Gateshead Safeguarding Adults Annual Report 2022/23

The Annual Report must demonstrate what both the SAB and its members have done to carry out and deliver the objectives of its strategic plan. Some of our key activities for 2022/23 are documented below and are aligned to the following SAB Strategic Priorities.

Quality assurance

• develop training for front line practitioners that is guided by learning from reviews and inquiries
• prepare our SAB for the new CQC regulatory model and assessment framework which is expected to commence in April 2023

Prevention

• become Adverse Childhood Experiences (ACE) / Adult Attachment / trauma informed
• revise the Self-Neglect Practice Guidance note and deliver updated multi-agency practitioner training
• develop a more flexible training programme, to include more e-learning and virtual learning opportunities

Communication and engagement

• effectively communicate and champion our good practice
• enhance communication and engagement with partners and providers who are not routinely engaged with the board and sub-groups
• widely promote our safeguarding website and social media presence
• implement our Safeguarding Adult Champion Scheme

Operational practice

• work in partnership to manage levels of demand, including development of an Adult Concern decision making tool
• develop a Gateshead Safeguarding Adults Board People in a Position of Trust (PIPOT) policy

Mental capacity

• develop and implement a programme of awareness raising for frontline practitioners, providers, partners and the wider public about the application of the Mental Capacity Act (See Training)

Quality assurance

Learning from SARs and other enquiries

During the year there have been seven SAR interactive workshops attended by 82 practitioners covering four reviews. The interactive workshops are an opportunity for practitioners to hear about SARs, reviews, and inquiries, both local and national. The sessions allow time for practitioners to reflect on the cases and to undertake group work to support their understanding of the key issues and the learning which can be drawn from the cases. During 2022/23 the following cases were used in the interactive workshops:

July 2022

The Stephen SAR (opens new window) was conducted by the Teeswide SAB and focused on the death of gentleman with a learning disability at the age of 56. Stephen had follicular lymphoma, however he contracted Covid and died of Covid pneumonitis.

The SAR Interactive workshop focused on working in partnership with families, partnership working between agencies, shielding people with health conditions during Covid, tenancy decisions for people with a learning disability, the availability of specialist services during the pandemic and understanding by practitioners of Lasting Power of Attorney (LPA) and Mental Capacity Act assessments.

"It allowed me to reflect on current practice, policies and procedures and their importance."

October 2022

The Mrs VC Appreciative Inquiry was undertaken by the Gateshead Safeguarding Adult Review and Complex Case (SARCC) Subgroup. Mrs VC lived in care home in Gateshead, during the first four months of her stay within the care home the family were happy with her care. Concerns were subsequently raised by the family with respect to how the home and partners responded to her deteriorating physical and mental health and associated increased care and support needs.

The objectives of the inquiry were to determine good practice and areas for improvement in:

• communication between partner agencies
• communication with Mrs VC and family representatives
• care and treatment (with a focus upon medication management, needs assessment, weight, and nutrition)
• managing concerns or complaints

The SAB Quality, Learning and Practice Sub Group have been tasked with taking forward the recommendations from the inquiry including, developing guidance for front line staff to encourage hosting multi-disciplinary team meetings when a person's physical and/or mental health is declining, develop the MCA training programme, develop and implement 'Making Safeguarding Personal' training to enhance our approach to engaging and communicating with adults and their representatives and develop and implement an adult concern decision making tool (opens new window) to support practitioners to raise concerns utilising the most appropriate pathway.

"It was a great opportunity to reflect on the importance of establishing a person's needs and to prioritise when people are in nursing care for respite purposes."

January 2023

The Adult N SAR was undertaken by Newcastle Safeguarding Adults. Adult N was a vulnerable dependent drinker and had a long history of alcohol and illicit drug misuse. This was a complex case with Adult N suffering with both physical and mental health issues, being the victim of domestic abuse and having an acquired brain injury after being knocked over by a vehicle.

Some of the recommendations from this SAR are being taken forward in Gateshead in response to the rise in the number of safeguarding referrals in relation to vulnerable dependent drinkers with complex needs. Work is being undertaken in partnership with Public Health to explore the implementation of the Blue Light project in Gateshead and training on Mental Capacity and Executive Dysfunction has been delivered with further sessions to follow.

April 2023

A Learning review was carried out by the Safeguarding Adults and Complex Cases Subgroup following the death of a young man in 2022. The young man had a diagnosis of paranoid schizophrenia a mild learning disability, and a suspected acquired brain injury. There was a longstanding history of involvement with psychiatric services including three admissions to psychiatric inpatient units.

Following discharge from hospital following detained under S3 of the Mental Health Act he was supported in his own accommodation by a supported living service. His mental health started to deteriorate when he began to misuse drugs and there were concerns of exploitation and home invasion.

The learning review identified several areas for development, including understanding of when to instigate an MDT prior to crisis and when to request unplanned reviews, recording of mental capacity and best interest decisions, recognising, and responding to potential exploitation, clarity about what information to share and when and recognising and responding to self-neglect.

"It's always great to have these sessions and to be able to look at the work we do in order to improve, support and develop".

CQC assessment framework

In June Steph Downey, Service Director, Integrated Adults and Social care service provided a presentation on the reform of Adult Social Care and the forthcoming CQC assurance inspections. SAB partners have a key role to play within the CQC assessments and it was agreed that a standing agenda item should be added to the board agenda to allow for relevant updates to be provided to partners.

The key theme for the board will be 'How local authorities ensure safety' and how as a partnership it can support in the provision of evidence around safeguarding enquiries, reviews, Safeguarding Adults Board, safe systems, pathways and continuity of care. Feedback was given on the peer assessment review which was an opportunity for the LA to fully understand strengths and develop action plans giving a clear trajectory for future developments.

SAB dashboard

During 2022/23 the QLP Group reviewed the information provided on the Safeguarding Adults Board performance dashboard. Feedback from partners:

• overall, the data is helpful
• ensure Making Safeguarding Personal (MSP) is more prominent within the report - It is a requirement within the Care Act to monitor and report on MSP
• provide information on which agencies are submitting SG referrals and how many progress to a concern or an enquiry, this will help identify where targeted support and guidance is required
• provide data on independent advocates, when they are requested to support people through the Section 42 enquiry process

The Quality Assurance Team are working to amend the dashboard to ensure the feedback from partners is incorporated into future report. The introduction of the new case management system Mosaic, will support improvement in the recording.

The report continues to support partners to develop an understanding of key safeguarding adult themes and trends. This is compared with the regional safeguarding dashboard to help determine if we are an outlier in any aspects of safeguarding, and to support regional or partnership working.

Priorities for 2023-24:

• ensure analysis of the data is carried out to provide meaningful feedback to the SAB and partner agencies

Out of borough placement update

Following the initial investigation into Whorlton Hall, the local authority as a commissioner needs to review how they ensure people placed outside of Gateshead have the same safeguards as someone who placed in a health or a care service within Gateshead where there is more robust local monitoring. The LA Quality Assurance Team provided information on the number of people placed out of borough. However, it was agreed that additional information should be provided to the board such as the overall outcomes of the reviews and concerns around safeguarding with the providers who are being commissioned.

It was proposed that the board should be provided with assurances that processes have been put in place to monitor out of borough placements but looking through a wider lens and jointly reporting on those people who are placed. Work is now being undertaken jointly between colleagues from performance teams in both the Council and the ICB. A suite of information will be made available to be presented to the board and board members will then be assured that out of borough reviews are taking place and robust processes are in place.

Prevention

Professional curiosity and trauma informed practice

As part of our objective to support trauma informed practice the SAB welcomed Lads Like Us, Danny and Mike to Gateshead in March. Danny and Mike shared their lived experience as children and adults trying to navigate the care system, adult social care, mental health services, drug and alcohol services amongst dealings with the police and a prison sentence. The honest and sometimes shocking accounts provided by Danny and Mike, are interlaced with humour and a sense that something good must come from their experiences.

They use their experiences to demonstrate the need for practitioners to adopt a trauma informed approach built on professional curiosity. 60 representatives from partner agencies attended the session and the feedback was exceptional.

Danny and Mike will be visiting Gateshead again in November 2023 as part of the Safeguarding Adults week programme of events.

"Today I asked a service user if they had any childhood trauma that was hindering their recovery."

"Excellent lived experience training. The lads were down to earth but honest and open."

"This is the most thought provoking, humbling training I have been on throughout my entire career. There wasn't a power point in sight, just raw honesty and brutal reality of the impact services (good and bad) can have on an individual's life."

"Incredible training, I have worked in substance misuse since 2007 and can categorically say this training has had the most impact and has been the most thought provoking to improve practice within this subject matter. Thank you to both or sharing your stories and using your trauma to make a positive difference for the future."

Self-neglect guidance

In November the Northeast Region of ADASS (Association of the Directors of Adult Social Services) launched their self neglect seven-minute guides and animation, highlighting the key issues around aspects of self neglect. The launch coincided with Safeguarding Adults week and Webinar and several bite-sized information sessions - all delivered by nationally recognised professionals and academics in their chosen fields of expertise and all with the overarching theme of self-neglect.

Gateshead SAB have a page of information on self neglect alongside the seven-minute guides and a link to the 'What to do about Self Neglect' animation. The bite-size guides are intended to complement over-arching self neglect practice guidance and support front-line practitioners in their response to self neglect cases. to reflect the information provided in the ADASS seven minute guidance and animation.

Training

The Gateshead Council Workforce Development Adviser worked with the SAB, Gateshead Safeguarding Children's Partnership (GCSP) and the Community Safety Partnership to produce a comprehensive training offer for 2022/23. Training courses advertised within the directory are free of charge to practitioners and volunteers within Gateshead. Training has been delivered virtually and face-to-face to allow delegates to choose the most convenient method of learning to suit their job role.

Multi-agency training and awareness raising for 2022/23:

The need to strengthen the support for practitioners in understanding the Mental Capacity Act, carrying out mental capacity assessments and recording of assessments has been evident from learning reviews which have been undertaken. The board continues to offer Introduction to MCA and Practical Application of MCA as part of its multi-agency offer. This offer has been enhanced during 2022/23 with the delivery of a session on Executive dysfunction and the MCA practice short. The session provided an overview of executive dysfunction, the impact it has on decision making and the complexity of or obstacles to assessment. Following the positive evaluation of the session a task and finish group has been established to develop the training further and to ensure it meets the requirements of all partners.

Responses from impact evaluation questionnaires highlighted the positive impact that the training had on learners' thinking and practice.

"Great information for cases currently working on and ways of implementing this in future cases." (Practical Application of MCA)

"Excellent session will have a significant impact on my skills of intervention with clients, and in report writing." (Executive function and MCA)

"Really beneficial hearing from service users and not just professionals." (Lads Like Us, Professional Curiosity and Trauma Informed Practice)

"Really detailed interactive training very helpful!" (SAR Interactive Workshop)

"I will use the knowledge from this training in my practice to identify risk and support people with care needs". (Safeguarding Adults Reporting Concerns, Level 2)

The new Learning Hub booking system was introduced in May, this allows all partners to search and book on to courses and receive email updates on new courses when they are published, delegates can also download their certificate once the course is complete.

Priorities for 2023-24:

• develop training resources using different approaches, including recorded webinars, dictated PowerPoints and podcasts
• offer further training on adopting a trauma informed approach to safeguarding
• establish a Mental Capacity Act training programme which will support the skills and knowledge in the practical application mental capacity assessment

Communication and engagement

Safeguarding Adults Awareness Week

Gateshead SAB Safeguarding Adults Awareness Week was held in November 2022 to coincide with the national safeguarding adult awareness events co-ordinated by the Ann Craft Trust. The overall theme this year was 'Responding to Contemporary Safeguarding Challenges' with each day of the week focusing on a specific theme, including exploitation and county lines, self-neglect, creating safer organisational cultures, elder abuse, domestic abuse in techsociety.

There was a variety of activities which took place during the week to raise awareness of various aspects of safeguarding adults:

• Gateshead Millennium Bridge lit purple on Monday 21st November to mark the start of safeguarding week providing a visual symbol for safeguarding adults
• Gateshead Safeguarding Adults team hosted a safeguarding information stand in the foyer of the Civic Centre with leaflets, information, and purple ribbons available to mark the event and raise awareness
• The QE Hospital Safeguarding Team had safeguarding stall in the main entrance of the hospital with a wide variety of information, leaflets, posters, and freebies to promote safeguarding

Briefings and training sessions ran during the week:

• an Introduction to Cuckooing (Home Invasion) (Ann-Maria Mitchell, ASSET Team Manager)
• Regional County Lines Exploitation training event (Northumbria Police)
• virtual Self Harm webinar (Ann Craft Trust)
• What to do about Self-Neglect - Learning from best practice. This included the launch of the 10 seven-minute guides and the 'What do to about Self-Neglect' animation (ADASS)
• Safeguarding Vulnerable Dependent Drinkers (Anne Thomson, SG Team Manager)
• Making Recruitment Safer (Disclosure and Barring Service)
• Elder Abuse webinar (Hourglass, Hosted by Durham SG Unit)
• How practitioners can contribute to safer cultures in their organisation (Ann Craft Trust)
• Fire Safety webinar (TWFR)
• Transitional Safeguarding webinar (Northumberland SG Unit and NWG) Network)

STSFT Safeguarding Team actively engaged within Safeguarding Adults week demonstrating positive multi-agency working with good engagement from STSFT staff. Representatives from local domestic abuse services and the STSFT Domestic Abuse Housing Alliance engaged with members of the public and staff at the Domestic Abuse stall with positive engagement from the public, especially when participating in the 'What's your red flag' activity.

Gateshead Health Foundation Trust had an information stand in the QE Hospital, to engage with staff and the public raising awareness of various safeguarding topics and the work of the team.

In the run up to and during safeguarding week there were updates and information provided on Twitter @GatesheadSafe:

• 15 tweets relating to activities
• 14 new followers (total number is now 971)
• 10,600 tweet impressions

Website

Gateshead SAB continues to maximise opportunities to ensure that our resources are accessible to our partners and workforce. Our Safeguarding in Gateshead website (opens new window) is kept up to date and during this year there has been new information added on fire risk, self-neglect and Safeguarding Adults Week.

Our online multi-agency policy and procedures (opens new window) has a useful local practice resources and local guidance section which includes a wealth of information such as our seven-minute briefings and an online video and learning library. We have an active Twitter account @GatesheadSafe which has over 900 followers and is a useful platform to share our resources and new initiatives.

Safeguarding Champions

Our Safeguarding Adult Champions scheme continues to be a useful mechanism for sharing information and raising awareness about safeguarding adults in Gateshead. We have 131 Safeguarding adult Champions representing 52 organisations, teams and establishments across Gateshead. The champions are responsible for raising awareness about safeguarding adults within their own organisation, ensuring that all staff and volunteers are familiar with the Gateshead multi-agency policy and procedures, disseminating updates and being a single point of contact for safeguarding adults.

The Safeguarding Champions annual forum took place with representatives from 13 organisations across Gateshead. The session covered some of the themes of SG week and gave the champions an update on the Gateshead SG workstreams and future plans. There was a meet and greet session to allow champions to chat to people working within safeguarding, including the SG Coordinators, representatives from the ASSET Team, Connected Voice, TWFRS and People @ the Heart. There were presentations on the role of advocates, learning from positive practice (joint working between ASSET and TWFRS, see case study), the blue light project and closed cultures.

The champions were asked to provide feedback on the support they require to be able to fulfil their role. This feedback has been developed into an work plan to provide the requested support, this is progressed and monitored through the QLP sub group.

Regional SAR Champions

Gateshead continues to contributed towards the work of the North East Regional SAR Champion network which was established to ensure learning from SARs and other enquiries is shared across the North East region. This group has been very proactive and succesful work to date includes:

• Gateshead continues to host the North East SAR Library via Teams which provides a comprehensive library of shared SAR learning
• the SAR Champions have been working to learn more about parallel processes (to SARs) in relation to Learning Disability Mortality Reviews (LeDeR)

Further information has been requested from the ICB in terms of governance, commissioning of reviews, training for reviewers, the review process, disseminating learning, publication and the annual report. Once this information is received, further discussion will take place around how we can use the interface effectively within the SAR Process (where appropriate).

• in response to the high numbers of fire deaths and injuries across the region, many of which have involved people with care and support needs a Fire Risk task and finish group has been created

Gateshead is a member of the group alongside the 4 regional fire and rescue services. The group works to share learning from the cases and promote fire prevention information and guidance, the group are working on the development of a fire prevention/ risk video for the public and practitioners.

• the North East Quality Markers checklist was updated inline with the guidance from SCIE

The checklists have been adopted in Gateshead to assist in ensuring that recommendations from the National SAR Analysis for sector led improvements are implemented

• work continues to develop the easy to read and access guide (co-produced with experienced experts) for service users around 'Safeguarding - What Happens?' which will provide clear information around what happens during the safeguarding process
• the North East SAR Champions were asked by SCIE to help to support the invigoration of the National Champions at the SCIE Quality Markers / SAR Methodologies Workshop on 13th July 2022

This gave the group the opportunity to:

• provide an overview of how the SAR Quality Markers can be used effectively to embed learning and influence practice through the SAR Process
• give insight into the culture change that needs to take place to move to a systems change process of learning
• provided an opportunity to showcase the regional SAR library

People @ the Heart (P@TH)

P@TH is Gateshead's multiple and complex needs transformation initiative. P@TH is a programme to support system change in Gateshead for people with multiple complex needs (MCN). It is not a project designed to work directly with people but to support and bring together the existing services in a more collaborative way.

The initiative was officially launched on 6th December 2022 at an event at Gateshead Civic Centre which was attended by representatives from various agencies across Gateshead including, Gateshead Domestic Abuse Team, CBC Workforce Initiative, Health Federation, Handcrafted, Housing, Adult Social Care, Gateshead Recovery Partnership, Edberts House, Community Mental Health services, ASSET.

There are very clear links between P@TH and the learning from some reviews which have been undertaken by the SAB. These workstreams include professional peer training and support, community involvement, reduction in use of inappropriate emergency services, addressing professional prejudice, hospital to rehab transitions and community withdrawal management, prison transitional work and new operating models for immediate response as preventative approaches to DRD and near misses.

The SAB is represented at the P@TH Programme Board by the SAB Business Manager and the SAB receive regular updates on progress from the Programme Manager, Suzanne Henderson.

Operational practice

Adult concern decision making tool

In response to the increase in the volume of adult concerns, and an increase the complexity of safeguarding adult cases. An Adult concern decision making tool was developed and published in June 2022. The tool has now been in operation for 12 months and the board will now undertake a review of the impact of the tool in terms of data and a survey of users on the usefulness of the tool.

Maintain compliance with Deprivation of Liberty Safeguards

Gateshead Council, as DoLS Supervisory Body, continues to remain legally compliant and there are no local backlogs.

Gateshead Council remains committed to investment in the DoLS staff team responsible for the processing and managing of all DoLS applications, ensuring there is the ability to meet most of our demands 'in-house', thereby improving efficiency.

Organisational abuse

The Northeast Safeguarding Adults network have highlighted to the national safeguarding network the need for national guidance on organisational abuse. This follows inconsistent approaches to how partners work together to manage and respond to cases of organisational abuse. A regional task and finish group has been established to undertake some regional benchmarking on organisational abuse and Gateshead are participants of this group. In Gateshead we are piloting a new procedure for how we respond to organisational abuse. To support this process, Gateshead Council have invested in a new Safeguarding Co-ordinator and Safeguarding Support Assistant to respond to organisational abuse cases.

Preparation for implementation of Liberty Protection Safeguards

The landscape with respect to the proposals for the introduction of the Liberty Protection Safeguards via the Mental Capacity (Amendment) Act 2019 during 2022/23 remained fluid and was closely monitored by partners within Gateshead. Following the announcement at the beginning of April 2023 of the indefinite pause of the Department of Health and Social Care that the implementation of the LPS, The Mental Capacity (Amendment) Act 2019 will be "delayed beyond the life of this Parliament" the board have refocused their attentions to embedding the Mental Capacity Act and providing focused support to practitioners on this.

Melony Bramwell, Service Manager (Safeguarding, Protection & Social Work Standards), has been appointed as the Chair for the National DoLs Network. The Network provides strategic guidance to local authorities nationally and will be strengthening links with ADSS, LGA and DHSE around the upcoming and coming changes around the LPS. This direct link into the network gives the SAB access to up to date and relevant information on progress with the LPS.