Safeguarding Adults and Children Annual Report · 2018-12-28 · and Social Work Bill 20171...
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Safeguarding Adults and Children Annual Report 2017 / 2018 September 2018
Transcript of Safeguarding Adults and Children Annual Report · 2018-12-28 · and Social Work Bill 20171...
Safeguarding Adults and Children Annual Report
2017 / 2018
September 2018
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Contents Page
1 Executive Summary
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2 Purpose of report
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3 Safeguarding is everybody’s business. 4
4 Achievements in 2017- 2018 5
5 Statutory Framework, National and local Policy Drivers 7
6 Changes in Safeguarding children 8
7 National Health Service Safeguarding Adult and Children Priorities
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8 Local Context
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9 Leadership, Management and Accountability
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10 Key Professionals 16
11 Haringey Safeguarding Children Board (HSCB) Activity 2017 – 2018
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12 Child Death Overview Panels (CDOP)
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13 Reviews and Audits
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14 Serious Case/ Significant Incidents: Adult Reviews (SCR/SARs)
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15 New Service Developments
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16 Haringey Children in Care (CIC) 35
17 Safeguarding Children Assurance data from Commissioned Services 2017-2018
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18 Safeguarding Monitoring of Haringey Clinical Commissioning Group (HCCG) 42
19 Safeguarding Monitoring of Haringey General Practices 43
20 Progress against Objectives 2017-2018 46
21 Key Objectives 2018-2019 60
22 Appendices Appendix 1 – Publications 2017-2018 63
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1. Executive Summary
1.1 Introduction
1.1.1 NHS Haringey Clinical Commissioning Group (HCCG) is committed to working with partner agencies to ensure the safety, health and well-being of the local people in Haringey. Protecting the vulnerable is a key part of the
CCG’s approach to commissioning and together with a focus on quality and patient experience, is integral to our working arrangements. Our approach to adult Safeguarding is underpinned by quality and contracting systems and processes that aim to reduce the risk of harm and respond quickly to any concerns.
1.2 The fourth annual report for Haringey Clinical Commissioning Group (CCG) which also covers the financial year 1 April 2017 - 31 March 2018.
1.3 The CCG recognises that residents have the right to live in safety, free from abuse and neglect and that safeguarding is everybody’s business.
2 Purpose of Report
2.1 The purpose of the report provides assurance that Haringey CCG was compliant with safeguarding duties during 2017-2018 as a set out in Section 11 of the Children Act 2004.
2.2 Key areas of priority and service development were established in the Haringey CCG Safeguarding Children and Adults Annual Report 2017-2018 and progress against the priorities is detailed in the three year work plan.
2.3 This report will summarise positive progress and activity undertaken in 2017-2018
and also highlight areas of further work detailed in the 2018-2019 work plan. 2.4 The annual report 2017/2018 will give an overview of the performance of each
provider highlighting achievements, risks and actions for 2017-2018.
3 Safeguarding is Everybody’s business
3.1 Safeguarding is ‘everybody’s business and the HCCG Safeguarding Team works to ensure that it remains a ‘golden thread’ running through all commissioned services.
3.1.1 It remains the responsibility of every NHS funded organisation and healthcare professional to ensure that people in vulnerable circumstances are not only safe, but also receive the highest possible standard of care.
3.2 Safeguarding comprises a broad and complex agenda that in addition to the more commonly known work streams includes the following:
Female Genital Mutilation
Domestic Abuse
Domestic Homicide Reviews
Child Sexual Exploitation
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Mental Capacity Act & Deprivation of Liberty Safeguards
Human Trafficking/Modern Day Slavery
Serious Case Reviews
Counter Terrorism (Prevent)
Response to Saville
Child Deaths
Adult Deaths where abuse is suspected or the circumstances are unusual
3.3 The HCCG Safeguarding Team continue to work in partnership with key
stakeholders to monitor the safeguarding arrangements of commissioned health services; to respond to adults and children who have been harmed or are at risk of harm, with the intention of delivering improved outcomes for the most vulnerable.
3.4 The success of this team requires the full engagement of the commissioned Acute, Community and Mental Health Foundation Trusts, GP Practices across the CCG and Partner Agencies.
4 Achievements in 2017- 2018:
4.1 There has been significant progress against the 2017 - 2018 objectives in addition to maximising opportunities to develop localised polices and protocols across North Central London CCGs, providers, commissioners and with partner agencies including London Borough of Haringey (LBH). Below are some of the
developments achieved during 2017-2018. A full summary of progress can be found in section.
HCCG made a significant contribution to the Haringey Neglect Joint Targeted Area inspection.
Fulltime health MASH practitioner secure in the MASH steered by HCCG (highlighted as a strength in (JTAI Dec 2017).
Safeguarding Children after Action Review (AAR) commissioned by HCCG to review the Health System response to the JTAI in December 2017.
The CCG has maintained the required full complement of safeguarding
personnel.
HCCG Designated Nurse Safeguarding Children (DNSGC) successfully submitted bid and secured funding for an STP safeguarding event.
HCCG Designated Nurse led the development and delivery of an NCL
STP Safeguarding accountability and assurance conference which raised profile of safeguarding across the STP.
Haringey CCG made a significant contribution to partnership working and the LSCB and HSAB in terms of staff and financial resource.
Regular supervision of Named Doctors, Nurses and Midwife in the Haringey provider health organisations overseen by HCCG Designated Nurse and Doctor.
The Designated Nurse and Doctor contributes to the monitoring of
provider’s compliance with safeguarding children standards.
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Designated Nurse receive alerts of Significant Incidents involving children under 18 years old.
Implementation of the Child Protection Information Sharing programme (CP-IS) with provider organisations who deliver unscheduled health care was steered for start date 01/04/2018.
GP Safeguarding Children training “working with teenagers with neglect”
was delivered and positive evaluations received.
Designated doctor facilitated a workshop with Haringey legal team on improving medical reports.
Designated Doctor facilitated a workshop for Children in Care Health
Team on Gangs in January 2018 and how they can report in a constructive and collaborative way.
Designated Professional for Safeguarding Adults (DPSA) supported the
VAWG lead in Haringey and Enfield Local Authority and North Middlesex University Hospital (NMUH) to successfully submit a bid to the national path finder project to develop a shared vision to achieve best practice responses to domestic abuse in health settings.
DPSA provided Monthly Safeguarding Adult Supervision and separate mentoring sessions to the Safeguarding Adult Lead in the NMUH.
Provided cover for Islington CCG in the absence of a DPSA and have since provided monthly safeguarding adult supervision to the interim
DPSA.
DPSA Supported the Safeguarding Adult Board (SAB) awareness campaign visiting GP surgeries in conjunction with Victim Support holding information sessions with general public and surgery staff.
Supported the development of the SAB dashboard and provide quarterly health safeguarding data. .
Supported the implementation of the Learning Disability Mortality Review in Haringey including providing SAB with quarterly reports.
Produced a new public facing NHS Haringey Intranet page to raise awareness and provide information to the general public. In addition to this produced a new staff GP intranet safeguarding adult’s page.
Collaborated with the Department of Health and Social Care on the Law
Commissions (DoHaSC) proposal for Deprivation of Liberty.
Reviewed and updated the DoHaSC “Pressure Ulcer Protocol “Whether to do a Safeguarding referral” with the Patient Safety Manager which was agreed by the SAB.
Instigated a monthly meeting with Haringey Safeguarding Lead to review themes from health related safeguarding’s.
Supported CHC commissioning to develop spec for legal procurement on Deprivation of Liberty Safeguards (DoLS).
Supported interim Continuing Health Care Nurses through Judicial DoLS procedure.
Supported the development of the CHC Clinical Team Policy, CHC Standard Operating Procedure and Panel process.
Audited safeguarding outcomes CHC team.
Supported health organisations to embed learning from SARs, DHR and safeguarding.
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Supported the NMUH to recruit a Learning Disability Nurse.
5 Statutory Framework, National and Local Policy Drivers
5.1 The duties and functions in relation to safeguarding for NHS Haringey CCG are articulated within NHS England Safeguarding Accountability & Assurance
Framework (June 2015). 5.2 National Legislation, policy and guidance documents:
5.2.1 Safeguarding adults & children activity is supported by the exiting legislation, guidance and frameworks:
Working Together to Safeguard Children (2015) updated in 2018
Children and Social Work Act 2017
Policing & Crime Act 2017
Safeguarding Vulnerable People In the NHS – Accountability and
Assurance Framework (2015)
Promoting the Health and Well-being of Looked after Children (2015)
Serious Incident Framework (March 2015)
Criminal Justice and Courts Act 2015
Channel Duty Guidance. Protecting vulnerable people from being drawn into terrorism (2015)
Safeguarding Children and Young People: roles and competences for Health Care Staff, Intercollegiate document (2014)
Care Act 2014
Equality Act 2010
Mental Capacity Act 2005 / Deprivation of Liberty Safeguards 2009
Health and Social Care Act 2008
Children Act (1989) and (2004)
Sexual Offences Act 2003
The Human Rights Act 1998, 2000
Mental Health Act 1983 / 2007
5.3 Updates in National and local Guidance and References
5.3.1 During 2017-2018, a number of additional references and national guidance documents were published in this financial year which the CCG refers
to and follows. These are listed in Appendix 1. 5.3.2 The LSCB’s are responsible for local child protection policy, procedure and guidance.
5.3.3 Details of legislation and guidance documents are listed in the Haringey CCG Safeguarding Children Commissioning Organisation Policy and
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Procedures Safeguarding children policy 2015. This policy document will be updated in 2018 to reflect changes in legislation.
6 Changes in Safeguarding Children Going Forward
6.1 In May 2016, the government published its response to the Wood Review. The Children and Social Work Bill 20171 received Royal Assent in April 2017, which legislates for reforms,
including the abolishment of LSCBs and removes the Children Act 2004 duties relating to them. 6.2 In their place, it puts duties on three 'safeguarding partners' - the Local Authority, any
CCGs operating in the area and the Chief Officer of Police, to make safeguarding arrangements that respond to the needs of children in their area. 6.3 It is anticipated it will take 12-18 months for the reforms to be put in place and the CCG will
support the work of LSCBs, until the reforms are in place and participate in future arrangements. 6.4 In October 2017, a national consultation process on revising ‘Working Together to
Safeguard Children’ was launched. Haringey CCG contributed to the consultation and the document of this work2. An updated Working Together to Safeguard Children was ultimately published in July 20183. The CCG supports the continuation of partnership working and engagement of health providers as key contributors to safeguarding children and families.
6.5 Other changes within the new legislation include:
6.5.1 Child Safeguarding Practice Review
A Child Safeguarding Practice Review Panel has been established, which will identify and review local safeguarding cases it judges to be complex or of national significance. The purpose of the review is "to identify any improvements that should be made by safeguarding
partners or others to safeguard and promote the welfare of children".
A local authority must notify the panel of any instance where a child dies or is seriously harmed in their area, or where a child usually resident in their area dies or is seriously harmed
outside of England. The panel has the power to request any information that will help it in its review. 6.5.2 Child Death Review Process
1 http://services.parliament.uk/bills/2016-17/childrenandsocialwork.html. 2
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/683115/Changes_to_statutory_guidance-
_Working_Together_to_Safeguard_Children.pdf 3
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/722305/Working_Together_to_Safeguard_Children_-_Guide.pdf
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A section of the Act provides for the functioning of child death review partners in a local authority area. The child death review partners must arrange for the review of every death of a
child usually resident in their area, and of children not usually resident in their area if they consider it. 6.5.3 LeDeR Reviews
The learning Disabilities Mortality Review (LeDeR) programme was established to support local areas to review the deaths of people with learning disabilities, identify learning from those deaths and take forward learning into service improvement initiatives. The programme is led
by Bristol University and commissioned by the Health care Quality Improvement partnership (HQIP) on behalf of NHS England. The LeDeR programme seeks to support local systems to embed reviews of deaths of people
with learning disabilities. It is a support and analysis function. The responsibility for oversight of ongoing structures that facilitate the review of deaths sits within local services. It is a requirement by NHSE to undertake Learning Disability and Mortality reviews for Adults
and Children. Haringey CCG have implemented a local Haringey LeDeR steering group. The Steering group utilises the LeDeR methodology to guide improvements in the quality of health and social care service delivery people with learning disabilities.
To support the process Haringey CCG and Provider LeDeR reviewers completed the training in 2017. NHSE and NCL LeDeR leads provide support to ensure that LeDeR process will work alongside CDOP processes ensure effectiveness of the programme. During the period covered by the report there has been no LeDeR reviews undertaken for a child under 18 years
old and 4 LeDeR cases for adults which are currently being reviewed and all deaths have been rigorously reviewed seen in CDOP section. The Designated Professional for Safeguarding Adults is the conduit between the LeDeR
steering group and the Safeguarding Adult Board and provides regular briefings to the board. 7 National Health Service Safeguarding Adult and Children Priorities
7.1 Safeguarding Children 7.1.1 NHS England priorities for 2017-2018 are:
- Female Genital Mutilation (FGM) - Domestic Violence - Child Sexual Abuse and Exploitation and Child Sexual Abuse /Child Sexual
Exploitation (CSA/CSE)
- Modern Slavery - Prevent - MCA/DoLS - Safeguarding against self-neglect
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7.2 NHS Haringey CCG have contributed to the delivery of the NHSE regional priorities as follows:
7.2.1 Child Sexual exploitation (CSE) The Haringey CCG Designated Nurse Safeguarding Children and Young people (DNSCYP) remains the CCG Strategic Lead for services around tackling CSE with the Haringey Local
Safeguarding Children Board (HSCB). The DNSGC is a member of the HSCB the priorities subgroup (formally the CSE sub group).
Child sexual exploitation is high within both the national and local priorities for safeguarding
children. Since notification of the Independent Inquiry Child Sexual Abuse (https://www.iicsa.org.uk). To date the CCG has not received notification from the Inquiry in
relation to any potential disclosures that involve the Haringey health economy. The enquiry has just published its interim report in April 2018 and work programme for 2018/19. The CCG
will continue to work in collaboration with provider trusts to ensure record management and retention are in line with recommendations to better protect children from sexual abuse.
7.2.2 Female Genital Mutilation (FGM)
There is continued national and international work being undertaken to eliminate new cases of
FGM in the UK in a generation. The Serious Crimes Act 2015 placed a duty on all regulated professionals to report FGM to the police on 101 if they have a direct disclosure from a child under the age of 18 that is a victim of FGM.
There is a requirement for all healthcare provider staff to undertake this reporting if they are the recipient of a direct disclosure. All provider trusts, through training and awareness raising continue to support their staff to make these reports if they have a concern that a child under the age of 18 has been affected by FGM.
HCCG and Providers are fully committed to providing better support to the violence against women and girls agenda; including FGM. The work to tackle FGM is embedded as a core part
of the safeguarding work across the Haringey health economy, and FGM work will continue to be taken forward by NHS England and locally by the CCG and LSCB in Haringey.
7.2.3 Child Protection Information Sharing Project The Child Protection - Information Sharing' (CP-IS) project, led by the Health and Social Care Information Centre (HSCIC), aims to improve the way that health and social care services
work together across England to protect vulnerable children.
CP-IS focuses on improving the protection of children who have previously been identified as vulnerable by Social Services when they visit the following NHS unscheduled care settings:
Emergency Departments
Walk-in Centres
GP Out of Hours
Minor Injuries Units
Paediatric Wards
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Maternity Units
Ambulance Services
CP-IS provides health professionals with prompt and easy access to key social care information to help them to assess whether a child is at risk.
The project links the IT systems of NHS unscheduled care to those used by social care child protection teams, so that information can be shared about three specific categories of child:
Those with a child protection plan;
Those classed as looked after (i.e. children with full and interim care orders or voluntary care agreements);
Any pregnant woman whose unborn child has a pre-birth child protection plan.
The DNSGC is the strategic lead for the roll out of the CPIS project across the health economy. The CPIS project is live within Haringey borough in the Acute Trust for NMUH and WH and Maternity Units. The CPIS national implementation programme is overseen by the
NHSE NHS Digital Implementation and Business Change Team. 7.2.4 MCA/DoLS
The Designated Professional for Safeguarding Adults is the CCG strategic lead for MCA and DoLS and was the co-chair of the MCA and DoLS SAB Sub Group partially during 2017-2018. During this time the Multiagency MCA and DoLS policy and procedure was updated and
embedded across all agencies, a number of staff across partner agency in role of BIA (including one HCCG CHC) and support them to undertake the role to develop practice within health settings and MCA multi agency training in place. In addition to this provided training and support to HCCG CHC team with community DoLS and was part of the Department of Health
and Adults Social Care round table discussion on the Law Commissions proposals for DoLS “liberty protection safeguards4”. 7.2.5 Safeguarding against self-neglect The Designated Professional for Safeguarding Adults is a member of the Learning and
Development SAB Subgroup, during 2017-2018 a poster safeguarding information campaign launched in June 2017 including self-neglect the DPSA distributed posters and leaflets to health organisations including holding information stalls in GP surgeries. The themes of the campaign continue to feature in the GP bulletin. The DPSA is a core member of the Haringey
high risk panel. 7.2.6 Domestic Violence
Haringey, together with Enfield successfully bid to be the London site for a national pathfinder programme5 aimed at improving the health responses to domestic abuse. The Designated Professional for Safeguarding Adults continues to support the work of the
IRIS6 project worker and Named GP for children. Themes from DHR have been shared with
4 https://www.gov.uk/government/news/new-law-introduced-to-protect-vulnerable-people-in-care 5 http://www.standingtogether.org.uk/local-partnership/pathfinder 6 http://www.irisdomesticviolence.org.uk/iris/about-iris/about/
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the named GP for Safeguarding Children and the Designated Nurse for Safeguarding Children and will be included in the Level 3 Child Protection Training with GPs during 2017 – 2018, information has also been shared with the project worker for IRIS who will also use this in
delivery of IRIS training. The Designated for Safeguarding Adults is a core member of the DHR panel review group and facilitates the participation for providers and GPs in the DHR process. The Designated
professional for Safeguarding Adults has responsibility for monitoring the actions and outcomes from Health providers Haringey CCG Designated Professionals are represented at the NHS England forums.
8 Local Context
8.1 Situated in the north of London, Haringey is an exceptionally diverse and fast changing borough. Within Haringey, there having some of the most deprived and the most
prosperous wards in the country. Of the approximately 278,0007 residents of the borough (GLA estimate 2017), 62% of the total population, and over 70% of the children and young people living in the borough are from Black and Minority Ethnic groups (BAME) . The child population in Haringey continue to increase steadily.
8.2 Haringey’s population is the fifth most ethnically diverse in the country, and at least 100
different languages are spoken in the borough. 48% of children in schools have another language rather than English as their first language (GLA 2015).
8.3 The wards with the largest number of people aged under 20 in Haringey are: Seven
Sisters, Northumberland Park, White Hart Lane, and Tottenham Hale. Seven of Haringey’s 19 wards are within the most deprived 10% nationally, and these are in the east of the
borough. Haringey is the 6th most deprived borough in London with the 10th highest level of child poverty in London. There are more children in the east of Haringey, which has higher levels of deprivation than the west. (2015 MYE by ward (experimental statistics).
9 Local Context
9.1 Situated in the north of London, Haringey is an exceptionally diverse and fast changing borough. Within Haringey, there having some of the most deprived and the most
prosperous wards in the country. Of the approximately 278,000 residents of the borough (GLA estimate 2017), 62% of the total population, and over 70% of the children and young people living in the borough are from Black and Minority Ethnic groups (BAME) . The child population in Haringey continue to increase steadily.
9.2 Haringey’s population is the fifth most ethnically diverse in the country, and at least 100
different languages are spoken in the borough. 48% of children in schools have another language rather than English as their first language (GLA 2015).
9.3 The wards with the largest number of people aged under 20 in Haringey are: Seven
Sisters, Northumberland Park, White Hart Lane, and Tottenham Hale. Seven of Haringey’s 19 wards are within the most deprived 10% nationally, and these are in the east of the
borough. Haringey is the 6th most deprived borough in London with the 10th highest level
7 https://www.haringey.gov.uk/social-care-and-health/health/joint-strategic-needs-assessment-jsna
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of child poverty in London. There are more children in the east of Haringey, which has higher levels of deprivation than the west. (2015 MYE by ward (experimental statistics).
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The safeguarding children activity shows an overall increase in 2017/2018 Source: Haringey Social Care Data
Safeguarding Children Activity Snap Shot 2017/2018
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9. Leadership, Management and Accountability
North London Sustainability and Transformation Partnership (STP) known as North London Partners in Health and Care The Accountable Officer (AO) and Convenor has responsibility for the STP and
provides management and leadership across the NCL five CCGs system. Please see link below outlining the STP system level governance arrangements. http://www.northlondonpartners.org.uk/about/governance.htm
During 2018/2019 the safeguarding children team will build on the safeguarding children leadership work that has taken place in Haringey CCG to create opportunities for raising the profile of safeguarding children across North London
Sustainability and Transformation Partnership (STP) work streams. 9.1 Haringey CCG (HCCG)
9.1.1 HCCG is the major commissioner of local health services across the borough and is responsible for safeguarding quality assurance through contractual arrangements with all provider organisations. Designated Professionals, as clinical experts and strategic leaders, are a vital source of advice to the CCG, NHS England,
the Local Authority and the Haringey Local Safeguarding Children Board. They also provide advice and support to multi-agency health professionals. 9.1.2 The Chief Operating Officer (COO) for Haringey and Islington CCGs is the
Executive Lead for Safeguarding and is responsible for ensuring that the health services contribution to safeguarding and promoting the welfare of children is discharged operationally and effectively across the health economy via local commissioning arrangements.
9.1.3 The Haringey and Islington CCG Director of Nursing and Quality reports appropriate safeguarding children risks and achievements to the COO and is responsible for ensuring that safeguarding monitoring across Haringey takes place
through the Quality Committee of the HCCG Governing Body; the Clinical Quality Review Groups (CQRG) for each of the three main provider Trusts; and in conjunction with the Haringey Safeguarding Children Board (HGBLG).
9.1.4 HCCG’s Governing Body Lead General Practitioner for children is responsible for ensuring that the Governing Body takes account of safeguarding children when making decisions regarding the commissioning of services. HGBLG chairs the HCCG Safeguarding Children Commissioning Group (SAG), which reports on a
quarterly basis to the HCCG Quality Committee. 9.1.5 The HCCG Safeguarding Team produce a joint Safeguarding Children and Adult Briefing for the bi-monthly Quality Committee informed by the safeguarding
children activity across HCCG and the Providers’ Internal Safeguarding Children Committees attended by the HCCG Designated Professionals.
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9.1.6 The Safeguarding Briefing and the HCCG Safeguarding Children arrangements and leadership are discussed and monitored via the quarterly HCCG Safeguarding Children Assurance Meetings.
9.1.7 The Designated Nurse and Designated Doctor Safeguarding Children provide support and assurance that safeguarding children arrangements, training and supervision is in place across the health community.
9.1.8 The DNSGC provided individual/group and planned and/or adhoc supervision for the:
Haringey Community Services Named Nurse
Haringey CCG Named GP
Haringey Acute Services Named Nurse and Midwife
9.1.9 The Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT) and North Middlesex University Hospital Trust Named Nurses receive planned supervision from the Enfield CCG Designated Nurse.
9.1.10 Designated Doctor Safeguarding Children has met regularly with the Named Doctors across the Haringey Borough for two acute trusts the community trust and the Barnet and Enfield mental health Trust. Designated Doctor attends monthly
supervision at Tavistock & Portman. 9.1.11 The Named GP attends the Designated and Named Doctors peer review/support sessions facilitated by Whittington Health. The Named GP attended quarterly peer supervision sessions facilitated by NHS England (London).
9.1.12 The DNSGC and Young People participated in additional 6-8 weekly North Central London (NCL) peer supervision and information sharing sessions with the Designated Nurses of Barnet, Enfield, Camden and Islington CCGs.
9.1.13 The Designated and Named Professionals for Safeguarding Children across the Health economy met:
To consider the effectiveness of the health response to safeguarding children in the Haringey borough
prepare for safeguarding inspection and enable peer support and supervision
9.1.14 The HCCG Safeguarding Children Designated Doctor and Nurses and Named GP met once or twice a month. This provided an opportunity to share good practice, update each other on any developments and monitor the implementation of work plans.
The Designated Professional for Safeguarding Adults at risk are directly accountable to the Director of Nursing and Quality. As safeguarding expert and strategic leader, the Designated Professional provides a vital source of advice to the CCG, NHS London, Local Authority and HSAB.The Designated professional also provides advice and support
for health professionals in the wider health economy. This role ensures that HCCG fulfils its statutory functions for Safeguarding as detailed in statutory and national guidance,
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providing assurance to executive leads for safeguarding, that there is a systematic approach to Safeguarding across HCCG.
10. Key Professionals
10.1.1 Haringey CCG Safeguarding Team and Arrangements
The HCCG Safeguarding Team works with partners to ensure that the Providers of the services we commission respond appropriately to children and adults at risk, with the intention of delivering improved outcomes and life chances for the most vulnerable.
10.1.2 HCCG is required to have the following statutory safeguarding posts in place:
Designated Professional for Safeguarding Adults
Designated Nurse for Safeguarding Children
Designated Nurse Looked After Children (LAC)
Designated Doctor for Safeguarding Children substantive from June 2017
Designated Paediatrician for Unexpected Deaths in Childhood substantive
from June 2017
Named General Practitioner (GP) Safeguarding
11. Haringey Safeguarding Boards Activity 2017 – 2018
11.1 Practical Arrangements
11.1.1 For Haringey’s Local Safeguarding Children Board, 2017-8 was a year marked by change and uncertainty due to changes to post holders in some key
roles relevant to the LSCB.
11.1.2 There is now a permanent DCS and Strategic Safeguarding Partnership Manager (previously known as Business Manager) in post to lead the
transformation process for the safeguarding children future arrangements.
11.1.3 The partners of the Haringey LSCB have engaged in preliminary discussions throughout the year to consider how the recommendations could
be implemented. It was agreed that a facilitated partnership safeguarding children workshop with the three statutory partners the CCG, Police and Social care should take place to consider a response to the options proposed about how the LSCB might operate in the future. The results of the workshop are
awaited and will inform decisions.
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11.2 The Structure of Haringey LSCB
Figure 1
11.2.1 During 2017-8 the structure of the Board remained largely unchanged
from the previous year, as depicted above figure 1. It was agreed that the restructuring and reviewing of the LSCB meetings and subgroups would be postponed until publication of the working together 2018 when there would be some clarity around what the new safeguarding arrangements would look like.
11.2.2 However the Executive group took a decision to become the LSCB Business group and to ensure that all chairs of sub-groups, key senior leaders and designated leads would attend. Additionally the Performance and Practice
Outcome (PPO) and the JTAI group were merged following the JTAI in December 2017. During the year the Joint Operational Group (JOG) was initiated.
11.2.3 The JOG offers monthly opportunity for the health professionals and partners and safeguarding leads to come together and hold learning and improvement sessions in order to develop a shared understanding of safeguarding practice in individual cases, but also more broadly to understand
what the safeguarding risks to children and young people in Haringey are and what are the effective ways of working with risk.
11.2.4 The DNSGC, Designated Doctor, and Named GP were full and active members of the HSCB; regularly attending and contributing to the quarterly meetings. The DNSGC and Designated Doctor were also full and active members of the HSCB Executive.
11.2.5 The DNSGC briefed the Director of Nursing and Quality regularly to ensure that she, in turn, can ensure the Accountable Officer, Chief Operating Officer and Governing Body are appraised of HSCB developments and key issues.
Haringey Safeguarding Children Board
Business Group
PPO Sub-group
Joint Operational
Group
(JOG)
Joint Targeted Area
Inspection Improvement
Group
Training, Learning &
Development Sub Group
Child Death
Overview Panel
MASH Strategic Board
MASH Operational
Group
Child Sexual Exploitation &
Vulnerable Children Sub-
group
Multi-agency Sexual
Exploitation Meeting
(MASE)
Serious Case
Review Subgroup
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11.2.6 The HCCG Safeguarding Team ensured that there was an HSCB update included in the Safeguarding Briefing to the bimonthly Quality Committee.
11.2.7 The following Haringey healthcare providers were expected to provide Director-level representation on the HSCB:
Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT)
North Middlesex University Hospital Trust (NMUH)
Whittington Hospital NHS Trust (Whittington Health) (WH)
11.2.8 Table below illustrates the attendance/representation of the respective Provider Trust Directors (Executive Leads for Safeguarding) at the HSCB Board Meetings
across the period reviewed: Figure 2: Health Attendance at LSCB meetings 2017/2018 (4 meetings held):
Health
Membership
2017 Meetings
Attendance
2018
Meetings Attendance
Total
Number of meetings held
Total Attendance
Health Services
14/06
20/09
13/12
21/03
Four
Number Attended
% Attended
HCCG Director of Nursing & Quality
* Yes * Yes * Yes * Yes Four 100%
HCCG Designated Nurse for SG
Children
Yes
Yes
Yes
Yes
Four
100%
HCCG
Designated Doctor
Yes
Yes
Yes
Yes
Four
100%
NHSE (London) Named GP
Yes
No
Yes
No
Two
50%
BEH-MHT
Yes
Yes
Yes
*Yes
Four
100%
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11.2.9 The DNSGC and Designated Doctor Safeguarding Children were members of
the following HSCB sub-groups which supported the HSCB during 2017/2018:
Figure 3: HCCG Safeguarding Children Team coverage of Haringey Safeguarding Children Board Subgroups:
HSCB Subgroup
HCCG Representative
Performance and Practice Outcomes
Designated Nurse Safeguarding Children
Serious Case Review (SCR)
Designated Nurse Safeguarding Children
Designated Doctor Safeguarding Children
Child Death Overview Panel (CDOP)
Designated Doctor Safeguarding Children Designated Doctor Safeguarding Children
(from Nov 2017) Child Sexual Exploitation (CSE)
Designated Nurse Safeguarding Children
MASH Board Designated Nurse Safeguarding Children Training, Learning &
Development Designated Nurse Safeguarding Children
(Chair) Performance Practice Outcome
Designated Nurse Safeguarding Children
NMUH
No
Yes
yes
No
Two
50%
WH
Yes
Yes
Yes
Yes
Four
100%
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11.2.10 The DNSGC and Young People resigned as Vice Chair of the HSCB in July 2017 as well as Chair of the CSE and vulnerability Subgroup to become the new chair of the Training Learning and Development Group (TLD) there has been
challenges throughout this year, with consistency of membership and accuracy in terms of the meetings, which hampered progress. This was compounded by a lack of training officer capacity. This has been flagged with the LSCB chair and LSCB business group. An improvement plan is now in place.
11.2.11 A Key LSCB achievements include:
In November 2017, two partnership threshold workshop training sessions
were well attended with significant contributions from several agencies including Haringey CCG Designated Nurse as facilitators. The training received positive evaluations.
Neglect Learning for Health Visitors was developed and delivered by the
LSCB Business Manager, Haringey CCG Designated Nurse and Doctor for Safeguarding Children in November 2017
The event discussed the national and local guidance around neglect and
informed the draft LSCB neglect strategy. There was good interaction and attendance. Live cases were presented, and themes considered around early recognition and responding to children and young people experiencing neglect. The aim is to roll out further neglect workshops
including the themes for practice improvements from the Haringey Joint Targeted Area Inspection with the focus on Neglect (2017).
12. Child Death Overview Panels (CDOP)
12.1 During the period 1 April 2017 to 31 March 2018 there were 20 deaths in Haringey. During this time Haringey had five panels and 40 cases were reviewed. The terms of reference were updated a confidentiality agreement introduced into the meeting, to strengthen information governance
arrangements as we discuss sensitive issues. 12.2 At the beginning of the time period there remained some backlog of cases, dating back to 2010; hence the large number of cases discussed. By
the end of this time period we had managed to review and close cases so that we were operating with a one year backlog. Some delay is inevitable where there has been a serious case review commissioned or there is a criminal case and the outcome is awaited, but in order to obtain learning we want to try
and maintain our reviews as current as possible. 12.3 Themes that came up were:
12.3.1 Hypoxic ischaemic encephalopathy
We noted a pattern of deaths of babies in North Middlesex Hospital from hypoxic ischaemic encephalopathy. The clinical director attended a CDOP
panel and discussed the changes being brought about within maternity at NMUH. He explained that CTGs are now visible in a central area in the labour
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ward so that any worrying traces can be spotted by clinical staff more quickly and intervention obtained.
NMUH also recently had a GIRFT (Getting It Right First Time) Obstetric visit. This is where the unit data is shared with the department by an independent external peer reviewer. Comparisons made with other units and data feedback showed that in terms of deprivation NMUH obstetric unit is 136th out of 137 units
across the UK. However, caesarean section rate and third degree tear rates are lower than other units. Hypoxic-ischaemic encephalopathy (HIE) is slightly above the
national average. Outcomes are largely good. Clinical standards are satisfactory but the communication with patients was poor. The new leadership team stated that they would respond to the shared intelligence and meet and support staff to improve their communication with women. There was also a
recognition that online training is not always as effective as face to face and equality and diversity training needs to be face to face. 12.3.2 Management of neglect where there are chronic health issues
Management of neglect where there are longstanding health issues was noted following review of a CDOP case where there had been worrying problems with asthma, and a death from acute anaphylaxis.
Haringey children’s commissioner held a discussion across the two acute Trusts to explore how the working Islington and Haringey differ, and what improvements we might be able to bring about from a health perspective.
12.3.3 Involvement of families in the child death review process. We initiated a quality improvement project looking at how parents and families of children who have died could be included in the CDOP process.
12.3.4 Healthy London partnership transformation work During this time period Healthy London Partnership were carrying out a piece
of work mapping the CDOP process, and helping Chairs of CDOP to move towards the new process where health will lead on review of all child deaths. The changes need to be in place by July 2019.
12.3.5 Deaths of two children where there had had GI tract repair; oesophageal atresia and duodenal atresia These children have lifelong risk of choking and there is generally a lack of
awareness of this risk. One case was referred back to the coroner for review of whether the inquest needed to be re-opened. 12.3.6 Anaesthetic input to Paediatric A&E North Middlesex Hospital
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Following the death of a child who had choked in a nursery setting, an SI investigation was carried out by NMUH. There had been difficulty in obtaining an airway for the child.
12.3.7 SI quality of investigation by Provider trusts The CDOP process is very much dependent upon the quality of information
given to the panel by provider Trusts. The Trust have a duty of candour to share the investigations with the families. The Designated doctor had some concerns in relation to the thoroughness of some Sis and met with the medical director at North Middlesex to raise the issue. There was a
commitment to ensure that a paediatrician would be involved in an SI where a child had died, and a willingness to engage with families. 12.4 Safeguarding issues that were highlighted were:
12.4.1 Safe employment of carers by parents Discussed the opportunity for health visitors at the mandated ante natal visit
to raise awareness of access to good quality childcare.
12.4.2 The management of how Harmful sexual behaviour is managed Haringey.
12.4.3 This has been highlighted by previous serious case reviews and is LSCB Safeguarding Board. 13 Reviews and Audits
13.1 Haringey Joint Targeted Area Inspection (JTAI)
13.1.1 The Haringey children’s safeguarding partnership was subject to a joint inspection between 4th and 8th December 2017. The inspection included an evaluation of the multi-agency ‘front door’ arrangements and an evaluation of practice with children that were neglected. There was a specific focus on
the experience of children aged between 7 to15 years old, using a ‘deep dive’ case analysis methodology. 13.1.2 This methodology was effective in drawing out the ‘lived experience of
these children’. The overall picture showed a variability in practice, with children that were being neglected, a robust system-wide multi-agency approach was lacking as was a coherent joint commissioning strategy. The findings of the JTAI will inform the business of the safeguarding partnership
during 2018-19 and the priorities going into the new multi-agency arrangements from September 19 onwards. 13.1.3 The full JTAI report can be found here with the LSCB chair’s letter from
30th January 2018 which accompanied the publication although it is also useful to include examples of the key strengths and areas for development
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specifically for the multi-agency partnership. The commentary regarding single agency work can be found in the report
13.2 Examples of Key Strengths:
There was praise for staff in individual agencies including health,
police, social care, youth offending, around their engagement with families, children and young people, and regarding understanding their role and responsibilities in safeguarding.
Age-appropriate approaches used by staff to engage young children
experiencing neglect, through drawings in the child and adolescent mental health services (CAMHS).
An appointment of a full-time health representative in the MASH.
Effective safeguarding practice, including the identification of neglect, in the community dental service.
North Middlesex University Hospital emergency department (ED)
makes good use of child protection alerts, and ED attendances are checked against the national child protection information system (CPIS) to ensure that risks, including those of the neglect of older children, are managed effectively.
Positive engagement with young people by the gangs’ youth worker team based at the North Middlesex University Hospital Emergency department.
GPs demonstrated good professional curiosity and appropriate flagging of concerns to the relevant agencies in cases with neglect. GPs
evidenced a good understanding of neglect of older children that enables effective identification and response to these children. General practitioners (GPs) receive good support from the Named GP for safeguarding in Haringey.
13.3 Examples of Areas for Improvement:
The MASH multi-agency practice was not robust in terms of the contribution by all agencies to risk assessment and decision making. MASH Health practitioner not yet realised the potential in the MASH.
Thresholds were not consistently applied, neglect was not being identified as an underlying cause of harm to children and young people and pathways out of the MASH were not clear.
The lack of use of tools and of purposeful intervention were evident and the ‘lived experience of the child or young person’ was not well enough understood.
Health leaders across Haringey provide senior leadership and there is a strong presence and engagement on the LSCB and subgroups.
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There is further room for all partners to be considered as equal partners.
13.4 The key areas going forward as health in response to the JTAI are as follows:
• Health - fully involved in the MASH assessment and decision making.
• Health - understanding and application of thresholds and decision-making. • Health - working together to support families at risk of / experiencing
neglect to include early recognition and use of tools. • Understanding the child’s lived experience in Haringey.
13.4.5 Complexities of health (primary care, acute, mental health and community health services) fully understood and health partner’s contribution considered more appropriately.
13.4.6 The council and its partners including the CCG, providers and LA Public Health commissioners have also worked together to produce a partnership JTAI action plan.
13.4.7 The plan has been developed on a clear understanding of the issues within the OFSTED letter and agreement to make the necessary improvements for better outcomes for children young people and their families.
13.4.8 The action plan has six themed headings and covers the areas for improvement listed in the letter. The plan is a working document and is being monitored by a partnership implementation group on behalf of Haringey LSCB. The group is chaired by the Director of Children Services.
13.5 The After Action Review (AAR)
13.5.1 In April Haringey CCG commissioned an AAR structured approach to
learning from health economy experience during the JTAI. Provider, and commissioner’s including Executive and safeguarding children leads for safeguarding children participated and were invited to answer four key questions, “What was expected?” “What actually happened?” “Why was there
a difference between expectations and what actually happened? The aim is to share the learning, create a simple framework for all inspections outlining roles and processes and communication structures as part of the work plan 2018/2019.
13.6 Haringey Safeguarding Children Board Multi-Agency Audits
13.6.1 The LSCB Performance and practice outcome subgroup established an annual programme of multi-agency audits which focussed on the following areas.
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The response to Child Sexual Exploitation
Neglect (before the inspection that was positively commented on
during the inspection).
Children who present to A and E who have been assaulted
The Lived Experience of the Child – building upon the huge amount of learning from the JTAI audit activity, the PPO challenges its agencies
to review how the lived experience of the child was gathered by practitioners – what skills, knowledge and tools were utilised to build this picture.
13.6.2 HCCG led the Health involvement within the above HSCB Multi-agency themed audits: The implementation of recommendations from audits are monitored by HSCB
13.7 Safeguarding Adult Board
13.7.1 The Haringey Safeguarding Adults Board8 is a statutory body that works to make sure that all agencies are working together to help keep adults in Haringey safe from harm and to protect the rights of citizens to be safeguarded under the Care Act 20149, Mental Capacity Act 200510 and the Human Rights Act 1998.11
13.7.2 The work of the Board is driven by its vision is that Haringey residents are able to live a life free from harm, where communities:
Have a culture that does not tolerate abuse;
Work together to prevent abuse; and
Know what to do when abuse happens.
13.7.3 The work of the Haringey SAB is underpinned by the safeguarding principles which were set out by the government in the statutory guidance accompanying the Care Act 2014.The Board has agreed four statutory SAB purposes under the 13.7.2 Care Act 2014 for achieving its vision and meeting its
statutory duties to ensure that local safeguarding arrangements are in place. These form the basis of our Strategic Plan in which we set ourselves, the partnership and community specific actions to prevent and respond to abuse:
We are assured that safeguarding practice is person-centred and outcomes focused
We prevent abuse and neglect
We respond to abuse and neglect in a timely and proportionate way
We are committed to learning and improving
13.7.4 Haringey CCG works in partnership with the Local Safeguarding Adult Board and is charged with providing assurance to the Board. The priorities for
8 https://www.haringey.gov.uk/social-care-and-health/safeguarding-adults/haringey-safeguarding-adults-board-sab 9 https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance 10 http://www.legislation.gov.uk/ukpga/2005/9/contents 11 http://www.legislation.gov.uk/ukpga/1998/42/contents
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assurance are shaped and directed by a number of factors including local demography alongside analysis of safeguarding activity from commissioned providers including training, learned from local case reviews and new initiatives.
13.8 Safeguarding Adults at Risk Audit Tool and Joint North Central London Challenge Event
13.8.1 HCCG participate in the yearly safeguarding adults at risk tool challenge event. The Safeguarding Adults at Risk Audit Tool was developed by the London Chairs of SAB Network and NHS England. The aim of the audit tool is to provide all organisations in the borough with a consistent framework to assess, monitor and/or
improve safeguarding adult arrangements. The use of the audit tool provides the opportunity to: benchmark; identify themes and improvements needed; and share best practice across sector level. The audits also support the Adult Safeguarding Boards to ensure that there is effective and consistent Safeguarding practice
across the 5 boroughs. 13.8.2 On the 1st November 2017, Islington Council hosted the North Central London (NCL) Challenge and Learning event. The objective of the challenge event
was to bring partners together across the NCL to share learning; to identify priorities for improvement; and to agree next steps. HCCG completed the Safeguarding Adults at Risk Audit Tool to identify areas of good practice as well as areas for improvement. Out of 25 areas HCCG rated it
self-4 amber and 21 green the 4 amber arears have now been actioned. 13.8.3 The NCL Safeguarding Adults at Risk Audit Tool findings identified the following themes for further development:
Explore more opportunities for more effective and efficient response to Deprivation of Liberty Safeguards (DoLS) across the sector;
Continue to develop multi-agency response to safeguarding;
Learning from exemplar MSP organisations and national/London peers;
Implementation and monitoring of the Boards performance framework;
MSP qualitative evaluation.
Where possible, the above areas for improvement have been embedded in to the Strategic Priorities for 2018-19.
13.9 SAB Activity 2017 – 2018
13.9.1 Data in relation to all safeguarding issues is monitored both locally and nationally. All safeguarding concerns and enquiries are recorded and co-ordinated by Haringey Council. Progress from initial concern through to
conclusion is monitored for timeliness and quality across a wide variety of measures including the nature and location of harm, service user groups, outcomes, age, gender, ethnicity, etc. This information is scrutinised by the Quality Assurance Sub-group who report key issues and trends.
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13.9.2 Haringey Council is required to submit annual Safegaurding data collection to the Department of Health and Social Care (DoHaSC) which uses the daat as comparison across Local Authorities in England.
13.9.3 In Haringey the safeguarding statistics over the past three years seem to be fairly consistent the board have reported the following:
The abuse location profile remains similar for the last two years, with abuse most commonly occurring in the person’s own home (62% in 2016-17, 55% in 2017-18). Abuse occurring in residential care homes has seen a decrease in 2017-18, down to 8% from 15% in 2016-17.
mainly older people (about half are aged 65+ years (65%) this is an over-representation compared with that age group in the general population (9.4%).12 Within the over 65 age group, the largest percentage of Section 42 enquiries involve people aged 75-84 years
(30%) and 85+ (39%);
An over-representation of black british/african/caribbean minority ethnic groups (24%) compared to haringeys general popoulation black british/african/caribbean minority ethnic groups 19%; White and
Asian/Asian British are both conversely under represented, as they account for 61% and 9% of Haringey’s population respectively, but only 46% and 6% of concerns raised.13
The most common abuse types are neglect, psychological/emotional
(23%) compared to 21% the previous year, physical abuse (15%) and financial abuse (13). Financial abuse has also seen a significant reduction this year, 20% in 2016- 17 to 13% in 2017-18. Physical abuse occurred in 15% of safeguarding concerns raised in 2017-18,
down from 21% in 2016-1714
13.9.4 In the period of 2017 -2018 there was 1953 safeguarding concerns
were raised. This represents a 10% decrease in the safeguarding concerns raised from 217915 in 2016-2017. During 2017-2018 the SAB ran a sucessful safeguarding awareness campaign with Haringey community and with providers. HCCG continue to support providers with preventative work in care
homes and with domicillary care agencies. 13.9.5 In 2017-2018, 266 (14%) of safeguarding concerns raised progressed to a Section 42 enquiry, 1177 (60%) were dealt with by preventative
measures such as sign posting ro referal for a care act assessment/review and 511 (26%) went on to safeguarding S42 enquiries.
12 https://www.haringey.gov.uk/social-care-and-health/health/joint-strategic-needs-assessment/figures-about-
haringey#ethnic_profile_of_residents_of_haringey_ 13 https://www.haringey.gov.uk/sites/haringeygovuk/files/safeguarding_adults_board_annual_report_2017-
2018_pdf_926kb.pdf 14 https://www.haringey.gov.uk/sites/haringeygovuk/files/safeguarding_adults_board_annual_report_2017-2018_pdf_926kb.pdf 15 https://www.haringey.gov.uk/sites/haringeygovuk/files/safeguarding_adults_board_annual_report_2017-2018_pdf_926kb.pdf
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Most safeguarding concerns are reported by the NHS (36%). Around a quarter of safeguarding concerns came from the Police, with 90% of these not meeting the Section 42 threshold. However, analysis of concerns referred by
the Police shows that many were directed to other services or support. 13.10 How safeguarding data does informed the work of the SAB?
13.10.1 The HSAB subgroups facilitate focused work in line with the objectives of the 3-year strategic work plan. Each subgroup is chaired by a member of the Board. There has been a significant amount of work undertaken and completed by the Board during the period 2017-2018.
13.10.2 The SAB has four sub-groups which support the development of specific areas in preventing and responding to the abuse of adults at risk. In
addition there may be occasions the SAB will establish specific, time-limited task and finish groups to report on particular topics according to the work required. The Designated professional is a core member of each sub group and is co-chair of the Multi Agency SAB Quality Assurance Subgroup.
13.10.3 The five subgroups are:
Safeguarding Adults Prevention and Learning Subgroup:
Oversee the delivery of the Haringey Safeguarding Adults Prevention Strategy 2017-2020, and development and coordination of multi-agency safeguarding adults training provision.
Achievements in 2017-18 have included:
Poster safeguarding information campaign launched in June 2017 and circulated to the Voluntary Community Sector (VCS) and schools.
Improvements to safeguarding data collection by addition of first language and ethnicity reporting.
Mechanism and feedback loop introduced to embed learning from Safeguarding Adult Reviews (SAR’s).
Improvements to evaluate employee training and reporting across partners, including presentations for quality assurance.
Staff from private sector providers and voluntary sector staff and volunteers continue to access the free safeguarding e-learning from the council’s website that covers issues of child and vulnerable adults
safeguarding and the Prevent Duty.
Over 9550 face-to-face safeguarding training sessions were delivered in the regions covered by our partners, which is over 2250 more face to-face sessions than last year.
Multi Agency SAB Quality Assurance Subgroup:
Coordinate and support the development of safeguarding adults work in Haringey with particular emphasis on developing best practice in safeguarding adults work and learning from experience. The group's Quality Assurance
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Framework will act as the mechanism by which the SAB will hold local agencies to account for their safeguarding work, including prevention and early intervention.
Achievements in 2017-18 have included:
Continued to refine and improve the multi-agency adult safeguarding dataset to enable the partnership to be informed of local adult
safeguarding activity and better placed to identify trends and patterns that the intelligence may highlight.
Multi-agency performance framework is in place and data analysis is provided every quarter to the HSAB.
The subgroup has continued to monitor the quality of care providers in all sectors to assure the Board that services provided and commissioned on behalf of Haringey residents meet specified quality standards, can prevent safeguarding incidents and respond effectively when they occur.
Mental Capacity Act and Deprivation of Liberty Safeguards (MCA/DoLS) Sub-group
To oversee the ongoing implementation and operation of the MCA 2005, including the DoLS.
Achievements in 2017-18 have included:
Best Interest Assessor (BIA) multi-agency/partner training plan in place • MCA training multi-agency/partner training in place
No backlog of assessments in Adult Services
All applications are allocated on a weekly basis
Increased bank of Section 12 Doctors and BIA under contract with the Local Authority
Trained a number of Local Authority staff in order to develop pool of BIA
available
Trained a number of staff across partner agency in role of BIA and support them to undertake the role to develop practice within health settings.
Safeguarding Adults Reviews Subgroup:
Consider referrals of any case which may meet the statutory criteria and to make decisions on this basis; to make arrangements for and to oversee all SARs; to ensure recommendations are made, messages are disseminated and that lessons are learned.
Chairs Executive Subgroup:
Oversee the Board's business and to progress and coordinate the work of the subgroups.
13.11 Safeguarding Adult Reviews
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13.11.1 Section 44 of the Care Act 2014 requires the HSAB to arrange a SAR when a case meets the statutory criteria: that is when an adult in its area dies as a result of abuse or neglect whether known or suspected, an there is concern that partner
agencies could have worked more effectively to protect the adult; or if the same circumstances apply where an adult is still alive but has experienced serious neglect or abuse.
13.11.2 The purpose of SARs is to ‘promote effective learning and improvement action to prevent future deaths or serious harm occurring again’. The aim is that lessons can be learned from the case and for those lessons to be applied to future cases to prevent similar harm re-occurring.
13.11.3 During 2017/2018 there have been six new referrals for consideration of a SAR, although only one of these referrals met the SAR criteria. One referral received at the end of 2017/2018 did not meet the criteria for a SAR but the SAB SAR
subgroup felt that there is learning to be gained from this case and a learning event will be held for the agencies involved later this year.
13.12 SAR ‘Robert’16
13.12.1 In July 2017, the SAB published its first SAR since the Care Act 2014 was implemented. The SAR was carried out by an independent reviewer and considered
the death of Robert. The main recommendations of the SAR were to develop a multi-agency protocol to better coordinate arrangements for vulnerable adults at risk of homelessness; provide clear information and training for staff on new housing policies; review the Housing Decision Panel; provide training to housing staff on
safeguarding and mental capacity awareness and their responsibilities; and complete adult social care referrals and assessments within Care Act timescales. 13.13 Multi-agency Safeguarding Arrangements and Partnership Work
13.13.1 Care Homes The collaborative work with Haringey Local Authority and other partners including the
Care Quality Commission (CQC) has continued during 2017/2018 to ensure a robust approach to address concerns and compliance within the Care Home sector in Haringey. HCCG continues to actively monitor contract compliance to all the Care Homes in Haringey. The HCCG Quality Matters in Care Homes Manager is the lead
support for Care Homes and is supported by the Designated Professional for Safeguarding for Adults. 13.13.2 The Designated Professional for Safeguarding and the Care Homes
Manager works closely with the Continuing Health Care, Quality Team, Commissioners, CQC and Haringey Local Authority in relation to monitoring quality and safety within care homes. As part of sharing information HCCG has initiated a monthly Care Homes Information Sharing Meeting with a view to having a shared
approach to improving quality across the sector. In addition to this the CCG
16 https://www.haringey.gov.uk/sites/haringeygovuk/files/sar_report_robert_2017.pdf
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safeguarding and QMICHT have refreshed the monthly data base to identify and intervene at an early stage with care homes on a downward trajectory. This year the QMICHT and DPSAM adapted an audit template which provides a more in depth
assessment covering essential areas of care. Following audits each care homes is provided with a report of the audit findings and any actions required to improve quality in care. QMICHT in conjunction with LBH commissioners oversee the improvement action plans.
13.13.3 The intention of more proactive work and support with providers to share good practice and focus on early intervention has been realised with the introduction of the quarterly Care Homes Forum and attendance at the LBH provider forum.
13.13.3 Through the NHS England Quality Surveillance Group, HCCG liaises closely with local authorities and CCG’s to consider any concerns arising from the providers of residential, nursing and domiciliary care. This process has enabled early
intelligence sharing across not only the local health and social care community but also national early warnings to be considered where providers have multiple sites across the country. The Designated Professional for Safeguarding provides regular updates to the director of nursing in relation to activity with commissioned providers.
13.13.4 During the period 2017-2018, 15 % of section 42 enquires pertained to a residential care home which is an increase in 11% there had been a decrease in S42s pertained to nursing home from 27% to 5%.
13.13.5 During the period 2017 – 2018, out of 11 care homes in Haringey 8 care homes were rated as good 3 as requires improvement. Where care homes have been rated as requires improvement or inadequate there has been a joint approach
to monitoring improvement plans with CQC and LBH. 13.14 Information sharing panel
13.14.1 The Designated Professional for Safeguarding Adults is the representative for the Haringey Information Panel, which is a confidential, multi-agency, collaborative information sharing group. This provides a forum for partners to share information in relation to concerns around quality and safety of services (including
where there are serious concerns and multiple safeguarding alerts). The purpose of the information sharing is to triangulate presented information and intelligence to inform decision making and next steps, which may include escalation to establishment concerns or prompt CQC unplanned inspection.
13.14.2 The panel meets on a quarterly basis and receives information from a variety of sources where concerns have been identified regarding residential, nursing and domiciliary care providers. The information received will inform decisions about how
best to support providers who have been identified as requiring improvements and escalate as appropriate. During 2017 – 2018 the information sharing panel met 4 times and have supported several providers to improve quality within their service.
13.15 Prevent Strategic Group
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13.15.1 The Designated Professional for Safeguarding Adults is the representative for the Haringey Prevent Strategic Group and has supported the development of the borough wide Prevent Strategy. Haringey is one of the 19 London boroughs
identified by the Home Office as a Priority Area (at risk and threat of extremism). Haringey’s Prevent Strategy is aimed at preventing violent and non-violent extremism, but is also very much about protecting our communities and supporting vulnerable people who may be targeted by extremists trying to recruit or radicalise
them. The group review local intelligence and data and including analysis of referrals to channel panel which informs the strategy and priority areas. During 207-2018 learning from the pilot Dovetail has been embedded and has seen a shift in Local Authority’s taking more control of the function of the Channel Panel, with the police
remaining as key partners. 13.15.2 The Local Authority is leading on assessing cases and holding initial meetings with those referred to Channel and is also taking responsibility for
commissioning Intervention Providers and other appropriate professionals to provide support to individuals. This shift in delivering Prevent brings it in line with existing provisions for safeguarding and the change in approach has seen a much more collaborative approach to sharing information, decision making and sharing risk
across health, LBH and the Metropolitan Police. The panel has met with key leaders from the home office as part of reviewing the pilot. 13.15.3 The safeguarding team provide support and advice to health care
professionals to help identify staff and patients in their organisations who may be at risk of radicalisation and appropriately signpost for intervention. We maintain close links with the Regional Prevent Coordinator and the local authority Prevent coordinator. The safeguarding team ensures that relevant referrals are made to the
Channel Panel, which aims to divert those at risk of radicalisation. Haringey CCG must seek assurances from providers and evidence that they are committed to ensuring at risk individuals are safeguarded from supporting extremism or being drawn into extremism as part of the Home Office counter terrorism strategy Prevent.
13.15.4 The DPSA is the CCG Lead for the Channel Panel. Channel is a programme which focuses on providing support at an early stage to people who are identified as being vulnerable to being drawn into extremism. The programme uses a multi-
agency approach to protect vulnerable people by identifying individuals at risk, assessing the nature and extent of that risk and developing the most appropriate support plan for the individuals concerned. The panel meets on a monthly basis and has provided positive interventions for a number of individuals. The panel is attended
by the Prevent Lead for BEH. 13.16 High Risk Panel
13.16.1 The DPSA is the CCG representative on the Haringey High Risk Panel (HHRP). The panel meets every 6 weeks and is a meeting where information is shared on cases presenting with the highest risk and/or complexity, and involves representatives of the local authority, HCCG, housing and fire brigade. The HHRP
considers cases in respect of adults aged 18 years or over, where existing mechanisms within agencies for resolving or minimising risk have not achieved this outcome and where the risk remains for the individual and/or others. The main focus
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of the HHRP is on addressing the risk to the adult at risk but in doing this it will also consider other persons affected and managing the behaviour of any perpetrator. The panel will decide on the best approach to managing the overall risk to the
person/community at large and on effective safety planning strategies. The panel meets monthly and is a collaborative approach to sharing risk and providing positive outcomes for individuals. All learning from the risk panel is fed into the Prevention and Learning SAB subgroup. 14 Serious Case Reviews/ Significant incidents/Adult Reviews (SCR/SARs)
14.1 Serious Case Reviews (SCRs)
14.1.1 A SCR takes place after a child dies or is seriously injured and abuse or neglect is thought to be involved. It looks at lessons that can help prevent similar incidents from happening in the future. The local Safeguarding Children Boards
(LSCBs) follow statutory guidance when conducting a SCR and partner agencies are required to participate if involved.
14.1.2 Over the period of this report, two SCR have been initiated by the Haringey
Safeguarding Children Board and are awaiting publication. One SCR was initiated by City and Hackney LSCB involving children known to Haringey health services.
Serious Case Review Child W In progress Serious Case Review Child X In progress
14.1.3 These reviews when published will result in recommendations formulated into action plans monitored by the HSCB.
14.2 SCR Child N and 0
14.2.1 Child N and 0 concerned 18-month-old twins. Child N died and Child O was seriously assaulted on the 18th March 2017.
14.2.2 The SCR was completed and published and is available on the City & Hackney Safeguarding Children Board (CHSCB) website.
14.2.3 Overall, whilst the SCR has identified a number of relevant practice improvements, these are limited in number. Furthermore, when considering the involvement of professionals immediately prior to the incident, this was overwhelmingly characterised by good practice. Learning in the case highlighted the need to reinforce the importance of the following:
Identified or unidentified fathers in terms of potential value or risk
Routine enquiries with respect to the possibility of domestic abuse The relevance of cultural / linguistic barriers to mutual understanding
14.2.4 The Child N and O SCR recommendations in the form of an action plan are monitored by the CHSCB and HSCB.
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14.2.5 As from July 2018 the new Working Together document indicates that all potential SCR’s will be considered by the new National Safeguarding Panel. This panel will then decide if the case should be considered at a local or national level.
14.3 Significant Incidents (SI):
HCCG DNSGC receives notification of cases reported as S.I.’s for Haringey children and young people. The Designated Professionals for Safeguarding
Children are experienced clinicians in children matters and are involved in the CCGs review of these cases from the onset.
CDOP reviews SI’s for child deaths and considers if service delivery was a
factor in each child death. These are included in the CDOP annual report summary.
During this year there was a delay in securing a specialist commissioned Tier 4
bed in patient bed for a Haringey young child. The partnership benefited from an NHSE independently commissioned multiagency review and learning event. The learning event convened in January 2017 was attended by multiagency professionals and covered the broader issue around provision of young children
who have very complex behavioral needs who cannot be managed in mainstream children’s residential units. In particular the achievement nationally where there are designated number of secure CAMHS tier four inpatient beds for young children.
Following an SI into a disabled child in care who developed pressure sores. The partnership benefited from a learning workshop. There were many learning points. Communication across partners at all stages of investigation and
pathways should aim to align decision making across the different processes involved with children with disabilities and ensure when required cases are escalated appropriately. Escalation of concerns of a child in care should be in line management and children in care specialist team.
SI recommendations and outcomes are monitored through relevant governance arrangements.
14.4 Domestic Homicide Reviews (DHR) 14.4.1 Domestic Homicide Reviews (DHRs) were introduced by section 9 of the
Domestic Violence, Crime and Victims Act 200417 (the Act). The provision came into force on 13th April 2011, and so applies to all such deaths reported to the Home Office on or after that date. Statutory guidance for those agencies involved in a DHR was issued by the Home Office on 13th April 2011, and has been revised twice, in 2013 and November 2016.
14.4.2 The rationale for the DHR process is to ensure agencies are responding appropriately to victims of domestic violence by offering and putting in place appropriate mechanisms, procedures, resources and interventions with an aim to
17 https://www.gov.uk/government/publications/the-domestic-violence-crime-and-victims-act-2004
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avoid future incidents of domestic homicide and violence. The DHR will also assess whether agencies have sufficient and robust procedures and protocols in place, which were understood and adhered to by staff.
14.2.3 Overall responsibility for establishing a DHR rests with the Community Safety Partnership (CSP) for the area in which the victim normally resided.
The purpose of a DHR is to:
Establish what lessons are to be learned from the domestic homicide
regarding the way in which local professionals and organisations work individually and together to safeguard victims.
Identify clearly what those lessons are both within and between agencies,
how and within what timescales they will be acted on, and what is expected to change as a result.
Apply these lessons to service responses including changes to policies and procedures as appropriate.
Prevent domestic violence homicide and improve service responses for all domestic violence victims and their children through improved intra and inter-agency working
14.5 DHRs in Haringey 14.5.1 Since the requirement to hold DHRs18 was introduced, there have been 5
reviews (with sadly another homicide on 30th March 2018 which will subject to a review). 14.6 Learning from Haringey DHRs
14.6.1 There are 5 key themes that have emerged from the Domestic Homicide Reviews that we have commissioned to date:
HR policy
Training
Health Response
Identification of risk – separation
Engagement 14.7 Health Response
14.7.1 In 3 out of 4 of the reviews the victims were not actively engaged in any services but did have contact with, or worked within, health. Mental health concerns were a feature in 3 out of the 4 reviews conducted to date but were seemingly not included in any assessment of risk. Each review conducted has highlighted that
there needs to be greater emphasis on health taking a clear role in addressing safeguarding vulnerable adults and also applying a greater understanding of domestic abuse to each patient, particularly within GP practices. The IRIS project
18 https://www.haringey.gov.uk/social-care-and-health/health/joint-strategic-needs-assessment/other-factors-affecting-health/domestic-violence
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has been commissioned jointly by Haringey Local Authority and HCCG for 25 GP practices this is a 3 year project (from June 2016). There has been positive uptake in the project to date by GP practices and nationally IRIS has shown real changes in
health responses to domestic abuse. Work is also ongoing to support the 2 acute trusts covering Haringey as well as Barnet, Haringey and Enfield Mental Health Trust (BEHMHT) to improve their responses to domestic abuse. Haringey, together with Enfield successfully bid to be the London site for a national pathfinder programme
aimed at improving the health responses to domestic abuse.
14.7.2 Themes from DHR are shared with the named GP for Safeguarding Children
and the Designated Nurse for Safeguarding Children and are included as part of Level 3 Child Protection Training. Themes from DHRs are shared with the project lead for IRIS who will also use this in delivery of IRIS training.
14.7.3 The Designated for Safeguarding Adults is a core member of the DHR panel review group and facilitates the participation for providers and GPs in the DHR process. The Designated professional for Safeguarding Adults has responsibility for monitoring the actions and outcomes from Health providers.
15. New Service Developments
15.1 Child Sexual Abuse Service 15.1.1 The child house in Camden will be a pilot of the Icelandic model funded by
MOPAC for a period of time and providing services across NCL. The hubs in existence at St Ann's and University College London (UCL) will gradually transfer over to the new premises. UCL are the lead acting as main provider, and psychotherapy aspects will be provided/ supervised by Tavistock.
15.1.2 The aim is that children, young people and their families receive the justice, support and therapy in a timely manner meaning that they can move forward towards recovering from the abuse.
15.1.3 The North Central London Child House will open in the autumn. The Child House will provide a child-centred journey after a child or young person has experienced sexual abuse. It will provide a coordinated approach to supporting
children and young people who have experienced sexual abuse. All medical, advocacy, social care, police, and therapeutic support will be delivered from one place.
16. Haringey Children in Care (CIC)
16.1 Haringey CCG have an ongoing responsibility for ensuring that the health needs of LAC are met. In Haringey the statutory Initial Health Assessments (IHAs) and the Review
Health Assessments (RHAs) are carried out by a specialist team – the Children in Care (CIC) Team who are employed by Whittington Health and commissioned by Haringey CCG. 16.2 Children In Care Team (CIC)
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16.2.1 The Whittington Health Children in Care Health Team (CIC) are a specialist team who provide Statutory Health Assessments for Children in Care, and health advice to Children Social Care.
16.2.2 The CIC team consists of a Designated Doctor, Designated Nurse, and Medical Advisor for Adoption & Fostering, and three CIC Specialist Nurses. They are based at Bounds Green Health Centre and are supported by two Administrators.
16.2.3 A new CIC Designated Doctor started in post January 2018, and the team appointed two new administrators during the year. The CIC Designated Nurse and three CIC specialist nurses endeavour whenever possible to see the same children each year to
provide continuity. 16.3 National Statistics
16.3.1 Nationally there were 72,670 looked after children at 31 March 2017, an increase of 3% compared to 31 March 2016. (Source: SFR 50/2017, 28 September 2017: Department of Education).
16.4 London statistics 2013 2014 2015 2016 2017
Haringey 540 510 455 405 445 Islington 310 305 350 355 340 Greenwich 575 450 520 520 495 Lewisham 495 505 485 460 455 Southwark 560 550 500 475 500 City and
Hackney 325 345 350 340 380
16.4.1 Haringey statistics on 31st March 2018 there were 437 CIC. 16.5 Initial Health Assessments
16.5.1 Assessments should be completed within 20 days of a child entering care, a report is written and health recommendations should be available for the child’s first statutory review. Assessments are completed by members of the Community Paediatric Team, supervised by The Designated Dr for Children in Care. If the young
person refuses an assessment or is missing, the doctor then completes a report with all the health information available. 16.5.2 There currently are 50 unaccompanied asylum seekers in CIC, where
Interpreters are arranged for the assessments. There is rarely any previous health information available for unaccompanied young people. Some of the young people are referred for age assessments arranged by the Home Office and are often worried about attending for their health assessments, as they are concerned the two
assessments may be linked (this is not the case).
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16.5.3 The assessments can take longer than usual, with some individuals reporting torture, sexual violence and physical violence on their journey to the UK that in some cases take several years. The Doctor will assess the young person’s health and a
psychologist from First Step has where possible attended the Initial Health Assessment. All are referred to University College London Hospital (UCLH) for infectious disease screening. Some require referral for specialist mental health support and have posttraumatic stress disorder.
16.6 Young People remanded into detention 16.6.1 Since May 2013, statutory requirements relating to young people remanded
into detention (who weren't previously looked after) changed. These young people no longer require a statutory health assessment (Care Planning, Placement and Case Review (England) (Amendment) Regulations 2013). The young people will be seen by the facility they are remanded to or by the nurse working with the youth
offending team.
16.7 Review health assessments and follow up
16.7.1 Reviews are carried out by the four nurses in the CIC team or by a doctor if the care plan is adoption. Each child is allocated a nurse and for continuity the same nurse tries to see the same children each year. During the assessment the doctor / nurse talks to the child on their own to give them
the opportunity to discuss any concerns or questions with regards to their health or Placement. 16.7.2 97% of CIC had an up to date assessment on 31.3.2018. Eight assessments
were not completed. The older young people can be difficult to book appointments with and some fail to attend appointments. The team works hard to try to engage with them to ensure they can highlight any outstanding health needs. 81% of CIC had attended the dentist within the last 12 months, 86% of CIC for over 12 months
were fully immunised. The team completed 19 health assessments for children living in Haringey who are placed by other boroughs and we receive payment for these assessments via service level agreements.
16.7.3 This year there has been increases in young people who are missing, at risk of sexual exploitation and criminal exploitation, with an increase of those involved in gangs and serious youth violence. Children are often targeted by gangs enticed by gifts or earning money and are used to deliver drugs via ‘county lines’. We liaise
closely with services involved and attend strategy meetings. There are a number of children with complex care needs with concerns around their mental health, with medical or health needs or a disability.
16.8 Voice of the Child and Emotional Health
16.8.1 Listening to children and young people and ensuring their wishes and concerns are captured in health reports is paramount. The impact of neglectful and
abusive parenting in infancy can have neurological, physiological and psychological impact and almost half of children in care have a diagnosable mental health disorder and two-thirds have special educational needs.
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16.9 Strategic work of the Designated Professionals
16.9.1 Strategic Work of CIC DPs
The CIC Service undertakes a strategic role on behalf of the CCG and continues to advise the CCG on local and national issues that affect children in care. The team
liaise well with partner agencies where there are concerns and works closely with First Step and Social Care. The emotional needs of some young people continue to be a concern and liaison with Carers, Key Workers, Social Workers and commissioning has ensured there is not a delay in getting funding secured for
CAMHS involvement when required. For these cases joint working between the team and First Step Plus has been proven particular important, as we noted that the difficulties the children and young people experience with frequent placement breakdown often affect health, mental health and education.
There has been an increase in children in secure units and residential homes with many having complex needs and visits are continued to review any health needs. The team has continued to participate in CAMHS transformation work that has
included the transition of young people to adult services. 16.10 Training and Seminars
16.10.1 The CIC nurses provide training to foster carers on child development, health needs and minor ailments and treatment. The team has made a contribution to the Social Worker induction programme and run a module for Social Workers on the health needs of CIC every 8 weeks. Training is also provided on the health
needs of CIC at the Level 3 Safeguarding Training run by Whittington Health. The paediatric registrars receive training from the team during their placement and Health Visitors and School Nurses visit the service as part of their induction.
16.11 Risk Management, Incidents and Complaints
16.11.1 No formal complaints have been received by the CIC Designated Professionals There is a formal reporting process in place for incidents. Incidents are
discussed in team meetings and the team endeavour to learn from the recommendations. There was a delay in completing Adult health assessments when the team was without a Designated Doctor and the backlog of requests has been cleared.
16.11.2 The Operational Group meeting and floor walks are used to meet Social Workers to discuss CIC and to ensure information is shared. The Operational meeting provides a safe place to raise systemic challenges and has improved
collaboration across the agencies in relation to CIC. 16.11.3 Plans for 2018-2019 Key Priorities include
Continue to Participate in the induction programme for new social workers
To meet with independent reviewing officers to provide an update on their service.
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Continue to meet with the Operational Group to evaluate the CIC pathways and outcomes by strengthening partnership working across social care, health
and CAMHS.
To review the CIC Designated Doctor meeting schedules
Attendance at the Complex care panel a multi-agency panel where the team can contribute with regards to the specific health needs children may have.
17. Safeguarding Children Assurance data from Commissioned Services 2017/2018
17.1 Haringey CCG (HCCG) requires organisations to submit information in regard to their safeguarding children arrangements and activity. The purpose of the reporting is to assure HCCG that the services commissioned are safe, have
effective arrangements in place to achieve good outcomes for children and young people and comply with national guidance and statutory duties.
The 17.2 “Safeguarding Vulnerable People in the NHS – Accountability and Assurance
Framework” (2015) defines the safeguarding responsibility and duty of Health Providers: https://www.england.nhs.uk/wpcontent/uploads/2015/07/safeguarding-accountability-assurance-framework.pdf
17.3 These arrangements included:
Safe recruitment
Effective staff training
Effective supervision arrangements
Working in partnership with other agencies
All providers ensuring they have a Named Doctor and a Named Nurse for
Safeguarding Children (and a Named Midwife if the organisation provides maternity services)
GP practices to have a lead for safeguarding, who should work closely with the Named GP and Designated Professionals.
17.4 The three healthcare providers submitting safeguarding children data to Haringey CCG are:
Barnet Enfield & Haringey Mental Health Trust (BEH-MHT)
North Middlesex University Hospital Trust (NMUHT)
Whittington Health (WHHT)
17.5 The Provider safeguarding children dashboards/metrics/balanced scorecards were monitored quarterly at the Clinical Quality Review Groups (CQRGs) and by exception at the HCCG Safeguarding Children Assurance Meeting and HCCG Quality Committee.
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17.6 Any issues arising that required escalation were discussed with HCCG Senior colleagues, within the Haringey CCG Safeguarding Children Assurance meeting and Haringey CCG Quality committee as appropriate. These include the
following:
Whittington Health (WH) - level 2 and 3 safeguarding children training levels
continued below compliance. Resulting in a resubmitted updated WH training action plan with timescales and trajectory, presented and monitored at the WH Internal Safeguarding Children Committee, Patient Safety, Quality Committee and the WH CQRG meetings.
A review of the health arrangements in the Haringey MASH by the designated Nurse for safeguarding resulted in additional resource and a fulltime MASH practitioner now in place. This was identified as a strength
during the recent JTAI in December 2017
Cover arrangements and recruitment process for vacant post of Haringey CCG Designated Doctor for CIC, post holder now in post. All Provider
Internal committees are attended by The HCCG Designated Nurse Safeguarding Team.
17.7 Safeguarding Monitoring of Adults Commissioned Services
17.7.1 HCCG as commissioners of local health services need to be assured that the organisations from which they commission have effective safeguarding arrangements in place.
17.7.2 HCCG largest health providers Safeguarding Adults are:
Whittington Health (community and hospital services),
North Middlesex University Hospital
Barnet Enfield & Haringey Mental Health Trust.
17.7.3 HCCG also commissions Continuing Health Care (CHC) services for
Haringey residents who are eligible for CHC or Funded Nursing Care (FNC) via a number of smaller providers.
17.7.4 The effectiveness of the Safeguarding system is assured and regulated by
a number of bodies and mechanisms. These include:
Provider Safeguarding Adults Committees, internal assurance processes and Board accountability.
The Safeguarding Adult and Children’s Board.
HCCG Quality Committee.
Clinical Quality Review Group meetings (CQRG).
External regulation and inspection – CQC.
Effective commissioning, procurement and contract monitoring.
Haringey information sharing panel.
Establishment Concerns Meeting
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17.7.5 All provider services, are required to comply with the Care Quality Commission Essential Standards for Quality and Safety which include
safeguarding standards (Standard 7). NHS Haringey CCG performance manages each provider organisation via Formal contract review meetings led at Director Level. In addition the following arrangements are in place to strengthen the CCG’s assurance processes:
Safeguarding Leads are members of each Provider Trust’s internal Safeguarding Committees.
Joint commissioner/provider quality contract meetings always considers safeguarding issues/priorities and receive updates on action plans from Serious Case/Domestic Homicide Reviews.
Systematic reviews of serious untoward incident reports are routinely received from NCL Commissioning Support Unit.
17.8 NHS Trust Providers 17.8.1 All NHS Acute providers have a Safeguarding Adult lead within their organisation. All NHS providers follow their own internal governance
structures with regards to the reporting of Safeguarding activity; there is a variation across providers in these governance arrangements. All organisations have Adult Safeguarding processes and performance monitored by their own trust boards and by representation on the HSAB.
17.8.2 Improvements in the way in which trusts collect data have improved. The introduction of the NCL quarterly dashboard has provided a consistent approach to data collection.
17.8.3 Additionally, all NHS providers are responsible for ensuring that all Serious Incidents, including those with Safeguarding elements, are reported to the Strategic Executive Information System (STEIS), which reports to the Department of Health via NHS England.
17.8.4 Haringey CCG the Designated Professional for Safeguarding Adults attends all providers’ Safeguarding Adults Committees. The Designated Professional for Safeguarding Adults utilises attendance at the committees
as one way of gaining assurance that Provider Trusts are ensuring high quality Safeguarding Adults practice is embedded within their organisations and providing supportive challenge where required. The Designated Professional for Safeguarding Adults monitors compliance with the Trusts
respective Safeguarding Adult training strategies through representation on the committees and takes action as required. Information obtained from these meetings is included in the Quality Committee Safeguarding Briefings.
17.8.5 The Safeguarding Adults Committees (which have representation from Inter-professional and inter agency groups) provide that strategic
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direction to Safeguarding Adult activities within the Trusts and monitor that Safeguarding commitments are met. One of the purposes of the committees is to promote engagement with departments internally and all
agencies and to gain assurance that standards set out in the London guidance ‘Protecting adults at risk: London multi agency policy and procedures to safeguard adults from abuse’ are met.
17.8.6 In all three Trusts, the Safeguarding Committees are chaired by either the Deputy Director of Nursing or the Director of Nursing and report to the Trust Risk and Quality Committee. This ensures that scrutiny can be achieved at several levels that also Involve Trust Non-Executive Directors.
The Safeguarding Adults Committees also maintain an organisational overview of the implementation of the legal provisions in the Mental Capacity Act and the associated Deprivation of Liberty Safeguards (DoLS) And Prevent duty. The three Trust Boards receive an Annual Safeguarding
Adults Report and Work plans and these are shared with HCCG.
17.8.7 Provider Safeguarding Adult and Children Training compliance
Is reviewed by the Designated Professionals as part of the CCG contracts review and escalation processes.
Independent Providers: Nursing/Residential Care Homes, Private Hospitals and Domiliary Care.
Safeguarding activity within Independent Providers is monitored through a variety of means including:
Safeguarding Adult Board
London Borough Haringey (LBH) Safeguarding Adult Team
Quarterly Safety & Quality Information Panels with CQC and LBH Commissioning Team.
Monthly care homes meetings with London Borough of Haringey
and Quality Matters in Care Homes Team.
Monthly meetings with Continuing Health Care (CHC) team.
Quality-Matters-in-care-homes team monthly dash board.
CHC annual reviews. The sharing of information through meetings, forums and the collection of data enables HCCG to triangulate information to ensure that early on, concerns or
issues are identified and prevention of avoidable harm is seen as a priority and measures are put in place to support this. There were three Establishment Concerns and one provider failure meeting in
Haringey in 2017-2018 and 6 establishment Concerns out of borough but affecting Haringey funded residents.
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18. Safeguarding Monitoring of NHS Haringey Clinical Commissioning Group (HCCG)
18.1 The HCCG Safeguarding Children Designated Doctor and Nurses and Named GP met every six to 10 weeks. This provided an opportunity to share good practice, update each other on any developments and monitor the implementation of work plans.
18.2 HCCG training strategy is currently based on the Bournemouth competencies this will be reviewed in 2018- 2019 in line with Safeguarding
Adults: Roles and Competences for Health Care Staff Intercollegiate Guidance 2018.
HCCG Safeguarding Training Compliance Training data for 2017-2018
The following table provides the detail on compliance relating to safeguarding
training for quarter 4 2017/18.
Safeguarding Compliance
Numbers Requiring
Training
Numbers
Trained
Compliance
Percentage
Safeguarding Children - Level 1 73 44 60%
Safeguarding Children - Level 2 7 2 29%
Safeguarding Children - Level 3 5 1 20%
Safeguarding Compliance
Number Requiring Training
Numbers Trained
Compliance Percentage
Safeguarding Adults - Level 1 73 44 60%
Safeguarding Adults - Level 2 4 4 100%
Safeguarding Adults - Level 3 3 3 100%
Safeguarding Adults - Level 4 1 1 100%
Prevent 73 28 38%
18.3 Safeguarding Children Level 1, 2 and 3 are below compliance. The training
figures for level 1, 2 and 3 is reporting some factual inaccuracies.
There has been a concerted effort to highlight the importance of staff completing mandatory training. There have been concerns raised by staff that the current system employed by workforce development has not actively captured the results of people training therefore it is difficult to state accurately the compliance rate. A new system
for completing eLearning will be introduced across the STP.
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Assurance that data is accurate and training compliance levels are being met will be reported as part of the safeguarding governance arrangements and the safeguarding
work plan objective for 2018-2019.
19. Safeguarding Monitoring of Haringey General Practices
19.1 With effect from 1st April 2017, the CCG acquired delegated responsibility (from NHS
England) to commission GP services. For all Haringey GP Practices (those with full delegation or otherwise) the CCG is responsible for ensuring that appropriate internal safeguarding arrangements are in place, relevant policies exist, and staff are appropriately trained to discharge their safeguarding responsibilities. Such requirements
form part of an individual GP Practice’s requirements, and this is regulated by the Care Quality Commission. This is an area to be included in the HCCG Safeguarding Children work plan for 2018-19. In this context we will give consideration to the role of the Safeguarding Team and Named GP, in relation to supporting Haringey CCG.
19.2 HCCG Safeguarding Children Team continue to drive improvements in the quality of
Primary Care safeguarding children services. Technology such as the HCCG GP website, GP bulletin and GP practice emails were used to highlight and disseminate learning. Practice visits and face-to-face or phone advice and support were used as opportunities to reinforce understanding and improve the quality of safeguarding children practice.
19.3 Level 1 and 2 training was available via e-learning and the Haringey Safeguarding
Children Board. The Level 3 annual two and half hour bespoke GP training programme continued and was led and written by the Named GP supported by the HCCG Safeguarding Children Team.
19.4 Recent national analysis of Serious Case Reviews (SCRs) and the Joint Targeted Area Inspection (JTAI) of Neglect in Haringey in December 2017 highlight poor interagency working as a key area in need of improvement. In response the training this year was GP led but with external speakers from collaborative agencies: the Named GP; Assistant
Director of Children’s Services Haringey and the Haringey Team Leader of Safer London (a charity commissioned in Haringey to improve outcome for children suffering or at risk of CSE).
19.5 The training cycle started in January 2018 and events held in January, March and May 2018 with more training planned for Autumn 2018. The 2018 training in addition to ‘neglect in the older child’, included feedback from the Neglect JTAI, CSE and its management, new health visitor contact information and key learning from Haringey SCRs complete and
underway. 19.6 The GP training sessions are evaluated. Feedback from participants is universally excellent, rated very good or good. The participants were asked to base their feedback on
the training contents, presentation and would they recommend a colleague to attend the training sessions. 94% rated the standard of the presentation and speaker as either good or excellent and 93% rated the content good or excellent, 88% rated the administration good or excellent and 67% rated the venue good or excellent.
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19.7 Promoting effective safeguarding children in GP practices requires understanding the current landscape of General Practice. Several smaller practices have closed, some have combined, recruitment is a challenge and some practices have a high number of locums.
To meet these challenges Haringey GP safeguarding training is offered to any doctor working in Haringey including locums. We provide appropriate motivation, information and support with context in mind. It is positive that GPs in the level 3 training sessions remain informed and interested in safeguarding.
19.8 The Haringey children’s safeguarding partnership was subject to a joint inspection between 4th and 8th December 2017. There was a specific focus on the experience of children aged 7-15 years old. A key strength identified during the inspection was that
Haringey GPs demonstrated good professional curiosity and appropriate flagging of concerns to the relevant agencies in cases with neglect. GPs evidenced a good understanding of neglect of older children that enables effective identification and response to these children. The JTAI inspection also noted that the General practitioners
(GPs) receive good support from the Named GP for safeguarding in Haringey. 19.9 GP reports to child protection conference has previously been an area of concern. To obtain an update of the current situation an in-depth cross agency (health and social care)
audit is currently under way and will be published at the end of September 2018. 19.10 Interagency working remains an area for improvement. Cases are raised by GPs when there is discordance between expectations and response. GPs are encouraged to
escalate their concerns with their GP practice safeguarding lead and with the HCCG safeguarding team who can guide and help them liaise with social care. If there are still concerns they will then be redirected to the LSCB escalation policy.
19.10.1 There have been a number of positive developments:
There is a fulltime health practitioner in MASH. A good relationship and communication with Named GP has developed
Contact information for Haringey GPs is circulated 3 monthly to social care
When a risk has been identified in relation to an event or SCR, rapid action is taken to reduce risk.
20. Progress against Objectives 2017-2018
Objectives 2017-2018
Objective
Key Milestones
Progress
LSCB Multi-agency MASH
Review audit
HCCG and health providers engage with MASH audit
Largely Met
LSCB Multi-agency MASH review completed report presented to the
June 2017 MASH
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Objectives 2017-2018
Objective
Key Milestones
Progress
Strategic board.
Recommendations superseded by the JTAI in December 2017.
Actions for MASH to be rolled over onto the 2018/2019 work
plan as part of JTAI implementation activity.
In partnership with other
agencies, implement the JTAI abuse and neglect findings
to ensure effective partnership working for
children and young people living with Neglect
HCCG to ensure the complexities of the health
landscape (primary care, acute, mental health and
community health services) are fully understood and
the importance of multiagency contribution is considered more
appropriately
Agreed health JTAI
Action plan in place
Agreed partnership JTAI action plan in
place
Commissioners and
providers actively involved in monitoring planning meeting chaired by DCS
Completed health JTAI action plan with evidence of improved
outcomes
Completed partnership JTAI
action plan with improved outcomes for children and families
Assurance from providers that the Neglect
tool/thresholds are
Met
Partnership
integrated JTAI action plan including health actions now in
place.
There has been good health attendance from
health providers and commissioners Designated Nurse,
Doctor and Children commissioner at the JTAI
implementation group meetings chaired by the local authority DCS
The aim of the meetings is to have oversight of the JTAI
improvements and completed actions to date.
As part of the
implementation
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Objectives 2017-2018
Objective
Key Milestones
Progress
.
understood and
applied in practice across health system
Support and
challenge process across the health system to quality assure completion of
health JTAI action plan with evidence.
Escalation and deep dive
process in place when concerns/risks identifies as part of challenge process
Partnership work shop involving HCCG Haringey CCG Safeguarding Children take place to discuss the
Alan Wood Review and agree how best to ensure that going forward complexities of health
understood and used effectively.
group the LSCB
have set up a quarterly partnership support and
challenge sessions. In order to quality assure the JTAI action
plans, outputs and outcomes.
Actions to be rolled
over onto the 2018/2019 work plan as part of JTAI
implementation activity.
LSCB Multi-agency MASH Review audit
HCCG and health providers engage with MASH audit
Largely Met LSCB Multi-agency MASH review completed
report to be presented to the June 2017 MASH Strategic board.
Assurances of robust application of thresholds and evidence of improved outcomes are still
required. To review, in
partnership with other agencies, the effectiveness
HCCG and Providers attendance and actively participate in
Largely Met The Designated Nurse lead the completion of the
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Objectives 2017-2018
Objective
Key Milestones
Progress
of partnership
working for a possible Joint targeted area inspection (JTAI)
the (JTAI)
improvement group
Assurance that all providers are
engaged with the JTAI self-evaluation process
Providers attendance at JTAI partnership case audit
Completed health JTAI self-evaluation
Assurance that
recommendations /actions from the JTAI self-assessment are met
Assurance that all frontline staff are engaged with JTAI
process and lessons learnt.
Health Economy JTAI
self-assessment signed off at the SAG meeting on the 6th December.
The Haringey partnership DA JTAI self-assessment is now in place and will inform any multiagency
joint inspection. Recommendations from Provider single JTAI self-
assessments are being monitored via the LSCB JTAI/PPO subgroup and their internal committees
Full engagement at the (JTAI) improvement group by HCCG
Designated Nurse and Providers
To request assurance from non NHS
providers of children’s services commissioned by HCCG that they
have taken all required action in response to the findings from the
Savile Inquiries
Assurance process in place based on receipt of response,
strength of evidence provided with the response, clarity of policies and protocols across organisations
Measurement of staff awareness and use of policies and protocols in practice will be
assessed via provider audit
HCCG monitoring and assurance will be
through quarterly
Largely Met
Assurance and
evidence received from all 4 non NHS providers.
51
Objectives 2017-2018
Objective
Key Milestones
Progress
HCCG Safeguarding
Children Assurance Meeting and via commissioning meetings with
providers CCG and health
providers to actively participate in partnership
working within LSCB Training subgroup
Assurance of health
economy attendance at L&D subgroup
Largely Met
Active participation by CCG and health providers within LSCB Training
subgroup
Develop Quality Assurance Framework for single agency
training.
Single agency training review undertaken to inform training need and LSCB training priorities
Largely Met LSCB Review of single agency training offer to
identify training need 2017/2018 completed. HCCG Designated Nurse is now Chair of
the Training and Development group as from June 2017 LSCB Review of single
agency training offer to identify training need 2017/2018 completed.
Providers submitted training offer including training offer for GPs. Now informed
multiagency assurance framework. The LSCB training learning and development subgroup
have agreed a process for single agency assurance details was finalised at the TLD half
52
Objectives 2017-2018
Objective
Key Milestones
Progress
In collaboration
with the Safeguarding Adult Lead develop the
Safeguarding Children element of the PREVENT
strategy in line 16.with The Counter Terrorism and
Security Act 2015 and NHSE PREVENT duty guidance
Comprehensive PREVENT policy and procedure that
supports legal requirements, NHSE Assurance and Accountability
Framework, NHSE PREVENT policy and competency framework and
intercollegiate guidance
Providers integrate PREVENT into their
governance arrangements so they can ensure they are complying with
legislative duty
Strengthen practice and outcomes for vulnerable adults
day workshop on 10th
May 2018. Largely Met
Prevent Strategy and Training Competency
Framework developed and rolled out.
Increase GP
awareness and compliance regarding the provision of
timely and high quality reports to Child Protection Conferences
Increase GP
awareness of previous audit findings regarding poor compliance in
providing GP reports to Conferences
Further and continued audit focussing on the
following areas: Increased focus on
GP engagement with Child Protection
Conferences and offer the opportunity
Met
Partnership audit approved by the LSCB performance practice outcome subgroup
describing audit to review the process from social care invitation to conference, GP report
provision and GP receipt of minutes and plans after conference.
Audit now underway by both the Named GP and
53
Objectives 2017-2018
Objective
Key Milestones
Progress
to support GPs;
acknowledging improvement as well as addressing any non-compliance and
establishing the cause and how to improve. Better Informed discussions
with Local Authority colleagues regarding the timeliness of invitations and notice
given when requesting reports.
the Social Care Head of
Safeguarding Children. Suggest rolled over to 2018-19
Strengthen internal assurance process by
identifying a GP board member with lead responsibility for
safeguarding adults.
GP board member identified and in place.
Objective achieved -Body member identified and briefed.
Health has appropriate representation on
Safeguarding Adult Boards (SAB) and Subgroups which
strengthens interagency working through contribution to
the work of the board.
HCCG executive and operational lead attendance at the quarterly SAB Board.
HCCG will facilitate and monitor relevant Health provider attendance.
Attendance at the Quarterly SAB subgroups. Co-chair the Mental
Capacity SAB sub group.
Attendance at Safeguarding Adults
Reviews and Domestic Homicide Reviews.
Objective achieved Designated Professional for Safeguarding Adults
are both members of the SAB. The Designated
Professional for Safeguarding Adults has contributed to the strategic direction of the
SAB and development of SAB strategic work plan. The Designated
Professional for Objective achieved
54
Objectives 2017-2018
Objective
Key Milestones
Progress
Safeguarding Adults is a
member of all SAB Sub groups. This can be evidenced in the minutes of the meetings.
The Designated Professional for Safeguarding Adults is
the vice - chair of the Quality Assurance SAB sub group and SAB Safeguarding Adult
Review subgroup. This is evidenced in the minutes of the meetings.
Provider attendance at SAB sub group is monitored, poor attendance escalated as
appropriate. Designated Professional for Safeguarding Adults
has participated in 2 DHRs and one SAR during 2017.
HCCG to gain assurances of
safeguarding arrangements within provider organisations
through attendance at internal trust safeguarding
committees.
Attendance at the bi monthly trust internal safeguarding
committees. HCCG will monitor provider compliance with NHSE
revised Safeguarding Accountability and Assurance Framework, Care Act and Prevent duty.
Safeguarding is an agenda item of Clinical Quality Review Group (CQRG)
meeting.
Objective achieved
Designated Professional for Safeguarding Adults attends all provider trusts internal safeguarding
committee. Evidenced through committee minutes.
Director of Nursing and Quality attends CQRG evidenced through CQRG minutes.
55
Objectives 2017-2018
Objective
Key Milestones
Progress
Compliance monitored via Bi monthly safeguarding briefings and annual reports to Quality Committee.
Bi monthly safeguarding
briefings and annual reports to Quality Committee.
Conduct a baseline
assessment of HCCG’s position against the NHSE
Revised Safeguarding Accountability and Assurance
Framework to ensure
compliance.
Complete a baseline gap analysis of HCCGs position
against the NHSE Revised Accountability and Assurance Framework 2015.
Report the analysis of the assessment to the Quality Committee by Oct 2015.
Implement changes during 2016/2017 via the work plan.
Objective achieved All actions from gap
analysis transferred to work plan in 2016. Objectives for year 2016-
2019 signed off by Quality Committee August 2016.
HCCG has a system for
identifying, analysing and referring complaints which
raise safeguarding concerns, including
potential neglect.
Complaints Policy specifically references child
and adult safeguarding Algorithm for screening. Provision of Quarterly
update reports and annual review reports to Quality Committee.
Bi monthly update reports and annual review reports to Quality Committee.
Objective achieved HCCG complaints policy
reviewed and checked with FOI officer, safeguarding referral pathway included is in
policy and is sufficient.
Where a patient under the responsibility of
HCCG is in a private sector hospital or care home there are
effective systems for recording and monitoring of Deprivation of
liberty application.
Monitoring of DoLS agreement with Local Authority.
Specific MCA and DoL monitoring and reporting requirements contained in all
contract agreements. Create and maintain a dashboard of all patients
subject to DoLS.
Action in progress and on track to be completed. Dashboard has been
replaced by tab on Care Track (electronic recording system) enables CHC team to log
HCCG patients subject to DoLS.
Scoping exercise
completed with CHC Team for those patients
56
Objectives 2017-2018
Objective
Key Milestones
Progress
Complete an analysis of
HCCG patients subject to judicial DoLS
subjected to judicial
DoLS. Report has been submitted to director of commissioning.
Strengthen governance arrangements
with provider organisations by holding 1:1
meetings on a Quarterly basis with the lead for
Safeguarding Adults in NMUH.
Quarterly meetings to discuss Key subject areas: safeguarding work and
activity, provider policies and practices, discussing areas of concern or complex cases or share best practice.
Quality assures training strategies and materials for Safeguarding Adults.
Exception reporting in the Bi monthly Quality Committee briefing.
Objective completed HCCG DPSA has provided monthly
mentoring sessions to NMUH safeguarding adult lead in addition to the Monthly 1-1 safeguarding
supervision.
Review
safeguarding elements of all existing provider contracts and
Service Level Agreements. Ensure contracts and Individual
Placement Agreements (IPA) are Safeguarding
Adults, MCA, DoLS and PREVENT Compliant.
Review current Contracts
and IPA with Commissioners, CHC and Care Homes Team. Individual placements
agreements (IPA) contain information regarding providers reporting and service standard pertaining
to safeguarding adults. Commissioning and contract monitoring has a clear focus on safeguarding and dignity
and any shortfalls in standards are addressed. Develop a quality monitoring dashboard with CHC and
Care homes Team. Develop a quality monitoring audit with CHC Team and Care Homes Team.
Develop a robust IPA which includes provider’s responsibilities for
Largely completed
Commissioning team procure service to monitor quality of CHC providers.
HCCG CHC commissioners complete checks with host authorities regarding
quality or provider prior to placement. CHC placement review
document carried out at 3 monthly and yearly intervals.
CHC commissioner holding quarterly commissioner assurance meetings.
HCCG contracts contain NHSE particulars for spot IPAs which contain service condition 32
57
Objectives 2017-2018
Objective
Key Milestones
Progress
Safeguarding Adults, MCA,
DoLS, PREVENT and contains quality standards
Safeguarding Adults,
MCA, DoLS, PREVENT. Further work required to ensure all contracts are
compliant with making safeguarding personal.
Alignment of Safeguarding and Serious Incident (SI)
investigations: The Adult Safeguarding Lead and the
Local Authority (LA) safeguarding team to align the
two processes so that duplication of effort is avoided and to
enable timescales to be met and learning recorded/shared
as required.
Review NHS London SI framework, work and Pan London Safeguarding Adults policy with NCL
Safeguarding Leads, LAs and quality leads. Develop and implement a
localised SI and Safeguarding pathway to reduce duplication of effort and to enable timescales to
be met and learning recorded/shared as Required.
Lead and the Local Authority (LA) Safeguarding team to align the two processes so that
duplication of effort is avoided and to enable timescales to be met and learning recorded/shared as
required. Link with L.A to agree time scales between S.G and S.I
Objective achieved DPSA worked with LBH to review and update the
S42 multiagency policy to reflect agreed changes and has been agreed at the Sept SAB 2017.
Evidenced in minutes.
Actions from Safeguarding Adult Review (SAR) and
Domestic Homerside reviews (DHR) are implemented,
Key details actions and lessons learned reported up via CCG governance processes.
Designated Professional to oversee HCCG action plans developed to address any
Objective achieved. Designated professional for safeguarding adults is
the vice chair of the SAB SAR sub group and a member of the prevention and learning SAB sub
58
Objectives 2017-2018
Objective
Key Milestones
Progress
monitored and
lessons shared across the all organisations including
provider services.
learning and present in
quarterly reports to CCG Quality committee. Disseminate and embed
lessons learned from enquiry. Action plans audited.
Designated Professional will Monitor whether the recommendations in health action plans have been
successfully completed through trust internal safeguarding committees.
As well as reflecting upon the previous SARs and DMRs, the CCG will incorporate
research on whether nationally SCRs have historically made a difference to practice
and how this can inform the ways in which organisations and their staff embed
learning in practice.
group. Learning from
incidents is utilised to inform multi agency training strategies.
HCCG has had one SAR in 2016, an action plan has been developed and updates on implementing
recommended actions will be presented at HCCG QC in Feb 2017 for ratification.
Learning has been shared with CHC and commissioning Team.
Review
Safeguarding internet page and existing links and material.
Work with coms to update Safeguarding
Adults web page.
Review Safeguarding
internet page and existing links and material. Work with coms to update
Safeguarding Adults web page.
Objective achieved.
Internet page reviewed and changes made to reflect changes in
national legislation and local policy. A new page added to reflect the Prevent statutory duty.
Haringey CCG joint adult’s children front facing safeguarding page
59
Objectives 2017-2018
Objective
Key Milestones
Progress
to provide information to
the public. Embed and
monitor Safeguarding Adult Key Performance
Indicator (KPI), quarterly and yearly audit to monitor provider
safeguarding arrangements.
Objective completed.
Evidence of compliance is provided through the trusts internal
safeguarding committee.
Review and update Safeguarding
Adults Policy and Procedure and training competency
framework to reflect changes in legislation and NHSE
intercollegiate guidance.
Review HCCG Safeguarding Adults Policy in line with Care Act guidance, NHSE
safeguarding Accountability and Assurance framework, Pan London Safeguarding Adults Policy and procedure
2016 and NHSE intercollegiate guidance to reflect legal and national policy changes.
Ongoing. Further work required to embed training
competency framework following release of intercollegiate guidance during 2018.
Consideration to develop a Haringey and Islington CCG policy during 2018-2919.
Develop performance and audit framework that explicitly
considers how person-centred safe-guarding interventions are
and how Reflective of users’ views and needs in line with
making safeguarding personal (MSP).
MSP audit developed and audit cycle agreed with CHC Team.
Reporting through safeguarding adult’s annual report.
Objective completed. Audit tool developed with CHC Team and audit cycle commenced Q1
2017-2018. Individual and team feedback given following audit.
Clinical Supervision
policy: This will
Develop Supervision Policy for all CCG clinical staff,
including CHC staff.
Objective completed.
60
Objectives 2017-2018
Objective
Key Milestones
Progress
be developed in
collaboration with the Continuing Health Care Team to ensure
safeguarding specific supervision is included.
Policy ratified at HCCG
quality committee July 2018.
Review HCCG Safeguarding
Adults at Risk Supervision Policy in line with intercollegiate
document.
Safeguarding Adult Supervision Policy refreshed
in line with SCIE best practice, including Bournemouth Competency framework and NHSE
Safeguarding Adult Intercollegiate guidance.
Action in progress and on track to be completed.
Intercollegiate guidance for safeguarding adults has been delayed and due mid-2018.
Supervision policy will require updating in line with competency framework.
Refresh the
localised Multi Agency Safeguarding
Adults Pressure Ulcer
Protocol in line with revised
serious incident framework.
To review NHSE Safeguarding Adults Pressure Ulcer protocol and align local PU protocol to
ensure a proportionate response to the investigation of pressure ulcer care. To review with SAB partners,
CHC Team and providers. To implement September 2018. To develop monitoring tool
for compliance.
Objective completed. PU safeguarding policy updated in line with DoH
guidance and ratified in March SAB 2018
Develop a
PREVENT strategy in line with The Counter Terrorism and
Security Act 2015 and NHSE PREVENT duty guidance.
PREVENT strategy in place
in line with The Counter Terrorism and Security Act 2015 and NHSE PREVENT duty guidance.
PREVENT strategy discussed with providers and provider PREVENT action plan monitored through
Safeguarding Adult KPI, NHSE quarterly dashboard
Objective completed.
Prevent strategy for HCCG in place.
Providers compliance with the prevent duty monitored through internal safeguarding
committee.
61
Objectives 2017-2018
Objective
Key Milestones
Progress
and Safeguarding Adult and
Children committees. PREVENT policy and procedure in place for HCCG.
Review the PREVENT competency framework and intercollegiate safeguarding Adults guidance. Develop a
PREVENT training strategy for HCCG. Providers integrate PREVENT into their governance
arrangements so they can ensure they are complying with legislative duty. Progress against training
reported in bi monthly QC briefing.
HCCG DPSA is a
member of the Prevent strategic group and channel panel.
HCCG DPSA ensures appropriate health representation at the channel panel.
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21. Key Objectives 2018-2019
22.1 The key objectives for 2018-19 are taken from objectives that have not been fully met within 2017-2018, as identified in the Annual Report and additional objectives was required. A detailed work plan for 2018-19 will be created to support the delivery of the objectives as part of the third year of
the 2016-19 Safeguarding Children Strategy and will be regularly monitored at the HCCG Safeguarding Children Assurance meeting.
The objectives are as follows:
To undertake a review and update the HCCG Safeguarding Children
policy in line with the new Children and Social Care 2017 Act and Working Together to Safeguard Children 2018.
To undertake a review to validate information held on the NCL new work force system. To ensure staff safeguarding training levels are aligned with their roles and responsibilities find that there are accurate
information on percentages of trained staff reported.
To seek assurance on behalf of HCCG that robust safeguarding process
in place in commission GP services in relation to acquired delegated responsibility (from NHS England).
In partnership with other agencies, to lead the health implementation of
the JTAI abuse and neglect actions to ensure effective partnership working for children and young people living with Neglect.
To actively participate in collaboration with other agencies in the
strengthening of effectiveness of the Haringey MASH. To ensure that MASH and application of thresholds are fully understood and functional across all staff groups.
Increase GP compliance regarding the provision of timely and high quality reports to Child Protection Conferences.
The challenges for Safeguarding over the coming year are to continue
to develop, expand and embed Safeguarding practice within the core work of the CCG; and to build up partnership working with the local authority, local health providers and NHS England (London). In line with developments across the North London Health and Care Partners
ensure safeguarding is firmly embedded in the work of the partnership.
Review and update HCCG Safeguarding and Islington Training Policy in line with NHSE intercollegiate guidance: Adult Safeguarding: Roles and
Competencies for Health Care Staff August 2018 to reduce variation in training. Identify the current level of practice and role expectations/requirements within the specific care context, identify and
63
develop the knowledge and skills in aspects of safeguarding to realise the potential of the role.
Review and update HCCG Safeguarding and Islington Safeguarding policy to reduce variation across both CCGs. Review both policies develop a combined policy.
Work towards a NCL Health Safeguarding Adult Quality Assurance Framework to reduce variation of data collection across NCL. Review current and existing QAF, send final version to NCL safeguarding leads
and agree with provider organisations implement a phased approach during 2018 Q3.
Develop a SAB multi-agency case file audit tool to ensure learning from
safeguarding cases is embedded in practice.
Develop a common methodology to audit specific themes across the partnership to ensure that learning from case file audits is embedded
and leads to improved safeguarding practice.
Develop and Implement the health pathway for ‘Liberty Protection Safeguards’ Develop an NCLP policy and process for authorisation of
LPS.
Work with MCA and DoLS SAB subgroup to develop knowledge and understanding across the partnership about MCA and consent including
consent for 16-17 year olds. Joint work between children and adult services across health and social care to identify when MCA should be used, develop program of training and support to staff across health social care and education.
Establish standards and agreed competencies in MSP and adult safeguarding prevention for all staff across the partnership: safeguarding workforce is person-centred and understands MSP; the
system is focused on prevention. Joint work through the training and prevention SAB sub group to deliver framework.
Embed the Multi Agency Safeguarding Adults Pressure Ulcer Protocol:
Effectiveness of policy to be reviewed through program of audit.
Strengthen safeguarding arrangements within primary care by submitting a business case to recruit a named GP, develop level 3
safeguarding training and monitor compliance across Haringey. Safeguarding leadership within primary care which promotes a culture of improvement and learning.
Actions from HCCG Safeguarding Adult Review (SAR) and DHR are implemented, monitored and lessons shared across the all organisations including provider services. HCCG will provide person
64
centred quality safe care. HCCG will ensure the effectiveness of safeguarding arrangements with commissioned services. Good practice shared across the health economy.
Develop a Policy and Procedure for Managing Allegations and Concerns around employees” to reflect requirements of the Disclosure
and Barring Service and professional registration requirements. HCCG will be compliant with local policy and national guidance
Authors:
Pauline Fletcher
Designated Nurse Safeguarding Children and Young People
Hazel Ashworth
Designated Professional for Safeguarding Adults September 2018
Acknowledgements:
Julie Thomas
Named GP Safeguarding Children Dr Kim Holt
Designated Doctor Safeguarding Lynn Carrington
Designated Nurse Children in Care
End of Report
65
22. Appendix 1: Publications in 2017 – 2018
DFE Research and analysis
DFE Safeguarding and radicalisation.
Small-scale study into the social care response to radicalisation. Published 3 August 2017.
The London Child Sexual Exploitation Operating Protocol 2017.
Working Together to Safeguard Children: revisions to statutory guidance July 2018.
Policy paper: Safeguarding unaccompanied asylum seeking and refugee children strategy setting out the government’s commitments to safeguard and promote the welfare of unaccompanied asylum seeking and refugee children.
Published 1 November 2017.
Child abuse and neglect: NICE guideline [NG76] Published date: October 2017
Home Office: Criminal Exploitation of children and vulnerable adults July
2017
RCN: Modern Slavery- guide for nurses and midwives
