Gateshead Safeguarding Adults Annual Report 2022/23

Adult Social Care

Quality assurance

In October 2022 in preparation for the CQC Assurance inspections Gateshead Adult Social Care took part in a sector-led improvement exercise. The CQC draft assurance framework allowed the service to assess themselves on how well they were performing against their duties under Part 1 of the Care Act 2014. This included Sections 42-43: Safeguarding enquiries and Safeguarding Adults Boards. The evidence was reviewed by an independent consultant who provided feedback on the areas of good practice and areas for improvement. ASC has developed an action plan to provide a structured approach to the areas which require improvement and is supporting actions for the SAB within this plan.

Prevention

The Gateshead Safeguarding Adults team continue to support the delivery of multi-agency safeguarding training on behalf of the board alongside representatives from partner agencies. The team have been instrumental in reviewing and refreshing the Level 1 and 2 training courses and reinstating the Level 3 course on undertaking enquiries which has been missing from the programme for several years.

The Safeguarding Team Manager and ASSET Team Manager have developed training in Mental Capacity and Executive Dysfunction and piloted the course early in 2023. This provided further insight into factors to consider in relation to mental capacity assessments when working with people with multiple complex needs often linked to alcohol or substance misuse. The success of the pilot session has led to further session being planned for the coming year.

Gateshead's ASSET Team worked in partnership with Tyne and Wear Fire and Rescue Service on a case involving a gentleman who was involved in 3 home fires and required dedicated, consistent and a multi-agency approach to ensure he was kept safe. This was recognised by the SAB as an excellent example of multi-agency working.

Communication and engagement

The Safeguarding Adults team actively supported Safeguarding Adults Week in November 2022. The team staffed the safeguarding stall in the Civic Centre foyer during the week and supported the SG Champions session which focused on organisational abuse and learning from SARs.

Northumbria Police

Quality assurance

Northumbria police have robust systems in place to ensure quality, including a triage system within the Multi Agency Safeguarding Hub.

Force wide 'Vulnerability Matters' training was rolled in 2022 and continues with all new recruits and ongoing refresher training to our front-line staff. This training supports our officers to take a trauma informed approach to dealing with vulnerability and assist officers to identify vulnerable adults in the community. The force ensures a focus on vulnerability and that Protecting the vulnerable is front and centre of our force response. In addition, we are providing bespoke training sessions to our force control room call takers to ensure they can recognise and respond to vulnerability at the first point of contact and get it right. All our leadership courses for newly promoted Sergeants and Inspectors also includes an input on the strands of vulnerability which includes vulnerable adults.

Right Care Right Person

Northumbria Police are following national best practice and implementing Right Care Right Person (RCRP). This will reduce longer term demand by ensuring the public are directed to the right agency at the first point of contact. Since implementing the initial stages and triage process in January 2023 445 missing incidents have not been deployed to, freeing up officer's time to focus on higher risk incidents.

This will continue over the next year where we look to roll out a consistent version of RCRP nationally. We are currently awaiting a national partnership agreement at government level which will agree the threshold of risk for calls for service which police need to attend.

Throughout this implementation we have maintained close working relationships with our partner agencies including our mental health trusts, hospitals, and social care to ensure that we will only withdraw from some of these calls for service when they are ready and equipped to step in to support the individuals involved.

The second phase of RCRP is our hostel policy (opens new window) which went live on 12 June after partnership consultation. This again should reduce demand by ensuring we are responding to missing reports where there is a critical concern for the person. This policy has a robust triage system and a quality assurance follow up.

Communication and engagement

We continue to work closely with the multi-agency partnerships and have shared learning and training over the last year in relation to the growing concerns of children and young people in the transitional period involved in serious youth violence. Our multi agency exploitation hub has attended partnership CPD days to deliver inputs on exploitation and this offer continues to be extended to support the understanding and identification of exploitation.

Through Operation Pecan we have delivered inputs on urban street gangs and continue to work with our partners to develop a focussed deterrence approach.

Operational practice

Throughout 2022 our professional standards department delivered inputs to partners on abuse of position, relating to officer's relationships with victims and witnesses and encouraged partners to consider their own protocols and processes in relation to their own staff.

Mental capacity

Northumbria police continue our close working relationship with Cumbria Northumberland Tyne and Wear NHS Foundation Trust (CNTW) to operate the Street Triage team which is a mixed team of police and mental health nurses. Over the course of the last 12 months with the implementation of RCRP we have utilised the expertise of the street triage officers to spend more regular time within our control room to offer live time advice to call handlers.

We continue to offer regular training to our frontline staff regarding the application of the Mental Capacity Act.

North-East and North Cumbria Integrated Care Board (NENC ICB)

The Newcastle Gateshead Clinical Commissioning Group (CCG) transitioned to NENC ICB on 1st July 2022 with the structure and governance arrangements being formalised at Executive Board level. Richard Scott was appointed as Director of Nursing for the North Integrated Care Partnership (ICP) in December 2022. There is now a Safeguarding Executive meeting chaired by the Chief Executive Nurse which facilitates escalation of safeguarding issues to the ICP. Several additional posts have been appointed to, including an Assistant Director of Nursing for Newcastle Gateshead, having oversight of safeguarding for the North. This development will support the safeguarding agenda throughout the region.

Quality assurance

The Safeguarding Professionals Network continues to provide a forum for safeguarding health staff from both commissioning and providers to develop safeguarding practice and share learning across the Integrated Care System (ICS). A recent review of members by survey, to continue with the forum as an established network for health professionals had a positive outcome, the forum is well attended from all areas.

Prevention

Training for Primary Care staff has continued with sessions being provided online and available as a resource on the GP Team net, this includes sharing of learning from Case Reviews and promoting good practice from recommendations. Several requests are now being received from individual GP practices for face-to-face sessions which is being reviewed in line with resource availability.

Communication and engagement

The ICB Safeguarding team continue to provide support and work collaboratively with multi-agency partners, including attendance at the Safeguarding Adult Broad subgroups and promotion of shared learning from reviews. The Designated Nurse for Safeguarding Adults is currently Chair of the Safeguarding Adults Review and Complex Case Subgroup (SARCC).

Partnership working includes involvement with projects supporting asylum seekers, hate crime prevention, Prevent and Safer Community Boards and Domestic Abuse Local Partnership Board.

Operational practice

Given the significant increase in the number of care home concerns and issues identified during Covid the ICB Safeguarding, and Quality teams have also been working with the local authority in Gateshead to develop an approach to organisational safeguarding which is intended to pick up concerns at an earlier point so that homes can be supported without the need to escalate concerns through the Serious Provider Concerns process. Linked to this work the ICB has scoped out an approach which builds on the multi-agency approach with GPs and will aim to strengthen communication between the care home link GP and local authority safeguarding.

Mental capacity

Liberty Protection Safeguards (LPS) were due to be implemented from April 2022, following further delays it was announced on 5 April 2023 by the Department of Health and Social Care that the implementation of the Liberty Protection Safeguards (LPS) The Mental Capacity (Amendment) Act 2019 will be "delayed beyond the life of this Parliament" (therefore likely beyond Autumn 2024) The ICB will continue to support the improvement of and training in Mental Capacity Assessment for the current DoLs (Deprivation of Liberty) system.

Gateshead Health NHS Foundation Trust (GHNFT)

GHNFT is committed to ensuring safeguarding is part of its core business and recognises that safeguarding young people and adults at risk is a shared responsibility with the need for effective joint working between partner agencies and professionals.

Managing demand

The trust has faced some challenges during 2022/23, including an increase in activity and complex referrals, an increase in care needs, and a lack of care packages and placements within residential and nursing homes. This has resulted in delays in discharges and not being able to discharge patients. Despite these challenges we have still managed to prioritise and maintain a high-quality service for the Trust.

Staff have continued to raise concerns on 1152 occasions relating mainly to domestic abuse, neglect, self-neglect, physical abuse, and financial abuse. Of these concerns 700 were shared with the local authority. The concerns that were not shared with the local authority were managed and addressed within the hospital, working closely with wards and departments, including Patient Safety, the Children's Safeguarding team, Housing, Psychiatric Liaison and Security.

Domestic abuse remains a high priority with 314 domestic abuse concerns raised between April 2022 and April 2023, compared to 374 the previous year with an increase in the number of complex cases. The domestic abuse concerns included 30 staff referrals, which is lower as the 37 received in the previous year.

Communication and engagement

Working in partnership remains an important part of the Safeguarding team's work, with such complex cases including self-neglect, substance misuse and complex health needs. The team continue to play an active role and contribute to various multi-agency meetings, Safeguarding Adult Reviews, Domestic Homicide Reviews, MARAC, MAPPA and MATAC. Focusing on sharing information, any key learning and implementing any recommendations made, which is vital in continuing to improve safeguarding practice within the Trust.

Operational practice

Over the past year we have focused on the level 3 safeguarding training, working closely with the Learning and Development team, and departments to improve our training compliance and raise the profile of safeguarding. Training will continue to be priority and working in partnership with our partner agencies. See case study below.

Mental capacity

The Trust continues to raise awareness of the application of the Mental Capacity Act and continues to recognise the challenges in the use of the act for practitioners. There remains a focusing on training compliance though the e-learning package of learning which is available across the Trust.

The Mental Health Legislation service within the Safeguarding Adults team works to ensure that professionals are working in accordance with legislation and ensuring patient safeguards are met by educating staff on the legal frameworks of the Mental Capacity Act (MCA), Deprivation of Liberty Safeguards (DoLS), and the Mental Health Act (MHA). The team supports practice with the provision of training, advice, support, and policies, to ensure the rights of our patients are supported and upheld.

The Safeguarding team review, monitor and report all uses of the DoLS throughout the Trust. Between April 2022 and March 2023, the Trust had 698 DoLS applications submitted. The submission of applications has seen a year-on-year increase with 548 applications in 2021/22 and 420 applications in 2020/21.

Neglect and self-neglect - case study

Gateshead Health NHS Foundation Trust

Miss A lived at home with her father and her brother, she has a diagnosis of a learning disability and ongoing health concerns. A safeguarding concern was raised whilst in A&E on her admission into hospital due to:

• learning disability
• vulnerable adult
• patient arrived in A&E with cellulitis
• patient denied having any contact with her GP
• patient appears to be unkempt, strong-smelling odour, incontinent of faeces, excoriated skin
• concerned for patient's wellbeing, health, and her dignity
• father and brother helping to care and support patient

During hospital admission, there was joint working between the Safeguarding team and the Learning Disability Specialist Nurse to establish vulnerability and care needs to facilitate safe discharge and identify any emotional and physical support.

During admission Miss A began to refuse to mobilise; choosing to be doubly incontinent which then resulted in further moisture damage. Capacity was assessed in relation to her hospital admission. It was agreed that a DOLs was not required, however when Miss A began to refuse treatment, her capacity was re-assessed adapting communication to suit her needs.

It was established that Miss A did not have capacity to retain information in relation to treatment but understood why she was in hospital. Therefore MCA 1 and 2 for treatment was put in place; guidance from the MHA Lead in relation to frameworks was advised.

A best-interest decision was made for all treatment to be given. Collaboration with Miss A was key to help her understand why intervention was needed. It was agreed that two hourly positional changes were to be implemented to prevent any further pressure damage; the tissue viability nurse (TVN) provided support.

Occupational Therapy and Physiotherapy were involved to support Miss A with encouragement to mobilise. Emotional support was provided in relation to low mood and to identify her wishes. Multi-agency working took place to discuss appropriate discharge plans to ensure a safe discharge.

At the point of writing, Miss A is ready for discharge and is awaiting a suitable care package and equipment. A referral to the community Learning Disability team has been made to support with her emotional and physical health. This is a positive outcome and professionals worked together to ensure her needs were met and a safe discharge was arranged.

Probation

Prevention

Safeguarding training is a priority for the Probation Service with mandated training now being linked to staff pay progression via the annual competency-based framework. Records indicate more than 85% of staff have completed the training. The remaining deficit is made up of staff on long-term sick, maternity or new staff recently joining the service who have not reached that section of their training.

Quality assurance

In addition to ensuring staff of all grades have completed relevant Safeguarding and Domestic Abuse training, all cases where there are relevant flags raising concern are subject to additional checks. This is an area of high interest for Probation Service, with regular management oversight to ensure this practice is both completed in a timely manner and is being embedded within teams.

Operational practice

Staff completed relevant referrals to Safeguarding Services where concerns are raised, attend Section 47 meetings as required, ICPC and ongoing child-safeguarding meetings whether this is child protection or child in need.

In October 2022, South Tyneside and Gateshead Probation Delivery Unit underwent HMIP inspection where 100% of cases at sentencing stage had relevant safeguarding enquiries undertaken. Partnership working and safeguarding were highlighted as an area of strength within the PDU.

Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust (CNTW NFT)

Prevention

Significant effort has been made in delivering the Level 3 safeguarding training across the organisation. Training sessions now run three times per week and substantial progress has been made. CNTW Academy continues to offer this training via the Microsoft Teams platform on a weekly basis to ensure consistent compliance. A 'Vulnerability not age' awareness session will be developed and delivered. There has been a sustained increase in safeguarding reporting demonstrating an increased awareness of safeguarding and public protection issues in Trust staff.

MCA learning themes have been shared with Trust MCA lead

A CNTW Domestic Violence training package was developed by Named Nurses utilising learning from local reviews. This so far has been delivered to 300 plus staff and will continue to be rolled out via the SAPP team. CNTW have shared the learning from Domestic Homicide Reviews undertaken within the year with particular focus on addiction services who have received the Trust DV training.

Quality assurance

This learning was reviewed and a Quality assurance document developed to provide assurance against the recommendations of the report. The assurance document will be provided to SAPP group in 2023/24 by locality groups.

A review of the demand and capacity of the SAPP team has been undertaken and the team structure and activities reviewed leading to additional resource at Named Nurse level. Demand and capacity will continue to be reviewed in light of sustained increase in reported incidents and review processes and approaches as necessary to ensure this demand can be met whilst maintaining quality.

Further work is to be undertaken to support accurate safeguarding reporting and data capture to better inform CNTW and external partners of our safeguarding activity and allow targeted improvement work to take place.

We will continue to engage with the PSIRF Implementation group and Safer Care leads or Safety leads who are reviewing and embedding the National Patient Safety strategy including the new incident reporting and review systems, to ensure that the classification of incidents retains relevant safeguarding Information to enable incidents to be reviewed, clinicians supported, and patients safeguarded.

Gateshead Housing

Operational practice

Hoarding disorders feature heavily in self-neglect cases both regionally and nationally. The links between hoarding and increased fire risk have been identified within SARs and learning reviews.

Hoarding cases

Within the Housing Support service, we have supported 17 council tenants with a hoarding disorder within the last 12 months. 10 cases carried over from previous year, seven new cases and eight have been resolved through joint work with Adult Social Care and Housing.

The average length of time taken to resolve hoarding cases is 629 days, due to the time required to build trust with the customer and engage the right type of support to help them address their fears of disposing of collected items.

The main type of hoarding we have experienced relates to rubbish hoarding, with the main customer group being middle aged single men, who have never married or remained in the family home following the death of their parents.

'Less is more' - hoarder support group

In collaboration with Northumbria University, Gateshead Council has established a group of customers identified as having a hoarding disorder, from across the region to share personal experiences and help professionals to understand what type of support helped them to identify that they had a disorder and needed help and ultimately helped them to stop hoarding.

The group, which has adopted the name 'less is more' has met twice this year and a third meeting is scheduled in July. With four current group members, supported by staff from Northumbria University and Gateshead Council's Housing Support Service the group intends to establish terms of reference and encourage new members to join and share their experiences. Longer term the group would like to play an influential role in policy and procedural change within local authority services across the region, to support those with hoarding disorders.

South Tyneside and Sunderland NHS Foundation Trust (STSFT)

Quality assurance

The rigorous programme of safeguarding audits have continued throughout 2022/23 to monitor safeguarding practice across STSFT. These have included MCA/DoLS policy adherence, MCA policy compliance for patients with a learning disability, safeguarding policy compliance (inclusive of routine and selective enquiry), procedural self-neglect guidance and threshold tool compliance and chaperone policy compliance. A safeguarding team service review was conducted via Survey monkey in December 2022. Findings were extremely positive.

A new model for safeguarding visibility has been implemented to increase face to face presence on wards and departments to further support staff and offer safeguarding supervision. This includes daily attendance at Emergency Department (ED) huddles (Monday - Friday).

The safeguarding team continue to complete a daily audit of ED attendances to ascertain if there are any missed opportunities. Any learning to arise from missed opportunities are incident reported. The Named Nurse attends ED Clinical Governance meetings to discuss any reported missed opportunities. The annual audit of ED attendance activity forms part of the safeguarding annual audit cycle.

The safeguarding team have undertaken joint working with ED staff to expand the asking of the safeguarding mandatory questions from initial triage and make them mandatory within Same Day Emergency Care (SDEC) documentation and within the speciality transfer letter.

Safeguarding training compliance has continued to exceed the 90% organisational target and this has been maintained throughout 2022/23. The Trust continues to exceed NHS England's 85% compliance target for WRAP Prevent training and Basic Prevent Awareness training (BPAT).

Prevention

The safeguarding team have continued to work in collaboration with multi-agency partners throughout the recovery phase and longer-term impact of the COVID-19 pandemic to ensure safeguarding measures are in place and learning is shared to support and protect adults at risk and their families. Main emphasis has been around MSP, self-neglect, fire safety awareness, trauma-informed practice, mental capacity, and professional curiosity. These themes have been shared via 7-minute briefings, quarterly Safeguarding Champions forums and bi-monthly safeguarding newsletters.

Safeguarding supervision sessions have been reviewed to ensure that delivery remains impactful and meaningful. A new model for safeguarding visibility has been implemented to increase face to face presence in areas to further support staff in their safeguarding practice and offer safeguarding supervision.

All levels of safeguarding training have been reviewed to ensure they are aligned to both adult and children intercollegiate document. Level 3 face to face 'Think family' training has been amended to reflect learning from recent scoping's, SAR's, DHR's, CSPR's and learning reviews. Slido (opens new window) is now being used to ensure that face to face sessions are more interactive and those delivering training can obtain training evaluations in real time.

MCA training has been reviewed and STSFT now utilise the National e-Learning package resulting in MCA training now being a stand-alone package.

Communication and engagement

A bi-monthly newsletter is shared with all STSFT employees via both the team brief and through the safeguarding champion's forum. This newsletter highlights learning from SARs or DHRs and CSPRs and incorporates any regional or local updates inclusive of 7-minute briefings. The newsletter is held on the Trust intranet site.

STSFT Safeguarding Team continue to be active members of local partnerships ensuring representation and contribution across all meetings and groups.

The Safeguarding Team are active participants within the Complex Adult Risk Management (CARM) meetings within the Sunderland locality and Safeguarding in Partnership (SIPT) meetings in South Tyneside.

The Safeguarding Team has worked closely with the Local Authority to understand the impact and prepare for the forthcoming implementation of LPS.

STSFT safeguarding team actively participated in Elder Abuse Day (15 June 2022), attending wards and departments to raise awareness of elder abuse.

Operational practice

The Domestic Abuse Health Advocates (DAHA) continue to work alongside the Safeguarding team to support staff in the identification and response to any disclosure of domestic abuse. The DAHA's are specialists working with victims of domestic abuse, targeting ward areas, ED and community in supporting staff to recognise and respond to DA. The increased visibility of the DAHA's across the Trust has resulted in increased domestic abuse referral activity. Recent DAHA feedback from both patients and staff include:

"Thank you, I do not know what I would have done if you had not been here to support me."

"Thank you so much you have been amazing in supporting me."

"The DAHA on duty came down to ED and was so kind and helpful and just offered to help with anything we needed. This was so kind, thoughtful and really welcomed."

The safeguarding team have worked alongside STSFT staff to further develop body map documentation to record marks, bruises and pressure damage on admission and discharge from hospital. The body maps are now incorporated into STSFT documentation, alongside a SOP to support practitioners accessing the document.

Mental capacity

An MCA/LPS lead, alongside an MCA Corporate Lead have been appointed to further embed MCA into practice alongside having the skills and expertise to robustly implement LPS once finalised. Improvements have been made to the MCA recording pathway on Meditech to support staff to re-consider MCA assessment and whether a DoLS is required or needs withdrawn. Community EMIS systems have been amended to incorporate MCA assessment within community records.

Connected Voice

During 2022/23 Connected Voice undertook the following in support of the SAB Strategic Plan:

• delivered advocacy awareness session to Safeguarding team to improve referral pathways
• provided training to the VCSE in Gateshead on the role of advocacy in safeguarding four times in the year
• provided a briefing to the SAB on Nice guidance and duties
• reported on safeguarding numbers throughout the year, leading to prevention and education for individuals on reporting concerns
• discussed safeguarding enquiries with Safeguarding team reducing alerts made that do not meet the threshold for Tyne and Wear Fire and Rescue Service

Tyne and Wear Fire and Rescue Service

Prevention

Following the rise in the number of fire deaths across the region during 2022/23 TWFRS have been proactive in their approach to raising awareness of fire risk. TWFRS have taken over chairing of the Regional Fire Risk Task and Finish group which is looking at the provision of information advice and guidance and highlighting the risk factors in relation to age, mobility, smoking, alcohol use, use of paraffin-based emollient creams, self-neglect, hoarding, mental health, living alone and isolation. The proposal is to develop a suite of resources and a video outlining the risks and how to keep safe.

The Safe and Well visits continue to be promoted and with the launch of the new 'When to Refer' card with QR code, this is now easier than ever. The Safe and Well visits are free and will cover fire escape plans, kitchen and cooking safety, electrical safety, smoking safety and candle safety but are also used as a mechanism to build engagement with hard to reach and 'at risk' people. Operatives carrying out the visits are often made aware of safeguarding issues and concerns and can be an essential link to raising concerns and supporting people during the safeguarding process. Some of the excellent work between TWFRS and the local authorities ASSET team are detailed in the case study below. The Safeguarding Champions also received a fire risk briefing in March to highlight the risks and promote the Safe and Well visits.

Operational practice

See Case Study on page 39 and 40.

Joint working (fire risk) - case study

Tyne and Wear Fire and Rescue Service and Gateshead Council

In September TWFRS received a 999 call to a house fire in Gateshead resulting from a Carecall monitored alarm activation. Mr D was rescued from the property and conveyed to hospital suffering from breathing difficulties. The cause of the fire was accidental, and a safeguarding referral was submitted to the local authority due to concerns for Mr D including self-neglect, alcohol issues, hoarding and mental health issues.

In October fire crews were called to a second house fire at the same address. Mr D was rescued by fire crews and required hospital treatment for breathing difficulties due to smoke inhalation. A further safeguarding referral was made with the same concerns. Due to the extensive fire damage following the second fire, the property was deemed uninhabitable. Discussions were held with the Gateshead Housing Company and Mr D was relocated to a hotel following his discharge from hospital, until a new property was secured for him. He successfully moved to his new address a short time later.

On 21 December fire crews were mobilised to a fire at Mr Ds new address. Mr D was rescued and taken to hospital for treatment which resulted in a lengthy admission. Another safeguarding referral was submitted, and a request was made for an emergency meeting to be held due to the fact this was an extremely vulnerable individual; elderly, lived alone, smoker, alcohol issues. Mr D had been involved in three significant house fires over a three-month period, on every occasion he had to be rescued by fire crews and required hospital treatment.

An urgent multi-agency safeguarding meeting was held on 22 December. Further meetings led to agreements by partner agencies to carry out the following action:

• as Mr D was known to smoke in bed the existing monitored alarm was extended to include the bedroom
• installation of a misting system (TWFRS Ultimate Protection model) within the property
• joint visit by Housing and TWFRS to conduct a Safe and Well check
• fire-retardant bedding, throw and mat issued
• referral to befriending services for Mr D due to feelings of isolation
• offer of referral to address alcohol dependency, this was declined by Mr D
• referral to the falls clinic
• daily welfare calls from Housing Warden

Between January and February Mr D withdrew his engagement with Housing and refused daily calls from the Warden. He also refused to engage with the Gateshead Recovery Partnership for support with his alcohol dependency and withdrew consent for the installation of the monitored smoke alarm in the bedroom.

Further safeguarding meetings were held to discuss the ongoing and increasing concerns from partners, particularly the high fire risk. Partners worked together to re-engage Mr D and because of hard work and persistence from all partners the misting system and smoke alarm were installed.

A further fire incident has occurred in Mr Ds home, however the heat detector activated causing the misting system to deploy preventing both serious damage to the property but most importantly injury to the occupier.

This case study shows how a high risk and vulnerable occupier can be protected by partner agencies working towards a common goal. Working together with determination and drive. This is an excellent example of partnership working by multiple partners to achieve a positive outcome and highlights potential best practice moving forward. Following this latest incident Mr D is currently engaging with his social worker and other partner agencies.