Annual Report: SAFEGUARDING ADULTS AND CHILDREN

Annual Report: SAFEGUARDING ADULTS AND CHILDREN Children, young people, vulnerable adults and victims of domestic abuse are considered in all interactions with service users and carers. Safeguarding, protecting and promoting the health and well-being of children, young people, vulnerable adults and victims of domestic abuse will be realised as an issue for all services and all staff across the Health Board regardless of role. (PTHB Safeguarding Strategy 2013-16) 1 Page

Introduction: Safeguarding Adults and Children Annual Report This annual report serves to inform the Board of the ongoing safeguarding activities undertaken by the PTHB in relation to Safeguarding Children, Young People, Looked after Children, Vulnerable Adults and Domestic Abuse for the period 2015/16. The main elements contained within this report are divided into themes and cover: Performance against last years agreed work programme; The national context for the provision and development of safeguarding children, young people and vulnerable adults; The local context for the provision and development of the safeguarding agenda; Local data in relation to Safeguarding Training data in relation to Child Protection and Adult Protection; Priorities for /17, including action underway. 1. Achievement against last years agreed Safeguarding priorities Action 1. Review the Terms of Reference and all Fora and sub-groups aligned to the Safeguarding People at Risk reporting Framework 2. Receive from each identified Locality / Directorate an annual safeguarding report to evidence: Governance Arrangements; Training needs analysis and training data; Datix Incidents and recommendations from Reviews and action plans. Progress Terms of Reference reviewed and PTHB Safeguarding Committee established with clear governance and reporting mechanisms and revised roles and responsibilities for members. Directorate reports have not been received but highlight reports are now a standing item at the new Safeguarding Committee. 2 Page

3 Implementation of the Safeguarding Training Strategy 4 Training for the Board on Safeguarding Adults / Children and PREVENT 5 Implementation of the Domestic Abuse, Violence against Women and Sexual Violence E- learning (Level 1) Training Package 6 Promote the National Training Package for Adult Protection and implement the E-learning Level 2 (Adult Protection). 7 Implementation and audit activity against Health and Care Standards, Quality Outcomes Framework (QOF) Safeguarding Children Network, Regional Safeguarding Boards audit, and Section 28 Audit. 8 Full engagement with the implementation of the Social Services and Wellbeing Act 2014 at National, Regional and Local level including the activities and membership at the Regional Safeguarding Boards 9 To work in collaboration with Workforce and Organisational Development to improve training compliance and recording 10 Review and enhance engagement with Primary and Community Care Service provision and Independent Contractors 3 Page Reviewed in line with SS&WB Act and VAWDASV Act Training undertaken at the Board development day Training package on NHS portal Training package on NHS portal QOF data has been collected and submitted on-time to WG Active attendance at all local, regional and national meetings There has been collaboration with WOD to improve training provision but this has not yielded full compliance with training as yet Members of the Safeguarding Team attend Directorate meetings to raise the profile of Safeguarding.

11 Review, audit and implement recommendations from the Learning Events, and the Statutory Guidance of Adult Practice Reviews, Child Practice Reviews and Domestic Homicide Reviews. 12 Audit and Review Clinical Supervision activity for key groups 13 Review arrangements for Deprivation of Liberty Safeguards in relation to administrative support and Best Interest Assessor 14 Link Deprivation of Liberty Safeguards (DOLS), Mental Capacity Act, PREVENT, Domestic abuse, MAPPA with Adult and Children s Safeguarding training 15 Audit the implementation of the Deprivation of Liberty Safeguards action plan for the implementation of the Cheshire West Judgement. 16 Review the reporting Framework to include Deprivation of Liberty to Protecting Vulnerable People s Group. 17 Implement and audit the activity and reporting compliance against Female Genital Mutilation This is being achieved via the new Safeguarding committee which includes an agenda item re: reviews and learning. Reviewed and audited yearly. Reviewed. The PTHB Safeguarding Service has employed a Best Interest Assessor. New guidance and legislation is expected December. Training events have been published and are on ESR. Multi agency audit and review occurs through the DoLS oversight group DoLS has been reported to the MH/LD Committee and will be a standing item for the Safeguarding Committee. This is a reporting framework for FGM but this has not been audited in-year. 4 Page

18 Promote improved use of the datix system for collation of adult protection data 19 Outcomes or findings from adult protection cases within health to be fed back to staff through team and peer meetings. Action plans will be developed and monitored through the Safeguarding Committee Datix system is being used for both adult and children s safeguarding matters. This is being managed through the Safeguarding Committee. 20 Develop a response and implement action plan from Operation Jasmine 21 Implementation of the CYSUR Child Sexual Exploitation strategy Multi agency action plan in place which is reviewed jointly through PLOGA. Implemented and an action plan has been developed in line with local, regional and national requirements. 5 Page

Overall there has been good achievement against the agreed priorities for 2015/16, despite staffing deficits within the corporate safeguarding team. Areas where there has been non-achievement have been incorporated into the / 17 priorities. 2. The National Context: The Health Board has a statutory duty to make arrangements to safeguard and promote the welfare of children under Section 11 of the Children Act 2004 and is a statutory member of the Safeguarding Children s Board under section 13 of the Act. The Social Services & Well Being (Wales) Act (2014), which became effective from April, places Adult Protection on a statutory footing, making it a statutory duty to safeguard, report, protect, co-operate and share information to protect adults from abuse. It is imperative for the Health Board to safeguard vulnerable people in accordance with the legislative frameworks and All Wales Policies and Procedures for the Protection of Children and Adults at Risk. During the past year Safeguarding has been undergoing a period of significant change with the introduction of several new Acts and Frameworks, which are summarised below: The Social Services & Well Being (Wales) Act (2014). This presents new duties for safeguarding Adults at Risk and set the footprint for regional relationships for Safeguarding under Part 7 of the Act Keeping People Safe. Powys is partnered with Ceredigion, Carmarthen and Pembrokeshire as a region. In relation to Part 9 of the Act, Working Together, and the VAWDASV Act Powys is seen as a region on its own. This leads to some complexities in relation to governance and accountability but there is senior representation on all regional safeguarding meetings CYSUR, Mid and West Wales Regional Adults Safeguarding Board, MAPPA SMB, VAWDASV and the Modern Day Slavery meetings. Whilst time consuming active attendance ensures that all safeguarding issues are addressed in their totality. The Counter Terrorism and Security Act (2015). From July 2015 this placed a legal duty on PTHB to have all staff trained in PREVENT. The aim of the Prevent strategy is to reduce the threat to the UK from terrorism by stopping people becoming terrorists or supporting terrorism. Violence against Women, Domestic Abuse and Sexual Violence Act (2015). This ensures a focus across the public sector on the prevention of violence, protection of victims and the support for those affected by such issues. The National Training Framework has been Lead Director for Safeguarding Report Page 6 of 18 Board Meeting

consulted upon and includes 6 levels of training from awareness raising and practical guidance, to strategic planning and leadership. The training is mandatory. Modern Day Slavery Act (2015). This strengthens law enforcement powers to tackle modern slavery and increase protection for victims. It includes Slavery and Trafficking Prevention and Risk orders, and introduces an Independent Anti Slavery Commissioner. There are agency Safeguarding Leads, Regional Multi Disciplinary Panels and changes to the National Reporting Mechanism. A review of the implementation of the Child Practice Review Framework has been undertaken, and there are ongoing activities relating to Safeguarding Adult Practice Reviews. The Safeguarding Children NHS Network has been established providing an environment for Health Boards, NHS Trusts and the Safeguarding Children Service to work together in recognising common issues, developing solutions and achieving healthcare standards to better safeguard children. It provides a bridge between strategies and arrangements at local level and national policy developments to support NHS Wales, LHBs and Trusts in fully discharging their responsibilities for safeguarding children. The National Independent Safeguarding Board has been established, under Part 9 of the SSWB Act, which is accountable to Welsh Government and is responsible for Policy direction and Strategy development. 3. The Local Context: PTHB Safeguarding Service Safeguarding services in PTHB have been strengthened in order to improve the way in which all staff work with each other to protect vulnerable people, whether in a hospital or community setting. This has included training Adult Protection Investigators, improved use of the Datix system for reporting safeguarding issues, a revised committee infrastructure and the ongoing development of the corporate Safeguarding Team. From an infrastructure perspective there are some dedicated posts for safeguarding, however it is essential to emphasise that safeguarding is a key responsibility for all staff, at every level of the organisation. There is ongoing redesign of the Safeguarding Team with an emphasis on an all age approach to safeguarding, whether it be safeguarding, protection or offender management. Lead Director for Safeguarding Report Page 7 of 18 Board Meeting

The Safeguarding Team have strengthened their links with a number of Directorates across the Health Board specifically but not exclusively the Women and Children and Mental Health. A member of the corporate team attends monthly directorate meetings to ensure safeguarding is an embedded agenda. The PTHB corporate team work very closely with Powys County Council. PTHB Safeguarding Committee There has been a refresh and review of the membership and Terms of Reference of the PTHB Safeguarding meetings. This has led to the formation of a new PTHB Safeguarding Committee, which is chaired by the Director of Nursing. It is a multi-disciplinary forum which provides leadership, commitment and operational support to the Safeguarding agenda. The reporting framework is designed to ensure both statutory activities and reporting arrangements are aligned to the corporate reporting framework for the Health Board and with the statutory multi-agency agenda. The Committee reports directly to the Patient Experience, Quality and Safety Committee and ensures implementation, monitoring and audit of relevant legislation and guidance. County and Regional context PTHB has been working in partnership regionally to progress the implementation of the Social Services and Wellbeing (Wales) Act (2014) and Violence Against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015. PTHB plays its full role in the Powys Local Operational Groups for safeguarding adults and children. The Mid and West Wales Safeguarding Children s Board (CYSUR) became fully functional in June 2014, and the Mid and West Wales Adult Protection Board became fully functional in April. Both have strong governance arrangements underpinning their work and feed in to local and Health Board meetings. The Director of Nursing and the Head of Nursing for Adult and Children s Safeguarding are members of the Regional Safeguarding Boards. PTHB actively contribute locally, regionally and nationally on a number of Safeguarding agendas including: Child Protection, Adult Protection, Looked After Children, VAWDASV and Gender Based Violence, Community Safety Partnership, Youth Offending Board, Deprivation of Liberty Safeguards, MAPPA, Female Genital Mutilation, Modern Day Slavery and Trafficking and Child Sexual Exploitation. Lead Director for Safeguarding Report Page 8 of 18 Board Meeting

4. Staff and Resources The Safeguarding Service consists of number of key professionals who are able to provide expert advice, guidance and support to health staff and other agencies to ensure children, young people and adults are safeguarded. The Safeguarding service have experienced a period of significant staff challenge over the past year with limited resource due to staff sickness and retirement. Despite this the Safeguarding service have benefited from a new appointment of a Best Interest Assessor for Deprivation of Liberties and a Health Visitor has been seconded to the Service for six months as a Project Lead for the Implementation of the Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015. The changing legislative framework has triggered a review of the service and its resource and the corporate safeguarding team are undergoing a period of redesign, with an emphasis on the whole safeguarding agenda, to include an all-age approach. A Clinical Nurse Specialist for Adults and Children s Safeguarding / Domestic abuse has been appointed and a further position is currently being recruited to. The senior nurse roles within the team will subsequently become more strategic, supporting the Head of Nursing with the complex and multifaceted agenda. 5. PTHB Performance: Child Practice Reviews, Adult Practice Reviews, Domestic Homicide reviews: There has not been a Child Practice Review (CPR) since the introduction of the guidance in 2013, but there is currently a multi-agency Independent Management Review (IMR) of a case where a looked after child committed suicide in April 2015. This did not meet the criteria for a CPR but it was felt that lessons could be learned in relation to transitional plans for looked after children and young people and the planning in relation to the needs of children and young people who have experienced abuse and neglect. There is currently an Adult Practice Review of a person who died in Hereford and a Domestic Homicide review in relation to an individual who was murdered by their spouse. These people were not known to local services. Procedural Response to Unexpected Death in Childhood (PRUDiC) The Safeguarding Team are only involved in the deaths of children which are unexpected, therefore other data in relation to child deaths and learning lessons is reported through the Women and Children s Directorate. There Lead Director for Safeguarding Report Page 9 of 18 Board Meeting

were 4 unexpected deaths from April 2015 to March. Three were accidents and one was suicide and is subject to review. Child Protection Medicals There is a Child Protection Medical Policy which is currently under review together with a review of medical cover arrangements, which due to the geographical nature of Powys presents a challenge. The current arrangements are dependent on the availability of 2 Paediatricians in South Powys. Child Sexual abuse medicals are undertaken outside of Powys, as there are no facilities across Powys. April 2013 March 2014 April 2014 - March 2015 April 2015 March Total Physical Sexual 10 80% 20% 36 80.5% 19.5% 37 86% 14% The table shows that there is an increase in the number of Child Protection Medicals over the past three years. It is believed that this is due to improvements in reporting. Safeguarding children statistics Figure 1: Child Protection Referrals as a proportion of all contacts with Children s services Q1 Q2 Q3 Q4 15/16 15/16 15/16 15/16 Total Other Referrals 646 591 541 482 2260 CP Referrals 128 69 97 115 409 CP as % of All Contact 16.5% 10.5% 15.2% 19.3% 15.4% An increase in referrals can be seen up to quarter 4, with no one factor evident for the increase. The Q4 figure relates to 115 children, 7 of which relate to likely or actual abuse and 92 suspected of abuse, which have required further investigation. The remaining 16 relate to family support in safeguarding matters. Figure 2: Child Protection referrals by agency (up to March ). Lead Director for Safeguarding Report Page 10 of 18 Board Meeting

The following graph illustrates the number of referrals by Agency. The data shows that the Police have the highest referral rate, followed by education and then health. Figure 3 - Initial Child Protection Conferences held by quarter Rate Grand Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 per Total pop.* Total 37 32 49 48 166 6.4 The data shows that there has been an increase in the number of Initial Child Protection Case Conferences held between April 2015 and March. A factor of note is the number of referrals and case conferences held where there are larger sibling groups. Figure 4 Review Child Protection Conferences held by quarter Rate Q2 Q3 Grand Q1 15/16 Q4 15/16 per 15/16 15/16 Total pop.* Total 108 63 61 79 311 12.1 Lead Director for Safeguarding Report Page 11 of 18 Board Meeting

Review Child Protection Conferences are held no later than 3 months after an Initial Child Protection, with subsequent meetings held with 6 months after the first review. Figure 5 - Child Protection Registrations by Category of Abuse Child Protection Registrations by Category of Abuse 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Q1 Q2 Q3 Q4 Emotional Abuse 44% 37% 36% 41% Neglect 42% 43% 45% 37% Neglect and Physical Abuse 1% 1% 2% 2% Physical Abuse 4% 5% 4% 9% Physical and Sexual Abuse 0% 0% 0% 0% Sexual Abuse 9% 14% 13% 12% Following the implementation of the Social Services and Wellbeing (Wales) Act 2014, further categories of abuse are to be included for future reporting. Table 6 illustrates factors that affect parent s ability to safeguard children Factors affecting parental ability to care adequately for children Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Total Domestic Abuse 15% 64% 27% 33% 44% Mental Health - 28% 17% 22% 24% Substance Misuse 20% 8% 13% 11% 17% Alcohol Misuse 50% 16% 15% 13% 25% Contact with Risky Adult 5% 16% - 22% 12% Learning Disabilities - - 3% 9% 5% YP Substance/Alcohol - - - - 0% Misuse Long Term Neglect - - 6% 7% 6% At Risk of CSE - - 4% 13% 7% Other 10% 24% 15% 18% 22% Lead Director for Safeguarding Report Page 12 of 18 Board Meeting

The higher numbers relate to domestic abuse, with a significant % evident in Q2, the reason for which is not yet fully understood. For a number of families there may be more than 1 factor that affects the parents ability to safeguard their children. See the table below: Factors Affecting Parental Ability to Care Adequately for Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Children 1 Factor 10 9 10 9 2 Factors 4 12 17 6 3 Factors - 2 8 2 4 Factors - - 2 - Safeguarding Adults The following table details the number of referrals that were received by Powys People Direct during Quarter Three and Four across the County in. The Population for each shire has also been included and used as a basis to establish the rate of Adult Protection Referrals per 1000 population. Q3 Q4 Inappropriate Referral 16 24 No Further Action Inappropriate Referral 20 41 Action Required Appropriate Referral 28 44 No Strategy Meeting Appropriate Referral 171 204 Strategy Meeting Total 235 315 Information is available that shows the location of abuse but due to small numbers the graph has not been included as there is a risk of person identification. The highest number of abuse occurs in peoples own home, followed by residential care and supported tenancy. Allegation status (Shire details have been removed): Powys Total 14/15 Q4 14/15 Q4 14/15 Q4 14/15 Q4 Admitted 4 7 2 3 7 5 13 15 Proved 12 125 5 3 1 6 18 134 Lead Director for Safeguarding Report Page 13 of 18 Board Meeting

Likely on 10 17 12 6 15 11 37 34 balance of probability Unlikely on 7 13 2 3 9 5 18 21 balance of probability Disproved 5 15 8 1 7 2 20 18 Allegation 6 2 3 0 1 0 10 2 withdrawn Inconclusive 15 16 11 4 29 11 55 31 Not 24 22 64 74 28 40 116 136 Recorded Total 83 217 107 94 97 80 287 391 Data for the above table is extrapolated from Draig, PCC electronic database, for all referrals at point of closure. There is a concerning number where the outcome is not recorded. This is identified as being due to instability within the teams. A new system of quality assurance has now been introduced. Of the status recorded, 134 cases were proven. Investigation The following table identifies the number of cases that proceed to investigation, based on the Type of Investigator field in Draig. Number referrals investigated Percentage referrals investigated of of 14/15 Q4 14/15 Q4 14/15 Powys Total Q4 14/1 Q4 5 35 189 26 15 24 33 85 240 79.5 % 88.73 % 38.2% 17.24 % 30.4% 38.37 % 44.5 % 62.1 8% Lead Director for Safeguarding Report Page 14 of 18 Board Meeting

Investigations 10% Social Services 1% 16% 9% 53% Health and Social Services Social Service and Police Other Social Services and Regulator/Inspection Police 6% 5% Provider The above graph shows the diversity of enquiries and investigation leads. The decision about who is the most appropriate agency to investigate is made at the Strategy Meeting. Alleged Victim Outcomes: The following table shows the outcomes recorded for all referrals completed during the reporting period. 14/15 Q4 14/1 5 Q4 14/15 Powys Total Q4 14/15 Q4 Actions refused by alleged victim 0 3 3 1 0 0 3 4 Adult Protection Plan / Care Plan 13 129 14 9 12 6 39 144 Alleged Victim changed 0 3 2 0 6 1 8 4 accommodation Increased monitoring by 27 98 4 5 18 14 49 117 care manager No Action 3 3 1 3 19 11 23 17 Not applicable - no abuse found 2 10 0 1 14 3 16 14 Other - please specify 5 95 10 4 16 10 31 109 Lead Director for Safeguarding Report Page 15 of 18 Board Meeting

Other Additional Services 1 15 3 5 2 3 6 23 Preparation for Court 1 0 0 0 0 1 0 1 Provider Support 0 3 2 0 1 1 3 4 Referral for Advocate 0 0 1 0 0 1 1 1 Referral for IMCA 0 0 0 0 1 0 1 0 Referred for counselling 0 0 0 0 0 0 0 0 Referred to Victim Support 0 0 0 0 0 0 0 0 Risk Removed 13 142 29 51 38 18 80 211 Risks reduced/improv ed safeguards to client/property 36 53 46 47 38 52 120 152 Safeguarding Training Despite a robust training strategy, e-learning packages, and multi-agency and single agency training being offered, the levels of staff compliance for adult and children s safeguarding remains an area for improvement. Without compliance to training a risk exists of poor recognition and response to abuse in vulnerable groups. Concerns about the methods of data collection have been raised and this is being reviewed in collaboration with Workforce and OD. There are also concerns about the amount of training required, not least with the introduction of new legislation. Training compliance is monitored via the Safeguarding Committee and the Workforce and OD Committee and has been an area of focus in the Internal Audit review. The Safeguarding training strategy has been reviewed in line with changes in legislation and guidance, although remains in draft currently. Though there is e-learning training for levels 1 and 2 in relation to adult protection and child protection, as well as multi agency training safeguarding training levels 2 and 3, there are still a large number of staff who have not accessed training. Due to problems with data capture on ESR and the lack of communications between PCC and PTHB training departments it is difficult to assess how significant the shortfall actually is, so non-compliance remains a risk. Current Training compliance based on ESR: Lead Director for Safeguarding Report Page 16 of 18 Board Meeting

Safeguarding Adults level 1-66% Safeguarding Adults level 2-22% Safeguarding children level 1 60% Safeguarding children level 2 38% These figures show an improvement compared to last year. Throughout, Child Protection level 3 training has been provided, with an update on substance misuse. Health staff have also benefitted from attending regional and national training such as Child Exploitation and Radicalisation. The number of Child and Adult Protection referrals has proportionally increased due to the implementation of the SS&WB Act and the duty to report, and this is being reviewed locally and regionally. It is anticipated that improved training compliance will also result in increased referrals. 6. Priorities for - 17 A number of priorities have been identified for the / 17 work plan, to include recommendations from the Internal Audit review. Additionally areas of limited progress from last years plan will be rolled forward. Priorities include: Further awareness raising of the implications of the Social Services and Wellbeing (Wales) Act 2014, which came into effect 6 th April. Implementation and monitoring of Violence Against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015 and action plan. Implementation of the VADASV Ask and Act training. Implementation and Monitoring of Child Sexual Exploitation strategy and action plan. Reconfiguration of the PTHB Safeguarding Service. Implementation of revisions to practice resulting from the Law Commission s review of Deprivation of Liberty Safeguards (December ) Review of the Health Board s responsibilities for PREVENT and CONTEST training to ensure compliance with Counter Terrorism and Security Act 2015. Review the Health Board s compliance with UNCHR and develop a Children s Charter. Lead Director for Safeguarding Report Page 17 of 18 Board Meeting

Implementation of the Wales Community Care Information System (safeguarding module). To improve Training compliance. The introduction of Highlight Reports from each Directorate to be discussed at the Safeguarding Committee. More transparent and robust reporting of DoLS. Implementation of the recommendations following the Internal Audit. Development of a bespoke Safeguarding Development Programme for members of the Safeguarding Committee. Lead Director for Safeguarding Report Page 18 of 18 Board Meeting