SAFEGUARDING ADULTS ANNUAL REPORT

SAFEGUARDING ADULTS ANNUAL REPORT APRIL 2013 - MARCH 2014

CONTENT SECTION PAGE 1.0 Introduction 3 2.0 Local Response to National Drivers 3 3.0 BHRUT Safeguarding Adults Team Structure 5 4.0 Governance Structure 5 5.0 Protecting Adults at Risk - Safeguarding Adults Policy 6 6.0 Safeguarding Adults Training 6 6.1 Overview 6 6.2 Training Needs Analysis & Strategy 7 6.3 Training Data 7 6.4 Additional Training - 2012/2013 7 6.4.1 Safeguarding & Learning Disabilities Champion Workshop 7 6.4.2 Learning Disabilities Training 7 7.0 Monitoring & Analysis of Safeguarding Adults Data 8 7.1 Overview 8 7.2 Referrals 8 7.3 Outcomes 9 8.0 Serious Case Reviews 10 9.0 Safeguarding Adults Audits & Surveys 10 10.0 Self-Assessment Framework 11 11.0 Mental Capacity & Deprivation of Liberties & Advocacy 11 12.0 Learning Disabilities 12 12.1 Overview 12 12.2 Learning Disabilities Initiatives Implemented 12 12.3 Learning Disabilities Standard Assessment Framework 12 12.4 Learning Disability Conference 13 12.5 Learning Disability Patient Passport 13 13.0 Dementia 13 13.1 Dementia Strategy 13 13.2 Dementia Week 14 14.0 Local Authority & Partnership Working 14 14.1 Local Safeguarding Boards, Committees & Sub committees 14 15.0 Key Priorities for the Safeguarding Adults Team - 2013/14 15 16.0 Conclusion 15 17.0 References 15 Appendix 1 BHRUT Safeguarding Adults Team Structure 16 Appendix 2 Revised Safeguarding Governance Structure 17 2

1.0 INTRODUCTION Safeguarding adults at risk has remained high on the national agenda for both health and social care organisations since the publication of No Secrets in 2000. The widespread publicity of recent high profile cases e.g. Mid Staffordshire NHS Foundation Trust in 2009 and Winterbourne View in 2011 which exposed systematic failings to patients in institutional settings has meant a continued focus on improving standards within organisations who aim to safeguard and protect vulnerable adults from abuse. Barking, Havering & Redbridge University Hospitals NHS Trust (BHRUT) has introduced measures at all levels to ensure that it is doing everything it can to prevent the abuse or neglect of the people who use the Trust services and their carers. The organisation has established processes, by way of the Trust s Protecting Adults at Risk - Safeguarding Adults Policy, Safeguarding Adults Training, Incident Reporting and Safeguarding investigations, to ensure there is a timely and proportionate response when allegations of abuse or neglect are raised. The purpose of this annual report is to inform the local Safeguarding Adult Boards, BHRUT Safeguarding Strategic & Assurance Group and the Quality & Safety Committee on the Trust s progress in delivering the safeguarding adults agenda, including Mental Capacity, Deprivation of Liberty Safeguards, Learning Disabilities and Dementia work during the period 1 st April 2013-31 st March 2014. In addition, the report identifies the Trust s progress on meeting national and local priorities and identifies key objectives for further development in the year to come. 2.0 LOCAL RESPONSE TO NATIONAL DRIVERS A number of reports and guidance have been published to support the existing legislation to ensure further development in the field of Safeguarding continues and assure sustained support in achieving safeguarding for all client groups who may be at risk of abuse. These include: The Mental Capacity Act, 2005, introduced a new legal framework for protecting the welfare and finances of vulnerable adults who lack mental capacity, creating the criminal offences of ill treatment and wilful neglect. The creation of Deprivation of Liberty Safeguards (DoLS), introduced in the Mental Capacity Act (2005) through the Mental Health Act, 2007, (enacted April 2007) ensures that vulnerable adults who lack mental capacity who are in a care home or hospital are not subject to restraint or infringement of their liberty without an assessment of the circumstances in accordance with this legislation. The Safeguarding Vulnerable Groups Act, 2006, created a centralised Independent Safeguarding Authority (ISA) which makes decisions on barring certain individuals from working with vulnerable adults. The ISA only existed until 1 st December 2012 when it merged with the Criminal Records Bureau to form the Disclosure and Barring Service. Clinical Governance and Adult Safeguarding - An Integrated Process (DH, 2010), outlines the links between reporting serious incidents. This guidance enables NHS organisations to develop local arrangements to ensure that clinical governance systems and adult safeguarding are fully integrated. The National Framework for Reporting and Learning from Serious Incidents Requiring Investigation (NPSA, 2010) details policy requirements in relation to clinical governance and adult safeguarding. Essential Standards for Quality and Safety (Care Quality Commission, March 2010) is designed to help providers of health and adult social care to comply with the Health and 3

Social Care Act, 2008, (Regulated Activities) Regulations 2010, and the Care Quality Commission (Registration) Regulations, 2009. CQC Outcome 7 relates to safeguarding assurance and Outcome 20 relates to notification of other incidents. Ombudsman Report: Care & Compassion Feb 2011, the report illustrates the story of ten people over the age of 65 in England. The investigation of these cases illuminates the gap between principles and values of the NHS. Government Statement May 2011, on 16th May 2011, the Government released a policy statement on adult safeguarding. It sets out the outcomes for adult safeguarding for both the individual and agencies. The statement reinforced the six new safeguarding principles highlighted in the DH Best Practice Guidance booklets released in March 2011, to be used by health, local authorities, housing, the police and other agencies. The aim of the Government policy is to prevent and reduce significant harm to vulnerable adults, whilst supporting the individual to maintain control, enabling the person to make informed choices without coercion. Safeguarding is everybody s business, with the community playing a part in the process and local services safeguarding against poor practice and other forms of exploitation. It is the State s role to provide the vision, direction and to ensure a legal framework is in place, with clear powers, duties and proportionality. All safeguarding arrangements should reflect the six principles, which are: Principle 1. Empowerment - Presumption of person led decision and consent Principle 2. Protection - Support and protection for those in greatest need Principle 3. Prevention - Prevention of harm and abuse is a primary objective Principle 4. Proportionality - Least intrusive response appropriate to the risk presented Principle 5. Partnership - Local solutions through services working with communities Principle 6. Accountability - Accountability and transparency in delivery safeguarding The document then goes on to translate these principles into outcomes for agencies and the individual. Winterbourne View Abuse - the BBC Panorama programme, broadcast in May 2011, exposed the abuse of people with learning disabilities at Winterbourne View private hospital, near Bristol, run by Castlebeck Care (Teesdale) Ltd. Following the programme the CQC was blamed for failing to detect and stop the abuse. South Gloucestershire Council launched a safeguarding investigation into the serious allegation concerning cruel and degrading treatment of learning disability patients by staff, involving the Police, NHS, Care Quality Commission (CQC) and the provider. Eleven staff members were arrested. The CQC and NHS London drew up an action plan to immediately inspect Winterbourne and to assure the immediate safety of London patients within Winterbourne View and other Castlebeck Care (Teesdale) Ltd establishments. The CQC findings led to the closure of the home. The Jimmy Saville sex abuse investigation (2012) highlighted that adults as well as children were exposed to systematic and repeated sex abuse at the hands of a celebrity. Saville used his power and status to hide the abuse he inflicted. This investigation also highlighted that all organisations have a key responsibility to ensure any staff including voluntary staff and guests who visit the hospital must be correctly monitored and reviewed for the safety and welfare of the members of public who they may serve or visit. The CQC published a report in March 2012, The Operation of the Deprivations of Liberties Safeguards in England 2010-2011. This was a review of the use of Deprivation 4

Applications and outcomes by Managing authorities across the country. In January 2014, the CQC published its 4 th Annual Report into the deprivation of liberties Safeguards (DoLS). It mentions concern that the Mental Capacity Act (MCA) is not understood or implemented consistently across health and social care services. Checks on the implementation of the MCA are to become a routine component of hospital and care home inspections. It is proposed that NHS England should include effective use of DoLS into the standard contract for service providers. The CQC identified that this will become an integral part of hospital inspection programmes. There was a key concern regarding the low numbers of Deprivation of Liberties raised by managing authorities and patients with dementia continue to have poor outcomes in hospital. The Francis Report (2013) highlighted the systematic failings and abuse to patients at Mid Staffordshire NHS Trust and made a number of recommendations to ensure that these acts of abuse do not happen again. NHS London (2013) reviewed the standard assessment framework for Safeguarding Adults and Learning Disabilities. This is a benchmarking audit completed by each respective organisation and gives a snapshot of where organisations are in relation to both these important processes. Some of these national drivers are referenced throughout this document and are aligned to the work that the Trust has undertaken in response to them. 3.0 BHRUT SAFEGUARDING ADULTS TEAM STRUCTURE The Trust restructured its Safeguarding Team in January 2014 by advertising for a Safeguarding Lead, whose responsibility it is to provide operational management to the Safeguarding Adult and Safeguarding Children s Team. Incorporated in the role is the responsibility of being the Trust s Named Nurse, Safeguarding Children. In addition, this role manages the Learning Disability Liaison Nurse who commenced in the Trust at the beginning of March 2014. The structure is outlined in Appendix 1 of this report. The Safeguarding Adult Team is fully established, comprising of a Named Doctor who provides 3 PA sessions per week, a full time Named Nurse for Safeguarding Adults, and a full time administrator. 4.0 GOVERNANCE STRUCTURE A revised Safeguarding Governance Structure was developed in November 2013 (see Appendix 2). The Safeguarding Children s & Adults Committees have been amalgamated to form the Safeguarding Strategic & Assurance Group. This group meets quarterly and is chaired by the Trust s Director of Nursing. Two Operational Safeguarding Groups have been established - Safeguarding Children and Safeguarding Adults & LD. Both of these groups are chaired by the Safeguarding Lead and these meet quarterly. A Learning Disability Working Group, replacing the previously named LD Sub-Committee, has been established to meet monthly and is chaired by the Learning Disability Liaison Nurse. 5

5.0 TRUST PROTECTING ADULTS AT RISK - SAFEGUARDING ADULTS POLICY The Trust s Protecting Adults at Risk - Safeguarding Adults Policy was reviewed and approved by the Trust s Policy Ratification Group in November 2013. The policy reflects the Pan London Policy & Procedures (2011) and the Southend, Essex and Thurrock guidance (2010). The policy will be reviewed again once the latter guidance is updated in April 2014 by the Essex Safeguarding Adults Board (ESAB). The policy incorporates the Mental Capacity Act (2005), Deprivation of Liberties process and Guidance on Restraint. This guidance assists staff in when to use restraint, how to manage and mitigate the risk by using proportionate restraint and the techniques applied. A Transition Policy was developed during 2013 to provide staff with the process expected in ensuring that young people within child health services, who have complex and chronic health needs, have a continuum and smooth handover of care to the adult health services within the Trust. The policy was ratified by the Trust s Policy Ratification Committee in February 2014. To date, this has not been made available to Trust staff to ensure new guidance in relation to the upper age limit of a young person is incorporated. 6.0 SAFEGUARDING ADULTS TRAINING 6.1 Overview BHRUT is committed to ensuring that all staff receive the correct level of training to ensure adults at risk receive the right care and safety whilst in our care. The organisation also promotes an interagency approach to training and development in relation to adults at risk. The National Framework of Standards for Good Practice and Outcomes (2005) - Standard 5, sets out the expectations of good practice and the levels of accountability organisations have in ensuring that staff are adequately trained and have the competencies to ensure effective and safe practices are in place in relation to managing adults at risk. Safeguarding training contributes to the achievement of the CQC Quality Outcomes 4 and 7. Due to a number of safeguarding issues that had been raised in the Trust during 2013, the Deputy Director of Nursing and Safeguarding Team felt that a more focused approach to safeguarding training was required, whereby a number of interrelated subjects would be discussed. The proposal for a whole day safeguarding module, as part of the Trust s Mandatory training programme, was approved by the Trust s Education and Training Committee in November 2013 and commenced in February 2014. The topics include: Safeguarding Children - Level 2 Safeguarding Adults including Learning Disability Dementia Training Domestic Violence Falls Privacy & Dignity End of Life Care Pressure Ulcer Management 6

E-learning packages for non-clinical staff, relating to safeguarding, have also been developed in conjunction with the Education & Training Department and are now available via the Trust s Intranet. 6.2 Training Needs Analysis & Strategy In 2013, NHS London and Skills for Health published the UK Core Skills Training Framework which sets out the level and type of training that should be provided to healthcare professionals within the London region. The Trust s Safeguarding Adults Training Needs Analysis and Strategy 2013-2014 was produced utilising this framework and was approved at the Safeguarding Adult Committee in April 2013. 6.3 Training Data As at March 2014 there were a total of 4508 members of staff trained at Level 1 and 2 (79.42% compliance). This training captures all new staff to the Trust and those staff attending Statutory and Mandatory training. A total of 31 members of staff were trained at Level 3 during 2013/2014. Attendance at these sessions remained low and as a consequence 9 sessions throughout the reporting year were cancelled. This training is non-mandatory and is available for those staff that lead a team who may at some point contribute to an adult safeguarding investigation and how they support that process. 22 Level 3 sessions are proposed for 2014-2015 to provide the opportunity for more staff to attend. 6.4 Additional Training - 2013/14 6.4.1 Safeguarding and Learning Disability Champion Workshops The Trust now has 66 Safeguarding Adult/Learning Disability Champions who work across the organisation to ensure that advice and signposting is available to all staff within the Trust. The Safeguarding and Learning Disability Champion workshops are held quarterly and aim to update the link workers on the latest national and local guidance for safeguarding adults at risk. Topics covered to date include: Patient Stories Mental Capacity Act and Deprivation of Liberty Safeguards Safeguarding Alert Outcomes Scenario work - Learning Disability & Safeguarding Updates relating to Safeguarding and Learning Disability Workshops have been facilitated by the Named Nurse, Safeguarding Adults and now include the Learning Disability Liaison Nurse. 6.4.2 Learning Disabilities Training Between April and August 2013, the Trust received 3 concerns regarding care provided to patients with Learning Disabilities. The investigations undertaken demonstrated a lack of knowledge amongst the staff involved. A key priority was to address the educational requirements of the staff by: 7

Providing on the job training to all staff on the wards where the incidents occurred which was delivered during November and December 2013 by the Community Learning Disability Team, Havering. Providing mandatory Learning Disability training for Bands 8b, 7 and 6 these sessions were held during January and February 2014 with LD service users co-presenting on four of the six sessions delivered. These sessions were well attended and positively evaluated. Incorporating Winterbourne View lessons learnt in the Safeguarding Adults training - this is delivered via Mandatory training, Registered Nurse Induction and Level 3 training. Since August 2013 there has been no further incidents raised that involve a service user with a Learning Disability. Autism Awareness training provided by the London Borough of Redbridge, commenced in January 2014 with further sessions planned throughout the year. The Trust s Emergency Department staff and Security Staff are currently being targeted before a programme is rolled out Trust wide. 7.0 MONITORING & ANALYSIS OF SAFEGUARDING ADULTS DATA 7.1 Overview During 1 st April 2013-31 st March 2014 there were a total of 393 safeguarding adult referrals. This is compared to 341 cases received during the same reporting period 2012/13. Of the 393 referrals a total of 340 referrals were raised internally by Trust staff and a further 53 were raised by external agencies. 7.2 Referrals Number of Internal Referrals by Type/Borough (April 2013 - March 2014) There were a total of 340 referrals made by Trust staff during 1 st April 2013-31 st March 2014. This is an increase of 86 referrals compared to the same reporting period during 2012/13. The highest number of referrals by the Trust relate to neglect / acts of omission (157). 66 raised relate to pressure ulcers, 36 of those patients resided in a care/residential home setting. B&D Essex Havering Redbridge Other Total Psychological / 7 1 8 7 0 23 Emotional Neglect / Acts of 49 8 57 40 3 157 Omission Domestic Violence 12 1 18 9 3 43 Financial 5 1 3 2 0 11 Sexual 1 0 1 0 0 2 Neglect - Pressure 14 8 29 15 0 66 Ulcer Physical 10 1 12 6 2 31 Other 3 0 1 1 2 7 Total 99 20 131 80 10 340 8

Number of External Referrals by Type/Borough (April 2013- March 2014) There were a total of 53 external referrals received by the Trust during 1 st April 2013-31 st March 2014. In comparison to the number of alerts received in the same reporting period for 2012/13 this demonstrates a reduction of 34 alerts. B&D Essex Havering Redbridge Other Total Psychological / 0 0 0 0 0 0 Emotional Neglect / Acts of 13 2 16 3 2 37 Omission Domestic Violence 0 0 0 0 0 0 Financial 0 0 0 0 0 0 Sexual 0 0 0 1 0 1 Neglect Pressure 7 0 4 2 0 12 Ulcer Physical 2 0 1 0 0 3 Total 22 2 21 6 2 53 A total of 37 allegations of neglect/act of omission were reported. Of the 37 cases: 15 were relating to neglect caused outside of the hospital setting. These were generally with regard to delays in the care provider s staff seeking medical treatment for the service user. 22 hospital related cases; the allegations included: delays in treatment discharged with an intravenous cannula in situ medication errors general concerns of quality of care nutrition/weight loss lack of discharge/transfer information to the care provider The safeguarding adults referral database underwent a data cleansing exercise in October 2013 to ensure that the recording of referrals was accurate and robust. 7.3 Outcomes The process of receiving outcomes from the local boroughs has been strengthened over the last six months. The Interim Named Nurse, Safeguarding Adults meets every six weeks or has regular telephone contact with the Borough Safeguarding Leads to ensure feedback from the Trust s investigations are provided. Increased contact with the Hospital Social Work/Discharge teams has also helped to facilitate this process. To date, the outcomes for the 22 hospital cases relating to neglect/act of omission are: Outcome Total Substantiated 7 Partially substantiated 1 Unsubstantiated 2 Redirected to another agency 0 Non safeguarding (de-escalated) 2 On-going 10 Total 22 9

12 cases were relating to patients allegedly developing pressure ulcers grade 3 and above whilst in hospital. To date, 1 case has been substantiated and a root cause analysis undertaken. 1 case was partially unsubstantiated and 2 unsubstantiated. The remaining cases are currently open. There were 3 cases of allegations of physical abuse - 1 relating to multiple bruising caused whilst in hospital, this was unsubstantiated. 1 case relating to bruising sustained outside the hospital setting within a care home, also unsubstantiated. 1 case of self harm which was redirected to another agency. 1 case of sexual abuse - this involved allegations made against a member of contracted staff, the case was investigated by the police and the employees contract of employment was terminated. 8.0 SERIOUS CASE REVIEWS A Serious Case Review is an inter-agency review of a case, to consider whether there are lessons to be learnt about the ways in which agencies worked together to safeguard vulnerable adults. This may be requested following a patient s death or where a case may have not concluded as expected. (Safeguarding Vulnerable Adults Policies, Procedures & Guidelines, October 2009). The Trust has not been involved in any Serious Case Reviews in the last 12 months. 9.0 SAFEGUARDING AUDITS & SURVEYS Audits are an important way of assuring the Trust and the teams on the quality of the process and practices used when implementing safeguarding adult processes. During the reporting period the following audits were undertaken: Completion of Safeguarding Referral Form An audit of the joint services safeguarding adult s referral form looking at the compliance in completing the form was undertaken during the first week of June 2013. The audit results identified that the form was being completed correctly in 87% of the 40 referral forms completed. 13% of the forms were not completed correctly. Out of the 13% of referral forms not completed correctly, 2% of referral forms were incomplete and the wrong referral form was used. 11% of the referral forms had one or more key elements of data incomplete on the form or the information on the form was illegible or unclear. The results were shared with the Senior Sisters and Charge Nurses. To address the small number of inaccuracies that were highlighted during the audit, the Interim Named Nurse, Safeguarding Adults, on receipt of a referral, will review the quality of completion and will actively provide feedback direct to the practitioner if omissions/inaccuracies are noted. This facilitates a positive approach to learning and aims to influence a positive change in practice. Reasonable Adjustment Audit A Reasonable Adjustment audit was completed in August 2013. This has enabled the Trust to obtain a baseline on how much staff are aware of the tools and services that are available to support reasonable adjustments whilst a service user with a learning disability is in the organisation. The results were presented at the Learning Disability Committee meeting in January 2014 and work will be undertaken by the Learning Disability Liaison Nurse during 2014 to address the deficits identified. The Outpatient Departments have been identified as a priority 10

area. The recommendations and actions identified from the audit are incorporated into the Trust s LD Action Plan. A snapshot audit of the completion of Mental Capacity Assessments was undertaken in February 2014. The results demonstrated a lack of knowledge amongst staff with regard to the processes and application of MCA/DoLs. This is consistent with the findings of the Care Quality Commission (CQC) in their 4 th Annual report on the Application of the Mental Capacity Act (MCA 2005) published January 2014. The Safeguarding Team has drafted a MCA/DoLS action plan to ensure the Trust is compliant with the recommendations made by the CQC and this will presented to the Safeguarding Assurance & Strategic Group in May 2014. The Trust s audit framework for 2104/15 has been updated to include audits of Mental Capacity Act and DoLS compliance. 10.0 SELF ASSESSMENT FRAMEWORK FOR SAFEGUARDING The Self-Assessment Framework (SAF) is a framework that ensures that each organisation is using best practice principles when commissioning and providing Safeguarding Adult Services. The SAF for the borough of Havering was completed and submitted at the end of January 2014. Four key actions for improvement were identified by BHRUT: Four key actions were identified by BHRUT: Production of a Safeguarding Adult s Strategy for 2104-2016 Development of a Safeguarding Adults Supervision Policy Production of a Safeguarding Leaflet Development of a Public Safeguarding Website All the above actions have been progressed and will be monitored at the Safeguarding Adults and LD Operational Group. The Havering Peer SAF challenge on the 10 th March 2014 attended by the Director of Nursing and the Safeguarding Lead, BHRUT provided the opportunity to present the Trust s strengths and weaknesses relating to safeguarding. This was a multi-agency event that was seen as an opportunity to be open and transparent and to identify and share good practice amongst interagency peers. 11.0 MENTAL CAPACITY & DEPRIVATION OF LIBERTIES & ADVOCACY SERVICE In January 2013, a database was created to capture the number of Mental Capacity and Deprivation of Liberty referrals made by the Trust. For the reporting period, 5 Deprivation of Liberties referrals were made. The Safeguarding Team will be making this a priority area for 2014/15 and a new database has been established. The Interim Named Nurse Safeguarding Adults and the Learning Disability Liaison Nurse are visiting ward areas on a weekly basis to raise awareness and support staff in recognising those patients that may need a Mental Capacity Assessment, Deprivation of Liberty Safeguards authorisation and/or a referral to the advocacy service. VoiceAbility is the national advocacy service that provides people who are vulnerable or marginalised to raise their voices and have their rights respected. The service continues to work with the Trust providing independent support and unbiased advice to those patients that require a best interest decision to be made. The service is for those patients who do not have capacity to make certain decisions or may not have family members to support them in the decision making process. 11

12.0 LEARNING DISABILITIES 12.1 Overview BHRUT continues to strive to improve the experience patients with Learning Disabilities receive whilst in our care. Equality in accessing healthcare is the central principle in the delivery of care within the NHS. The reports, Death by Indifference (2007 & 2012), Healthcare for All (2008), the Ombudsman Report Six Lives (2009) provided the evidence that equality for patients with a Learning Disability who use NHS services was sadly lacking. Despite these reports and the recommendations made within them, in October 2013, the CQC through a confidential enquiry highlighted further failings in the care of patients with learning disabilities, identifying that patients are still dying needlessly due to inadequate care being provided (CIPOLD, 2013). 12.2 LD Initiatives Implemented Key initiatives implemented during the reporting period include: As part of the Trust s mandatory Safeguarding module training a 30 minute session on the care and management of patients with Learning Disabilities is included People with Learning Disabilities and their carers contribute to teaching on Trust wide inhouse study days, which has given staff the tools to understand the complexity of the patient s needs. Each ward/department has a Safeguarding Adults and Learning Disability Champion. This number across the Trust has now increased to 66. The Emergency Pathway for Learning Disability outlining a clear process to follow when a patient with a LD is admitted to hospital was introduced in October 2013. Good Practice Checklist was introduced in October 2013 to be completed on admission by the ward Matron/Senior Nurse. The hospital passport on the Trust Intranet site. The appointment of a Learning Disability Liaison Nurse who commenced in the Trust at the beginning of March 2014. This role will provide support and professional advice to staff, patients and their families and will ensure that the reasonable adjustments required will be put in place to ensure the patient with learning disabilities experience is the best it can be. 12.3 Learning Disability Self-Assessment Framework (LD SAF) The LD SAF is a benchmarking tool and gives a snapshot of how the services we provide make reasonable adjustments to care for patients with Learning Disabilities. Using a multidisciplinary approach, information gathered locally in partnership with people with learning disabilities and their families, this assessment ensures that organisations are taking action to improve healthcare and health outcomes. NHS London has developed a Self-Assessment Framework, which will provide an assurance system for clusters and sub clusters on Autism and Learning Disabilities. The Trust completed the Learning Disability SAF in October 2013. There were no actions for improvement identified. 12

12.4 Learning Disability Conference The Trust held a Learning Disability Conference in August 2013 to celebrate how far the Trust had come in providing better care for those patients who have a Learning Disability and looked at what more can be done to serve this vulnerable group of patients. It was also the first birthday of the Trust launching the MENCAP Charter. The Conference, chaired by the Trust s Director of Nursing, was a resounding success with over 50 delegates attending the day. It commenced with the Trust s Deputy Director of Nursing providing an update on initiatives that have been put in place since the launch of the MENCAP Charter in June 2012. The Policy & Development Lead, MENCAP (London) gave a compelling and thought provoking resume of the developments of a number of reports that Mencap has published including Death by Indifference a Progress Report (2013). She told the stories of six individuals identified in the report, highlighted the failings that occurred in acute services and how these situations could be avoided with the correct assessment and right care provided at the time. A Learning Disability service user discussed his experiences as a patient in outpatients, highlighting what had worked well and what could have improved during his journey whilst one of the Community Learning Disabilities Nurses from Havering tested the audience s knowledge of what is currently available to support staff within the Trust by way of resources to support the patient with Learning Disabilities whilst under the care of the Trust. The Director of Nursing chaired the afternoon workshop. This incorporated four facilitated groups in the form of a World Café looking at four key themes (communication, patient journey, patient environment and discharge planning), which had been highlighted as areas for further development in previous Learning Disability patient surveys and LD Audits completed by the Trust. 12.5 Learning Disability Patient Passport As a requirement and recommendation from the White paper Valuing People (2009) the target that all patients with Learning Disabilities should have a Patient Passport by September 2013 was established. NELFT, in collaboration with Bart s Healthcare and BHRUT, streamlined the Passport to enable fluid and transferable needs assessment that will be effective in whichever patient environment the patient journey takes. The final document was peer reviewed by staff within BHRUT and following very positive feedback was approved by the Trust s Safeguarding Adults Committee in October 2013. This is now available to staff on the Trust s intranet site. 13.0 DEMENTIA 13.1 Dementia Strategy The Trust established a Dementia Strategy for patients using BHRUT services aligned to the National Dementia Strategy (2009) ensuring patients have access to early diagnostics, correct and NICE approved medication and the highest standard of care whether in an inpatient facility or community care environment. The Trust s Dementia Nurse Specialist, who was appointed in November 2013, is instrumental in driving forward the Dementia Strategy and meeting the Trust s CQUIN for Dementia. Key initiatives implemented during the reporting period include: 13

The provision of Dementia awareness training, achieving the Trust s 1500 target. The inclusion of Dementia within the Safeguarding Module on mandatory training and the development of six e-learning modules. The introduction of Behaviours that Challenge training February 2014, initial target audience is Care of the Elderly staff although all staff are encouraged to attend. A Dementia Link Nurse Forum was introduced in February 2014 An audit of the Dementia/Delirium pathway was registered with the Audit Department in March 2014. The audit will focus on pathway completion, compliance amongst staff. 13.2 Dementia Week The Trust embraced dementia week during the last week in January 2014. Professor Burns, National Clinical Director for Dementia, delivered a talk on Dementia awareness and held a study session on Dementia Friends. This was open to all Trust staff and invitations were sent to staff from external agencies; approximately 50 people attended. The work undertaken by BHRUT in raising awareness was acknowledged by Professor Burns as: The best example I ve seen of raising dementia awareness in the general hospital and really doing things for patients. Professor Orrell, UCLP, also shared the work they are currently doing on training and the impact this has on reduced length of stay for this client group. An awareness stand was displayed in the atrium at Queen s Hospital with both internal and external healthcare professionals available to provide advice and guidance to staff and visitors who were interested. 14.0 LOCAL AUTHORITY & PARTNERSHIP WORKING 14.1 Local Safeguarding Boards, Committees and Sub committees BHRUT is a member of four Local Safeguarding Adult Boards, which are the London Borough of Havering, Barking & Dagenham, Redbridge and Essex. The Deputy Director of Nursing or the Safeguarding Lead represents the Trust at these meetings. The Trust also attends all partnership committees and sub-committees hosted by all four Boroughs. These meetings include Domestic Violence, Performance and Serious Case Reviews, Training and Development. 14

15.0 KEY PRIORITIES FOR THE SAFEGUARDING ADULTS TEAM - 2014/15 Priorities To embed the identified key actions of the Safeguarding Adults Strategy 2014-2016. Raise awareness and promote the system of reporting Mental Capacity Assessments (MCA) and Deprivation of Liberty (DoLS) applications amongst staff. Timescales 2014/15 2014/15 Maintain the MCA/DoLs database to fulfil the Trust s reporting responsibility. Establish a training package for MCA/DoLs. July 2014 To produce a Safeguarding leaflet for the general public. April 2014 To produce a Safeguarding webpage for the BHRUT April 2014 external website accessible to the general public. To develop and implement a Safeguarding Adults May 2014 Supervision Policy Embed the principles of the MENCAP charter within the 2014/15 Trust. Finalise the Trust Transitional Policy June 2014 This is to identify a process in which children with complex care needs are transferred to adult services safely and with reasonable adjustments. Hold a Learning Disability Conference. Deliver safeguarding adults training as per the Training Needs Analysis and Training Strategy. Ensure all audits are completed as per the 2014-2015 Safeguarding Adults Audit Plan. September 2014 2014/15 2014/15 16.0 CONCLUSION This report clearly demonstrates the continued improvement and commitment of staff in safeguarding the adult at risk. This includes the continued working in partnership with other agencies in all four Boroughs. The Trust will continue to strengthen care provision in line with national and local directives and legislation related to safeguarding adults at risk. 17.0 REFERENCES CIPOLD: Confidential Inquiry into the deaths of people with leaning disabilities (2013) http://www.bristol.ac.uk/cipold/fullfinal report.pdf Dementia Strategy (2009) hhttp://www:dh.gov.uk Deprivation of Liberty Safeguards (DOLS) http://www.dh.gov.uk 15

Mental Capacity Act (2005) http://www.legislation.gov.uk/uk Mencap Death by Indifference (2007) http://www.mencap.org.uk Mencap (2012), Death by Indifference: 74 deaths and counting. A progress report 5 years on Michaels J (2008) Healthcare for All: Report of the Independent Inquiry into access to health care for people with learning disabilities. http://www.dh.gov.uk NHS London UK Core Skills Training Framework (2013) Subject 9 Safeguarding Adults pge 69-75 http://www.skillsforhealth.org.uk/developing-your-organisations-talent/uk-wide-core-skillstraining--framework/ No Secrets 2000 Guidance Department of Health and Home Office10693 Crown Copyright Protecting Adults at Risk: London Multi Agency policy and procedures to safeguard adults from abuse (Jan 2011). http//www.scie.org.uk/publications/reports/report39.pdf ýsafeguarding Vulnerable Adults Policies, Procedures & Guidelines, October 2009) The Ombudsman Report Six Lives (2009) http://www.dh.gov.uk Transforming Care Winterbourne View Final Report https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127310/finalreport.pdf.pdf The Mid Staffordshire - NHS Foundation Trust Public Inquiry (Chaired by Robert Francis QC) (2012) http://www.midstaffspublicinquiry.com/sites/default/files/report/volume%203.pdf The Safeguarding Adults: A National Framework of Standards for Good Practice and Outcomes in Adult Protection Work (2005). The Association of Directors of Adult Social Services http://www.adass.org.uk Andrea Crisp Interim Named Nurse, Safeguarding Adults Gary Etheridge Deputy Director of Nursing 16

Appendix 1 BHRUT SAFEGUARDING CHILDREN & ADULT STRUCTURE Dr Kantha Niranjan Named Doctor, Safeguarding Adults 0208 970 8405 or 01708 435000 Ext: 3391 Dr Seyi Solebo Named Doctor, Safeguarding Children 01708 435000 Ext. 6350 Flo Panel-Coates Director of Nursing (Executive Lead for Safeguarding) 01708 435000 Ext: 2609 Gary Etheridge Deputy Director of Nursing 01708 435000 Ext: 2820 Safeguarding Children s Administrator 01708 435000 Ext: 2892 Stephen Hynes Safeguarding Lead/Named Nurse Safeguarding Children 01708 435000 Ext. 4930 Safeguarding Adults Administrator 01708 435000 Ext: 3391 Bernie Gibbings Named Midwife 01708 435000 Ext. 4925 or DECT: 6322 Ruth Gardner Interim Paediatric Liaison Nurse 01708 435000 Ext. 4890 or DECT: 6322 Heather Woollard Learning Disabilities Liaison Nurse 01708 435000 Ext. 4928 Andrea Crisp Interim Named Nurse Safeguarding Adults 01708 435000 Ext. 4930

Appendix 2 BHRUT REVISED SAFEGUARDING GOVERNANCE STRUCTURE Trust Board Chair: Chairman Frequency of Meeting: Monthly Local Safeguarding Children s Board - B&D Local Safeguarding Children s Board - Havering Quality & Safety Committee Chair: Non-Executive Director Frequency of Meeting: Monthly Safeguarding Strategic Group Chair: Director of Nursing Frequency of Meeting: Quarterly Local Safeguarding Adult s Board B&D Local Safeguarding Adult s Board - Redbridge Local Safeguarding Adult s Board - Essex Local Safeguarding Children s Board - Redbridge Local Safeguarding Adult s Board - Havering Safeguarding Children Operational Group Chair: Safeguarding Lead Frequency of Meeting: Every Six Weeks Safeguarding Adults & LD Operational Group Chair: Safeguarding Lead Frequency of Meeting: Every Six Weeks LD Working Group Chair: LD Liaison Nurse Frequency of Meeting: Monthly