Agenda item

This report sets out details of written evidence received in respect of safeguarding vulnerable adults. 

The order of business has been agreed (at the last meeting) as follows:

1.                  The Chairman to welcome everyone to the meeting and go through the usual business of the meeting

2.                  The following should be invited to respond to the issues raised in the attached report:

Barbara Bradley, Safeguarding Vulnerable Adults Board Manager

Susan Roots, Lead for Safeguarding Adults, NHS Medway

Sallyann Larkin, Safeguarding Adults Co-ordinator

3.                  Responses from Marion Dinwoodie, Chief Executive, NHS Medway and David Quirke-Thornton, Assistant Director, Adult Social Care/Rose Collinson, Director of Children and Adults

4.                  The meeting will then be open for Member questions and debate

5.                  Unless there are specific recommendations which the Committee wish to make from the meeting there will be a meeting of the task group arranged to form recommendations to be put to 30 September 2010 meeting of the Committee.

The Kent and Medway Safeguarding Vulnerable Adults Board Manager introduced the discussion by explaining her position as manager of a small multi-agency safeguarding vulnerable adults team, which is funded by key agencies across Kent and Medway and accountable to those funding partners.  These included Medway Council, Kent Adult Social Services, Kent Police and the three NHS Trusts in Medway, East and West Kent.  The role of the multi agency team is to:

• Service the Kent and Medway Safeguarding Vulnerable Adults Executive Board, Executive Team, the Network, Policy, Protocols and Guidance Review Group, Training Group and Serious Case Review Panels
• Effectively co-ordinate the work of all these groups
• Regularly report to the Executive Board and Executive Team and other partner meetings
• Ensure effective communication of the work of the various groups
• Design, deliver and evaluate multi-agency safeguarding training
• Manage the multi-agency budget

A review of the multi-agency governance arrangements had been undertaken resulting in clearer terms of reference for all groups to ensure that each group was more focussed on outcomes and sure of its responsibilities.  The importance of strengthening multi-agency working was also stressed.

Medway Council’s Safeguarding Adults Co-ordinator then gave a short introduction to her role and highlighted the importance of the Committee setting up a themed meeting on the topic of safeguarding adults.  She emphasised that the protection of Medway’s most vulnerable citizens was everyone’s responsibility and that this theme was echoed in a recent multi-agency public awareness campaign. 

Members were advised that 2-4% of Medway’s older population were likely to have suffered neglect at the hands of their family in the last year according to recent research, this equated to approximately 1,500 older people in Medway.

Ahead of an anticipated Care Quality Commission inspection later in the year preparation was underway to ensure that evidence of best practice could be demonstrated.  The key message was to look at what currently worked well and how this could be developed although there was a place for reviewing lessons learnt following audits and serious case reviews.

The Lead for Safeguarding Adults, NHS Medway then gave an introduction to the work NHS Medway was involved in regarding safeguarding vulnerable adults.  She informed Members that NHS Medway was committed to safeguarding adults and set out ways it used to monitor its main providers to obtain assurance that a range of safeguarding strategies were in place to prevent abuse.

There had been a sustained investment by the health sector over the last three years to safeguarding adults and all statutory health organisations now had a designated Safeguarding Adult and Mental Capacity Act lead person.

The Committee were informed of extensive training programmes in place for both safeguarding adults and Mental Capacity Act and the fact that this training was part of the mandatory corporate induction for new members of staff.

As a result of this training there had been more referrals with the outcome of more patients being safeguarded from harm.

It was stated that NHS Medway had a statutory responsibility under the Mental Capacity Act Deprivation of Liberty Safeguards to ensure that patients who lacked capacity to make decisions were not unlawfully deprived of their liberty. 

As Lead for Safeguarding Adults she explained that she was part of a number of networks both locally and across the South East Coast to share best practice and improve collaborative relationships.

The Deputy Chief Executive, NHS Medway referred to the weight of responsibility on all agencies working to protect vulnerable adults and the importance of getting it right.  She stated that there was more to be done particularly with regards to working with General Practitioners (GPs) and practice teams as they saw people over a long period of time and as such were well placed to identify where abuse was taking place, and that the Lead for Safeguarding Adults was working proactively with GPs on this.

The Assistant Director, Adult Social Care, reinforced what had been said and stated that when the Care Quality Commission, as the regulator of social care, had inspected care homes in Medway only one was rated as adequate with the remainder being rated as good or excellent.  In spite of this there was no room for complacency and he was concerned to ensure that there was continued improvement and that the public could be reassured that action would be taken to prosecute those who were found to have abused vulnerable adults.  In relation to the personalisation agenda he explained the thoroughness of the checks undertaken with service users, which included taking up references and Criminal Records Bureau (CRB) checks.  He stated that he wanted to ensure that the vulnerable adults in Medway were cared for and that this would be evidenced in the forthcoming inspection.

The Director of Children and Adults stated the importance of creating and sustaining a culture which recognised and acknowledged that adult harm happened but should be dealt with in a multi-agency way and learnt from.

The meeting was then opened for Member debate.  A summary of the issues raised are listed below:

• Members were assured that the recent awareness campaign had been a multi-agency one which had also included Police Community Support Officers (PCSO’s) and Community Safety Officers.
• With regards to reporting abuse the contact numbers were set out on cards, which were handed to each Member of the Committee prior to the meeting.  It was confirmed that the telephone number shown would be answered personally over a 24 hour basis.  Action would be taken to deal with each enquiry and the most appropriate agency would be alerted to the issue.
• Lessons had been learnt from the public awareness campaign about the way the leaflets were written and this would lead to changes to the wording and format.
• Further details were given about the Care Quality Commission inspection and what that entailed.  During this it was mentioned that the Care Quality Commission (CQC) had rated Kent County Council as ‘good’ with regards to safeguarding vulnerable adults and that Medway Council had conducted a self-assessment ahead of the CQC inspection. 
• It was stated that prior to being inspected Kent County Council had commissioned an external pre-inspection by a consultant and that this would be a useful exercise to undertake in Medway.
• Discussion took place about the need for unannounced inspections of care homes to ensure that a true picture was seen.
• Members were informed that the Kent and Medway Safeguarding Vulnerable Adults Board had the task of auditing each agency’s working.  It was also emphasised that everything regarding vulnerable adults was ‘on the record’ with records kept of all email exchanges, meetings and visits.  The CQC would also carefully monitor any cuts in training on safeguarding and what impact this had.
• Details were given of the Improving Home Life Programme for care homes, which had been launched last month.
• In relation to concerns about problems experienced following discharge from hospital the Deputy Chief Executive, NHS Medway undertook to look into the possibility of producing a contact card for people as they are discharged from hospital setting out details of who the person should contact in the event of experiencing difficulties.
• The Director of Children and Adults, in response to a query, undertook to ensure that the Safeguarding Adults Co-ordinator from Medway Council makes a visit to Medway Pensioners Forum in order to publicise adult safeguarding.
• The importance of categorising carers as potentially vulnerable adults was emphasised.
• It was confirmed that all staff, including agency staff, in care homes were subject to a CRB check.
• Some concern was expressed that 38% of referrals were not substantiated.  The Director of Governance, Medway NHS Foundation Trust explained that as far as complainants were concerned action was always taken as a result of a referral although this may not always lead to a conviction (i.e. a substantiated referral).  The Safeguarding Adults Co-ordinator stated that, as a result of making a referral she wanted people to feel that they were safer at the end of the process as an outcome.  She reassured Members that having one unsubstantiated claim did not prevent a person from making further claims.  90% of the referrals lead to an agreed protection plan with 20% having increased monitoring.
• The Director of Children and Adults stated that in future reports on safeguarding further narrative would be given to explain the outcome of referrals.
• It was explained that mentoring was provided in the case of some referrals and that family conferencing/facilitating had been used to help communicate about the abuse across a family group.
• Responding to a question about the number of investigations completed within 6 months it was stated that delay sometimes related to the sign off procedure by a senior manager at the conclusion of the referral.   He emphasised that this did not mean that the investigation itself was delayed.  It was confirmed that there had also been self-referrals.
• The Director of Children and Adults, in response to a question about a recent case in Hertfordshire stated that responsibility for safeguarding was a shared one and there could be no guarantees that a similar event could not happen in Medway.  However she restated the commitment to working to ensure that there was a wider awareness of the possibility of abuse so that people felt able to report incidents and challenge events in order to protect vulnerable adults.
• With regards to long-term trends it was stated that after an initial increase it was anticipated that the trend of referrals would plateau.
• It was suggested that more advertisement was needed in cases where prosecution action was taken to protect vulnerable adults to demonstrate that referrals were taken very seriously.
• It was confirmed that there was no regulation in respect of privately owned residential retirement properties and no requirement on the owners to use staff that had been CRB checked.

The Chairman thanked everyone for their contribution to the meeting and stated that the collective expertise had been very useful in guiding Members in their deliberations.

Decision:

The Committee agreed to:

(a)               Note that officers will commission an independent review into safeguarding and, if possible, incorporate into this a meeting with the task group prior to it feeding back to the Committee;

(b)               Note that an initial meeting of the task group would take place on 2 September 2010 and that depending on the agreed timescale of completion of the independent review, the task group may not put forward recommendations until 11 November 2010 meeting.