Islington Safeguarding Adults Partnership Board · Hospital which have emerged over the year have...

Islington Safeguarding Adults Partnership – Annual Review 2012-13 1

Islington Safeguarding Adults Partnership Annual review 2012-13 A Safer Islington

Appendix: 6.2a


About us Safeguarding adults is everyone’s business. Everyone in Islington has a responsibility to help adults at risk stay safe from harm. Certain organisations in Islington have very specific responsibilities to safeguard adults. These tend to be the organisations that work with, or on behalf of, adults at risk. Many of these organisations have joined up to the Islington Safeguarding Adults Partnership Board. The names of each organisation and its lead representative are given below, in alphabetical order.

Who makes up the partnership? Age UK Islington – Andy Murphy, Chief Executive Officer Camden and Islington NHS Foundation Trust – Colin Plant, Director of Integrated Care Camden and Islington Probation Service – Donna Jones, Senior Probation Officer Care Quality Commission – Jane Ray, Compliance Manager Crown Prosecution Service – Borough Prosecutor Healthwatch – Geraldine Pettersen Independent Chair – Marian Harrington Islington Clinical Commissioning Group – Martin Machray, Director of Quality and Integrated Governance (and Vice Chair) Islington Clinical Commissioning Group - Dr Rathini Ratnavel

Islington Council – Cathy Blair, Director of Child Protection Islington Council – Sean McLaughlin, Corporate Director for Housing and Adult Social Services London Ambulance Service, Islington – Patrick Brooks, Community Involvement Officer London Fire Brigade, Islington - Rhys Powell, Borough Commander Metropolitan Police, Islington – Steven Wallace, Detective Chief Inspector Moorfields Eye Hospital NHS Foundation Trust – Tracy Luckett, Director of Nursing & Allied Health Professionals Notting Hill Housing Trust – Lyn Lewis, Head of Operations Single Homelessness Project – Liz Rutherfoord, Chief Executive Whittington Health NHS Trust – Alison Kett, Deputy Director of Nursing & Patient Experience


Foreword I am pleased to be writing the foreword for the Islington Safeguarding Adults Board Annual report. I was appointed as the Independent Chair of Islington Safeguarding Adults Board in March and chaired the Board for the first time in May. I was previously a Director of Adults Services and Chair of the London branch of the Association of Directors of Adults Services. In this capacity I led the development of the pan London Adult safeguarding procedures. I am very pleased to be able to continue to contribute to the work of keeping vulnerable adults safe by chairing this Board. I am also Chair of Camden Safeguarding Adults Board and I am hoping to bring the work of the two Boards together wherever it would be appropriate. This has been a very challenging year for adult safeguarding. The details of the terrible events at Winterbourne View and Mid Staffordshire Hospital which have emerged over the year have served as a clear reminder that we can never be complacent about the quality of services. This has shown so clearly how important it is to listen to the voice of people who use services and their carers. This will be one of our main priorities for 2013-14. Islington Safeguarding Adults Board is a strong partnership which has very effective multi agency involvement. I have been impressed by the thoughtfulness of all agencies in setting out the contribution their organisation has made to safeguarding adults. I would like to thank them all for their contributions to the Board and to this report

Keeping vulnerable adults safe has always been a high priority in Islington. The partnership has established a comprehensive approach ranging from prevention and awareness raising, to dealing promptly and appropriately with complex safeguarding issues. We have been working very closely with the newly established Islington Clinical Commissioning Group this year. GP practices have ensured that their teams are trained and aware about adult safeguarding and how to refer to Adults services in Islington Council for investigation. We are also very pleased that our close work between Islington Council and the Metropolitan Police has achieved two successful prosecutions resulting in prison sentences for the perpetrators. I would also like to thank Islington residents and workers for their vigilance in bringing suspected abuse to attention. A great deal of progress has been made over the last year but of course there is always more we can do. This is a time of great change in all our organisations but we are determined to ensure as a partnership that safeguarding vulnerable adults remains a top priority. Thank you for your interest in this report. Together I hope that we can prevent abuse and reduce the harm caused when abuse does occur. Marian Harrington Independent Chair June 2013


About us ....................................................................................................... 2 Who makes up the partnership? ................................................................... 2

Foreword ................................................................................................................ 3 Introduction .................................................................................................. 5 You said, we did ........................................................................................... 6

You said, we did ..................................................................................................... 6 1. Be able to show how we safeguard adults ........................................... 7 2. Meet local and national standards in safeguarding adults .................... 7 3. Let people know what safeguarding adults is ....................................... 8 4. Make sure all staff and volunteers know how to safeguard adults ........ 8 5. Policies and procedures ...................................................................... 9

Community Conference 1. Welcoming people to the conference ................................................. 10 2. Awareness of abuse .......................................................................... 10 3. What’s changed? ............................................................................... 10 4. You said, we did ................................................................................ 11 5. Compassionate care .......................................................................... 11 6. What can we do to raise awareness? ................................................ 11 7. Conclusion......................................................................................... 11

Experiences & Statistics 1. Experiences ....................................................................................... 12 2. Statistics ............................................................................................ 12 3. People who raised their concerns ...................................................... 14 5. Location of abuse investigated .......................................................... 18 6. Decisions taken ................................................................................. 20 7. Action to help the adult at risk ............................................................ 21 8. Action taken against people alleged to have caused harm ................ 22 9. Serious Case Reviews...................................................................... 23 10. Equality & Diversity ............................................................................ 23 11. Deprivation of Liberty Safeguards ...................................................... 24

Appendix A How the partnership board fits in Appendix B Making sure we safeguard everyone Appendix C Our Impact on the environment Appendix D What should I do if I suspect abuse?

Contents table


This review looks at

• How much we have achieved towards our vision in the last year (people’s experiences and statistics)

• The work done to implement our three-year strategy

• What service users, carers and others in the community have said about our work, our new strategy and plans for the future.

Everything we do links to our overall vision to: Improve safety and people’s feelings of safety, by promoting the right of all people who are vulnerable to live free from abuse and neglect.

Although this review focuses on Islington, we also keep a close watch on national developments. Our vision is flexible enough to allow us to shape our work around national changes in thinking. We want to learn from national experience, not just local experience.

Safeguarding in the Headlines An undercover reporter for Panorama television programme filmed horrific abuse of residents by care workers in a private hospital, Winterbourne View. In 2012 eleven care workers from Winterbourne View were sentenced for abuse and neglect. Although this abuse did not take place in Islington, we took it seriously and are working to make sure that our residents and patients do not suffer similar abuse. To help us make sure people are safe we have put in place an action plan and are taking many measures to be certain that people in care homes and hospitals like Winterbourne are treated with kindness, dignity and respect. We are also working towards placing people closer to Islington so that relatives and friends can visit residents more often and spot the early signs of poor quality in care homes and hospitals.

There was a second story in the news this year which was about a hospital in Staffordshire. Too many patients died in this hospital. Many of these people died from conditions that hospital staff should have spotted and prevented. Judge Francis QC led an inquiry into the concerns and looked at evidence from over 900 patients and families. The inquiry made many recommendations which hospitals and other health and social care providers are taking very seriously. We are committed to ensuring that similar abuse/neglect of patients in Mid Staffordshire doesn’t happen in Islington and we want to learn from the Mid Staffordshire experiences. We continue to try to get perpetrators of abuse and neglect prosecuted. In Islington, there have been two prosecutions where the victim was an adult at risk and the abuser was their carer. In both cases, the abuser was sent to prison for a significant period of time.

The government has signalled it wants safeguarding adults boards to become statutory. We are preparing for this possibility.

Introduction


You said, we did Every year, we hold a community conference. It allows us to hear local people’s views directly. What follows is a list of some of the things people told us to do at last year’s community conference, with a summary of what we did this year as a result. We have put people’s ideas under headings below.

How we work with you You asked us to improve the way we handle safeguarding cases by asking service users what they want to happen, offering choices and listening to what service users tell us.

• Updated our training and guidance for social workers and managers to emphasise the importance of involving the service user and taking their views into account.

• Delivered a training course to social workers on ‘Person Centred Practice’.

• Are auditing our case files so we can check to see if social workers are helping service users and carers to tell us what they want to happen.

• Produced guidance on advocacy for professionals • Included information in professionals’ guidance on

signposting service users to support groups and victim support.

• Offered a range of courses to social workers and other staff to improve their interpersonal skills including: ‘courageous conversations’, ‘effective communication’, ‘customer care training’ and ‘customer resolution’.

Help for carers You asked us to give more information for carers on what help they can get.

• The Islington Carers Hub has been set up to give carers advice, information and support.

How the partnership works You asked us to think about how our partnership Board works. In particular you asked us to think about how we involve service users and carers at the Board and Subgroups, to find ways to help staff get their views to the Board, to get voluntary organisations more involved in the work of the Board and to give more information about what the partnership Board is.

• Widened representation on our subgroups and Board to include service users and carers.

• Consulted widely among staff and service users and carers on our new strategy and the annual plan.

• Doing a survey on staff and volunteers awareness of safeguarding adults.

• Over the year we have asked more people from voluntary organisations to join us on the Board

• Producing a newsletter to tell everyone about the Board and about other safeguarding work that has happened in Islington

.

1. You said, we did


All actions set out in the Partnership’s 2010-13 strategy have been done, or are on course to be done. Some actions which relate to on-going development work will be reviewed and refined through the Partnership’s new 2013-16 strategy. The five strategic themes from the 2010-13 strategy are set out below, together with the key actions taken. Much of the work on implementing the strategy was carried out by the Sub-Groups of the Board.

1. Be able to show how we safeguard adults

We have shown that the partnership is well-governed, accountable and improving safeguarding in Islington. This annual review is just one example of the way that we are accountable for how we safeguard adults. Specific achievements are:

• We have reviewed user, carer and public feedback (community conference and independent audit)

• We have reached agreement over resources and the boundaries of our safeguarding work

• We reviewed the partnership against our strategy and the ‘Good Governance Standards’ set by the Association of Directors of Adult Social Services

• We conduct a self-audit of partner agencies annually

• We have not needed to commission a serious case review during this year, but we have learnt from relevant serious case reviews in other local authorities

• Learning from management reviews and domestic homicide reviews involving adults at risk has been embedded.

This work was led by the Chair of the Board.

2. Meet local and national standards in safeguarding adults

Measuring how effective our safeguarding arrangements are is difficult, but important. We need to be assured that all of us play a full part in protecting vulnerable adults. We are able to show local safeguarding works and meets the standards and expectations set for us, particularly those set out in the London Safeguarding Adults Procedures. This work has been led by the Quality, Audit and Assurance Sub-group of the Board. • We have show the positive difference

safeguarding makes through independent audit

• We have implemented an extensive programme of audits to continually assure the quality of our investigations

• Central to our work is making sure we hear feedback from those how have experienced our services

• The sub-group reviews all sorts of information, including regular reports on how many safeguarding alerts there have been. Other sources of data used include independent and

Progress with our strategy


Feedback from our training courses

“The course was very participatory and I learnt from listening to perspectives of other participants as well as the trainer.”

“The discussion element highlighted the oftentimes nuanced nature and complexity of safeguarding issues and encouraged reflection on these.”

peer audits, partner audits, investigation data and some comparative data from other boroughs.

• We have worked with NHS and Council contracts and commissioning managers to make sure service users are treated with dignity and respect by the services they buy on behalf of Islington residents.

Martin Machray Chair of Quality, Audit and Assurance Sub Group

3. Let people know what safeguarding adults is

We wanted people in Islington to know what safeguarding means and what they can do about it. This work was led by the Policies and Procedures Sub-Group of the Board. • We re-launched our communications campaign

in 2012, with a focus on ‘harder to reach’ service users, carers and staff.

• Service users and carers became more involved in the partnership through the annual community conference, joining subgroups and taking part in various consultations

• We produced the ‘Keep me safe’ materials for service users and the basic leaflet produced in accessible formats, such as a British Sign Language version, Easy Read version and 6 community languages.

• We delivered targeted briefing sessions to specific groups of staff, for example to GPs and voluntary sector organisations.

• We visited several service user and

carer groups to raise their awareness of safeguarding.

• We made sure people know what difference safeguarding can make through our annual report and articles in community newsletters

• The number of referrals for home fire safety visits has increased

• We improved the voluntary sector’s awareness through briefings

Colin Plant Chair of Policies & Procedures Sub Group

4. Make sure all staff and volunteers know how to safeguard adults

We aimed to make sure staff and volunteers are suitable, trained and able to safeguard people at risk of abuse or neglect. This work was led by the Learning and Development Sub-Group.

• We have had assurance from our partner organisations that they have ‘safer recruitment’ practices in place

• We have agreed ‘Safer Recruitment’ guidance and continue to promote this to organisations in Islington who work with adults at risk

• An annual learning and development needs analysis and plan was developed. We


promoted a competency framework offered workshops on the competency framework

• Joint training for service users and carers to both deliver and attend training took place regularly, for example, drama-based training.

• We provided many different learning opportunities, including e-learning, which was advertised on the internet. Particular groups were targeted such as GPs.

• Our wide-ranging training has been attended by nearly 1000 people and has continued to be well-received.

• The quality and impact of learning on outcomes for adults at risk has been measured where possible.

Neil Chick Chair of Learning & Development Sub Group

5. Policies and procedures We wanted to make sure our policies and practice were fit for purpose and grounded in local experience. The Policies and Procedures Subgroup led on this work. • We continue to suggest amendments to the

London policy to keep them in line with best practice

• Our independent audit included service user and carer feedback on policies

• We reviewed our local procedures • We continue to engage actively in regional and

national policy development and national consultations relevant to safeguarding adults. Colin Plant Chair of Policies & Procedures Sub Group


Quotes from the conference

‘I had good experiences at my hospital.’

‘How do we know that services are joined up?’

‘You can have all the knowledge but without a caring attitude you will not have COMPASSION’

We held another community conference. It’s our chance to hear what people in Islington have to say about safeguarding adults. We also get to update them on the work we’ve been doing. The focus of this year’s community conference was ‘Compassionate care & safeguarding’.

1. Welcoming people to the conference

This year, ‘Your Life Your Say’, a group of Islington service users, led the conference. The theme of the conference was ‘Compassion and Safeguarding’. Marian Harrington, the new Chair of the Board, spoke about the work of the Board and what it means to be compassionate. In the questions session, several people said they were worried that changes in hospital care might have a negative impact on residents in Islington and adults with learning disabilities in particular. Another person asked whether the Board was sure that services were joined up. Improving our partnership working is an important part of our work.

2. Awareness of abuse Everyone at the conference took part in a quick survey on awareness of adult abuse. 85% of people selected the right answer to the question ‘What is an ‘adult at risk’? More than half of people knew that they should report suspected abuse to the Adult Social Services access team.

It is reassuring that many people at this year’s conference knew the right answers to the questions, but we need to do further work to make everyone in Islington aware about adult abuse and where to report concerns.

3. What’s changed? Elaine Oxley, Head of Safeguarding Adults at Islington Council gave an update on safeguarding adults. She explained that safeguarding adults has been in the news a lot, particularly since serious abuse of

Community Conference

What is an ‘adult at risk’? …Someone who is at risk of abuse or neglect because they are frail, disabled or have a mental health problem.


…There has been a move away from the concept of ‘protection’ to one of ‘safeguarding’. This recognizes the growing emphasis on responsible risk taking, the individual’s rights under the Mental Capacity Act 2005, service user involvement and empowerment.

We now work with adults at risk to identify and minimize risks and we recognize that in many situations they have the right to make what we consider ‘unwise decisions’ – decisions that we may not think are in their best interests….

‘Before we talked about ‘Vulnerable Adults’ and now we use the term ‘Adults at Risk’. ‘This helps us to recognise that not everyone with a disability or health problem is ‘vulnerable’ and to think more about the risk of abuse by others rather than focusing on the disability of the victim.’

adults with learning disabilities at Winterbourne View was uncovered. More recently, an Inquiry Report into the abuse and neglect at Mid-Staffordshire Hospital Trust has been published. The Board has been looking at whether there are lessons from these cases which we can learn from in Islington. We have changed some of the terms we use in Islington. For example, the term ‘adult at risk’ replaces the term ‘vulnerable adult’.

4. You said, we did At last year’s community conference, people asked us to improve the way we handle safeguarding cases by asking service users what they want to happen, offering choices and listening to what services users tell us. We updated everyone on the work we have done to improve this. You can read more about this in Section 1 of this review.

5. Compassionate care Annie Stevenson from ‘My Home Life’ spoke about putting compassionate care into practice. For people who receive care, quality of life means having relationship-centred care. This means that people need: • to feel safe (security) • to feel part of things (belonging) • to experience links and connections (continuity) • to have goals to aspire to (purpose) • to make progress to these goals (achievement) • to feel that you matter as a person

(significance).

6. What can we do to raise awareness?

Everyone at the conference took part in an exercise to think about what the words ‘respect’, ‘dignity’, ‘compassion’ and ‘choice’ meant to them and how we could share this with the whole community. There were many excellent suggestions and we will be looking at how we can use these in our communications campaign in the next year.

7. Conclusion The conference ended with a question and answer session. Questions covered a range of issues including making choices about independence and supported living arrangements; drug and alcohol dependence prevention and relapse work and the impact of possible budget cuts on safeguarding adults. Someone suggested we find safeguarding adults champions. At the close, everyone was thanked for their contributions. Without the willing participation of service users, carers and partner organisations, our community conferences would not be such a success. Together we are achieving our vision to improve people’s feelings of safety and wellbeing in Islington.


1. Experiences We continually seek ways of understanding the experiences of those who have been safeguarded. That’s why we hold an annual community conference. It’s also why we audit cases and ask for feedback from service users and carers. We know there is much more we could learn about best practice so we will continue to involve service users and carers wherever possible in our work. Here are some examples of safeguarding cases (we have changed names and some details to protect identities).

2. Statistics Alerts When someone reports a concern about abuse or neglect of an adult with care and support needs, it is known as a ‘safeguarding alert’. In April-March 2011/12 we had 1040 alerts about possible abuse In April-March 2012/13 we had 815 alerts. This is a decrease of 22%.

Experiences and statistics

Statistics are very useful in helping us to understand how we are achieving our vision. But they do not give the whole picture. We also need to understand the experiences of those who we help stay safe from harm. This helps us to learn what works and what doesn’t. It also shapes what we do in the future.

Case Study David lives in supported housing – he has mental health issues and is Deaf. He goes to an activity group once a week. Because David gets easily scared walking to the activity group, a communication support worker, Callum, accompanies him there and back. One day, David told the activity group leader that he had no money left in his savings account at the Post Office. He said that the worker Callum was helping him manage his money. The leader of the activity group knew that it was not part of Callum’s job to help David with his money and so reported the concerns to Adult Social Services Access team. After a careful investigation involving the police, enough evidence was found that showed Callum had pressured David into giving him money out of David’s account and spent it on himself. The police arrested Callum and the Court found him guilty of fraud. He is now serving time in prison for this crime.


We have been working hard to help people understand when to raise a general social services enquiry and when to raise a safeguarding alert. This may explain why there has been a decrease in the number of safeguarding alerts.

Every year, we look carefully at the cases where there have been more than one alert for a person. The reasons for repeat alerts are many. But in each case we want to make sure that these people are supported to keep safe from harm. If we find that there is a pattern of alerts which didn’t go on to be investigated, we look into the case to check that those people are getting the right help and support. Referrals After an alert has been received, we then gather more information about the person and the concern. Once this has been done, we decide whether the case needs to be referred for investigation. A case that goes on to be investigated is known as a ‘referral’.

Out of all the safeguarding alerts we received, 39% (409) of these resulted in formal safeguarding investigation.

In 2011/12 we had 409 investigations (39%) about suspected abuse.

In 2012/13 we had 489 investigations (60%). This is an increase of 20% on last year.

These statistics seem to confirm that fewer general social services enquiries are now reported wrongly as safeguarding concerns. People may have a better understanding about what to do when they have concerns about an adult which are not related to abuse or neglect. Also, it may be that generally people are getting better at spotting the signs of possible abuse or neglect. Investigations take time and effort. Because the number of investigations has increased, we need to check that all partners are properly resourced to do this important work. We will continue to ask our partner organisations to give assurances on this.

Case Study Sara is a young adult with mild learning disabilities. Until a year ago, she lived with her parents. She was very pleased when she got the opportunity to move into a flat and live independently. A support worker takes Sara out twice a week. Sara’s parents contacted her social worker because they were worried about their daughter’s new friends. They felt she had got in with the wrong crowd and that the friends were taking advantage of Sara. Sara was so desperate to have friends that she had let them move into her flat. She had also cancelled arrangements with her support worker. The social worker visited Sara to find out more. When she arrived, the door was opened by an older man – one of Sara’s new ‘friends’. He agreed to let the social worker in to see Sara. The flat was in a terrible state and it seemed that several people had been staying there. Whenever the social worker asked Sara a question, Sara’s ‘friend’ answered first. Usually Sara is quite chatty, but that day she seemed frightened of saying the ‘wrong’ thing to the social worker and kept looking to her ‘friend’ before answering. A safeguarding investigation was started. Sara’s friends seemed to have taken over Sara’s flat and benefit money. Sarah had to sleep on the kitchen floor, while her ‘friends’ slept in her bedroom. Many of Sara’s things and furniture had been broken or gone missing since her ‘friends’ had moved in. After careful work with Sara, she admitted that she was scared of her ‘friends’ and no longer wanted them in her home. All the agencies worked together to get the so-called friends out of Sara’s flat. Much work has gone into finding opportunities for Sara to socialise and make new friends. Sara’s extended family have also started visiting Sara much more frequently and including her in social gatherings so that she is not isolated at home.


3. People who raised their concerns

A wide variety of people raised concerns about adult abuse or neglect. The chart on the next page shows which people raised concerns. Overall, agencies raised more alerts than family and members of the public.

The largest number of alerts (96 alerts) came from ‘other healthcare staff’. Examples of staff in this category of alerters include occupational therapists, reablement staff and palliative care workers.

A large number of alerts came from ‘other individuals’ (72 alerters). We have taken a closer look at the records and it seems that most of these ‘other individuals’ belonged to one of the other categories and should have been recorded differently. We are working with staff and systems professionals to improve recording. It is important that we have accurate data about alerters so that we know where to focus our training and awareness-raising.

The next two largest categories of alerters were other social work staff (83 alerts) and hospitals (81 alerts). Extended family/household/carer/parent are also frequent alerters. It is not surprising that family and household members often witness or suspect abuse, because more abuse takes place in the community than in any other setting. And it is reassuring to see that when family and household members have concerns, their concerns are often also shared by professionals and these cases go on to be investigated. However, more than three-quarters of the alerts from the police did not go on to be investigated. This was similar to last year. We will continue to work with the police and others to make sure that they know when and how to raise a general social services enquiry and when to raise a safeguarding alert.

There have been no alerts from prisons in the last two years. This may be accurate, but as there are two prisons in Islington, HMP Pentonville and HMP Holloway, we want to make sure that harm to

adults at risk in prisons is not being missed. So, we have been in contact with the prisons to raise awareness of safeguarding adults. We have also been finding out what safeguarding adults training their staff need. In total 326 alerts did not progress to investigation. We audited a sample of these alerts to check the reasons why people suspected abuse, but those concerns were then not investigated. There are many reasons why investigations do not take place, but the most common reason is that the adult at risk of harm told us they did not want us to investigate. Another reason is that similar concerns were reported from another source and so the concerns were investigated under one investigation; instead of two separate investigations. This means that one investigation would be closed on our recording system.


0 20 40 60 80 100

AnonymousConsultant Psychiatrist

Council FinanceDistrict Nurse/Health Visitor/Midwife

Education Establishment/SchoolElectronic Referral

EmployerExtended Family/Household/Carer/Parent

Fire ServicesFriend/Neighbour

General PractitionerHospital

Housing DepartmentIndependent Legal Representative/Solicitor

Independent Provider AgencyLondon Ambulance Service (LAS)

Mental HealthNot Known

OtherOther Health Care Staff

Other IndividualOther Local Authority

Other Social Work Staff (Occ Therapy,…Police

ProbationPsychologist

Residential/ Nursing Care HomeSelf (Service User/ Carer)

Social WorkerVoluntary Agency

People who raised concerns

Alerts not Progressed to Investigation

Alerts Progressed to Investigation


4. Types of abuse investigated The different types of abuse that were investigated are shown in the chart below:

95 (19%)

12 (3%)

81 (17%)

128 (26%)

144 (29%)

1 (0%)28 (6%)

Types of Abuse 2012/2013

Physical Sexual Emotional / PsychologicalFinancial Neglect DiscriminatoryInstitutional

Physical abuse, financial abuse and neglect have remained the top three categories for several years. The picture is similar across the country. For the first time in several years, financial abuse is no longer the leading type of abuse in Islington. It is now nearly equal with neglect (both at 27%). Only one case of discriminatory abuse was reported to us. This is similar to many other London boroughs. Discriminatory abuse can be difficult to spot. Often, discriminatory abuse happens alongside another type of abuse, such as physical abuse. Research shows that discriminatory abuse is under-reported.

This chart refers to the 489 cases that were investigated. Some cases involved more than one type of abuse.

What is neglect? Neglect is not giving reasonable or agreed care. It includes failing to give medication in the way prescribed by a doctor, poor hygiene or poor standards of care. For example, we would investigate when we think a nursing home resident got a pressure sore which could have been avoided. We have agreed a pressure ulcer policy with partner organisations which sets out our expectations for avoiding pressure sores.



5. Location of abuse investigated

This chart shows that more than half (52%) of cases we investigated took place in the adult’s own home. Generally, people are not targeted by strangers in their own home, but if, for example, the person has been the victim of a scam, we will work with Trading Standards and the Police to give advice on how to prevent it happening again.

Most people find it hard to imagine that elderly and disabled adults can experience harm at the hands of family and friends. It is a largely hidden problem

in society. Where we suspect abuse or neglect from family and friends, we will help the adult involved to find ways to stay safe in their own home. Only in a very small number of cases, would we help the adult to move to a care home for their own safety (see chart 4.7).

Where an adult at risk is receiving homecare services contracted by the Council or the NHS, there are monitoring processes to keep a check on standards of care. We may increase monitoring if

0 50 100 150 200 250 300

Own Home

Care Home - Permanent

Care Home with Nursing - Permanent

Care Home - Temporary

Care Home with Nursing - Temporary

Alleged Perpetrators Home

Mental Health inpatient setting

Acute Hospital

Community Hospital

Other Health Setting

Supported Accommodation

Day Centre/Service

Public Place

Education/Training/Workplace Establishment

Other

Not Known

Location of abuse 2012/13

This chart refers to the 489 cases that were investigated. Some cases involved more than one type of abuse.


there are concerns about a particular contracted homecare service. Care homes, of various types, were the location of abuse or neglect for about 28% of the cases we investigated. This does not mean that care homes were necessarily the perpetrators of the abuse or neglect in these cases. For example another resident in the care home may have caused the harm. But we take care to monitor the number of cases relating to each care home in Islington. If we notice a trend of increasing alerts or a number of serious cases relating to one particular care home, this would trigger our Establishments Concerns process. Acting on Establishment Concerns helps to get to the root of problems in a care home or other

institution and find ways to make it a safer place for everyone. Where there are concerns about a particular care provider, we develop action plans and monitor the provider until quality standards are achieved. Actions could include:

• Focused clinical support and advice from a

Lead Nurse • Input from community matrons and specialist

nurses • Key workers from the community palliative

care team

Bespoke training programmes for particular issues such as end of life care, dementia and good nutrition.


6. Decisions taken

At the end of a safeguarding investigation, the agencies involved decide whether it is likely that abuse took place or not. Reaching this decision can be complex because there may be many factors to consider. This year, the number of cases where the investigated abuse was ‘substantiated’ or ‘partly substantiated’ has increased. Similarly, the number of investigations where abuse was ‘not substantiated’ has decreased. This means that we may be getting better at deciding when to go on to investigate concerns. It also means that our time

and resources are being better used to protect those who really need it. Harm is often hidden. It takes skill to investigate concerns fully and partner organisations need to work together to find out whether abuse took place or not. Sometimes it is very difficult to say whether abuse took place, because there isn’t enough evidence to say either way. Or no-one witnessed the incident, so it’s difficult to know what happened. In these cases we record the outcome as ‘not determined’. The proportion of ‘not determined’ cases is roughly the same as last year at 23%.

136 (30%)

153 (33%)

100 (22%)

69 (15%) 83 (26%)

129 (41%)

74 (23%)

29 (9%)

0

20

40

60

80

100

120

140

160

180

Substantiated Not Substantiated Not Determined Partly substantiated

Outcomes of Safeguarding Investigations 2012/13

2012-13 2011-12

This chart refers to 458 investigations which were completed during the year. It includes some cases which were started in the 2011-12 year, but completed in 2012-13. It excludes cases which had not been completed because the outcome had not been decided yet.


7. Action to help the adult at risk

In nearly half of the cases we investigated (214 cases), we took ‘no further action’. We have audited a sample of these cases to check whether it was appropriate to have taken no further action. Our audit found that in most cases, no further action was taken because it was found that the alleged abuse or neglect did not take place. For roughly 1 in 5 cases we helped the adult at risk through increased monitoring. There are many different ways to monitor an adult at risk. An example would be that a family member has agreed to visit the adult once a week. As well as this helping the adult to not feel so lonely, it means that any new concerns about the adult’s safety and wellbeing will be picked up quickly.

7 8

29 84

4 26

1 1

8 2 5

214 69

0 50 100 150 200 250

Application to Change Appointee-shipApplication to Court of Protection

Community Care Assessment and ServicesIncreased Monitoring

Management of Access to FinancesMoved to Increase / Different Care

Referral to Advocacy SchemeReferral to MARAC

Restriction/mgmnt of access to alleged perpetratorReview of Self Directed Support

Vulnerable Adult removed from property/serviceNo Further Action

Other Outcome

Outcome for Adult at Risk 2012/13

This chart refers to 458 investigations which were completed during the year. It includes some cases which were started in the 2011-12 year, but completed in 2012-13. Often there is more than one outcome for the adult at risk.

An agency care worker noticed that Mrs P, who is 85, had a lot of bruises on her body. When she asked Mrs P how she had got the bruises, she just shrugged her shoulders. A social worker went to visit Mrs P. She took care to interview Mrs P alone, when her husband was out doing the shopping. Mrs P explained that she seems to bruise very easily now and she finds it difficult to get out of her chair into her wheelchair. Mrs P said that her husband always treats her with great respect and kindness. Further information from the GP revealed that Mrs P is on medication which may make her bruise easily. After discussion, it was agreed that there was not enough evidence of abuse to investigate the concerns further. Before closing the case Mrs P was given information about how to contact the Access Team if she was not being treated with dignity and respect by others. The social worker referred her to an occupational therapist for advice about getting in and out of her wheelchair safely.


8. Action taken against people alleged to have caused harm

The number of cases where there was no further action recorded has decreased in the last year. Better recording is likely to be the reason for this. However, we continue to look into the reasons for no further action being taken against the person alleged to have caused harm. It seems that most often the adult at risk asked us not to take any action against the alleged ‘perpetrator’. In some case actions were in fact taken but were recorded incorrectly as ‘no further action’. For example, in some cases another type of investigation, such as a hospital incident investigation process took place instead of a safeguarding investigation and the outcome of the other investigation process was not known. We will work with our practitioners to improve recording. Also, in many cases it might not be right to take any action. For example, the adult might have asked us not to take any action. If the adult has

the capacity to make this decision, we would usually respect that decision. Another reason for not taking any action is that the situation has changed and a protection plan is no longer necessary. And sometimes the concerns resolve without our help. Continued monitoring is a common action. For example, where a staff member was found to have caused harm through neglect, the manager might check daily on the quality of the staff member’s work.

1 2

1 2

31 9

2 10

3 8

2 9

50 6

0 10 20 30 40 50 60

Action by Care Quality CommissionAction by Contract Compliance

Action under Mental Health ActCommunity Care Assessment

Continued MonitoringCounselling / Training / Treatment

Criminal Prosecution/Formal CautionDisciplinary Action

Mgmt of Access to the Vulnerable AdultPolice Action

Referred to PoVA List/ISA**Removal from Property / Service

No Further ActionOutcome Not Known

Outcome for Person Alleged to Have Caused Harm, Where Abuse Substantiated 2012/13

This chart refers to the 136 completed investigations where abuse was substantiated. *There may have been more than one outcome for each person alleged to have caused harm.


What is a Serious Case Review? A serious case review is undertaken by a Safeguarding Adults Partnership Board when a serious case of adult abuse or neglect takes place. The aim is for agencies and individuals to learn lessons to improve the way in which they work

9. Serious Case Reviews There has been one Serious Case Review this year. It related to an Islington resident who was placed in a care home in Haringey. As is the agreed protocol in such cases, the Serious Case Review was led by the Haringey Safeguarding Adults Partnership Board

The Review is nearing completion and the Islington Serious Case Review subgroup will be looking to learn the lessons relevant to Islington by: • Producing an information sharing paper with

learning from this serious case review and other research that can be shared across agencies

• Reviewing the content of safeguarding and other training courses to ensure that relevant research and learning is embedded in all safeguarding courses.

The Home Office has also directed that a Domestic Homicide Review take place. This related to a case involving an Islington resident who met the definition of an ‘adult at risk’. Because this case involved an adult at risk, any learning from this case may be relevant for our partnership.

The Domestic Homicide Review is still underway. Once the report has been finalised, the Home Office will consider the findings of the report. The Serious Case Review subgroup will oversee the implementation of any learning from this review.

10. Equality & Diversity Please see Appendix B for a full report on how different people in Islington are represented in safeguarding alerts.

What is a Domestic Homicide Review? A Domestic Homicide Review is one way to improve responses to domestic violence and prevent future deaths from domestic violence. The review tries to ensure that public bodies like social services, councils, policy and other community based organisation understand what happened that led to the death of the person and work out where responses to the situation could be improved. The review is not about laying blame but working out what happened and what could have been done differently


11. Deprivation of Liberty Safeguards .

0

5

10

15

20

25

30

35

40

ApplicationsCare homes Hospital New Renewals Granted Declined Reviews

Deprivation of Liberty Safeguards applications

2011/12

2012/13

The partnership monitors applications and authorisations for Deprivation of Liberty Safeguards from care homes and hospitals in Islington.


What are Deprivation of Liberty Safeguards?

They are legal safeguards to make sure people who may lack mental capacity and are in care homes or hospitals are looked after in a way that does not limit their freedom unnecessarily.

The safeguards make sure a care home or hospital

• only deprives someone of their liberty in a safe and correct way

• only does it in the best interests of the person when there is no other way to look after them.

Applications and authorisations Applications for Deprivation of Liberty Safeguards have remained relatively unchanged in recent years. However the number of authorisations has decreased. The Courts have clarified the circumstances in which to authorise a Deprivation of Liberty Safeguard application. This has resulted in a 36% decrease in authorisations from last year. The number of referrals from hospitals has increased 40%. Although referrals from care homes still make up more than 60% of the total number of referrals, they have decreased by 28%. More than half of all the referrals received were declined, that is, they did not result in a deprivation of liberty authorisation being granted. This was mainly because a Best Interests Assessor decided the person's circumstances did not amount to a deprivation of liberty.

Demographics Referrals are starting to more accurately reflect the ethnicity demographics of Islington. Referrals were equally split between women and men. There is a wide range of ages for referrals. Most referrals are for people who have dementia. Referrals for people who have a learning disability have increased year on year.

0

5

10

15

20

25

30

35

40

Dementia Learning Disability Physical disability Mental Health

Demographics of Deprivation of Liberty Safeguards applications

2009/10

2010/11

2011/12

2012/13


Adults in Islington are safeguarded

1. People in Islington know what to do if

abuse happens

2. Abuse of people

with care and support needs is prevented where

possible

3. Adults are protected

from harm when they need to be

4. Skilled staff &

volunteers spot abuse & take timely compassionate &

proportionate action to ensure protection

5. Partners work

together and link well with others

6. Safeguarding adults

policies and procedures work

Next steps for the partnership

We have signed up to a new strategy for the next three years. The new strategy focuses on six key outcomes, which are shown below.


Making it happen Our next steps will be to implement this strategy. To do this we have developed an annual plan. You can see our strategy and annual plan on our website: http://www.islington.gov.uk/services/social-care-health/adultprotection/Pages/sap_board.aspx We have set ourselves clear goals over the next year. Some of these are listed below: By December 2013, we will:

• publish a range of multi-agency guidance and toolkits on recognising and preventing financial abuse for professionals and the public, including guidance for Client Financial affairs

• set up an audit programme, which includes investigations, their conversion rate (from alerts) and completion rates.

• our Health Partners will review their approach to prevention and protection through the completion of the Department of Health Safeguarding Adults Assessment Framework (SAAF)

By March 2014, we will:

• check that general public and staff awareness of safeguarding adults has improved on the 2012 baseline

• agree a programme of audits from across the partnership, including looking at prevention and risk management

• survey people with care and support needs about their service experience following an investigation

• set up Safer Recruitment courses for all managers who recruit in all agencies

• seek regular feedback from service users and carers about the work of the partnership

• review awareness of Multi-Agency Risk Assessment Conference (MARAC) and referrals and consider latest MARAC Quality Assurance Review.

• review local safeguarding policies and procedures to ensure they are consistent with national and other guidance.

Appendix A How the partnership board fits in

http://www.islington.gov.uk/services/social-care-health/adultprotection/Pages/sap_board.aspx

http://www.islington.gov.uk/services/social-care-health/adultprotection/Pages/sap_board.aspx


The picture below shows how the Islington Safeguarding Partnership Board fits in with other bodies. The arrows and lines show who reports to whom.

Council – All elected councillors. It is the lead body for the local authority.

Executive – Eight councillors who are responsible to the council for running the local authority.

Scrutiny – This is a group of ‘back bench’ councillors who look very closely at what the council does.

Safer Islington Partnership – This is a group which looks at crime and community safety. It involves the council, police, fire service, voluntary sector and others.

Corporate Director (for Housing and Adult Social Services) – Is responsible for setting up and overseeing the ISAPB.

ISAPB – This has an independent chair who does not work anywhere else in the council or partner organisations.

MAPPA – Multi-Agency Public Protection Arrangements is a group which oversees management of offenders who pose a serious risk to the public.

ISCB – Islington Safeguarding Children’s Board works to safeguard children in the borough.

MARAC – Multi-Agency Risk Assessment Conference. This group responds to high risk domestic abuse.

The next few pages look at the different people that alerts were raised for, to make sure that all key groups are getting the safeguarding help they need.

Appendix B Making sure we safeguard everyone


Age Many older people were represented in safeguarding alerts in the last year. This is very similar to what happens in other boroughs in London and England. Unfortunately, it seems that the older a person is, the more at risk of abuse they become. This is the same across the country; not just in Islington.

Sex More alerts are raised about women than men. Islington is not very different from other parts of the country on this. In part, there are more alerts about women because women tend to live longer than men. And more than half of alerts are raised about people aged over 75 years.

247, 30%

132, 16% 246, 30%

190, 24%

Safeguarding Adults 2012/2013: Age

18-64 65-74 75-84 85+

This chart refers to the 815 total alerts raised


Ethnicity For roughly every 1000 adults in Islington, we received 5 safeguarding alerts. However, some of these alerts would have related to the same individual. (There were 673 individuals who had alerts raised about them). The number of alerts about adults from the Black Caribbean community is twice as high as the average. And the number of alerts about adults from Other ethnic groups is more than 4 times as high as the average. The reasons for this are not clear and we will be looking into this over the next year. The number of alerts about Bangladeshi adults during the last year was zero. We would have expected one or two alerts during the year about adults from the Bangladeshi community. It may be that this is a hard-to-reach community and that we need to increase our efforts to raise awareness of adult abuse and how to report it in this community. We have already produced a leaflet in Bengali about safeguarding adults. We will continue monitor the number of alerts for various ethnic groups to make sure all groups are getting the help they need.

509, 62%

306, 38%

Safeguarding Adults 2012/2013: Sex

Female Male

This chart refers to the 815 total alerts raised


Ethnicity Alerts Islington adult

population* %

White (includes any other white, white Irish, traveller of Irish heritage and gypsy/Roma)

588 137,188 0.43%

Black Caribbean 70 6,496 1.08%

Black African 15 6,788 0.22%

Any other Black background 11 3,336 0.33%

Indian 8 3,465 0.23%

Any other Asian background 12 2,744 0.44%

Chinese 11 4,639 0.24%

Pakistani 2 949 0.21%

Bangladeshi 0 3,039 0%

Other (includes information not yet obtained, any other ethnic group, any other mixed background, refused to say, white and black African, white and black Caribbean, white and Asian.

98 5,544 1.77%

Totals

815

174,188

0.47%

Service user’s main need The chart below shows that the number of alerts for adults with mental health needs has remained similar to last year. However, alerts for adults with physical and sensory disabilities have increased 18% since last year. The number of alerts about adults with learning disabilities has almost halved. We are not entirely sure of the reason for this and will be looking into this. The higher number of alerts in 2011-12 may be related to the publicity that was given to abuse of people with learning disabilities following the first Panorama programme about Winterbourne View in May 2011.

This table refers to the 815 adults who have had total alerts raised about them The population data comes from projected 2012 statistics from the Greater London Authority 2010 Round Ethnic Group Projections


595

152

46 22 0

503

159 125

8 0 0

100

200

300

400

500

600

700

Physical Disability,Frailty and Sensory

Impairment

Mental Health Needs Learning Disability Substance Misuse Other VulnerablePeople

Safeguarding Adults 2012/2013: Service User Category

2012-13 2011-12


The work of the Safeguarding Adults Partnership Board has a low impact on the environment in Islington. Environmental impacts include fuel use for vehicles visiting service users, carers and their family and other general office impacts such as paper and energy use. Wherever possible, we manage the impact on the environment. Sometimes our work also highlights opportunities to reduce household environmental impacts. For example, we might refer adults at risk to the Seasonal Health Intervention Network (SHINE). SHINE gives energy saving advice to residents. Not only does this help the environment, but it also reduces fuel poverty and improves the health and wellbeing of residents in Islington. For more information about SHINE, see http://www.islington.gov.uk/services/parks-environment/sustainability/sus_awarmth/Pages/shine.aspx

Appendix C Our impact on the environment

http://www.islington.gov.uk/services/parks-environment/sustainability/sus_awarmth/Pages/shine.aspx

http://www.islington.gov.uk/services/parks-environment/sustainability/sus_awarmth/Pages/shine.aspx


Appendix D What should I do if I suspect abuse?

If you suspect abuse of a vulnerable adult, please contact: Adult Social Services Access Team Tel: 020 7527 2299 Email: [email protected] Fax: 020 7527 5114 You can also contact the Community Safety Unit which is part of the police: Tel: 020 7421 0174 In an emergency, please call 999. For more information please see: www.islington.gov.uk/safeguardingadults

mailto:[email protected]

http://www.islington.gov.uk/safeguardingadults

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