Agenda Item 15 Enclosure KPCT/11/44 NHS KIRKLEES Report To:
2010/11 Annual Report: Safeguarding Children & Young People & Vulnerable Adults
FOI Exemption Category
Sheila Dilks Director of Patient Care & Professions
Karen Hemsworth Assistant Director for Safeguarding Children & Vulnerable Adults
Key Points to Note:
The 2010/11 Annual Safeguarding Report outlines the safeguarding work that has taken place across Kirklees over the last year in relation to both the childrenâ€&#x;s and adultâ€&#x;s agenda. This includes performance management of providers, training, supervision and ongoing service development. It includes updates in relation to both local and regional work, learning from serious case reviews, key achievements over the past year, key changes and areas for further development in the coming year.
In this current climate of Liberating the NHS it is essential that safeguarding remains at the forefront of change management.
Improved outcomes for Children, Young People & Vulnerable Adults
Organisation needs to comply with Local and National guidance relating to safeguarding children (Children Act 1989, Children Act 2004, Working Together to Safeguard Children 2010).
Sub Group/Committee: Recommendation:
That the Board notes the Safeguarding Annual Report.
This Page has been left Blank
SAFEGUARDING CHILDREN, YOUNG PEOPLE & VULNERABLE ADULTS MARCH 2011 Karen Hemsworth Assistant Director for Safeguarding Children & Vulnerable Adults MA Child Protection, BSc Hons (HV), RCSN, RM, RGN
PURPOSE The 2010/2011 Annual Safeguarding Children and Vulnerable Adult Report outlines the work of the Safeguarding Team over the past year and provides the Board with assurances that NHS Kirklees is discharging its function. It highlights key achievements in 2010 and identifies areas of further development in 2011.
INTRODUCTION Protecting children from abuse and neglect has been high on the political agenda for decades. Whilst safeguarding children is a well established statutory function, safeguarding adults has received far less attention due to the absence of a clear statutory framework. Working Together to Safeguarding Children was re-published in 2010, with further revisions likely due to ongoing reforms of health and social care. However, the publication of the revised safeguarding adult‟s guidance, “No Secrets” 2000, is still eagerly awaited following the public consultation in 2009. Within this current climate safeguarding children and adults brings new challenges for all those commissioning and providing services. Liberating the NHS makes it clear that patients must be at the heart of the NHS and Commissioners and Providers have a responsibility to ensure that patients receive a high quality of care and that their rights are upheld, including their right to be safe. It is therefore essential in this changing landscape of health commissioning and provision, that commissioning of healthcare must ensure safeguarding is managed across the commissioning cycle so that services are planned to meet the needs of those who are most vulnerable or at risk of harm. Contracts should be developed that safeguard, monitoring arrangements should be in place and decisive action should be taken when quality fails. As we move into a new era of safeguarding, this continues to be a priority at NHS Kirklees as we strive towards working in partnership to further develop robust quality and safe services in order to improve outcomes for those who are most vulnerable. Development of dynamic and collaborative partnerships both locally and regionally and the provision of expert clinical leadership has been key in improving the quality of front line practice and patient safety across the Kirklees health economy and will continue over the coming year. NHS Kirklees is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults. The safeguarding team is responsible for taking the safeguarding agenda forward and ensuring that the organisation fulfils its statutory safeguarding responsibilities and provides a service that is fit for purpose.
LINKS WITH YORKSHIRE & HUMBER STRATEGIC HEALTH AUTHORITY The role of the SHA in safeguarding is clearly set out in their 3 year strategy which was published in November 2009. The strategy includes developing metrics for safeguarding adults that are consistent with those for children and establishing clear safeguarding standards for service specifications and contracts. It also highlights the need to establish named and designated leads for safeguarding adults in NHS Provider and Commissioning organisations, to replicate those already in place for safeguarding children.
NHS Kirklees is able to provide assurances that named and designated safeguarding leads, both for children and adults are in place in the main across the Kirklees health economy. Clear safeguarding standards have been developed and agreed as reflected in NHS Kirklees Safeguarding Commissioning Policy 2010. The Assistant Director for Safeguarding at NHS Kirklees has been involved in regional work over the past year, both from an adult and childrenâ€&#x;s perspective, to drive the safeguarding agenda forward. This has included the development of policy standards and consultation about future service development. This work continues in the current climate of change and uncertainty. 4.
RECRUITMENT & EMPLOYMENT Whilst the Trust had implemented the Independent Safeguarding Authorityâ€&#x;s Vetting and Barring scheme and has a duty of care to share relevant information about staff who might pose a risk to any child or adult, the requirement to register new employees from October 2010 has been put on hold pending the Government review. Current roles and core competencies across the Kirklees health economy continue to reflect safeguarding responsibilities in all job descriptions. Safeguarding also remains a feature of induction programmes for all staff across the health economy.
SAFEGUARDING TEAM 5.1 The safeguarding team was part of the Patient Care and Professions Directorate.
However, as part the Transforming Community Services agenda the Named Nurses moved to the community provider, Kirklees Community Healthcare Services on the 1 February 2011. A detailed Memorandum of Understanding outlining roles and responsibilities of the Named Nurses who now sit within Kirklees Community Healthcare Services have been developed and agreed in order to ensure a continuation of an effective service. The Assistant Director for Safeguarding Children and Vulnerable Adults, does however, continue to provide safeguarding supervision and support to all the named safeguarding leads across the Kirklees health economy. Formal supervision contracts are in place and the structured supervision sessions are fully documented. The Assistant Director for Safeguarding, whose role also includes the Designated Nurse for Safeguarding Children, takes a strategic lead on all aspects of safeguarding and manages the PCTâ€&#x;s portfolio, ensuring that the organisation complies with statutory requirements and embeds local and national policy in all practice. The named safeguarding leads continue to be committed to working with staff to make sure that standards of care are of the highest quality and result in improved outcomes for vulnerable children and adults. The named safeguarding leads across the Kirklees health economy continue to work with partner agencies to improve outcomes for children and vulnerable adults. They also provide skilled expertise, knowledge and support within and outside the organisation on all aspects of safeguarding.
Influencing Promoting Developing
Contributing To National Research & Policy
Vision & Values
Managing Complex Cases
Leading Coordinating Responses to Policy & Legislation
The safeguarding leads also continue to develop strong links across the wider health economy, with other partner agencies and across the region;
Local & National Forums & Networks
Prof Bodies DOH
Yorks & Humber
5.2 The Vision and Values
All safeguarding work continues to reflect the local and national policy in that; It recognises that people are at the heart of everything we do It supports people in taking responsibility for their own health and wellbeing It shows understanding, dignity and respect for all our clients, partners and staff It encourages open, clear and honest communication It values diversity and will challenge discrimination It encourages innovation and continuous improvement and celebrates the contribution made by our staff It is accountable for the decisions it makes, the work it does and the resources it uses and the impact on the environment. The safeguarding leads across the Kirklees health economy continue to work towards ensuring; Improved opportunities and outcomes driven by change in service delivery Genuine partnerships across professional boundaries Fundamental cultural change in the way people work Legislation that can encourage and support Shift to prevention, early identification and intervention A culture that supports and motivates 6.
TRAINING Both Kirklees Safeguarding Children Board and Kirklees Safeguarding Adult Board continue to provide comprehensive multi-agency training programmes which reflect local and national requirements. The community, acute and mental health providers across Kirklees all have clear training strategies and provide additional in-house training for specific staff groups. This includes both child and adult protection and domestic violence and is delivered at different â€œlevelsâ€? based on the role of the professional and competencies required. This also reflects the statutory training requirements outlined in Working Together to Safeguard Children (2010) and the Intercollegiate Document (2010). Basic Awareness/Induction training is delivered to all new staff and E-learning packages are also available and widely used. Additional ad-hoc training has been provided to general practice with 60% of practices having received training. A Practice Protected Time event for general practice was delivered in November 2010 with good attendance and evaluation. Work is ongoing to develop Practice Protected Time events for community pharmacists and dental practices, the events arranged for March 2011. Provider organisations continue to audit the uptake of safeguarding training and this is also monitored by the respective safeguarding boards. Between January and December 2010, the following training was delivered; 7
NHS Kirklees/Kirklees Community Healthcare Services - Children; Induction (Level 1) – 67 Non-clinical mandatory (Level 2) – 235 Clinical mandatory (Level 2) – 508 Independent Contractors (Level 2) – 460 Safeguarding (Level 3) – 117 Bespoke (Level 2/3) – 122 NHS Kirklees/Kirklees Community Healthcare Services – Adults; Induction – 67 Non-clinical mandatory – 235 Clinical mandatory – 508 Safeguarding updates – 57 Safeguarding forums – 58 Care Home event – 44 Further, more detailed training is reflected in the annual training report. 7.
KEY RESPONSIBILITIES & LINES OF ACCOUNTABILITY Clear lines of accountability exist within the PCT and all provider organisations which are clearly defined in all policy documents. NHS Kirklees works closely with the Local Authority to commission and provide coordinated, and wherever possible, integrated services. It has a senior lead for children and young people, who ensures that their needs are at the forefront of local planning and service delivery. Engagement of public health ensures issues relating to children and vulnerable adults are addressed. The Chief Executive of the PCT has a responsibility for ensuring that the health contribution to safeguarding and promoting the welfare of children and vulnerable adults is discharged effectively through the PCT‟s commissioning arrangements. The PCT‟s role is not only about specific clinical services but also about exercising a public health responsibility for a whole population and a key task is ensuring the health and wellbeing of children and vulnerable adults across the health economy. The PCT‟s responsibilities in relation to children include; Identifying a senior paediatrician and a senior nurse to undertake the role of a designated child protection professional across the health economy. Identify a named doctor and a named nurse who will take a professional lead within the PCT on safeguarding children‟s matters. The designated professionals are performance managed in relation to their designated function at the level of Board Director and works closely with senior clinical governance leads and senior clinical professional leads. The designated professionals responsibilities also include; Coordinating the health component of serious case reviews Providing expertise and advice to KSCB and other agencies Ensuring all health providers for whom they commission services are supported in meeting their statutory function. 8
As part of the drive to transform NHS community services in Kirklees, the provider arm, Kirklees Community Healthcare Service (KCHS), is now moving towards a Social Enterprise and will be responsible for community services. A Memorandum of Understanding (MOU) has been developed to establish and clarify the formal partnership and agreement between NHS Kirklees and Kirklees Community Health Services in relation to safeguarding children and vulnerable adults. 8.
8.1 Background Information
In the past, adults at risk or victims of abuse have received significantly less attention than children. There has been no one piece of legislation that covers vulnerable adults, procedures being driven by a range of statutes and policies. The elderly and those with learning disabilities are particularly vulnerable and at risk of abuse. It is therefore crucial, that agencies work together to provide specialist services and non-specialist services to ensure that they are inclusive of the elderly and those with learning disabilities. Whilst local authorities have statutory and discretionary powers towards people with learning disabilities under the Community Care Act, it is essential that effective partnership working between agencies is at the forefront of all services commissioned and provided in order to ensure safeguarding is at the core of all service delivery and development. 8.2 National Policy
Safeguarding adults continues to gain importance on the national agenda. The „No Secrets‟ guidance is currently under review and the outcome of the consultation will direct and influence the future of safeguarding adults work. 2009 saw the phased implementation of the Safeguarding Vulnerable Groups Act 2006. This strengthened the safeguards around staff employed to work with children and vulnerable adults. The final part of the Mental Capacity Act 2005 has also been implemented, with the introduction of the Deprivation of Liberty Safeguards. In July 2009, the Department of Health publicised its report following the consultation on the review of “No Secrets”. A number of themes and challenges were identified by the consultation including balancing personalisation with safeguarding and the need to ensure systems which empower and listen to the victims of abuse are in place. Respondents also clearly said that whilst there maybe some lessons to be learned from children‟s safeguarding they did not want a system designed for the protection of children. Whilst we are waiting the Governments response to the consultation which has been further delayed, it is anticipated that there will be no significant change in policy direction. 8.3 Regional & Local Networks
Safeguarding Adults Regional Network (NHS Commissioners) has now been established with support from NHS Yorkshire & Humber. This new network is providing an opportunity for safeguarding adult‟s leads in NHS Commissioning organisations to share initiatives and best practice across the region.
Locally, the NHS Kirklees safeguarding adults lead continues to meet regularly with leads from provider trusts in the Kirklees district in order to support them and explore NHS specific safeguarding adultâ€&#x;s issues. The provider organisations across Kirklees have all identified safeguarding adult leads. Significant work has taken place within NHS Kirklees and Kirklees Community Healthcare Service over 2010 to raise the profile of the vulnerable adult agenda. 8.4 Kirklees Local Picture
Within NHS Kirklees the main focus over 2010 has been to develop the infrastructure in order that robust systems and processes can be developed which reflect the national framework of the safeguarding adultâ€&#x;s standards. The safeguarding leads continue to work to ensure compliance with the 11 recommended standards which will help to shape our work in the future: To ensure effective joint planning and capability Strengthening the effectiveness of the multi-agency partnership to lead and develop a Kirklees wide response to safeguarding adults. Contributing to the work of Kirklees Safeguarding Adults Board. Embedding safeguarding in all practice and within all our partnership arrangements that relate to vulnerable adults. To prevent abuse and neglect Promoting the right of every person to live a life free from abuse and neglect with a well publicised policy on zero tolerance of abuse within each organisation. Actively promoting this message to the public through the Local Strategic Partnership and the Safeguarding Adults Partnership. Ensuring good practice in mainstream health and social care services though high quality care management, clinical governance and robust contract management and ensuring these systems link to safeguarding Providing advice, support and good quality information to help people to safeguard themselves. To ensure a well trained and skilled workforce Contribute to the multi-agency training strategy on safeguarding and ensure it is of a high quality and appropriately resourced. Continuing to develop our workforce development plan in partnership. Contribute to the growing independent care sector to support skills development and promote best practice. To ensure prompt and effective responses to abuse and neglect 10
Providing accessible information about how to gain safety from abuse and violence, including information about the local safeguarding adults‟ procedures. Implementing and having audit systems in place for our multi-agency procedures. Development of internal guidelines that are consistent with the overarching procedures. To promote access and involvement Developing user, carer and patient involvement in all aspects of safeguarding work. Actively promoting advocacy services. The following table demonstrates the total number of safeguarding adult notifications from partner agencies made to Kirklees Safeguarding Adults Board
No. of Notifications Ethnicity Neglect Physical Financial
Sept – Dec 2009 588 656 262 235 103
Sept – Dec 2010 738 701 352 290 79
The majority of notifications continue to be from social care staff. However, over 2010, there has been an increase in notifications made by health care staff. Between January and December 2010, Kirklees Community Healthcare Services staff made 16 notifications. 8.5 Role and Remit of Kirklees Safeguarding Adults Board
The Safeguarding Adults Board is the strategic group that has responsibility to lead on the multi-agency strategy for safeguarding. The governance for the Board is within each agency‟s accountability framework and in addition, the Board has accountability to the Local Public Service Board (LPSB) for Older People and Healthier Communities, part of the Local Strategic Partnership. The Kirklees Safeguarding Adults Board is represented by NHS Kirklees Assistant Director for Safeguarding Children and Vulnerable Adults. 8.6 Kirklees Safeguarding Adults Board (KSAB)
The Kirklees Safeguarding Board has a revised constitution and membership to reflect its clearer strategic direction and governance arrangements. The Assistant Director for Safeguarding Children and Vulnerable Adults at NHS Kirklees continues to be The Vice Chair of the Board as such, is actively involved in driving the agenda forward. All the Acute providers across the Kirklees health economy are represented on the Board. The role of the Lay Member has continued to develop over the last year and this has been seen as an important development in engaging a community perspective. The Board continues to develop its role and critically challenge each other as partners in the safeguarding arena.
There has been much progress over the year in developing partnerships with adult services. There has been excellent attendance at KSAB meetings and a high level of commitment and energy to take the work forward. New key personnel in various agencies have added resources and focus to the work. The new constitution for the Board in 2010 has been recognised as just the beginning, and further work is timetabled to look at how the Board can further develop its effectiveness. This work will lead into a review of priorities and how it operates to achieve its objectives. Over the past year the sub groups for training, quality and performance as well as the Mental Capacity Act Local Implementation Network have reported into the Board on progress. The Board has clear links with the LPSB and other strategic partnerships across Kirklees and work continues to take place to strengthen this further. Work continues to take place to make sure that safeguarding is central to joint health and social care commissioning strategies. 2010 has seen Kirklees Council and NHS Kirklees join forces to launch a high profile poster campaign to promote Dignity in Care. Involving people who use services and carers is an important step in furthering the aim of ensuring dignity of care in health and social care and the new poster campaign highlighted the need to treat older people with respect. Both organisations have carried out audits, in order to raise standards in hospitals and care homes. The Named Nurses at NHS Kirklees have been instrumental in the Dignity in Care Campaign, ensuring that Dignity champions are identified and that it is put at the heart of health services. The recently revised multi-agency procedures were agreed and launched through respective organisations structures and 2009/10 saw the launch of the Large Scale Investigation policy. Kirklees Safeguarding Adults Board has also seen the launch of a new training strategy, focusing on the delivery of high quality learning and development activities to all levels of staff to enable them to respond to safeguarding concerns with prompt, timely and appropriate action. The introduction of the Deprivation of Liberty Safeguards has ensured that any decision to deprive someone of their liberty is made only following a defined authorisation process and Kirklees Council has worked with NHS colleagues to develop an implementation project to ensure that we are on target to meet the statutory requirements. 2009/10 saw the launch of the Safeguarding Adults Board Network which aims to act as an information exchange and to share learning and good practice for all agencies across Kirklees. 8.7 Operational Sub Groups/Task Groups
The breadth of the Boardâ€&#x;s work programme means that responsibility for delivering aspects of the work is devolved to operational groups. Joint work with Kirklees Safeguarding Children Board has taken place over 2010 to develop joint adult and children workstreams which focus on mental health, drug/substance misuse and domestic violence.
NHS Kirklees is represented on all the workstreams and progress and performance is monitored by the Board. 8.8 Serious Case Review (Adults)
Kirklees Safeguarding Adults Board commissioned its first Serious Case Review in July 2009 following the death of an elderly woman who had been resident in a local care home. The review looked openly and critically at how agencies had worked together and a number of recommendations were made. Whilst the review is now complete, it is awaiting publication and work is ongoing to embed the learning in practice across relevant agencies. The health recommendations are being monitored by the Safeguarding Committees across the Kirklees health economy and overall by Kirklees Safeguarding Adults Board. 8.9 Key Achievements over 2010
2010 has seen updated information for staff posted on the intranet which is now much easier to access. All vulnerable adult posters and leaflets have been updated and circulated across the workforce. Significant work has continued across the workforce to provide support and supervision and the development of â€œdrop-inâ€? surgeries in Kirklees has proved successful. The Named Nurses for Adult Protection now provide structured formal supervision to the workforce in relation to complex safeguarding cases and clear links with professional forums and teams have been established across Kirklees Community Healthcare Services. Between January â€“ December 2010, 136 health staff were supported in managing complex safeguarding adult cases. Work continues to strengthen the support to independent contractors via both training events and individual contact. 8.10 Audit
In 2008/9 Kirklees Safeguarding Adults Board Multi-agency Policy and Procedures were reviewed and re-launched. In order to raise the profile of the safeguarding adult agenda, gain an understanding of staff knowledge of the process and direct future work, an audit was undertaken in 2009. The questionnaire was sent electronically to all employees within NHS Kirklees, Kirklees Community Health Care Services (KCHS) and to Independent Contractors (General Practice, Opticians, Pharmacists, and Dentists). The timeframe for return was deliberately short. A total of 434 questionnaires (26% response rate) were returned from clinical and non-clinical staff, with 81% indicating that they knew how to report concerns within their service. Of those that completed the audit, 66% reported that it had raised their awareness of the safeguarding adult agenda. In 2010, work began to repeat this audit and the results are due shortly. 9.
DOMESTIC ABUSE It has been widely acknowledged that domestic abuse can and does affect children and young people who witness it and research has demonstrated that exposure to domestic abuse is harmful to children and young people. Research tells us that domestic abuse kills and that it can affect anyone, whether client or staff working within an organisation. 13
Work has taken place over 2010 with partner agencies, in particular with the police, in order to strengthen services relating to domestic abuse. Any incident of threatening behaviour, violence or abuse between adults who are, or have been in a relationship (including family members), regardless of gender or sexuality, should be seen in the context of domestic abuse. Over the past year work has been undertaken within the organisation and with other partner agencies to raise awareness of domestic abuse, through training events and briefing sessions. This has included NHS Staff and Independent Contractors. Partnership working is relatively strong and the police now share information relating to domestic abuse incidents with health and social care, when children have been present. On average, in Kirklees, 150-200 domestic violence notifications where children have been present are received every month. DOMESTIC VIOLENCE COUNT DECEMBER 2010 BASE DEWSBURY HC CLECKHEATON HC BATLEY HC RAVENSTHORPE SAVILE TOWN F N P TEAM GOLCAR CLINIC HOLME VALLEY NORTH HOLME VALLEY SOUTH DEARNE VALLEY SHEPLEY ALMONDBURY BRIAN JACKSON HC DALTON MILL HILL NEWSOME NETHERTON SURGERY ASHBROW CHESTNUT CENTRE BIRKBY CHILDRENS CENTRE PADDOCK CHILDRENS CENTRE PRINCESS ROYAL HC SHEPLEY H C FARTOWN HC TOTALS
W/C 21.12.09 SN HV 2 1 5 6 7 4 1 6 4 2 1 1 1 3 8 5 4 2 2 1 2 37 31
W/C 27.12.10 SN HV 8 5 4 6 8 3 2 1 1 2 3 2 2 3 15 1 2 2 1 1 1 3 1 46 31
Alcohol, drugs, learning disabilities and mental illness continue to be contributory factors. The information is recorded electronically on the child‟s record in accordance with information governance principles. This information provides a context for the possible risks to the child and any action that professionals may need to consider, and is included because of potential safeguarding issues that may be identified. In 2010, the Practice Protected Time event for General Practice included working with families where domestic violence is identified and „In-house‟ training programmes have been developed and delivered as part of the internal training programme to NHS Kirklees and KCHS staff.
10.1 Current Climate
The emerging legal and political landscape following a number of high profile child deaths both at a local and national level over the past years continue to highlight the growing complexities of our child protection systems. Improving the ways key people and agencies safeguard and promote the welfare of children and young people are crucial to improving outcomes for this group of individuals. Lord Laming‟s report into the death of Victoria Climbié (2003) concluded that her death had been a gross failure of the system and that the support and protection of children cannot be achieved by a single agency but that every agency has its part to play. The government‟s response to the inquiry placed a duty on all agencies to ensure that they discharge their function with regard to Safeguarding Children and Young People (Section lI Children Act 2004). Following the tragic death of Baby P in Haringey, there has been heightened awareness of safeguarding children, both within the Government and by the media. ‘A Review of Arrangements in the NHS for Safeguarding Children; Care Quality Commission’ was published in July 2009 following the death of Baby P. The review had been carried out by CQC at the request of the Secretary of State to look specifically at „Board Assurance‟ around child protection systems, including governance arrangements, training and staffing, and partnership working. NHS Organisations were required to self assess and individual feedback was given in Autumn 2009. Safeguarding children continues to remain a priority for NHS Kirklees and the acute providers within the health economy and assurances can be given that; The Trust meets the statutory requirements of carrying out CRB checks on relevant employees Child Protection policies and systems are up to date and robust A process is in place for following up children who miss appointments An alert system is in place to flag up children whose safeguarding is of concern All staff working in healthcare settings (clinical and non clinical) have undertaken level 1 training A training plan has been developed for staff that will require more in depth training (level 2 or 3) Service agreements and job descriptions provide clarity on the role of a designated and named professional e.g. a named doctor should do 4 sessions per week for a population of 50,000 children and a designated doctor should do 5 sessions for 50,000 children Service agreements, including job descriptions provide clarity on the role of the designated and named professional Board Level Executive Lead for Safeguarding has been identified The Board reviews safeguarding arrangements on an annual basis at a minimum The Board is assured that robust audits are in place to ensure safeguarding systems and processes are functioning effectively PCT‟s have robust performance monitoring systems in place for all providers, including the independent sector, in relation to safeguarding PCT‟s ensure that GP practices and staff have robust systems in place to ensure they can fulfil their role in safeguarding children 15
10.2 Key Achievements of 2010
A Best Practice Framework for information sharing with General Practice has now been developed and is currently in use. The development and use of a child protection communication template has been helpful as a means of both structuring collaborative work, particularly with GPs, and regularly reviewing aspects of safeguarding children work. Whilst this work is still being developed, early data suggests that health practitioners and GPs are beginning to communicate more effectively. GP practices also now have an identified Health Visitor/School Nurse Link and regular documented meetings are taking place to discuss vulnerable families. Face to face training continues to be offered to all practices with uptake currently being at 60%. E-learning is also offered to all practices and safeguarding updates and briefings are provided to all practices via the twice yearly safeguarding newsletter. Significant work has taken place over 2010 with representatives from the LMC and GP colleagues to develop a “Safeguarding Pack” for all General Practices. This includes key safeguarding information, key contact numbers, training information, basic safeguarding standards and a safeguarding policy. This has now been agreed and circulated to all practices and meetings are currently underway to meet with GP safeguarding leads on an annual basis. All practices have now identified a safeguarding lead and have acknowledged receipt of the safeguarding pack. Work is currently underway to develop a similar pack for dental practices. All health agencies across Kirklees submitted their Section 11 Audit to Kirklees Safeguarding Children Board (KSCB). The Board has a responsibility to ensure that agencies that are represented on KSCB are safeguarding and promoting the welfare of children as outlined under Section 11 of the Children Act 2004. Agencies are required to complete a Section 11 Audit in order to establish whether they are achieving desired outcomes and meeting their statutory responsibilities. A Challenge Event subsequently added extra value to the process. The Section 11 Audits submitted by health agencies across Kirklees were well received and provided assurances that they were meeting their statutory responsibilities. Work has continued over the past year to develop SystmOne in relation to recording and sharing information and the named safeguarding leads have worked with colleagues in KCHS to develop a monthly report which provides details of the level of structured “Child in Need” work undertaken by health visitors and school nurses with children who have identified child protection vulnerabilities. These reports indicate that there is an increasing incidence of children being identified by health practitioners as having child protection vulnerabilities. Child protection supervision continues to be delivered and monitored across the workforce in line with the current supervision policy and CQINN REQUIREMENTS. An audit is planned for 2010/11. Work has been undertaken to develop basic safeguarding standards for inclusion in all contracts and service specifications. This is reflected in the Safeguarding Children and Adults Commissioning Policy which was ratified in 2010.
10.3 Kirklees Safeguarding Children Board (KSCB)
Kirklees Safeguarding Children Board has an Independent Chair and the work of the Board is managed by a dedicated manager. Assistant Director for Safeguarding Children and Vulnerable Adults continues to be the Vice Chair of the Board and works with partners to drive the agenda forward in line with local and national guidance. NHS Kirklees are well represented on Kirklees Safeguarding Children‟s Board (KSCB) by the Director of Patient Care and Professions, who has the responsibility for safeguarding, the Assistant Director for Safeguarding Children and Vulnerable Adults (whose role includes the Designated Nurse) and the Designated Doctor for Child Protection. Health is also represented at a strategic level on the KSCB by 2 Acute Hospital Trust‟s, the Mental Health Trust and Kirklees Community Healthcare Services. All health partners play an active role in the work of the KSCB and attendance is good. The various KSCB Workstreams are equally represented well by health and other partner agencies. These include; Development & Business Planning – responsible for monitoring the progress of KSCB Business Plan. Serious Case Review – responsible for fulfilling the statutory duty of the KSCB in respect of serious case reviews. This includes the commissioning of SCR‟s, monitoring the implementation of recommendations and ensuring that lessons are learned, understood and acted upon. Evaluation and Effectiveness – responsible for monitoring and challenging the effectiveness of arrangements within each of the partner agencies that have statutory responsibilities. Communications – responsible for raising awareness of safeguarding. Learning and Development – responsible for delivering the core objectives of the training strategy. Joint work has taken place over 2010 with KSAB to amalgamate some areas of work into a joint workstream, i.e. mental health, substance/alcohol misuse and domestic violence. Progress for 2010 includes; Strengthening of workstreams (chaired by Board Members) Successful delivery of training and review of KSAB training strategy Appointment of a Lay Member to the Board Establishment of child death review process KSCB - reviewing and refreshing of website Monitoring of S11 Audits and subsequent Challenge Event Development of formal links with the Children and Young People‟s Local Partnership Strategic Board 10.4 Current Picture In Kirklees
Children subject to a child protection plan as at 30/09/10: Period Kirklees Kirklees Rate per 10,000 National Rate per 10,000
30/09/08 216 23 27
31/03/09 229 25 27
30/09/09 273 29 27
30/9/10 241 26 31 17
Number of children subject to a child protection plan by category of abuse as at 30/09/10: Category of Registration
Sexual Abuse Physical Abuse Emotional Abuse Neglect Multiple
16 25 71 90 39
Locality of Children with a Child Protection Plan as at 30/09/10: Locality Batley, Birstall & Birkenshaw Denby Dale and Kirkburton Dewsbury &Mirfield Huddersfield North Huddersfield South Spen The Valleys Not obtainable Total
30/09/09 Number 53
30/9/10 Number 55
54 45 69 19 24 2 273
40 29 50 29 32 3 241
Duration of Children with a child Protection Plan as at 30/09/10: Duration 0-6 months 6-12 months 12-18 months 18-24 months 2-3 years 3 years + Total
30/09/09 Number 125 60 41 17 28 2 273
30/9/10 Number 103 72 35 17 14 0 241
Age Distribution of children with a child protection plan as at 30/09/10: Age Unborn Under 1 year 1-4 years 5-9 years 10-15 years Over 16yrs Total
30/09/09 Number 5 37 88 73 62 8 273
30/9/10 Number 0 24 79 66 64 8 241
Ethnicity of Children with a child protection plan as at 30/09/10: White Mixed Asian/Asian British Black/Black British Chinese other Total
30/09/09 197 34 21 5 0 16 273
30/9/10 164 17 25 7 0 28 241
10.5 Serious Case Reviews – Children
In 2010, one high profile Serious Case Review in Kirklees was completed and the Executive Summary was published. Recommendations and subsequent action plans have been monitored via the Safeguarding Committees across the Kirklees health economy and via KSCB and good progress has been made to embed learning in practice. Another Serious Case Review was commissioned by KSCB in the Spring of 2010 following the death of a young child. This serious case review is near conclusion. A new Serious Case Review was commissioned by KSCB in December 2010 following the death of a young child and work is currently underway in relation to this case. NHS Kirklees Safeguarding Committee continues to monitor the subsequent action plans and ensure that all recommendations are implemented. KSCB Serious Case Review Workstream, which is chaired by NHS Kirklees Assistant Director for Safeguarding, continues to monitor all agency action plans and report back to KSCB on a regular basis. Learning from these cases continues to be cascaded throughout the organisation and incorporated into ongoing training and supervision. Key themes from Serious Case Reviews reflect the local and national picture and include; Sharing of information between professionals, particularly GP’s / Health Visitors / School Nurses Mental health/substance misuse Neglect Domestic Abuse Communication issues Substantial work has already been undertaken in all these areas in order to strengthen and improve practice. NHS Kirklees will continue to work in collaboration with Kirklees Safeguarding Children’s Board and its partners, to ensure arrangements for safeguarding children are reviewed and are in line with legislation. Staff working in this area of work will be supported appropriately at this difficult time. It is anticipated that given the current climate in safeguarding, media attention will continue to increase. The NHS Kirklees Communications team are in close contact with the SHA and Local Authority Communications teams, in order to ensure coordinated responses where necessary.
Safeguarding Committees have now been established both within NHS Kirklees and within the provider organisations in order to strengthen the current safeguarding systems and processes. In doing so, it ensures that health organisations and their subsequent Boards are provided with assurances that they are fulfilling their statutory duties in relation to all their safeguarding activities. We must remember that the purpose of a serious case review is to learn lessons and not apportion blame. It is essential that all those involved in such cases are supported and that work is undertaken to learn lessons and improve practice. Any actions identified following a serious case review are closely monitored within the NHS Kirklees and by KSCB. There is a body of research that suggests Serious Case Reviews have not fostered the learning culture which supports improved practice. The first Government guidance back in 1974 was only 7 pages long, whereas the 2010 guidance is over 390 pages linked to 10 other pieces of supplementary guidance, plus other extensive links. This makes it very difficult for professionals working in such a climate. Child protection arouses strong protective feelings in most adults as is evidenced by the intensity of the public reaction when a child dies. However, people also react strongly when they see families being broken up by what they see as overzealous professionals. The media carry 2 perennial forms of stories. Cases where dangers have been over estimated or cases that have been under estimated. Professionals are often therefore left in a “no win” situation. The public learn of cases when a child dies or is seriously harmed and with the benefit of hindsight make judgements on how easy it was to see the dangers. However, this is not the way issues look for the professionals who only have foresight. Professor Munro, who has been tasked by the Government to review the current child protection system, is examining how local systems can be developed to build more reflective and adaptive learning organisations which instil a fair culture of transparency and accountability and how such an approach could improve practice. 10.6 Next Steps in relation to Local and National Issues
Kirklees Safeguarding Children Board and all agencies continue to consider how we locally might want to approach and satisfy ourselves about key issues emerging in the national debate. The Board will seek to anticipate some of the expectations from Government departments and Regulatory Bodies which may significantly impact on safeguarding services. At a time of rapid change both within health and social care; it will be essential that agencies continue to work in partnership to provide services for those who are most vulnerable. In June 2010, the Secretary of State for Education, asked Professor Eileen Munro to conduct an Independent Review of child protection in England. The final report is due in April 2011. Interim reports to date indicate that previous reforms have been designed by well informed and well intentioned people, but the problem has been that they have not led to the expected improvements in front line practice. There is also a substantial body of evidence that past reforms are creating new and unforeseen complications. A dominant theme is the criticism of current practice in the skew in priorities that has developed between the demands of the management and inspections processes and a professional‟s ability to exercise professional judgement and act in the best interest of the child. Professor Munro‟s report which is due to be published in April 2011 will give some clear direction about how safeguarding services will need to be developed in the future. The review of the statutory guidance that is likely to follow will hopefully give agencies some clear direction about how they move forward in this important area of work. 20
LOOKED AFTER CHILDREN
11.1 Background Information
As part of the drive to transform NHS community services, the LAC Nurses have now transferred to KCHS. However, the team continues to be based with LAC/Aftercare team within Kirklees Children and Young People Safeguarding and Specialist Service providing a service across Kirklees and neighbouring authorities Looked After Children are amongst the most socially excluded group in England and Wales, often having increased and unmet health needs. It is widely documented that this group have significant health inequalities and children leaving care often have poor health, education and social outcomes. The information relating to this group demonstrates that this is a dynamic and constantly changing population. Meaningful engagement in partnership working is crucial to meeting the health needs of looked after children, care leavers and children with a disability in care. The health advisors for Looked After Children are co-located with social care staff which has proven to be a good example of effective multi-agency working. The LAC nurses not only provides a service to children and young people but provide advice, support and training for a variety of staff groups and carers on a wide range of topics. 11.2 Overview of Service
The main aim is to ensure that statutory health assessment arm of the service is fully operational and effective. Performance Indicators are in place to monitor this, and a return is sent to Government Office each year for the period 1 October - 30 September. A mainstream approach to the health assessment of Looked after Children has been adopted in Kirklees which means that the LAC health assessment is undertaken by the named health visitor or school nurse. The LAC Health Team support this by providing training, support and supervision. This supports the development of good practice in the Kirklees Community Healthcare Services Supporting Families Teams (health visiting/school nursing teams) in meeting the health needs of looked after children and ensures mainstream health services are working towards reducing health inequality experienced by this vulnerable group. This mainstream approach to health assessment and health planning also reduces the risk of stigmatisation and institutionalisation and enables and empowers children and young people to access mainstream/universal health services. Looked after Children who do not fall into the remit of the Kirklees Community Healthcare Services Supporting Families Teams (health visiting/school nursing teams) or who are deemed more at risk of not reaching their health potential are directly supported by the LAC health team. This includes all young people leaving care and all young people living in residential units. The LAC health team work closely with social workers, foster carers and residential carers and contribution to fostering and adoption panel work. The current number of Looked After Children in Kirklees In October 2010 was 566. There is a clear and consistent upward trend in the numbers of Looked After Children in Kirklees and this reflects the regional and national picture; 21
October 2007 435
October 2008 483
October 2009 535
October 2010 566
All children new into care are required to have a statutory health assessment within 28 days of admission to care, with review health assessments every 6 months under the age of 5 yrs, and annually for children 5 yrs and over. A separate and more detailed Looked After child Annual Report was presented to the Board in Oct/Nov 2010. 12.
YOUTH OFFENDING TEAM
12.1 Background information
As part of the drive to transform NHS community services, the YOT Nurses have now transferred to KCHS. However, the YOT Nurses remain co-located with the multi-agency Youth Offending Team, which is based on two sites, Huddersfield & Dewsbury, serving two distinct communities, two youth courts & two police divisions Dewsbury/Batley & Huddersfield. The Youth Offending Team is a multi-agency partnership formed by; Childrens social care Probation Police Housing Careers Health Collectively they provide a service to the courts and young people aged 10 -18 yrs who come into contact with the youth justice system, currently 494 young people across Kirklees. Most of the young people who present through the YOT are facing more than one challenging issue in their life. This is often mirrored in their health, with them presenting with multiple health issues. Research shows that; 17% of male offenders have suffered abuse 49% of female offenders have admitted to suffering abuse 39% of young offenders in prison had long standing disability/illness 60% of remanded male youths and 30% sentenced youths have a diagnosed mental disorder The YOTâ€&#x;s prime focus is to help safeguard the young people and families that they work with and there is an ethos of collaboration to achieve the best possible outcome for the young people and families who find themselves within the youth justice system. Strong partnerships exist between health and those working within the youth justice system and the Assistant Director for Safeguarding Children and Vulnerable Adults who represents NHS Kirklees on the YOT Management Board.
12.2 Overview of Health Advisors Role in the Youth Offending Team
Both teams have staff from Children & Young Peoples Service, police, education, health, drugs, victim liaison, housing, parenting & careers. In addition a Learning Disability Nurse works across both sites. Intensive Supervision & Surveillance & Resettlement & Prevention Teams are organised within each team. The Health Advisors role is to work within the multi-agency team and with outside agencies, to maximise awareness of and address health issues which affect young people, in particular those involved with offending. The role also involves work with their families & carers, e.g. Looked After Childrenâ€&#x;s Service. The role also requires the worker to be a resource for colleagues, providing health advice & information. Collaborative partnership working is paramount to the role. Networks are extensive and too numerous to name, but include any physical or mental health agencies/practitioners in and out of area, voluntary/statutory agencies, education, youth offending secure estates throughout the country and local authority departments. The Health Advisors in the YOT, as well as contributing to the core ethos of the YOT preventing offending, take a lead on supporting the young people achieving positive health and longer term health outcomes. The delivery of intervention is negotiated locally depending on thresholds. 12.3 Inspection of Kirklees Youth Offending Team
The recent HMIP inspection of the Youth Offending Team has identified a number of areas of good practice and areas for further improvement. A team of five inspectors spent a week at the two different Youth Offending Team offices in October 2010. Headline results stated that work on risk of harm to others was satisfactory while both safeguarding work and work to reduce the likelihood of reoffending was good. The inspection looked in detail at over 60 cases of young people supervised by the YOT and received direct feedback from 70 young people who were under supervision and over 20 victims of crime. The report said that the vast majority of respondents felt positive about the service given to them and young people felt they were less likely to reoffend as a result of their involvement with the YOT. Although work to reduce the likelihood of reoffending was often done well, it was felt that more consistent attention needed to be paid to the assessment and management of vulnerability and risk of harm to others. In line with inspections at all the authorities in the region HMIP identified areas for improvement. These are now being addressed by an improvement plan, approved by the YOT Management Board and the Probation Inspectorate. The health component within the YOT is well established and is integral to improving outcomes for this vulnerable group.
PUPIL REFERRAL SERVICE
13.1 Background Information
As part of the drive to transform NHS community services, the Lead Nurse in the Pupil Referral Service has now transferred to KCHS. However, the post holder remains co-located with the Local Authority. The health advisor for the Pupil Referral Service works with young people aged 14 â€“ 16yrs with behavioural, emotional or social difficulties, who are outside mainstream education, have been excluded or who are at risk of being excluded from school. In the Kirklees area there are two pupil referral units, one based in Batley and one based in Huddersfield. Throughout Kirklees, young people can take up work based learning and in Huddersfield; the Ethos Pupil Referral Unit houses the Genesis team where pregnant schoolgirls or teenage mothers are welcomed if they do not wish to remain in mainstream education. The unit also houses the Phoenix Group for anxious young people who are not attending school for a variety of reasons such as bullying. 13.2 Overview of Service
The health advisor in this service undertakes one to one health assessment interviews with young people to ascertain their health needs. Working as part of a multi-agency team, the practitioner is able to advise on personal health, and social education. As a section of Children and Young People Service, the PRS believes that the best place for the majority of young people is in mainstream schools, however, there will be a small number of students for whom large comprehensive schools are not appropriate and it is for these students that the KS4 Alternative Provisions cater. This post is jointly funded by NHS Kirklees and Education. A wide variety of provision is offered to students who may require a therapeutic environment, academic emphasis or practical skills; with care taken on appropriate placements (it would be inappropriate to mix anxious non-attendees with serious offenders for example). Referrals to the PRS come from mainstream schools via a multi-disciplinary panel which is held once a month and students who are accepted will be solely on the roll of the PRS. The team comprises educational social workers, educational psychologists, specialist literacy and dyslexia teachers, behavioural support workers, and administrators. 13.3 The Role of the Health Advisor
The Health Advisor within the Pupil Referral Service provides a school nursing service to the students within the PRS (and their families where appropriate) to facilitate access to a broad range of health services. They provide effective leadership with regard to the health needs of the pupils and work closely and in partnership with other services and agencies.
13.4 Key Developments/Achievements
The many positive developments/achievements include; development of a new Drug and Alcohol policy for the PRS, involvement in 'Delay training', collaborate relationship building, development of new 'Open Door' sessions organising training sessions for PRS staff 14.
CHILD DEATH REVIEW PROCESS NHS Kirklees now has a well established Child Death Review Panel. From 1 April 2008 it became a statutory requirement that all child deaths (under 18 yrs) are reviewed. A joint panel represented by key personnel from Kirklees and Calderdale has been established to review all child deaths across Kirklees and Calderdale. Through a comprehensive and multi-disciplinary review of child deaths, the Calderdale and Kirklees Child Death Review Panel aims to better undertstand how and why children in those two areas die. The panel meets on a bi monthly basis and is well represented and attended by relevant agencies across Kirklees and Calderdale. . Over the past year the panel has met 6 times which is appropriate for the population covered. A total of 42 deaths of children were reported to Kirklees Child Death Review panel between April 2009 - March 2010. Of the reported 42 deaths, 20 of these have been considered by the panel and a conclusion reached in all 20 cases. The remaining 22 deaths continued to be considered as and when sufficient information is available. . Of these 22, 7 are awaiting inquests, 1 is waiting a prosecution and 12 did not have information available to be reviewed. Over 60% of the deaths reported to the child death review team were infants. Kirklees has one of the highest infant mortality rates in Yorkshire and Humber. The role of chromosomal, genetic and congenital anomalies in this is likely to be one of the significant factors that should be considered. A more detailed annual report was published in 2010.
WORK TO DATE & KEY ACHIEVEMENTS IN RELATION TO SAFEGUARDING Ongoing review of all internal policies, procedures and guidance relating to safeguarding children, young people and vulnerable adults have been reviewed in order to reflect Local and National guidance . Senior management commitment to the importance of safeguarding and promoting the welfare of children has been strengthened, with clear structures and lines of accountability identified. All service development incorporates the duty to safeguard children and vulnerable adults. The safeguarding policies have been reviewed and developed further alongside a clearly defined child protection supervision policy and professional practice guidance has been produced for all staff working within the PCT. Safe recruitment processes are in place and the PCT is committed to inter-agency working and collaboration in order to ensure safeguarding children and vulnerable adults is high on the agenda. 25
The Local Public Service Boards in Kirklees believe that the mark of a fair and healthy society is how it supports its most vulnerable and disadvantaged members. The PCT‟s clearly defined role in relation to safeguarding children and young people 16.
OTHER DEVELOPMENTS & ACHIEVEMENTS INCLUDES; Development of PCT intranet site Development of Community Child Protection Locality Links Model New West Yorkshire Safeguarding Children Procedures (web based) E-Learning training Ongoing work with GP practices to strengthen links with HV‟s and SN‟s Development of shared electronic templates and read codes in order to strengthen information sharing Strengthened links with Yorkshire and Humber SHA Work with Lifeline to support them in their safeguarding responsibilities Most staff within the Safeguarding Team have undertaken, or are in process of undertaking, post graduate studies in Child Protection/Child Welfare. National publication of Named Nurse work relating to „risk‟ in child protection work Development and publication of twice yearly safeguarding newsletter Establishment of links with Family Nurse Partnership Appointment of Named Doctor for Child Protection – 1 session per week.
ASSURANCES The Assistant Director for Safeguarding children and vulnerable adults meets with Named and Designated Professionals across the Kirklees Health Economy to discuss safeguarding issues which may influence practice and service delivery. Supervision contracts are in place and all meetings are well documented. The safeguarding committees across the Health Economy provide a vehicle for monitoring safeguarding activity and the quality of safeguarding practice across Kirklees. Assurances are then provided to the Governance committee via quarterly reports. The Quality Boards also consider any issues which are raised.
CURRENT RISKS The current climate both at a local and national level has put all safeguarding services under immense scrutiny. Liberating the NHS and changes within health and social care put immense pressure on all staff providing services, and even more so on those working within safeguarding. Whilst statutory guidance in relation to safeguarding is currently under review, the future safeguarding services across all organisations remains unclear. Whilst services strive to improve quality and patient safety, the adverse affect maybe difficulties in recruiting to safeguarding posts in the future. The significant risks to those who are most vulnerable and at risk of harm, continues to be a worry in this current climate of major change, and the impact on the organisations responsible for providing services and professionals undertaking such roles needs to be acknowledged.
KEY TASKS FOR FUTURE SERVICE DEVELOPMENT Ongoing work for 2011 will include; Reviewing current structures and considering new ways of working, ensuring a consistent approach across the PCT until it‟s abolishment in 2013. Ensuring forthcoming statutory guidance is taken into account and reflected in service development. Engaging with GP consortia in discussion and planning around the commissioning responsibilities for safeguarding up to and post 2013, to ensure they are fully prepared to take forward their safeguarding agenda. Working with Executive Director Leads to ensure safeguarding is integral to the clustering arrangements. Review of safeguarding policies and procedures to ensure they reflect current local and national policy directives Ensuring clear links with the Vulnerable Adults agenda/Domestic Violence agenda Developing action plans in order to fulfil recommendations from the SCR and ensure all actions are implemented and embedded in practice. Improve engagement with all independent contractors Work with KCHS and other acute providers to ensure statutory compliance with safeguarding responsibilities Monitor statistical information relating to families of concern Strengthening of all service specification to ensure safeguarding responsibilities reflected
CONCLUSION Child / Adult protection work involves working with uncertainty – we cannot be sure what is going on in families – we cannot be sure that improvements in family circumstances will last. Many problems in current practice stem from defensive ways in which professionals are expected to manage that uncertainty. For some, following rules and being compliant can feel less risky than carrying the personal responsibility for exercising judgement. The problem is that evidence of abuse is not clearly labelled. Getting the balance right between having clear policies, but at the same time allowing professionals to make judgements is key if we are to change front line practice and having a competent workforce that is well trained and supported is essential if we are to make a difference and make this happen. Safeguarding children, young people and vulnerable adults is everyone‟s responsibility and work must continue and remain a priority to ensure that a first class service that is fit for purpose is delivered. The Safeguarding Team will continue to work with all partners both locally and regionally in order to drive safeguarding services forward. Safeguarding remains high on the agenda both at a local and national level and I look forward to taking the safeguarding agenda forward in the future.
RECOMMENDATIONS It is recommended that the Committee note the 2010/11 Safeguarding Annual Report.
Karen Hemsworth Assistant Director for Safeguarding Children & Vulnerable Adults MA Child Protection, BSc Hons HV, RSCN, RM, RGN