Ealing Safeguarding Adults Board

Annual report 2017– 18

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Table of Contents

1.

Foreword

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2. Executive summary

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3. Safeguarding adults - the national and local picture

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4. The Board’s work – 2017 / 18

- Key achievements - Work of the sub groups - Carers’ voice

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8

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5. How well are adults safeguarded? 11

6. Spotlight on practice

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7. Priorities for 2018/19

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Appendix 1 Board membership & attendance 2017/18

Appendix 2 Background information – what does the Board do?

Appendix 3 Financial

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Foreword I am pleased to present the Annual Report of Ealing Safeguarding Adults Board for 2017/18. This report is published on behalf of our multi-agency board. It focuses on how Ealing‘s public agencies and wider partners are working to reduce and prevent abuse and neglect in our older citizens.

The last year has been one of change for the Board and its partners. We have experienced some staffing changes and some senior posts filled on an interim basis while work on getting recruitment right has been undertaken. The staffing of the Board Business unit has presented some challenges but nevertheless we have progressed actions from last year’s report

We are working more closely with the Ealing Safeguarding Children Board and the Community Safety Partnership. A partnership budget is in place, showing the importance Ealing Council, Ealing Police and the Clinical Commissioning Group place on working together to protect vulnerable adults.

Work is being done by our partners to re-examine multi-agency safeguarding arrangements to ensure they are as effective as possible. This will give the Board a key role to play in the year ahead in helping to provide independent scrutiny and assurance that local safeguarding practice continues to improve and enhance the quality of life of adults in Ealing. As the implementation of innovative ways of working is embedded through Better Lives the Board will work to support partners to achieve the best outcomes.

We have made some great progress in the last year, particularly on the issues we identified last year.

➢ Putting people at the heart of practice ➢ Improve awareness of safeguarding adults ➢ Improve responses to safeguarding of adults with complex needs ➢ Learn from experience to improve how we work ➢ Improve performance and assurance activity ➢ Improving the care market and work with providers

This year coming year we want to strengthen arrangements even further and all we do will be underpinned by an intention to promote and enable effective partnership working. The Board does not have an operational role but has a key role in giving partners and agencies the chance to come together and to focus on working collaboratively to prevent abuse and neglect wherever possible.

In 2018/19, I want to ensure our Board is effectively strengthening understanding across the agencies we represent of the challenges faced, sharing good practice and helping members to see the potential opportunities for working across health, social care and policing to reduce harm. Importantly, we will work to give those agencies a forum to hear from wider partners, providers and service users about their experiences and their needs. We will, going forward, focus on:

➢ Revitalising arrangements – the changes within the children’s safeguarding world afford an opportunity to strengthen the adults work

➢ Building a confident workforce

➢ Embedding further Making Safeguarding Personal

➢ Delivering real sustainable change through support to the Better Lives programme

These partnership goals will we believe help improve outcomes for adults at risk in Ealing.

Sheila Lock, Independent Chair

Executive summary

This year we have

✓ Brought together the Adults’ and Children’s Boards to focus on issues of shared interest: this included a focus on domestic abuse, contextual safeguarding and Board development.

✓ Developed a shared performance framework across the partnership, to better understand the journey of vulnerable adults through the safeguarding system

✓ Recruited new lay membership to the Board

✓ Held an overarching organisational audit (akin to a Section 11 Children Act audit) and subsequent challenge event to ensure agencies presented the required assurance

✓ Implemented learning arising from a serious Safeguarding Adult Review undertaken during 2016/17

✓ Commenced and completed a Management Case Review (MCR) involving an adult who was a former care leaver, developed appropriate action plans and implemented learning

✓ Raised the issues of unregulated accommodation at a national level and with ADASS to lobby for changes to the regulatory framework

✓ Developed a safeguarding handbook for the VCS sector, which is ready for consultation and roll out

✓ Worked with the West London Mental Health Trust to understand the transition issues for children with mental health into adult services

✓ Contributed to pan-London work on audit and quality, developing a new audit tool for roll out in 18/19

✓ Delivered training across the workforce on radicalisation and the Prevent Duty (2015).

✓ Analysed national learning from CSE cases that have led to the publication of SCRs where adults with learning disabilities are at risk

✓ Sought assurance from the provider of local mental health services in relation to the adequacy of safeguarding arrangements

✓ Worked closely with the local police in relation to the Metropolitan Police change programme and the implications for Ealing residents.

Last year we said we would:

✓ Put people at the heart of practice - Work has been embedded across the safeguarding

arrangements to comply with the Care Act and to embed the six safeguarding principles. These are at the heart of the transformation programme Better Lives which the Board has facilitated discussion around during the year.

✓ Improve awareness of safeguarding adults – All agencies have supported staff to become aware of the Care Act requirements and to understand the needs and challenges of working with those adults who present with safeguarding needs. Understanding the individual’s capacity to make decisions and the inherent challenges has been a feature of this awareness raising.

✓ Improve responses to safeguarding of adults with complex needs – We have completed one Safeguarding Adult Review and implemented findings from a review completed last year; this has led to some changes in how agencies deliver services. Issues such as fluctuating capacity, quality of care, housing needs, mental health, the relationships with family members have been the focus of discussion and action.

✓ Learn from experience to improve how we work – We have used learning and a briefing methodology to cascade learning from cases locally and nationally to the front line

✓ Improve performance and Assurance activity- A framework for performance monitoring is now in place that is indicative of the journey through the system and the multi-agency role

✓ Improving the care market and work with providers – A systematic approach to addressing provider concerns is in place with a view to improving the quality of provision through a climate of high challenge and high support. Agencies have developed strong links with regulators to share concerns and to act in a coordinated way

3. The national and local picture

Ealing is the fourth largest Borough in London according to latest ONS data, but work undertaken in the preparation of the Joint Strategic Needs Assessment suggests that at any one time there may be up to 30,000 people unregistered with statutory agencies in the Borough. It is believed that many of these people fall into the older age range.

The working age population based on the latest data suggests the population is around 350,000 with numbers of males and females evenly spread. The number of adults of working age is rising year on year at a rate greater than the England average, and the number of older adults, aged over 65 is also growing although at a rate slower than the England average. The rises, nevertheless account for the increased pressure on services at a time when budgets have become more constrained. Life expectancy is not very different from London or England averages, but there is variation between wards: South Acton and Norwood Green have significantly lower life expectancies as compared to the national average. Acton Central, Hanger Hill and North Greenford have significantly higher life expectancies. The JSNA highlighted that rates of all disabilities in Ealing are predicted to rise significantly by 2020.

Unpaid care, that is care provided by a friend, relative or neighbour, is broadly in line with that in London overall, the provision of such care is higher in the older age groups, the highest being in the 50-64 age band where nearly 17% of residents provide some form of unpaid care.

The rate of permanent admissions to care homes in Ealing is lower than the England average.

This is the context in which demand in the system needs to be seen. After seeing a significant rise in the number of safeguarding concerns that are being raised over the last three years, this year is no exception. The total number of concerns raised grew rapidly between 2013 and 2016 with the total number almost doubling in two years. This level of concerns raised reflects an increased understanding that safeguarding adults at risk is a responsibility we all share and the willingness of professionals and members of the public to report their concerns.

Of those concerns raised, 98% were triaged in less within two days, showing that the local system is working to provide a timely response to those who raise concerns.

National figures for 2017/2018 are not yet verified, but reports suggest that Ealing is wholly in line with what is being reported through ADASS. However, it is important to note that a small number of concerns raised does not necessarily reflect low levels of abuse or neglect but may indicate an unwillingness to report concerns or a lack of understanding of how to do so – if abuse or neglect is suspected it needs to be reported so it can be dealt with.

Only a third of the concerns raised in 2017/18 resulted in a full safeguarding investigation under section 42 of the Care Act. That means that many of the concerns raised, after initial conversations and work by professionals to ascertain what had happened, proved not to be related to abuse or neglect. The conversion rates in Ealing are higher than in other parts of the country, suggesting that agencies understand well what thresholds exist.

Whilst all the concerns that are raised are responded to, there remains work to be done to ensure that professionals fully understand when to report a concern and when and how to manage issues relating to more general concerns about the welfare of adults in a proportionate and effective manner as part of their daily work.

In addition, locally we currently see a relatively high proportion of concerns raised by staff at residential care homes and a lower number of concerns raised by staff from the domiciliary care sector. Work in 2018/19 will seek to address this imbalance and ascertain whether it

relates to a lower level of abuse or neglect, the higher level of need for care and support of those in residential care or to a lack of understanding about safeguarding and how to report concerns in the home care sector.

Locally, and nationally, the safeguarding agenda has widened to focus on prevention and on the transition of children with care and support needs to adult services. Nationally, Safeguarding Adults Boards (SABs) have been focusing on:

• The challenge of sustainably meeting the cost of completing Safeguarding Adult Reviews; and on ensuring that the lessons learned from these reviews are shared and lead to appropriate change

• Working with Local Safeguarding Children Boards

• Maximising opportunities for service users’ engagement to put people with care and support needs at the heart of the work of Safeguarding Boards

• Working with trading standards teams and Community Safety Partnerships to reduce financial abuse

• The risk of exploitation posed to vulnerable adults from changes in criminal behaviour, criminal exploitation, human trafficking and modern slavery

• Working with environmental health teams on complex issues relating to self-neglect and hoarding

These have all been areas of local focus over the last year.

Locally, as well as nationally, there continue to be challenges:

• Forthcoming changes to the Deprivation of Liberty Safeguards (DoLs) and Mental Capacity Act legislation following a Law Commission review in Spring 2017

• Ensuring we capitalise on organisational changes within the police, NHS and the local authority to improve the way vulnerable adults are safeguarded

• Changing demographics and the increase in the over 75 and 85 population and the impact of associated complex health needs

• A continuing reduction in the provider agencies available to meet the increasing volume and complexity of need and demand on the care sector

• The challenge of social isolation and loneliness

• A need for high quality training for the care sector workforce to support staff and reduce high staff turnover and adequate pay structures

The referral rate for authorisations has remained high throughout 2017/18 covered by this annual report. The Law Commission review has potential to streamline the DoLS process ensuring it is administratively less burdensome but making sure it remains a robust process. However, it remains unclear if and when these recommendations will be made into law.

4. The Board’s work – 2017/18

Key achievements

In 2017/18, to provide assurance the local safeguarding arrangements are continuously improving and enhancing the quality of life of adults in Ealing, the Safeguarding Adults Board:

✓ Brought together the Adult and Children’s Boards to focus on issues of shared interest:

this included a focus on domestic abuse, contextual safeguarding and Board development.

✓ Developed a shared performance framework across the partnership, to better understand the journey of vulnerable adults through the safeguarding system

✓ Recruited new lay membership to the Board

✓ Held a section 11 and subsequent challenge event to ensure agencies presented the required assurance

✓ Developed a robust and coordinated response to providers causing concern

✓ Implemented learning arising from a serious Safeguarding Adult Review undertaken during 2016/17

✓ Commenced and completed a Management Case Review involving an adult who was a former care leaver, developed appropriate action plans and implemented learning

✓ Raised the issues of unregulated accommodation at a national level and with ADASS to lobby for changes to the regulatory framework

✓ Developed a safeguarding handbook for the VCS sector, which is ready for consultation and roll out

✓ Worked with the West London Mental Health Trust to understand the transition issues for children with mental health into Adult services

✓ Contributed to pan London work on audit and quality, developing a new audit tool for roll out in 18/19

✓ Delivered training across the workforce on radicalisation and PREVENT

✓ Analysed national learning from CSE cases that have led to the publication of SCRs where adults with Learning disability are at risk.

✓ Sought assurance from the provider of local mental health services in relation to the adequacy of safeguarding arrangements

✓ Worked closely with the local police in relation to the Metropolitan Police change programme and the implications for Ealing residents.

Work of the subgroups

Learning and Development

The focus of multi-agency learning in relation to adult safeguarding has been to focus on joint agency learning from serious cases. In the assurance and challenge event in February 2018 all agencies provided evidence of training that was taking place to support the development of staff post the legislative changes.

During 2017/18 this is best summarised as:

• Embedding the principles of MSP across organisations and practice

• Ensuring a wider understanding of the impact of the Care Act 2014 on learning and

development activity

• Providing a forum for staff to share information and good practice

• Providing induction for newly elected Councillors to increase Member awareness of adult safeguarding

• Designing training events that will raise the profile of safeguarding adults and share good practice

• A focus on prevention, promoting independence and Better Lives

The must be a focus going forward of increasing the levels of multi-agency training. The Board recognises this is essential in developing a confident and ambitious workforce. There are a number of issues that the challenge event highlighted as challenges linked to learning and development:

• Deliver a multi-agency conference in Spring 2019

• Recruit a Principal Social Worker in the LA to lead and drive work around quality and practice

• Raise Councillors’ awareness in autumn to refresh and develop understanding of adult safeguarding among elected members

• Deliver training to the Registered Managers Network to increase awareness among senior care agency staff

• Build the website

• Develop a training matrix for tiers one and two staff

• Publish a needs assessment on training within the home care sector and recommendations on how gaps can be addressed

• Review nationally published SARs to identify lessons learned and implications for

practice

• Publish of a series of video training clips (on the website and promoted on social media)

Performance Audit and Review

The Performance, Audit and Review subgroup – PAR - is chaired by the chair of the Board as part of the desire to get a group established. The core membership of the subgroup is:

• Manager Safeguarding Adults Team in Ealing Council

• Detective Sergeant from the Safeguarding Adults Investigations Team, Ealing Police

• Head of Service, Adult Social Care, Ealing Council

• Designated Adult Safeguarding and Clinical Quality Manager, Ealing Clinical

Commissioning Group

• Safeguarding Lead LNWUH NHS Trust

• Safeguarding Lead WLMHT

• Performance Lead Ealing Council

The PAR subgroup’s role is to ensure that the ESAB has appropriate safeguarding policies that enable it to maximise the outcomes for adults at risk in Ealing and reflect the diverse communities of the Borough. In previous years the subgroup has focused on an analysis of the data report published by the Ealing Council Safeguarding Team but in 2017 the group developed a multi-agency dashboard. The newly developed dashboard reflects the wider nature of work to safeguarding adults in Ealing. Discussions are taking place with health agencies to ensure that the data also reflects the experience of those using health services.

During 2017/18 the group:

• Developed a multi-agency dataset and established a performance regime

• Completed a guide for voluntary sector

• Supported a pan London workgroup on audit

• Monitored progress against a Safeguarding Adult Review completed in 2016/17

• Forged closer working links with colleagues on the Ealing Safeguarding Children Board (ESCB)

• Commenced work on reviewing the process for safeguarding investigations relating to providers and situations of potential institutional harm; regular review of data and intelligence to reflect how well adults at risk are safeguarded in Ealing – highlighting areas for concern and providing challenge where appropriate

• Developed of a multi-agency dashboard

• Members completed a self-assessment audit and met to identify key points of learning and areas for development which formed the basis for the challenge event

During 2018/19 the subgroup plans to:

• Refresh terms of reference for the Board and review structure, governance and membership of ESAB and its sub groups in line with proposed changes in the ESCB to ensure maximum efficiency and effectiveness

• Work with partners to support the implementation of Better Lives

• Develop policy and procedures to support MASH development

• Develop a new strategy on self-neglect and hoarding to enable a more joined up approach with public protection

• Implement the pan-London audit tool

• Carry out an assessment of the SAR referral process

• Work with trading standards to progress multi-agency approaches to preventing

financial abuse

Carers’ Voice

The Board has been able to use feedback from the VCS sector, Healthwatch, Carers Forum and individual agencies to hear first-hand the experience of how local systems are working.

Hot topics in 2017/2018

• Development of the Ealing Council Carers Strategy

• The protection of personal data

• Concerns about the service provided to vulnerable adults or their families who make

complaints

• Care homes at risk of closure

• The lack of training for unpaid carers

• Problems experienced accessing local information about safeguarding

• Concerns about how carers might be the subject of a safeguarding enquiry because of their attempts to deal with the challenging behaviour of the person they care for.

Information the Board has shared

• Minutes and feedback from all the main Board meetings and work of the subgroups

• The Board’s Business plan was shared, and feedback was sought before publication

• A presentation was given by the Chair to the VCS on priorities, performance and challenges

• A presentation was given by the Safeguarding Adults Team on safeguarding, what happens when an alert is received by the team and how to make a referral

5. How well are adults safeguarded?

The challenge event in February 2018, alongside the assurance statements of agencies, provides a snapshot of how well the system is performing.

The challenge event highlighted a number of key strengths within the system alongside a number of challenges which agencies recognised, and which were part of a forward plan.

In a number of key areas, analysis of performance shows us how well the system is responding:

Early enquiries and concerns Data suggests that, in Ealing, around a third of concerns translate into enquires as defined under the Care Act. In line with the national picture, numbers have increased significantly over the last three years. But the high rate of conversion in Ealing suggests appropriate matters are being referred and that agencies understand the issues of risk and threshold well. The figures show a gradually increasing number of Concerns raised in the first half of the reporting year, followed by large increases in October and November, after which numbers fell back but remained higher than previously. Work in is now complete to make the data more robust using the Frameworki system for reporting, however administration capacity continues to cause delays in recording data onto the IT system. The age profile and ethnicity data, highlight that the vast majority of concerns are raised relating to those aged over 65 years of age. The London Borough of Ealing Whole Population Ethnicity breakdown (GLA Ethnic Group Projections Long Trend, 2015/16) for 2016/17 was: BME 47%, White 47% and other 6%.

4445 47

50 49 50

74 73

55

63

56 57

3234

29 2729 30

2327

20

38

28

34

0

10

20

30

40

50

60

70

80

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Concerns

Enquiries

Important note - in order to prevent the disclosure of individuals, figures between 0 and 4 inclusive are displayed as a "*" (star symbol). All other figures have been rounded to the nearest multiple of 5 and therefore aggregated figures may not equal the England and regional figures when summed.

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Concerns by London BoroughOther Safeguarding Enquiries *

Section 42 Safeguarding Enquiries 20

Safeguarding Concerns 30

273

143

285257

52

4

Concerns by Age

Total

01.White

02.Mixed

03.Asian

04.Black

05.Other

06.Not

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GrandTotal

526

19

197102

16

154

1014

Concerns by Ethnicity

0

100

200

300

400

500

600

01. Male 02. Female

437

577

Concerns by Gender

The Board has also had access to information relating to the nature of the reported abuse with Physical Abuse, Neglect and Financial Abuse rating highly, although domestic abuse involving older people is an increasing factor. Much of the reported abuse is reported with the family as the alleged perpetrator and with the home as the location.

Note: concerns can be raised for multiple abuse types

020406080

100120140

1 2 4 5 10 11 12

59 64

92

124

Risk types by concluded enquiries (Section 42 and Other)

Types of abuse - comparison to other areas These charts show the number of Section 42 Enquiries per 100,000 adults for the comparator councils and each region. Since different councils have different populations this makes the data easier to compare. Other Risk Types are; Sexual, Discriminatory, Organisational

Local Authority Other Risk Types

Financial or Material Abuse

Psychological Abuse

Physical Abuse

Neglect and Acts of Omission

England 9% 16% 15% 26% 34%

Ealing 8% 14% 20% 21% 37%

Brent 8% 21% 11% 28% 32%

Hounslow 11% 16% 15% 24% 33%

Croydon 7% 20% 20% 25% 28%

Redbridge 7% 21% 10% 23% 38%

Enfield 10% 13% 14% 19% 45%

Waltham Forest 6% 15% 11% 21% 47%

Haringey 5% 20% 24% 24% 27%

Merton 14% 15% 15% 25% 31%

Barnet 13% 15% 16% 24% 32%

Harrow 9% 19% 22% 24% 26%

Lewisham 9% 19% 13% 26% 33%

Lambeth 11% 19% 13% 17% 40%

Greenwich 8% 11% 12% 20% 50%

Wandsworth 15% 16% 14% 29% 26%

Hillingdon 11% 14% 12% 31% 32%

Comparator Group 9% 17% 16% 24% 34%

Note: Other Risk Types are Sexual; Discriminatory; Organisational.

0%

10%

20%

30%

40%

50%

60%

Other Risk Types

Financial or Material Abuse

Psychological Abuse

Physical Abuse

Neglect and Acts of Omission

New Section 42 Enquiries per 100,000 Adults for selected

LA and Comparator Group 2015/16

Deprivation of Liberty Safeguards

There was a total of 249 referrals raised for Deprivation of Liberty Safeguards in quarter 4 of 2017/18. This compares to 200 for the same period in 2016/17. Quarter 4 referrals have shown a balancing across the previous 2 months and this may be due to reporting improvements and new systems now coming online. The tables that follow show the quarterly number of referrals during the past 9 quarters, with an average of 261 requests per month.

231279

396

257

200

265

183

288

249

0

50

100

150

200

250

300

350

400

450

Quarter 42015/16

Quarter 12016/17

Quarter 22016/17

Quarter 32016/17

Quarter 42016/17

Quarter 12017/18

Quarter 22017/18

Quarter 32017/18

Quarter 420017/18

DoLS Referrals2017/18

158

208

328

190

141

213

145

232249

73 71 68 67 59 5238

56

n/a0

50

100

150

200

250

300

350

Quarter 42015/16

Quarter 12016/17

Quarter 22016/17

Quarter 32016/17

Quarter 42016/17

Quarter 12017/18

Quarter 22017/18

Quarter 32017/18

Quarter 42017/18

Standard

Urgent

DoLSType of Assessment

We know as a system we have more work to do in relation to understanding the journey of adults

at risk through the system, however an area of significant progress over the last year has been in

raising the standard of care and work with providers across the Borough. This has been an area in which development work has improved the quality of provision substantially. Alongside this activity within agencies has supported the assurance process considerably Within the Council

✓ A significant investment in Better Lives ✓ Commitment to secure permanent staffing ✓ Quarterly oversight of performance by the Local Authority CEX and leader ✓ Investment in a principle social worker ✓ Development of a violence against women and girls strategy

Ealing CCG

• The CCG has continued to actively scrutinise serious incidents originating from its lead commissioned services, in accordance with the NHS Serious Incident Framework. Part of this work includes identifying any themes relating to adult safeguarding and seeking any additional assurance as required; and supporting the sharing of any lessons learned.

• The CCG attends safeguarding planning meetings convened by the Council for cases in which health commission the care.

• The CCG continues to contractually monitor its NHS Provider Trusts (Community, Acute and Mental Health) to ensure they effectively discharge their responsibilities in relation to Safeguarding Adults, Mental Capacity Act and the Prevent Duty.

• The CCG provides safeguarding support and expert advice across the health economy via the Designated Adult Safeguarding and Clinical Quality Manager.

Ealing Police .

• The Met Police reorganisation to improve approaches to risk and vulnerability and the associated plan to deliver a local BCU. This sets out what Ealing Police will do to improve the service to the most vulnerable in society. The strategy has a focus on reducing the victimisation of the vulnerable, reducing the unnecessary criminalisation of the vulnerable and reducing the exploitation of vulnerable people.

• Significant improvements have been made by the police in the way that they record crimes against vulnerable adults. This change in process has resulted in an increase in recorded crimes, which has allowed the Police to better understand the volume and nature of abuse that is committed against the most vulnerable.

• The process by which the Police identify vulnerable people and allocate resources to investigate crimes against the vulnerable as well as protect the vulnerable from further harm has been revised. This process is known as the ‘three strands of vulnerability’ and during 2017/18 all control room members of staff have received additional training. The revision of the process ensures that partner agencies are more quickly involved in the support of vulnerable adults

• The police led on bringing together leads from Adult and Children’s services from the authorities in the new Borough command to discuss safeguarding and agreed to facilitate further events to raise the profile of key issues particularly in relation to Adult Safeguarding. This will be a focus in the new year.

There have also been wide reaching changes across other Board member agencies and these are summarised below.

The CRC produced an annual safeguarding report as did Healthwatch; this was presented to the Health and Wellbeing Board.

Healthwatch Ealing is a public champion for health and social care and has continued to support and challenge the Board to engage with people who use health and care services and consider the real-life experiences of vulnerable adults. Healthwatch Ealing fulfils its statutory role in relation to safeguarding adults from abuse through:

• Sharing and reflecting the outcomes from our own engagement work with local people

• Carrying out ‘enter and view’ visits to care homes and hospitals;

• Working with the system on complaints issues, including the provider of NHS Complaints Advocacy (SEAP), to identify trends and emerging concerns;

• Contributing to the work of the Ealing and the regional NHS England ‘Quality Surveillance’ groups;

• Ensuring that we provide good quality information and signposting if anyone has a concern about a vulnerable adult.

Fire and Rescue Service

• DWFRS provided safeguarding training to all staff. Updated and clearer procedures were also put in place for staff which will help foster a better understanding of safeguarding. Staff are now more aware of what to look for and have the confidence to raise concerns, ask questions and seek advice.

• The service participated in the challenge event.

• Work has been developed around self-neglect and hoarding and the Board through

the Chair has contributed to the Fire Safety in specialist housing guidance, published

through ADASS.

NHS England

NHS England, as with all other NHS bodies has a statutory duty to ensure that it has arrangements in place to safeguard and promote the welfare of children, young people, and vulnerable adults. From a safeguarding assurance responsibility perspective, NHS England ensures it is appropriately engaged in the Local Safeguarding Boards and any local arrangements for safeguarding both adults and children, this including Ealing Safeguarding Adult Board. Over the year NHSE has engaged in three strategic discussions with the chair aimed at:

• Sharing strategic safeguarding concerns

• Identifying common themes, trends and early warnings

• Identifying safeguarding concerns that may need to be escalated

• Identifying areas of work that could benefit from regional or national input

• Providing an opportunity to share good practice, developments and experiences

• Sharing lessons learnt from Serious Incidents, Serious Case Reviews, DHR’s,

Independent and Multi-Agency Investigations

• Providing up to date information and guidance from a national and regional perspective

• Promoting clearer partnership working and strengthening safeguarding networks across the region

Safeguarding in Ealing – understanding the local picture

Sources of enquiries Enquiries relating to care homes and domiciliary care agency enquiries make up a large proportion of total concerns raised. Anecdotal evidence from care homes remains that many enquiries are the result of a risk-averse approach which assumes that it is better to raise a concern and record having done so than not. The proportion of these concerns that are closed at the initial triage stage has continued to increase. The data shows many of the concerns raised by and about care home management were not considered appropriate for a safeguarding investigation.

Type of abuse by setting (at the enquiry stage) The patterns of the type of abuse in the various settings are broadly similar across the last three years. Concerns about physical abuse, neglect or omission in support are most commonly reported while there are very few reported cases of discrimination. Many of these occurred in people's own homes including supported accommodation where there are several occupants. Self-neglect remains a common theme and will be an area for the Board to focus attention in 2018/2019.

Cases where neglect or acts of omission were broadly reported occurred in own home situations and nursing or residential care homes. These tend to be missed medication, not supporting transfers appropriately or failing to prevent customers falling when mobilising. There were notably less instances of any type of abuse or neglect reported in hospitals or other settings. This may be an indication of a lack of reporting from these settings.

Emotional or psychological abuse remains more likely to be experienced by people living in their own homes by family member(s) applying pressure on adults at risk (AARs) – bullying or threatening them with physical violence.

Residential care homes are where the most physical abuse is reported while levels of reported financial abuse are markedly higher at home.

Enquiries (formerly known as Investigations) Enquiries have decreased on the previous year, despite the less marked drop in the number of concerns reported. This reflects the relatively minor nature of some enquiries; many are more appropriately managed under care management than safeguarding. Relationship of the alleged perpetrator to the adult at risk While the profile of alleged perpetrators (in terms of relationship to alleged victim) was broadly similar in previous years there was a drop in the number of care home staff implicated.

While the number of incidents involving a stranger or unknown individual remains very small

Location of the alleged abuse Care homes and the adult at risk’s own home dominate where abuse is said to have taken place, with own home averaging 45% across 2 years and care homes averaging 40%. All other locations are similar in their proportions over the 2-year period.

Type of abuse The numbers of types of abuse have broadly similar ratios over the 3 years. From 2015/2016 there have been new categories of abuse being recorded and reported: Domestic Abuse, Modern Slavery, Self-Neglect and Sexual Exploitation.

Financial abuse has increased as a percentage of types of abuse as has the percentage of

incidents involving an element of neglect. Organisational (formerly institutional) abuse has fallen as a proportion.

Essentially, substantiated abuse or neglect in all of the categories above, except sexual exploitation (increased from 0 to 2 instances) have reduced.

Abuse by type of enquiry conclusion

In 2017/18, 271 enquiries were completed. The numbers of concluded cases by the type of abuse are shown above. With many cases involving multiple types of abuse, these numbers will not equate to the total the number of concluded cases. Neglect and acts of omission remain the most common feature of substantiated allegations.

Agencies involved in investigations (completed enquiries only)

Agency involvement with investigations is dictated by the nature of the abuse, who raised the initial concern and those agencies that need to be involved with expert advice and skills to help reach an outcome and/or to help deliver future services.

Most commonly Social Care, care providers and the police are involved in enquiries. Health agencies are involved in around 15% of enquiries.

6. A Spotlight on Practice: Case Study 1 The challenge In 2017, delayed transfers of care (DTOC) were considerably higher than the national standard. The Partners resolved to take action to improve both the quality and experience of patient care and to support system-wide improvements. What was done Over the last 12 months, the trust has implemented a number of initiatives:

• Placing greater focus on accountability and responsibility

• Established an internal weekly challenge process at individual patient level, helping to illuminate the reasons for delays.

• Introducing new patient pathways to improve quality of patient service and experience

• Improved Patient audit to track The results The trust has seen a significant reduction in DTOC (Delayed Transfers of Care). Alongside this the work has improved patient outcomes, with staff more proactive in recording the date of intended discharge, discharge planning and addressing issues that arise. The pathways better support patients to be partners in their care and having a clear process helps to manage expectations. There is also improved accountability and responsibility among staff, with clear recognition that DTOC is a cause of harm. This is monitored through regular internal DTOC calls. Establishing the reasons for DTOC has allowed the Mental Health Trust and the Local Authority to identify gaps in ongoing care provision in the system and to raise them through appropriate channels. This has also improved relationships with other providers and third sector organisations. Case Study 2 The challenge As is the case in many places across the country, the demand for Adult Social care is rising in Ealing and this comes at a significant cost to resources. Alongside this the models of delivery have focused on very traditional approaches that put emphasis on the deficits that come with aging. Ealing has embarked on a significant transformational change programme, ‘Better Lives’ focusing on efficiency, partnership, culture and most importantly a relationship with residents to allow them to receive the right level and type of support at the right time, to maximise independence and to reduce /delay the need for ongoing or formal; support. What was done The service is continuing to embed the core tenets of Personalisation and the principles and duties of the care act. With a focus on equipping staff to embed these principles into a strengths-based approach to practice to ‘Help residents live better lives ‘. The premise is a wider cultural change programme that looks at the social care offer, the partnership with statutory partners and providers, the partnership with residents and the principles of social work practice. A number of key activities have taken place:

• A mobilisation phase, reviewing spend, assessing VFM, considering market shaping and resilience, improving internal challenge and oversight

• Transformation activity – understanding the journey through services

• Benchmarking

• Case reviewing processes A key area of all of these approaches has included significant work with staff, to promote a cultural shift necessary for delivery of improved outcomes based on a strength and resilience-based interaction with residents.

In other words, the output (of a community care assessment) needs to change, from being a ‘prescription for services’ to become a ‘statement of desirable outcomes for the individual’. The results Key features of the innovative approach include an increased use of the community offer, encouraging people to stay local to areas with which they are familiar. This also has the benefit of growing the local economy. An improved Early Support offer that enables independence and prevents the need for formal social care intervention. This includes support for carers. A corresponding shift over time in the resources spent on formal and informal packages of care

7. Conclusion and priorities for 2018/19 The board can offer assurance in relation to the conduct of adult safeguarding but recognise there is more to do. There are a number of priorities moving forward:

1. Work to build a more confident and assured workforce, through learning and development and through balancing risk and change

2. Revitalising the work of the Adult board using the change in children’s arrangements as an opportunity.

3. Developing arrangements to assure ourselves that making safeguarding personal is embedded- through use of audit and other qualitative measures

4. Developing a multi-agency risk register that recognises issues around demand and financial constraint.

Appendix 1 - Board membership & attendance This report details attendance of member organisations or deputies at the Board meetings held during the year, 29th June 2017; 28th September; 7th December; and 29th March 2018. Member & agency Attendances Attendance rate

Independent chair, ESAB 3 / 4 75

Business Manager, ESAB 4 / 4 100

Executive Director Children, Adults & Public Health, LBE 4 / 4 100

Director of Adults Social Care, LBE 3 / 4 75

Director Community Safety, LBE 1 / 4 25

Director Children & Families, LBE 2 / 4 50 Deputy Director of Quality, Nursing & Patient Safety, CWHHE CCGs

3 / 4 75

Director of Public Health, LBE 2 / 4 50

Borough Commander, Ealing Borough Police MPS 2 / 4 50 Designated Adult Safeguarding Clinical Quality Manager, Ealing CCG

3 / 4 75

Director of Safeguarding, West London Mental Health NHS Trust 3 / 4 75

Deputy Chief Nurse, LNWUH NHS Trust 3 / 4 75

Borough Commander, London Fire Brigade 2 / 4 50

Head of Major Projects and Supporting People, LBE 4 / 4 100

Operations Manager, London Ambulance Service 0 / 4 0

Assistant Chief Officer, London Probation Service 0 / 4 0

Assistant Chief Officer, Community Rehabilitation Company 0 / 4 0

Inspection Manager, Care Quality Commission 0 / 4 0

Executive Director, Dementia Concern 0 / 4 0

Director HealthWatch Ealing 1 / 4 25

Lay member (from March 2018) 1 / 1 100

Appendix 2 - What does the Board do? The overarching purpose of Ealing Safeguarding Adults Board (ESAB) is to help and protect adults with care and support needs in Ealing. We do this by:

Providing vital assurance that local safeguarding arrangements are in place and that local

safeguarding practice is person-centred and outcome-focused

Working collaboratively to prevent abuse and neglect wherever possible

Ensuring agencies and individuals give timely and proportionate responses when abuse

or neglect have occurred

Continuously improving and enhancing the quality of life of adults

Ealing SAB leads adult safeguarding arrangements across the Borough and oversees

and coordinates the effectiveness of the work of its member and partner agencies. This

requires us to develop and actively promote a culture with its members, partners and the

local community that recognises the values and principles contained in ‘Making

Safeguarding Personal’. The Board also has a wider duty to consider issues which can

contribute to the wellbeing of its community and the prevention of abuse and neglect, such

as:

• the safety of people who use services in local health settings, including mental health

• the safety of adults with care and support needs living in social housing

• effective interventions with adults who self-neglect, for whatever reason

• the quality of local care and support services

• the effectiveness of prisons in safeguarding offenders

• making connections between adult safeguarding and domestic abuse.

Under the Care Act 2014 our Board has three core duties. We must:

• develop and publish a strategic plan setting out how we will meet our objectives and how our member and partner agencies will contribute

• publish an annual report detailing how effective our work has been

• commission Safeguarding Adults Reviews (SARs) for any cases which meet the criteria

At the heart of all we do are the six safeguarding principles:

Empowerment - people being supported and encouraged to make their own decisions and give informed consent

Prevention - it is better to take action before harm occurs Proportionality - the least intrusive response appropriate to the risk presented Protection - support and representation for those in greatest need Partnership - local solutions through services working with their communities and recognising that communities have a part to play in preventing, detecting and reporting neglect and abuse Accountability and transparency - in safeguarding practice.

Appendix 3: Financial information

ESAB income & expenditure 2017/18

Ends

Contributions Expenditure

LBE 58,597 Staff costs 67,764

CCG- core funding 35,000 Independent chair 19,000

CCG- contribution to SARs

3,035 SARs 14,938

MPS 5,000 Annual Conference 430

LFB 500

TOTAL INCOME 102,132 TOTAL EXPENDITURE 102,132