures that people know how and when to raise concerns, and this is built into care planning and the set-up of care packages.

·         Safeguarding activity is monitored, with oversight of the data by the SAB. There will increasingly be comparative data available in relation to home care.

14.4     The Director also advised the committee of plans to undertake an Association of Directors of Adult Social Services (ADASS) peer review of safeguarding in  ...  view the full minutes text for item 14

– Report by Independent Chair of Adult’s Safeguarding Board 

25.1     The Board considered a report by the Independent Chair of the Safeguarding Adults Board (SAB) on the SAB Annual Report 2015/16.

25.2     The Chair of Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG) thanked the SAB for its close work with the CCGs in helping to raise the awareness of adult safeguarding in the primary care sector. The Care Quality Commission (CQC) inspections include checking whether all individuals – including non-clinical staff – are trained in adult safeguarding, and it is now one of the first issues raised at team meetings when before it would not have been.

25.3     The Board applauded the work of the SAB in making organisations more aware and conscious of adult safeguarding needs than they previously had been.

25.4     The Board RESOLVED to note the report.

13.1     The independent Chair of the Safeguarding Adults Board(SAB) presented the annual report, production of which is now a statutory requirement as part of the changes to adult safeguarding introduced by the Care Act. He noted that the increase in safeguarding alerts over the past year primarily relates to the new categories of domestic violence, self-neglect and modern slavery. There has also been an increase in alerts received from the police and homecare providers following awareness raising activities with these sectors. The following three areas of work were particularly highlighted:

·         Safeguarding Adult Reviews (SAR) – these reviews are now a statutory requirement for relevant cases, of which there were none in 2015/16 and one so far in the current year. In 2015/16 one multi-agency review was undertaken for a case which was outside the criteria for a full SAR. The review identified the need for a specific strategy around domestic violence for older people and the need for better data collection and staff training on this issue.

·         Clients and carers safeguarding advisory network: this group, chaired by Healthwatch, has been very active in challenging the board from a carer and client perspective.

·         Training sub-group: this group has extended its original remit to include delivery of training on modern slavery, self-neglect, and coercion and control.

13.2     The following points were made by the SAB Chair in response to the Committee’s questions:

·         The Board’s effectiveness is monitored through annual review of the business plan (which includes performance measures and evidence) and accountability is through reports to Lead Member, Health and Wellbeing Board and the Scrutiny Committee. In addition, there is a desire to increase the involvement of clients and carers in order to better see impact in terms of improved outcomes.

·         The increase in domestic violence alerts appears to be due to a combination of increased reporting and increased incidence. The key outcomes are increased safety/protection and education.

·         The Board is aware of an increase in homelessness and street sleeping and will keep this issue on the agenda. The Director of Adult Social Care and Health assured the Committee that the SAB works in conjunction with other agencies e.g. community safety, to ensure there are no gaps, but equally no duplication, and to ensure that responsibilities are clear.

·         The effectiveness of safeguarding plans is monitored by a sub-group which reviews and oversees any single agency audit, identifying gaps and good practice. A plan for multi-agency audits is also being developed, building on the focus to date on Care Act compliance. The first year’s data suggests reduction in risk has improved, outcomes were met in 99% of cases and advocacy take-up is good. The Director added that the Adult Social Care outcomes framework includes statistical reporting but for an overview of quality this needs to be looked at alongside analysis of specific cases, such as through multi-agency reviews.

·         The work of the Board is funded from contributions from local authorities, police, NHS Clinical Commissioning Groups and East Sussex Healthcare NHS Trust.  ...  view the full minutes text for item 13

14.1     The Committee considered a report by the Director of Adult Social Care and Health containing the Safeguarding Adults Board Annual Report 2014/15 and Safeguarding Strategic Plan 2015-18.

14.2     In response to questions raised by Members, officers provided the following additional information:

• The East Sussex Safeguarding Adults Board (SAB) has now appointed Graham Bartlett as its Independent Chair. Due to the fact that Mr Bartlett is the Chair of the Brighton & Hove SAB and Brighton & Hove Local Safeguarding Children’s Board (LSCB), and there are already pan-Sussex safeguarding policies and procedures in place, this appointment is expected to deliver economies of scale.
• The SAB has recorded a reduction in safeguarding referrals from GPs for 2014/15 and is working with the CCGs to understand why this is the case. SAB believes that working with the CCGs to raise awareness of safeguarding issues amongst GPs will have a greater impact than contacting GPs directly. This is because CCGs already have oversight of and influence on GPs (as their membership is derived from GPs) and they are obliged to ensure that there are suitable safeguarding arrangements in place amongst GPs. SAB is aiming to create an environment within CCGs where GPs who sit on the CCG boards understand that safeguarding is a priority, cascade this message down to GP surgery level, and put a monitoring regime in place.
• The reason for the change in policy for reporting pressure ulcers – which explains the reduction in safeguarding alerts in 2014/15 – is that they are no longer automatically flagged as a safeguarding issue unless there is a suspicion of neglect.  Prior to 2014/15, all safeguarding referrals due to pressure ulcers were being flagged as examples of neglect as part of a response to historic underreporting. However, the reporting policy changed in 2014/15 to a more proportional response that focusses on raising awareness of pressure ulcers amongst staff in residential and community settings. Under the new system, if an initial safeguarding alert is raised, then the Quality Team will intervene to provide advice and guidance. However, if there are repeated and systemic safeguarding alerts then it is likely that it could be investigated as a case of neglect.
• SAB collects incident reports from multiple sources to ensure that they are as accurate as possible. These include incident reports produced by the CCGs and the reporting procedures that the Care Quality Commission (CQC) follows when it inspects care homes. There is no absolute guarantee that incident reports will tell the whole picture, so the SAB remains proactive in developing qualitative and quantitative information as well as looking out for anecdotal safeguarding issues.
• In the 7% of cases where there was action under safeguarding arrangements and risk was not reduced or removed – usually because the victim wanted to maintain a relationship with the family member who was the source of the risk – SAB continues to work with the victim.
• The SAB identifies areas where there may be issues in the reporting of safeguarding issues and works  ...  view the full minutes text for item 14