Agenda item

Purpose of the item: To provide an update on adult social care performance for safeguarding adults.

Witnesses:

Sinead Mooney, Cabinet Member for Adult Social Care

Luke Addams, Interim Director, Practice, Assurance, and Safeguarding

George Kouridis, Head Of Safeguarding

Children, Families, Lifelong Learning and Culture Select Committee Members:

Fiona Davidson, Chairman of CFLLC

Key points raised during the discussion:

1. The Interim Director for Practice, Assurance and Safeguarding introduced the report.

2. The Chairman of AHSC asked what improvements were implemented to the Improvement Plan since Healthwatch Surrey’s reports, and how coordinated working amongst Integrated Care Boards (ICB) and Integrated Care Services (ICS) had improved the experience for families and carers. The Chairman also asked where the adult safeguarding team felt there were still issues. The Head of Safeguarding explained there was a series of individual cases highlighted in the Healthwatch reports that were noted by the adult safeguarding team. The main improvements were driven through the Safeguarding Improvement Plan. There was an existing Improvement Plan set up, in relation to preparations for CQC assessments, which was being updated for completion. A range of areas were being looked at such as how the volume of safeguarding enquiries was managed and the different trends across a range of areas.

3. The Cabinet Member for Adult Social Care added that there was commitment within Adult Social Care to improve safeguarding practice, which was highlighted in the report, along with a focus on improving communication across agencies. Since the Healthwatch report was published, the Cabinet Member met with the Chief Executive of Healthwatch Surrey to discuss the report and understand how adult social care and Healthwatch Surrey could improve communications and outcomes for vulnerable residents.

4. The Interim Director for Practice, Assurance, and Safeguarding explained that the senior director team met with Healthwatch Surrey. Data and case tracking audits were used to ensure understanding of the experiences in the Healthwatch report. At the Safeguarding Adults Board (SAB), system partners and health partners were worked with closely. The Executive Director of Adults Wellbeing and Health Partnerships met regularly with the Chief Nurse of Surrey Heartlands Health and Care Partnership. In terms of remaining safeguarding issues that needed addressing, there had been a risk-averse culture which led to significant volumes of safeguarding referrals. The Adult Safeguarding team wanted to shift to positive risk management, rather than risk averse. There was a risk enablement board to promote this proactive and positive approach to risk management within the Council’s Adult Safeguarding framework. The primary goal was to facilitate a practice culture shift toward risk enablement that focussed on wellbeing, managing risk effectively, and reducing unnecessary section 42 enquiries.

5. The Chairman of CFLLC asked how poor communication was measured and improved amongst carers, NHS England, other organisations such social workers and between different family members that were often contacted at different times. The CFLLC Chairman also asked if there was a complaints process. The Interim Director for Practice, Assurance, and Safeguarding explained that the safeguarding team tried to engage more with users of the safeguarding service. There was a user survey, take-up of which had traditionally been low. The Adult Safeguarding team tried to make people and carers aware that there was a complaints process and encourage take-up of the survey.  As part of the new practice assurance board, feedback received was taken forward as lessons learned. Complaints received through the Council’s complaints process were measured. This was a single tier, statutory process. The nature of complaints were defined and analysed through the data recording process. The number of complaints received about specific issues could be understood, and the team tried to make best use of this communication to drive service improvements. Staff were reminded of the importance of consistent good communication, such as explaining eligibility and social care processes from the outset. Training on complaints for staff was provided by the complaints department. Complaints also included Ombudsman investigations which were reported to the Council’s Corporate Leadership Team and the Directorate Leadership Team. Under the new governance arrangements, lessons learned were taken from complaints to disseminate them across the County.

6. Regarding the SAB, the Chairman of AHSC raised that in a multi-agency approach, gaps and problems in communication sometimes occurred. The Chairman asked what improvement efforts were being taken to ensure this was not the case. The Interim Director for Practice, Assurance, and Safeguarding explained that Surrey’s SAB endorsed several principles which underpinned the adult safeguarding approach. No single agency could create an effective safeguarding system by itself, and only a joined-up approach at a strategic level could deliver a better response. To test the effectiveness of strategic arrangements the adult safeguarding team always asked how the partnership made a positive difference to the lives and experience of local people. Local arrangements showed that ambitious, joined-up strategic partnerships had clear sight on lines of practice and on the experiences of local individuals. This is what all the partners involved in the SAB focussed on. Ambitions had been progressing to improve county-wide links and working, to improve the ability to understand communities across Surrey and strengthening the voice of people with lived experience. In early 2024, the SAB established a new communications network that had a broad membership from all sectors to inform and extend methods of raising awareness of all adult safeguarding issues. Main SAB meetings encouraged inclusive membership and were used to share learning, insights, local, regional and national practices and research, as well as Safeguarding Adult Reviews (SARs). The Independent Chair of the SAB was leading a review of the Adult Safeguarding team’s approach to quality assurance and was working with the SABs quality and performance Sub-group. In the SAB, the team aimed to develop a new quality assurance framework, with a focus of a multi-agency approach to assurance. The Adult Safeguarding team asked partners a range of questions to fill any gaps such as where abuse took place, what the biggest risks were, and whether the views of local people were listened to.

Riasat Khan left at 2.25pm

7. With reference to those living in poverty, the Chairman of AHSC asked how the Improvement Plan and integrated collaboration with ICBs and the community helped improve safeguarding amongst vulnerable adults in Surrey’s priority neighbourhoods, and where the biggest improvements were needed. The Interim Director for Practice, Assurance, and Safeguarding explained there was a link between impoverished neighbourhoods and safeguarding. Priority neighbourhoods were set out in the Health and Wellbeing Strategy that were being used to target specific resources to prevent safeguarding issued. Prevention was a focus of the SAB and partnership work. Resources included, for example, local area coordinators to understand the need experienced by the neighbourhoods and enable better service access.

8. The Vice-Chairman of AHSC asked what improvements were being made to address difficulties in accessing professional help, and what improvements were being made to help people access the right support to reduce risk and promote wellbeing. The Vice-Chairman also asked what improvements to staff training and management had been implemented, and if any safeguarding protocols were implemented for clients and volunteers. The Interim Director for Practice, Assurance, and Safeguarding explained that improvements were being made to address the difficulties in accessing professional help. The Council’s triaging process had been improved, with a single point of access approach being adopted, so people could be connected to the most appropriate service. The Interim director outlined Council initiatives such as the fuel poverty and energy efficiency network, warm welcome venues, and Community Link Officers that linked people to services needed. Work was also done with partners to make physical activities more accessible, and to connect people with safeguarding prevention programmes. There was an academy and dedicated sites within the Council which listed safeguarding training competences. The adult safeguarding team linked with the SAB competences framework to enable staff to identify specific training for each role and develop awareness. This was being audited as part of the safeguarding improvement plan, to ensure staff receive the right training. The Adult Safeguarding team were establishing no response guidance and agreed to the new process for handling low-level provider concerns.

9. A Member asked how the Adult Safeguarding team could assure the committee that there were better systems for reporting and recording safeguarding concerns and that issues would not be neglected. The Interim Director for Practice, Assurance, and Safeguarding explained that the team took every safeguarding concern seriously. Professional curiosity training was offered within the Council, and this training would be refreshed. Within Adult social care professional curiosity was about exploring issues until the team was satisfied about the concern.

10. The Member asked if there were unannounced visits to care homes. The Interim Director for Practice, Assurance, and Safeguarding confirmed there was and explained it was part of the quality assurance process within commissioning. When monitoring visits were undertaken residents were actively spoken to and evidence of how residents were treated was reviewed. Each care home had whistleblowing policies, as well as the Care Quality Commission (CQC), which carers of family members were made aware of.

11. The Cabinet Member for Adult Social Care added that the SAB had a good and easy to navigate website. Regular meetings with providers occurred and there was also a provider forum where concerns and issues could be raised. Safeguarding was regularly on the agenda to discuss. There was co-production and discussions with stakeholders, providers and residents. The routes to raise safeguarding concerns were clear, but more could be done to raise awareness.

12. The Chairman of CFLLC asked how confident the adult safeguarding team felt that there were good whistleblowing policies in place and to what extent whistleblowing was followed through. The Chairman of CFLLC referred to Winterbourne View and the concern around this and similar experiences. The Interim Director for Practice, Assurance, and Safeguarding explained that all providers were required to have whistleblowing policies in place and publicise them. CQC inspections had tightened this up since Winterbourne View and was something the CQC looked for, as well as the Council’s commissioners and quality assurance team. Whistleblowing policies worked in Surrey and were effective. Future reports could provide reassurance to the committee by including references of whistleblowing. The Cabinet Member for Adult Social Care suggested that the importance of whistleblowing should be reflected on the Adult Safeguarding website. The Interim Director for Practice, Assurance, and Safeguarding agreed.

13. The Chairman of AHSC asked how the Adult Safeguarding team was tackling issues around modern slavery and the vetting of organisations. The Interim Director for Practice, Assurance, and Safeguarding explained this needed to be taken away to consider and discuss with commissioning colleagues how providers were contracted to ensure issues of modern slavery was considered carefully.

14. In relation to Making Safeguarding Personal, a Member asked how support for carers could be ensured. The Head of Safeguarding explained that carers assessments were offered to unpaid carers to understand the carer’s position. The adult social care role was to ensure there were right tools, skills and experience in place to find issues at an early stage, preventing escalation. The carers assessment process would be reviewed to support carers and intervene at the right time. The Risk Enablement Board looked at how situations were risk assessed in a more positive way and at the right time.

15. The Cabinet Member for Adult Social Care explained that the importance of unpaid carers could not be underestimated. Some providers commissioned by the Council provided carers with respite. Support for carers was being looked at for opportunities to do more and may become part of the adult social care transformation plans over the next four to five years.

16. The Member asked how unpaid carers were specifically being supported in relation to safeguarding. The Head of Safeguarding explained that the main platform for supporting carers was the carer assessment process where the circumstances of the carer were identified. Timeliness was a key part in the carer assessment process, as carers tended to enter the process at a later point.  At times people did not recognise themselves as a carer. It needed to be ensured staff recognised this and offered carer assessments when, for example, other people were referred to the service.

17. The Chairman of CFLLC asked how the Adults, Wellbeing and Health Partnership’s Improvement Plan was delivering improvements for safeguarding the most vulnerable adults, particularly those with communication difficulties who may not be able to alert others. The Head of Safeguarding explained that situations involving people with communication challenges would be treated individually. There were other risks for people with sensory challenges, which would involve ensuring that the workforce was appropriately skilled to understand the situations and keeping the individual at the centre of the safeguarding process was important. If an individual presented issues with their mental capacity the involvement of an independent advocate through a Section 42 enquiry would be considered. Necessary adjustments would be required and ensuring the workforce picked up on issues at the right time.

18. The Chairman of AHSC asked when the July 2023 audit report recommendation for the safeguarding workforce to undergo training in risk assessments, re-launch the risk assessment form and guidance, and improve management oversight and responsibility was expected and how it would improve processes. The Interim Director for Practice, Assurance, and Safeguarding explained that the recommendation was included as part of the safeguarding team’s overall audit training offer. Each locality had its own safeguarding advisor that regularly delivered training, which was being reviewed by the Head of Safeguarding. This training was being standardised to ensure consistency and that it included appropriate risk assessment and risk management. This would be concluded within the next month, and the safeguarding training audit would be completed in the next few months.

19. The Vice-Chaiman of AHSC asked how the Safeguarding Improvement Group would oversee and drive continuous improvement in safeguarding practice and how the safeguarding team would work collaboratively to achieve improvements.  The Head of Safeguarding explained that the Safeguarding Improvement Group started developing a safeguarding improvement plan which would be reviewed on an annual basis. The plan was informed by the current areas of focus that needed to be worked on moving forward. The plan was built on what was done in preparations for the CQC assessment. Now that the self-assessment was completed, the plan was intended to be expanded further. The plan was also informed by the data from the overall performance around safeguarding. The learning from SARs would also be reviewed through the Safeguarding Improvement Group. Close work with the academy to ensure the workforce had the right skills, knowledge and tools would be undertaken.

20. The Vice-Chairman of AHSC asked how collaborative work would be undertaken to ensure communication was responded to and that the timeliness of referrals would be ensured whilst the improvement work was under review. The Vice-Chairman also asked who would monitor the process improvements. The Head of Safeguarding explained that he had oversight from the multi-agency safeguarding hub, where all safeguarding referrals went. The Head of Safeguarding had regular meetings with the performance team on how the team did against key performance indicators. The Head of Safeguarding’s role was to work closely with the performance team and with the Multi-Agency Safeguarding Hub team to focus on identified areas that had blockages, to create a flow in the safeguarding system, to ensure timely responses to concerns. Whilst there was a range of monitoring and oversight, the Safeguarding team intended to enhance data further to allow for a more robust reporting framework. This work was expected to be completed soon. The Interim Director for Practice, Assurance, and Safeguarding added that the responsiveness to Section 42 enquiries and concerns had not always been as robust as desired. The Interim Director believed every enquiry was entitled to an acknowledgement. This was an area of improvement for the safeguarding team and steps were already taken to improve this.

Actions:

1. Safeguarding team to reflect on the importance of whistleblowing (particularly on the safety aspect, such as around confidentiality) on the adult safeguarding website.

2. Regarding modern slavery, the Director of Practice, Assurance and Safeguarding to discuss with commissioners, the vetting of organisations, raising awareness and provide a written update to the committee.

Resolved:

The Adults and Health Select Committee recommended that the Adult Safeguarding team:

1. Provide an update from the new Safeguarding Panel on progress on the questions raised, particularly around communication and working in partnership, ensuring that people don’t fall through the gaps.

2. Provide a measurement of feedback from staff, patients and from other services, so we can see what improvements have been made, and as a result can show how we deliver a safer environment.

3. Provide an analysis of how effective your measurement service is so we can be reassured on how effective the service is running, and that activities are resting in more resolve.

4. To examine best practise on whistleblowing, and to make every effort to provide a process that protects the individuals who are using the process, and that it is effective.

5. Continue improving the measurement of safety, and demonstrate that the service as a whole is actively eliminating problems.