milton keynes safeguarding board annual report...milton keynes, promote their welfare, enhance their...
TRANSCRIPT
2018/19
Milton Keynes Safeguarding Board Annual Report
1
Chair’s Foreword 2
Introduction 3
Introduction to Milton Keynes 5-8 Safeguarding Board
Safeguarding in numbers 9
Our priority areas 10-21
- Neglect 10-13 - Missing 13-15 - Early Help/Early Intervention 15-17 - Emerging Areas of Vulnerability 18-20 - Reviews 20-21
Other MKSB activity of note 22-23
Conclusion 23
Appendix A - Agency representation 24 at 2018-2019 meetings
Appendix B – Contributions and summary 25 of 2018/19 end of year budget position
Appendix C - Glossary of terms 26
Worried about a child?
If you are concerned a child or a young person is at immediate risk of harm please call Thames Valley Police on 999. If you require advice from Thames Valley
Police, or to report a crime, please dial 101.
If the child you are concerned about is not in immediate danger you should report your concern by completing a
Multi-Agency Referral Form.
Worried about an adult?
If you have a concern about an adult at risk of abuse and they are in immediate danger you should contact the relevant emergency services by ringing 999.
If the adult you are concerned about is not in immediate danger you should report your concern by completing an Adult Safeguarding Alert. If you know or believe a crime has been committed you should also contact the Police. If you are not sure whether abuse is happening you can telephone the Access to Adult Health and Social Care
Team to discuss your concerns.
Contents
Contacts
Multi-Agency Safeguarding Hub
(MASH)
Monday to Thursday from 9am
to 5pm & Friday 9am to 4:30pm
T: 01908 253 169 | 253 170
In an emergency, outside of these
hours T: 01908 265 545
Contacts
Safeguarding Adults
Monday to Thursday from 8:30am
to 5pm T: 01908 253 772
In an emergency, outside of these
hours (incl Bank Holidays)
T: 01908 725 005
2
Chair’s Foreword As the chair of the Milton Keynes Safeguarding Board, I am very pleased to present
the 2018/19 Annual Report on our work. It has been a very positive year, one of
innovation and consolidation and one which has delivered concrete change and
improvement for adults, children and their families in Milton Keynes.
Whilst the new arrangements took some time to settle in, the outcomes have been a
far stronger strategic leadership arrangement, with common shared strategic goals
and priorities for all the partner agencies. In addition, there has been an improved
focus on key areas of activity, greater understanding of the effectiveness of practice
and stronger review and learning arrangements. It also improved the amount of time
senior leaders and middle managers were able to focus on action rather than talking
about action, whilst frontline staff were able to get on with delivering services
informed by learning from review and audit activity that helped improve practice.
It was not without its challenges of course. We continued to find it a challenge to
engage with adults and children in meaningful and appropriate ways, where their
voice had a bearing on our work. We also found it harder than anticipated to navigate
our way through changing training and learning expectations and workforce standards
and requirements. That said, these challenges have really influenced our thinking
about the next steps in our partnership arrangements, as did the growing realisation
that there was still significant duplication in areas of work between the Community
Safety Partnership and the Safeguarding Board. 2018/19 was a year in which we built
on our strengths and learnt from our developments and is a great foundation on which
to build the new arrangements.
I am grateful to every single individual across the partnership who has worked so
hard, not always in easy circumstances, to do their best to support the citizens of
Milton Keynes, promote their welfare, enhance their health and wellbeing, and
protect them from harm, neglect and abuse. They are rarely recognised and this
report shows just how hard they work. I am also proud of the leadership shown by
Chief Officers and Senior Leaders and their commitment to getting it right.
Jane Held
MKSB Independent
Chair
3
Introduction Local Safeguarding Adult and Children Boards are required (under the Care Act 2014 and Section 14A of the Children Act 2004) to publish an annual report on the effectiveness of safeguarding and promotion of the welfare of children and adults at risk of abuse and neglect and identify areas for improvement. This report constitutes an assessment of our performance and effectiveness as partners in safeguarding children and adults in Milton Keynes over the year 2018/2019.
Agencies contributing to this report:
Milton Keynes Council (MKC)
Milton Keynes Clinical Commissioning Group (MKCCG)
Thames Valley Police Milton Keynes (TVP)
Milton Keynes University Hospital NHS Foundation Trust (MKUHFT)
Central and North West London NHS Trust (CNWL)
Thames Valley Community Rehabilitation Company (TVCRC)
National Probation Service
Oakhill Secure Training Centre
South Central Ambulance Service NHS Foundation Trust (SCAS)
The legal framework Safeguarding adults Safeguarding duties apply to an adult who:
Has care and support needs (whether or not the local authority is meeting any of those needs)
Is experiencing, or at risk of experiencing abuse or neglect
As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect
The aims of adult safeguarding are to:
Prevent harm and reduce the risk of abuse or neglect to adults with care and
support needs.
Stop abuse or neglect wherever possible.
Safeguard adults in a way that supports them in making choices and having control about how they want to live their lives.
Promote an approach that concentrates on improving life for the adults concerned.
Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect.
What is Safeguarding? Safeguarding means protecting people’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent both the risks and experience of abuse or neglect, while at the same time making sure that the individual’s wellbeing is promoted.
4
Provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult.
Address what has caused the abuse or neglect. Six key principles underpin all adult safeguarding work:
Empowerment – people being supported and encouraged to make their own
decisions and give informed consent.
Prevention – it is better to take action before harm occurs.
Proportionality – the least intrusive response appropriate to the risk presented.
Protection – support and representation for those in greatest need.
Partnership – local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
Accountability – accountability and transparency in delivering safeguarding.
Safeguarding children
Safeguarding and promoting the welfare of children is defined as:
Protecting children from maltreatment.
Preventing impairment of children’s health or development.
Ensuring that children grow up in circumstances consistent with the provision of safe and effective care.
Taking action to enable all children to have the best outcomes.
Key principles for effective safeguarding of children:
Safeguarding is everyone’s responsibility – For services to be effective each professional and organisation should play their full part. A child-centred approach – For services to be effective they should be based on a clear understanding of the needs and views of children.
5
Introduction to Milton Keynes Safeguarding Board
The Milton Keynes Safeguarding Board (MKSB) was a multi-agency statutory body fulfilling the objectives, functions and responsibilities set out for adults and children safeguarding boards in the Care Act 2014, the Children Act 2004, Working Together 2015 and Working Together 2018. New arrangements are now being embedded in Milton Keynes. These were published on 29 June 2019. More information about our new arrangements can be found on page 5 of this report. MKSB was made up of MKCCG, TVP and MKC, plus Milton Keynes University Hospital Foundation Trust (MKUHFT) and Central and North West London NHS Trust (CNWL). Membership of MKSB Programme Boards and Groups included key strategic partners such as the National Probation Service, Thames Valley CRC, Bucks Fire and Rescue, and educational settings.
MKSB was responsible for supporting the coordination of multi-agency arrangements to protect and safeguard children and adults in Milton Keynes and for monitoring their effectiveness at a multi-agency strategic level to gain assurance that:
Local safeguarding arrangements were in place as defined by the Children Act 2004 and the Care Act 2014 and all relevant statutory guidance.
Safeguarding practice was person-centred and outcome-focused.
Safeguarding practice was continuously improving and enhancing the quality of life of children and adults in its area.
MKSB’s strategic goal: high support and high challenge – to provide a safeguarding
lens on the system. High support is achieved through:
Engaging with people
Support with coordination
Resolving and unblocking problems
Learning from good and poor practice
High challenge is achieved through:
Assurance
Scrutiny
Diagnosis
Holding to account
Identifying gaps and blockages
Reviewing practice
6
MKSB met bi-monthly and was supported by dedicated Children and Adult Programme Boards, responsible for the statutory functions specific to children and adults safeguarding. The Child Death Overview Panel, which met quarterly reported into the Children’s Programme Board. In addition, the board had three groups covering both adults and children:
Case Review Management Group (CRMG)
Performance, Quality and Improvement (PQI)
Workforce Development and Standards (WDS) During the summer of 2018 we merged the Children and Adults Case Review panels into a joint Case Review Management Group and introduced the Local Case Review Panel to oversee Rapid Reviews in response to the changes in Working Together to Safeguard Children 2018. (For more information see Reviews section in this report)
The MK Together Partnership is the umbrella under which the MKSB operated. This set of partnership arrangements was designed to bring together the core ‘people partnerships’ to work as effectively and efficiently as possible. This was the first full year of the MK Together Partnership with the new MK Together team in place. MK Together continues to be characterised by:
Simple partnership arrangements that are easily understood
Flexible arrangements that can adapt to future needs, changes to legislation or emerging local issues
Streamlined and well-co-ordinated planning and action
Joined up, system-wide partnerships and cross partnership working
A single support team able to work across partnerships and multiple issues relieving pressure on limited resources
We have spent much of the year further developing the MK Together Partnership into innovative system wide partnerships which will deliver our multi-agency safeguarding arrangements from September 2019.
7
Our new Milton Keynes multi-agency partnership arrangements, which were informed by extensive consultation with partners, have been published on our website www.mkscb.org
MKSB Business Priorities
What we have done this year What we will do 2019/2020
Holding to account The Performance, Quality and Improvement (PQI) Group met bi-monthly to monitor performance against multi-agency plans. We trialled a Peer Challenge Section 11 event, as part of multi-agency assurance work. As a result of this members of the PQI Group approved a proposal to continue this approach to seeking assurance in relation to the Section 11 audit. The PQI group has reviewed a range of partnership data including the number of CSE toolkits completed by partners and sent to the CSE Coordinator in Children’s Social Care.
We will: Implement a new Assurance Board. The Assurance Board will monitor performance against partnership plans and organise thematic reviews, audits and data analysis as appropriate. This Board will be responsible for providing oversight of the statutory safeguarding assurance duties. Embed the new Exploitation, Transitions, and Early Help strategies and monitor their impact. Facilitate the first full Section 11 Appreciative Enquiry Session.
Engaging We have been out and about in Milton Keynes talking to residents, businesses and our partners about Gangs and Self-neglect and Hoarding. We have started consultation with young people about their experiences of the transition to adult services in order to help shape the Milton Keynes Transitions Policy. Explored ways of feeding in the views of local people into our safeguarding arrangements
We will: Effectively implement a new Voice Board. This Board will ensure the voice of local people is fed into our partnership work and that feedback is provided to stakeholders, service users and the public. The Voice Board will work closely with Healthwatch and other existing groups and will coordinate multi-agency public consultation. Launch the multi-agency Transitions Strategy that will include the views and ideas of the young people who supported its design.
8
Challenging and Changing We have supported Oakhill Secure Training Centre in their improvement of safeguarding practice via the annual Restraint Review. We have completed two local learning reviews and implemented action plans to improve multi-agency working for vulnerable adults.
We will: Implement a new Review Board. The Review Board will manage local and statutory case and practice reviews, ensuring they are appropriately commissioned, meet quality expectations, and are delivered in a timely fashion. Ensure that actions are taken forward and learning shared through the Assurance Board.
Complete and publish a thematic review into self-neglect. Publish a Safeguarding Adult Review on homelessness and implement the action plan.
9
Safeguarding in Numbers: The estimated population of Milton Keynes based on 2015 data (mkinsight.org/mk-basics) is 261,750. Of those that live in Milton Keynes 26% are from an ethnic minority background and 23% are aged under 16. Child protection
Vulnerable adults in Milton Keynes
10
Our priority areas
Neglect We had noticed an increase in referrals with a theme of self-neglect and hoarding, suggesting that this is an emerging area of concern. Local learning reviews indicated that agencies had operated in silos with adults who declined support, and often had nowhere to escalate the risk the individuals posed; mostly to themselves. A newly introduced CR-MARAC (Community Resolution Multi-Agency Risk Assessment Conference) which focused on anti-social behaviour, was reviewing many cases where adults with care and support needs were not engaging with services. The PQI Group conducted a Rapid Review into self-neglect and hoarding, engaging with the public to ascertain the levels of awareness on the issue. Colleagues from MKC, Bucks Fire and Rescue and MKCCG spent the day talking to residents of Bletchley and Wolverton about the Clutter Index (hoarding) and inviting them to spin our wheel of ‘self-neglect or self-care’. We engaged with a number of GPs and other health care professionals from across Milton Keynes to raise the issue of self-neglect and hoarding so that community health care professionals could recognise signs in their patient group and access the appropriate support. What did we learn?
The rapid review demonstrated a reasonable level of awareness within the community and health care professionals.
We do not have robust data on the prevalence of self-neglect and hoarding, however some multi-agency problem-solving meetings to record hoarding and neglect do occur when necessary.
The work that has been done with care navigation should enable adult social care to support health colleagues to be more aware of the issues.
There was a lack of clarity on pathways for adults who hoard or self-neglect What did we do? We established a new Vulnerable Adults Risk Management (VARM) group to work alongside the CR-MARAC. This new multi-agency group provides a place where the cases of vulnerable adults who are not engaging with services are reviewed. This meeting is attended by statutory agencies as well as local housing and voluntary sector providers. The panel considers the best approach to managing the overall risk and the actions needed to safeguard those who need it.
11
We have agreed a new decision making framework for referrals to adult social care, which includes self-neglect and hoarding to support all agencies to refer accordingly and appropriately and access the right level of support for their service users. What will we continue to do?
We have started work on a new multi-agency guidance document on self-neglect, using recognised best practice from elsewhere in the country. This is being led by Bucks Fire and Rescue and MKC and will be published in 2019/20. In April 2019 we commissioned a thematic review into self-neglect and hoarding which will be completed in 2019/20. An external independent reviewer will not only look at the three cases included in the review but also the effectiveness of the work done so far. In our commitment to continued improvement we will take the learning from this review to further advance our approach to recognising and responding to adults who hoard and/or self-neglect. How did our partners contribute?
MKCCG and MKUHFT completed an audit on children’s neglect carried out by the Designated Doctors for Safeguarding. This highlighted that child protection medical assessments were only carried out on children with suspected physical abuse. Therefore new pathways are being developed in consultation with community paediatricians. The CCG also leads on a multi-agency self-care steering group which engages with the public to understand barriers to self-care and feed this into new initiatives such as 5 ways to wellbeing for mental health awareness day.
MKCCG planned a conference for June 2019 around complex safeguarding issues, including self-neglect and hoarding, in partnership with Bedfordshire CCG. This will be followed up with a neglect medical pathway workshop with key stakeholders to look at developing integrated neglect pathways for community based medical assessments.
TVP in Milton Keynes has continued to use the learning from Serious Case Reviews and Safeguarding Adult Reviews to inform training and working practices and continually develop and review operational guidance around areas such as ‘Adults at risk’ and Autism. Milton Keynes LPA received bespoke Neglect training to improve the first contact by Police with the victims of crime. TVP are represented on the Local Case Review Panel and Case Review Management Group (CRMG) and regularly support local and statutory reviews which have in the reporting year included self-neglect. TVP continues to support mental health triage and has improved the knowledge of staff around working with people with autism and dementia and worked in partnership with MK Multi-Agency Safeguarding Hub (MASH) to improve communication and sharing of information. A strategic priority of TVP for 2019-20 is to improve how the police protect the vulnerable, including victims of neglect and self-neglect by proactively understanding, identifying and reducing the risk of harm. MKC facilitated a Peer Review in Adult Services by the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) in February 2019 with the focus on self-neglect and safeguarding. The review was asked to establish whether current arrangements across adult services met the needs of vulnerable adults in Milton Keynes. The review focused specifically on people with whom it can be difficult to engage, who may self-neglect and do not easily fit into the current service structure. In response to the recommendations of the review, work has started to improve the pathways including developing new guidance due to be published later this year. MKC ASC chairs the VARM meeting and will report any challenges or emerging concerns to the new Risk Board.
12
For MKC children’s social care working with neglect is business as usual, as well as a core responsibility of education services. In neglect cases that reach the threshold for statutory intervention, CSC typically see families improve during periods of intervention and decline when support and scrutiny is withdrawn. Neglect is therefore a key theme of routine management oversight and professional case supervision. Quality assurance of social work practice scrutinises practice in assessment, planning and review and offers challenge where necessary. This includes service user feedback, the voice of the child and the involvement of families. Recently the Head of Children’s Social Work has met with all Family Support (Social Work) teams to map neglect cases which have been open for one year or more and/or where there have been repeat referrals: actions have been agreed to ensure robust management and to prevent drift. MKCSC is currently planning a deep dive audit into long term neglect cases to inform practice improvement. Children’s Services managers met with health partners to review their joint response to neglect late in the reporting period and are continuing to support this piece of work.
CNWL introduced an outcomes tracker for adults referred to Adult Social Care, which includes the category of neglect and self-neglect. Anonymised examples are used for reflective practice to improve staff competency in working with these issues. CNWL also established a Safeguarding Adults Champions Group to promote grassroots knowledge relating to all areas of safeguarding vulnerable adults, including neglect and self-neglect. CNWL Champions work together with the Safeguarding Adults Specialist to consider how they can best help vulnerable people, for example by signposting to other agencies or by raising a formal safeguarding concern. CNWL have trained Champions on Making Safeguarding Personal. In 2018-2019 CNWL MK based teams raised more adult safeguarding concerns in relation to potential neglect and self-neglect than any other abuse or harm category. CNWL is therefore reviewing processes in regard to Mental Capacity Assessments, including guidance to support staff to assess capacity in relation to neglect and self-neglect. CNWL continue to promote the use of the Children’s Assessment Framework which can provide essential intelligence to inform decision making once a child is referred to the MASH.
As well as the joint audit with MKCCG, MKUHFT reviewed its safeguarding training against the new Intercollegiate document (safeguarding children competency framework for health professionals) to ensure it covers all forms of neglect. MKUHFT has introduced a neglect toolkit and will monitor its
13
effectiveness over the coming year. Section 42s (safeguarding enquires) are led by the Lead Nurse for Safeguarding Adults to ensure a comprehensive response is given and that learning is shared. Work is also continuing with MKC to review the process for allocating section 42s and to agree a robust mechanism for sharing learning. Work on a ‘Was Not Brought’ policy has included engagement across multidisciplinary health professionals. A good example of this work has been presented at the Trust’s safeguarding committee, where collaboration between professionals ensured that reasonable adjustments were made for a young person with learning disability, who had not been brought to a series of appointments. This resulted in a positive patient and family experience.
The National Probation Service developed a neglect toolkit to assist staff in recognising children at risk of neglect. NPS ran a number of development workshops across Thames Valley that had a focus on neglect delivered by quality development officers. Thames Valley CRC also delivered training on neglect and ensured good attendance across the workforce to improve competency in this area.
Oakhill Secure Training Centre carried out work to improve child centred practice within the centre using Maslow’s Hierarchy of Needs. New CCTV has been installed to allow concerns to be identified more readily, and new care plans have been introduced to tackle issues such as self-harm.
Missing What did we do? In 2018, Thames Valley Police demonstrated ELPIS to the Adult Programme Board (APB). ELPIS is a Missing Persons database which is being used in other areas to gather multi-agency data. The system provides a way of quickly sharing information on missing vulnerable adults, children and young people. The APB agreed to trial the use of ELPIS for children and adults so that multi-agency data is used to inform disruption and prevention work, and allowing agencies to identify people who are more vulnerable and who may need support. The PQI group mapped our out of area children in care who are placed in Milton Keynes by other authorities after establishing that a significant proportion of our missing episodes are these young people. The mapping included which areas regularly place in Milton Keynes, age and education status of these children and where in Milton Keynes they are likely to be placed. This work concluded in June and the outcomes will be fed into the Risk Board. What will we do? ELPIS will be rolled out in the MASH and will allow us to monitor missing rates to understand if it is a significant issue in Milton Keynes and to better safeguard those who do go missing. MKC continue to work with those authorities who place looked after children in Milton Keynes to ensure they are kept safe. We identified that there is no current escalation route for trends identified in forums such as the MARMM (Multi-Agency Risk Management Meeting). Therefore our new arrangements will include a Risk Board that will be sponsored by TVP. Operational groups dealing with missing, including MARMM, will report to the Risk Board on a quarterly basis ensuring appropriate strategic overview.
14
How did our partners contribute?
MKCCG ensure their providers have robust systems in place to protect vulnerable people at risk of going missing. MKCCG are responsible for sharing information relating to missing people across health services and other CCGs that retain responsibility for a child placed in Milton Keynes. Vulnerable people accessing health services within Milton Keynes have been identified through the robust sharing of national missing alerts for adults and children in Milton Keynes. In the coming year, MKCCG’s Safeguarding Team will highlight ‘hidden’ children and ways of making them more visible, particularly children missing in education. This will include creating electronic patient record templates, alerts, and health assessments for children missing in education. TVP is creating more links with health across Milton Keynes and the Designated Nurse as part of their strategic role across health will facilitate this. The Designated Nurse will also work closely with the Named Nurse for looked after children at the local community health trust and GPs to develop a safeguarding template for Unaccompanied Asylum Seeking Children (UASC) including alerts and a leaving care passport.
TVP has invested in learning and development for the Missing Person Coordinator role in order to meet emerging challenges, and expanded the remit of the Missing Person’s Team to include an analytical role. TVP will continue to explore Memorandums of Understanding with private children’s homes to ensure they are taking responsibility and staffing homes correctly. TVP is moving towards co-ordinated teams focusing on missing and exploitation that sit within hubs across the force and will be enhanced by multi-agency working. By utilising a multi-agency approach, partners are able to provide service-specific input whilst working together to develop common understanding and shared perspectives on protecting vulnerable persons and pro-actively disrupting offenders.
MKC ensures the MARMM has representation from adult social care enabling the team to support young people who are turning 18 and at risk of going missing as they transition to adult services. MKC is committed to providing appropriate
15
transitional support for young people approaching adulthood and to ensure services are fit for purpose for this age group.
Missing children continues to be a high priority for MKC. Last year young people told us that they did not find the return from missing interview (RFMI) process helpful, so we have revised it to make the questions more meaningful and to offer the option of an independent person to meet with them. Having identified improvements that could be made to the RFMI process, a new system is going live in 2019-20. MKC is working with Thames Valley Police to introduce t the ELPIS database. ELPIS will provide one core set of data about adults and children who go missing so that individuals can be safeguarded as well as identify themes and issues arising from collated data.
CNWL implemented a new assessment tool in their inpatient mental health services to assist staff and patients in shared decision making regarding patients’ leave. This visual tool and the team approach to managing patient leave has improved communication and promoted safer leave to reduce the likelihood of patients being ‘absent without leave’. Leave plans are formulated and revised in partnership with people being cared for in the inpatient setting. CNWL developed cards for patients that include telephone numbers for the wards and reception so that they can phone whilst out and about if they feel they need support.
Work has commenced between the MKUHT safeguarding leads and designated police officer to review current missing person’s data. In particular the potential for adopting a common risk assessment framework with the local police when referring for assistance and welfare checks. MKUHFT is also embedding the concept of sharing with relatives the use of the HERBERT protocol for those patients with a diagnosis of dementia, alongside the comprehensive use of the “This Is Me” document to support dementia care.
SCAS focused their staff training on missing and trafficked people.
Early Help/Early Intervention What did we do?
In 2018 it was identified that MKC Adult Social Care had a significantly higher number of safeguarding referrals when compared to statistical neighbours. Review of the data identified that many of the referrals were not appropriate safeguarding alerts. Work was started and continued into this reporting year to address this with a training programme for partner agencies including the ambulance service and care homes, to support them to make appropriate referrals. This ensures that those who are most in need of assessment and support get it. Figures are now in line with national data. The Adult Programme Board developed a new Decision Making Framework that has been made available to the MK workforce. This will allow agencies to refer appropriately into adult social care and the case to be quickly allocated to the right team, thus providing earlier intervention. This was developed in partnership with the East Midlands Safeguarding Adults Network. In 2018, a task and finish group was set up by the Children’s Programme Board to develop a new Early Help Strategy. This group included partners from Thames Valley Police, MKCCG, National Probation Service, TVCRC, and Universal Children’s Services. The group defined early help as “a range of universal and targeted support to help identify needs and concerns for children and young people and their families as soon as possible”. The group consulted on a proposed Early Help framework, identifying the agencies that can offer early help and taking into account current barriers to receiving early help.
16
What will we continue to do?
Once the consultation period is complete, feedback will be used to inform the final strategy which will be published in 2019. We will also monitor the impact of the new adult’s Decision Making Framework to ensure it has a positive impact. How did our partners contribute?
The CCG Quality Monitoring Nurse (QMN) has worked with MKC on the development of a quality observation tool to be used by Continuing Health Care assessors and Social Workers visiting adult care homes to promote early intervention of care issues and emerging risk. The Designated Nurse for Safeguarding Children and Looked After Children at the CCG is also the chair of the multi-agency Self-Harm task and finish group, with the aim of introducing a tool-kit for professionals to use to identify early signs of self-harm and putting into place support for young people.
TVP hold a quarterly strategic Early Intervention meeting to ensure best practice is shared. Neighbourhood Teams identify families and individuals that need support before reaching thresholds for statutory intervention. TVP has also been working with Parish Councils to encourage them to fund youth work provision locally to prevent escalation of low level issues. TVP acknowledge there is more work to be done around improving front line staff knowledge of Early Help to embed the new strategy once it is published.
The co-ordination of effective early intervention and family support via the
Strengthening Families Programme continues to be a success story in Milton Keynes for MKC as the programme exceeds its target of engagement with 1600 families. The current major risk is that the national Troubled Families programme is due to close on 31 March 2020 and much of the grant supports the work of the Children and Family Practices. Other funding routes are currently under review. The Early Support Project in the MKC Youth Offending Team uses external grant funding to support young people at risk of entering the formal youth justice system through additional activities, mental health support and speech and language assessments. Targeted youth support and the support for
17
vulnerable families continues to be provided through a network of 17 Children and Family Centres. The Children and Family Centres conduct annual parent/carer surveys to ensure they meet the needs of the families who use them. Further engagement with young people is achieved via the Youth Cabinet and participation activities with youth services. This ensures our children and young people help shape services for the future.
In October 2018 guidance on the use of multi-agency Common Assessment Framework (CAF) and a Health Universal Services Early Help (level 2/3) Action Plan was launched within CNWL. The action plan was developed specifically for the 0-19 health visiting and school nursing services, for use after the completion of a CAF to take forward plans to support the family. The 0-19 universal service went live with a single point of access (SPA) in January 2019. This provides a more responsive service to clients and professionals. The SPA allows staff assessing risk to contact a duty health visitor directly and share information promptly. Feedback from families is positive in regard to increased access through the SPA. The 0-19 service is now configured into four integrated locality teams, which include health visitors, school nurses, nursery nurses and health care assistants. The integrated service enables flexibility in meeting the needs of children and families, and supports a more holistic ‘think family’ approach. This incorporates joint working with colleagues from the hospital and CNWL perinatal mental health services.
MKUHFT hold a daily ‘safety huddle’ which provides the safeguarding team with an overview of potential safeguarding concerns including identification of vulnerable individuals who may benefit from early intervention, with particular reference to discharge planning. Within maternity services the Better Birth initiative is being embraced following the recommendation that the NHS should roll out continuity of care to ensure safer care based on a relationship of mutual trust and respect between women and their midwives. This has been proven to lead to better outcomes and improved safety for the woman and baby, as well as offering a more positive and personal experience. Electronic confidential communication within maternity services also assists midwives and health visitors in collaborative working by identifying and sharing information of women and unborn babies that may have additional needs.
Oakhill has a comprehensive induction programme for young people arriving at the centre, which involves internal and external partners such as CAMHS and Barnardos. The young person’s induction is based on the information provided by external agencies such as pre-sentence reports and social care information, allowing plans to be put in place so that staff can effectively work with the young person and respond to their needs appropriately. There is also a resettlement team in place that brings together the Centre’s Safeguarding Team with external agencies who will work with the young person in the community to ensure any risks to their safety on release are minimised.
SCAS has a procedure for making welfare referrals for vulnerable people who do not meet a statutory threshold but who have identified needs that may escalate to risks.
18
Emerging Areas of Vulnerability What did we do? In May 2018 the PQI group carried out a Rapid Review on the issue of gangs and peer violence. This followed a successful survey of residents and professionals where they were asked to tell us about what issues they were most concerned about in Milton Keynes. Over 200 professionals and 80 members of the public completed the survey and identified county drug lines, gangs and youth violence as significant concerns. The Rapid Review consisted of a morning of community engagement where representatives of the Board visited schools, A&E, MK College and businesses in Milton Keynes to talk to people about their perception of the topic. In the afternoon we held a practitioner event where local professionals from across public, private and voluntary sectors were able to contribute to a discussion. We learnt that we do have the right conditions in Milton Keynes, if not monitored and addressed, for an increase in youth violence and gang/drug activity. We are therefore committed to undertaking further work to review the impact that out of area care placements have on our risk of gangs and raise awareness to families. The PQI group reviewed a multi-agency mapping exercise on out of area placements and identified that a significant proportion were from London Boroughs. The impact of this, if any, isn’t clear. We identified that a disproportionate number of both locally placed and out of area placed looked after children and young people are provided with care in Bletchley which will have an impact on local resources such as schools and GPs. This will therefore been escalated to the MK Together Management Board with a view of commissioning further partnership work to seek assurance that we have the appropriate resources in Bletchley to appropriately safeguard these children and young people.
What will we continue to do? Our new arrangements include the introduction of a Risk Board. This will give specific strategic support to operational meetings that manage individual risk including the FGM Panel, MARAC, and MARMM. The work of the Risk Board will be directed by the MK Together Management Board but it will also be informed by emerging vulnerabilities, ensuring our work is needs led and specific to our local area. We will develop a multi-agency Exploitation Strategy based on learnings in other areas and the National Child Safeguarding Practice Review Panel’s first thematic review on youth violence. How did our partners contribute?
MKCCG has established a panel approach to LeDeR (learning disability mortality review), and having completed five reviews during the year is working with the learning disability team to develop the provision of annual health checks. This will allow the LeDeR panel to monitor emerging vulnerabilities more effectively. The CCG also hosts regular GP Safeguarding Forums and during the reporting year had guest speakers from CAMHS, MK-ACT and Service 6 to discuss how GPs can keep abreast of emerging vulnerabilities amongst their patient group. MKCCG supported MKUHFT to introduce a new database to log and monitor daughters born to mothers who have undergone FGM to manage the risk to both mother and child. Following a health review on a case where there was Fabricated and Induced Illness (FII), the CCG also held a legal workshop looking at a number of cases and how practice can be improved. Following the FII review the MKCCG
19
and the Milton Keynes MASH developed a FII toolkit for agencies to use. This has been rolled out across the multi-agency workforce.
In 2018-19, TVP championed the Hidden Harm Campaign and produced ‘Ellie’s Story’ which highlighted the plight of victims of online abuse and the learning for police in how to support them. ‘Ellie’s Story’ was widely publicised on local television and social media. TVP also supported Operation Delegation to reduce the number of repeat offenders of domestic violence and is represented at the High Impact User Group, which monitors residents who have a high impact on local services.
As previously referred to MKC led on the set up and now chair the VARM. Referrals to the VARM include people who are at risk of modern-slavery, trafficking and domestic abuse and the group encourages collaborative working between agencies to support person centred intervention to reduce the risk to victims of abuse or exploitation. This group will report to the Risk Board from September 2019. During 2018 MKC moved from a Child Sexual Exploitation response to a wider exploitation model for children. This includes emerging vulnerabilities associated with criminal exploitation such as involvement in gangs and weapons, county lines, youth violence and risks to children who go missing from home and care. The Youth Justice Plan 2018/19 focussed on these areas. MKC Children’s Services launched a new exploitation risk indicator tool to aid professionals in analysing concerning behaviour against a range of exploitation indicators and the ‘Responding to exploitation’ guidance was updated for practitioners. Since January 2019, CSC and TVP have been piloting a scheme to monitor children who have been referred to the National Crime Agency for trafficking concerns. A new Strategic Lead for Exploitation has been identified from within the service who will lead on the development of a new Exploitation Strategy.
In 2018 CNWL launched an online PREVENT training package for all staff. This complements the classroom based training that remains available to staff. Training compliance figures consistently remain over 95% for the Trust. Emerging vulnerabilities based on the MK Together themes also feature in safeguarding training for all staff. CNWL has become a partner on the PREVENT Board and made links with the Willow Project to improve recognition of risk of modern slavery.
MKUHFT hold a monthly safeguarding forum to provide a platform for multi-disciplinary safeguarding professionals to discuss current investigations and emerging concerns. Themes identified are then further reviewed and if appropriate proposals presented at the quarterly safeguarding committee. This has included the implementation and monitoring of a collaboratively produced fabricated illness toolkit.
A priority for the Trust is ‘care for people with learning disabilities’ who are high risk of being victims of exploitation. A learning disability strategy has been written and is currently being shared with local learning disability stakeholders (including service users and their families) for their engagement and feedback. The Trust has also agreed to adopt a lower threshold to incidences where a patient with learning disabilities is involved. Domestic violence incidences, repeat attendances of vulnerable patients with mental health care needs, modern slavery and female genital mutilation are being reviewed by the Trust.
Oakhill STC is becoming more focused on criminal exploitation, mental health and transgender as current issues/concerns of young people being admitted to the centre. Safeguarding and resettlement teams are looking to strengthen policy and process in terms of working with external agencies to ensure that
20
safeguarding is promoted for young people more effectively on release. Oakhill has also introduced a young person’s forum that allows the young people to tell staff what they and their peers are worried about, either at the centre or on release. This allows the safeguarding team to monitor themes and introduce new practice as necessary.
Since the beginning of 2019 SCAS has been the sole ambulance service involved in a national project with regard to contextual safeguarding. This group has a role to inform legislative and process changes.
Reviews What have we done? This year has seen a significant change in how MKSB managed the case review process. This was largely due to the changes brought about by Working Together 2018, however, we used the opportunity to streamline the process for both Children and Adults. We worked with the Children’s Safeguarding Team in Children’s Social Care to introduce the new notification process that begins the Rapid Review required by the new National Panel. We updated the adult SAR referral form and developed a Rapid Review process for adult referrals to replicate the process for children’s notifications. We introduced a Case Review Panel (CRP) of senior leaders from the three statutory safeguarding partners who agreed recommendations to the Independent Chair for each Safeguarding Adult Review Referral or Children’s Serious Incident Notification. We moved away from two separate case review groups and introduced the Case Review Management Group (CRMG), which project-manages reviews once they have been commissioned. During the reporting year we completed one SAR which we agreed we were unable to publish, however, a robust action plan was developed that specifically looks at escalation of concerns and multi-agency information sharing at commissioning level. A further SAR was completed and published in June 2019 (Adult B). The action plan, which focuses on improved multi-agency case management of adults with care and support needs who are homeless, is being implemented. We also completed two adult Local Learning Reviews which led to the introduction of the VARM for multi-agency working with people who do not wish to, or find it difficult to, engage with services. A further four Local Learning Reviews for incidents involving children were commissioned, which are still in progress. Our Reviews and Learning Group was stood down and work needed to review national learning from serious case reviews was managed via the CRMG. What difference did we make? We have experienced a significant increase in referral activity. We believe this is due to awareness-raising across agencies, precipitated by our new arrangements. The majority of referrals and notifications received have not reached the criteria for statutory review, however, we have been able to identify learning and improve practice by carrying out high quality, challenging and supportive local learning reviews. Training was provided to a pool of local reviewers to manage the increase in activity for both adults and children. Having a pool of local reviewers increases our
21
capacity to complete reviews and also provides a development opportunity for staff keen to learn new skills. The newly formed CRMG has improved the process of facilitating reviews and increased the pace at which they are completed. We have embedded the new Rapid Review process and have developed it over the year to ensure the local process is robust and effective.
We have completed a review of the use of restraint within Oakhill Secure Training Centre, which has included an action plan for the agency. The restraint review recognised the work that has been done to address the high level of restraints at the centre and the number of incidents referred to the Local Authority Designated Officer (LADO) and Police. It was acknowledged that the cohort of young people receiving custodial sentences are serving sentences for serious violent offences and have a variety of complex needs, including anger management. The review, which was informed by the voices of young people and staff at the centre, revealed that there had been some improvements in terms of safety at the centre, however more work is needed to support staff in de-escalating situations before they result in a restraint and to manage restraints consistently. What next? We will introduce the new criteria for Child Safeguarding Practice Reviews (Working Together 2018) from 30 June 2019 and work closely with partner agencies to ensure learning continues to be gained from reviewing incidents appropriately. We will also bring Domestic Homicide Reviews (DHRs) under our CRMG to ensure all of our reviews are managed consistently. We will complete the local learning reviews currently in progress and disseminate learning via the new Workforce Board. The Assurance Board will be responsible for monitoring the progress and impact of the action plans.
22
Other MKSB activity of note Self-Harm Task and Finish Group In January 2019, the Children’s Programme Board agreed and established a Self-Harm Task and Finish group. The aims of the Task and Finish Group are to:
Develop a reliable and easy to access toolkit with information and resources about self-harm for young people, parents and professionals across all agencies.
Recommend training programmes (using evidence based approaches) for professionals to increase resilience, emotional literacy and competence amongst the children and young people’s workforce, and promote self-help and signposting for young people, their families and communities.
To set up a collaborative real-time data analysis agreement. The group will continue into 2019/2020 to complete the three listed work streams above.
Workforce Our Workforce Development and Standards Group did not sit regularly due to the impact of a number of key staff changes. The group did however draft a multi-agency Competency Framework which will be published in 2019/2020. This has been the first year where multi-agency training has been delivered by MKC on behalf of MKSB. A review of this training will be completed by the new Workforce Board in 2020.
Transitions Children Programme Board members discussed whether transitions for young people in Milton Keynes could be improved. As a result of this a Transitions Task and Finish Group was commissioned to review the current MKC Policy and Procedures (2016) and design multi-agency transition tools. A comparison with other local area policies has been completed. Consultation with young people began March and continued into April 2019. This is now being tied into a piece of work on transition for SEND being conducted by CNWL to avoid duplication.
CDOP During the year 31 child deaths were reviewed by the multi-agency Child Death Overview Panel. The CDOP is chaired by the Director of Public Health for Bedford and Milton Keynes, which provides greater opportunities to work across the BLMK STP and with other CDOPs to share findings and implement recommendations. In five of the deaths reviewed ‘modifiable factors’ were identified, which included smoking and co-sleeping. Both of these factors have been identified in previous years and are also identified as modifiable factors by other CDOPs. Agencies across Milton Keynes continue to reinforce safe sleeping messages and promote non-smoking in pregnancy. One of the deaths reviewed by CDOP also met the criteria for LeDeR and the death was therefore referred to the LeDeR programme The CDOP has continued to progress the recommendations reported to MKSB in the 2017 – 2018 CDOP annual report.
23
MK CDOP members are responding to the Child Death Statutory Operational Guidance published in October 2018 and have been working with colleagues in other agencies to introduce the child death review arrangements in Milton Keynes. The MKCDOP will continue to explore opportunities for shared learning with colleagues supporting CDOP processes in Bedford and Luton.
Conclusion Overall 2018/19 was a challenging but very productive year marked by an increased degree of partnership working, with common priorities and new flexible and creative working arrangements which increased our ability to simplify what we did whilst improving outputs and outcomes. The year also provided an opportunity to develop the innovative new arrangements currently being introduced. Whilst overall the year was a good and productive one, which made significant strides forward in addressing our impact and effectiveness in our priority areas, we continued to find it hard to fully engage with and utilise the voice of the children, young people and adults we work with. The new Voice Board is tasked with rectifying this over 2019/20.
24
Appendices
Appendix A: Agency representation at 2018-2019 meetings
Mar
19
Jan 1
9
Nov18
Oct1
8
Oct
18
Develo
p
ment
Day
Jul 18
May 1
8
MKSB Independent Chair (Chair)
CEO, MK Council x
Head of Patient Care, MK UHFT x x x x
Director of Adult Services, MK Council x
Director of Children’s Services, MK Council x
Superintendent, TV Police x x
Dep Director MK CCG
Head of Patient Care, MKUHFT NA x x x x
Director of Nursing, CNWL X
DCI, TV Police x x
Director H&SC Integration, MKC/MKCCG x
Chief Officer, MK CCG NA NA NA x x x
25
Appendix B Agency Contributions
Agency Total contribution
MK Council £149,004
MK Clinical Commissioning Group £65,782
Thames Valley Police £26,395
Central & NW London-MK £5224
MK University Hospital NHS Foundation Trust £5224
TV Community Rehabilitation Company (TVCRC) £3648
G4S (Oakhill STC) £1974
National Probation Service £891
Bucks Fire & Rescue Service £650
Cafcass £550
TOTAL £259,342.00
Summary of 2018/19 end of year budget position
Income Brought forward -74,082
Contributions -259,342
Expenditure
Employee costs 207,792
Independent chair (including some carried forward costs from 17/18)
28,685
Serious Case Review/Safeguarding Adult Review (including outstanding 2017/18 reviews)
21,899
Phew Support (website, policies and procedures) 4,556
Miscellaneous (including annual report) 5,808
Total -64,684
(underspend)
26
Appendix C: Glossary of terms
ACRP Adult Case Review Panel LeDeR Learning Disability Mortality Review
A&E Accident and Emergency LPA Local Policing Area
ASB Anti-Social Behaviour LSCB Local Safeguarding Children Board
ASC Adult Social Care MAPPA Multi-Agency Public Protection Arrangements
CAMHS Child and Adolescent Mental Health Service MARAC Multi-Agency Risk Assessment Conference
CCG Clinical Commissioning Group MASH Multi-Agency Safeguarding Hub
CCRP Children’s Case Review Panel MCA Mental Capacity Act
CDOP Child Death Overview Panel MK Milton Keynes
CFP Children & Families Practice MKC ASC Milton Keynes Council, Adult Social Care
CFLT Children and Families Leadership Team MKC CSC Milton Keynes Council, Children’s Social Care
CJB Criminal Justice Board MKCCG Milton Keynes Clinical Commissioning Group
CNWL MK Central and North West London NHS Foundation
Trust Milton Keynes
MKSAB Milton Keynes Safeguarding Adults Board
CPB Children’s Programme Board MKSB Milton Keynes Safeguarding Board
CP-IS Child Protection Information Sharing MK UHFT Milton Keynes University Hospital NHS
Foundation Trust
CR-MARAC Community Risk-Multi-Agency Risk Assessment
Conference
MOJ Ministry of Justice
CSC Children’s Social Care NHS National Health Service
CSE Child Sexual Exploitation NPS National Probation Service
CSP Community Safety Partnership OFSTED Office for Standards in Education, Children’s
Services & Skills
CQC Care Quality Commission PQI Performance, Quality and Improvement Group
CuSP Custody Support Plan PVP Protecting Vulnerable People
Divisional DA Divisional Domestic Abuse RAG (rating) Red, Amber, Green rating
DoLS Deprivation of Liberty Safeguards RLG Reviews and Learning Group
ED Emergency Department SAR Safeguarding Adults Review
ELPIS Police ‘missing’ data system SCAS South Central Ambulance Service NHS Foundation
Trust
FGM Female Genital Mutilation SCR Serious Case Review
FII Fabricated or Induced Illness STC Secure Training Centre
GP General Practitioner STP Sustainability and Transformation Partnership
HMP Her Majesty’s Prison TVCRC Thames Valley Community Rehabilitation Company
LADO Local Authority Designated Officer TVP Thames Valley Police
LDU Local Delivery Unit VARM Vulnerable Adults Risk Management