safeguarding, mental capacity act and looked after

of 26

West Lancashire CCG

Safeguarding, Mental Capacity Act and Looked After Children

Annual Report

April 2019 to March 2020

of 26 201019 NHS West Lancashire CCG Annual Report April 2019 to March 2020 Final

Introduction 3

2019/2020 Safeguarding Priorities 4

1. Delivery of Statutory Safeguarding Functions 5

2. Development and Strengthening Pathways of Services 19

3. Using Intelligence and Information to Inform Decisions 21

4. Influencing Partnerships 23

Summary and Forward Planning 25

Report Contributors Lorraine Elliott Designated Lead Nurse Safeguarding Adults and Mental Capacity Act Louise Burton Designated Lead Nurse Safeguarding Children and Looked After Children Kristy Atkinson Deputy Designated Professional Safeguarding Adults and Mental Capacity Act Colette Lawler Deputy Designated Nurse Safeguarding Children and Looked after Children


Introduction Purpose of the Report

The CCG Annual Report for Safeguarding Adults, Children and

Looked After Children comes at a time of significant change linked

to the developing Integrated Care System (ICS), which supports a

system wide approach to safeguarding during the forthcoming year.

This report describes the range of activities and developments that

the safeguarding team have supported in designing and delivering

across the locality footprint. The report provides assurance to the

Governing Body and members of the public that the CCG has

fulfilled its’ statutory responsibilities to safeguard the welfare of

children, adults and looked after children.

The narrative throughout this report provides an overview and

summary of assurance against the CCG’s statutory functions and

the shared local priorities of safeguarding partners. Furthermore,

the report reflects on positive achievements and service

developments.

At the time of writing, the CCG continues to respond to the impact of

a Covid-19 pandemic, which has begun to impact into all walks of

life. It is unclear what the future consequences will be on vulnerable

children and adults. What is known is that all Health Services and

Partners have been instrumental in responding to the needs of the

population in unprecedented times.

This report will conclude by looking forward to the year ahead

identifying key priorities for 2020/2021; this includes plans to

continue to strengthen the safeguarding arrangements across

Health and Social Care Partnerships.

A key area of work during 2019/2020 has been to support the

development of a Safeguarding Health Governance Structure within

the ICS. This supports a whole system approach and responds to

the statutory changes in the Children and Social Work Act, 2017,

which led to a revised publication of Working Together to Safeguard

Children, 2018.

The CCG’s core business is to support vulnerable people keeping

individuals at the centre of service delivery. The CCG is committed

to working with Partners to drive continuous improvements and a

move towards an outcome based approach. A priority is a focus on

the impact of safeguarding on the lives of children, young people

and adults:

• Keeping them free from harm, abuse or neglect

• Protecting their wellbeing and human rights

• Protecting their health.


2019/2020 Safeguarding Priorities - Key Achievements

Mental Capacity Act Implementation

• Undertaken a scoping exercise of patients who will be impacted by the Liberty Protection Safeguards

• Launch of the Children and Young People MCA and legislation Interface Guidance

• Strengthening communication links to support COP applications

• Case law analysis, review and impact on practice across the ICS

• System leadership of the MCA portfolio

Primary Care

• Strengthening of safeguarding response across Primary Care and targeted training opportunities

• Review of the GP training brochure to support application of the Adult and Children Intercollegiate Documents

• Review GP sample safeguarding policies including SOP language line safeguarding adults and children, domestic abuse

• Improved information sharing pathways to support GP input into Section 42 Safeguarding Enquiries and MASH Information Sharing Pathway

Regulated Care

• Focussed activity to improve quality and safeguarding initiatives across Regulated Care and launch of Best Practice Care Planning Tools across the Regulated Care sector

• Strengthened quality assurance arrangements regarding the monitoring of domiciliary care packages

• Embedding of the Domiciliary Champion Model across the sector

Partnership working

• Strengthened arrangements to support the quality assurance and monitoring of in and out of area Looked after Children

• Implementation of the ICS Safeguarding Model; learning shared across Regional and National Safeguarding Forums

• Implementation of the Lancashire Self Neglect and Hoarding Framework and evaluation of its effectiveness

• Delivery of targeted training to support a culture of learning through training, embedding lessons learnt

• Launch of the FGM Pathway for adult facing services

• Implementation of Safeguarding Children Partnership Arrangements and development of published plans, structures and processes

• Development of the ICS Health Governance Arrangements

Safeguarding Children

• Transition to Working Together to Safeguard Children (2018)

• Implementation of the Looked After Children Health Assessment Improvement Plan

• Implementation of the new Child Death Guidance

• Revision of the SUDC protocol


1. Delivery of Statutory Safeguarding Functions…

Safeguarding Leadership and Accountability The accountability for safeguarding rests with the Chief Accountable Officer of the CCG. The safeguarding team is led by the Designated Lead Nurses for Safeguarding Adults and Children whom have a direct reporting structure via the Chief Nurse and Chief Accountable Officer. Quarterly Safeguarding Assurance Reports are provided to the Quality and Safety Committee, which are embedded within Governing Body reporting arrangements. The CCG safeguarding model incorporates the statutory safeguarding roles supported by two Deputies: a Designated Nurse and a Designated Professional. This includes a Designated Doctor for both safeguarding and Looked after Children, a GP Lead for Safeguarding along with administrative support.

Discharging Statutory Duties for Safeguarding

Accountability Policies and Procedures

There is a clear line of accountability for safeguarding reflected in the CCG governance arrangements, including statutory roles as described above. At the time of writing this report the CCG has achieved almost full compliance against the requirements of the NHS Accountability and Assurance Framework. One area remains outstanding due to the designated resource not meeting the requirements of the intercollegiate documents for adults and children.

Policies and procedures are in place setting out a commitment and approach, to safeguarding children and adults including Mental Capacity Act (MCA) implementation. Policy development for 2019/2020 includes a review of the CCG Safeguarding Policy and a review of the Safeguarding Standard Operating Procedure (SOP) for mandatory training, to reflect both the adult and children intercollegiate documents. The SOP provides details of the recommended training options to achieve the required levels of competency to support safeguarding skills and knowledge. The Primary Care GP sample policies on adult, children and domestic abuse have also been reviewed and updated and are available for practices to adopt.


Effective Supervision and Training

A series of training events and GP Safeguarding Champions sessions have been delivered on a variety of safeguarding topics. This has included:

• Spotting the early signs of radicalisation and to improve confidence in making referrals to the Channel Panel along with the principles of information sharing

• Level three Safeguarding Children to strengthen the delivery of a Multi-Agency Early Help response

Bespoke training has also been offered to Primary and Regulated Care which has included MCA/DoLS and learning from reviews. Targeted training has been offered to support the delivery of the Regulated Care and Domiciliary Champion events. This has included:

• The role of advocacy

• Learning from Safeguarding Adult Reviews

• Roles and Competencies within the Adult Intercollegiate Document

• Role of the Multi Agency Safeguarding Hub

• Person’s in a Position of Trust

Dissemination of key messages via the safeguarding email account regarding best practice resources, lessons learnt, learning briefs and policy updates have also provided positive learning opportunities. Ensuring that CCG’s staff have the required competencies to carry out their responsibilities for safeguarding through a culture of learning across the system through effective supervision and training.


Safeguarding Governance Framework

West Lancashire CCG’s Safeguarding Accountability

West Lancashire CCG

Chief Accountable

Officer

Chief Nurse

CCG

Safeguarding Team (included Designated/Deputy

Nurse/Professional for Children and Adults and

Designated Doctors and GP Safeguarding Lead)

Individual Accountability Structures/Committees

CCG

Governing Body Meeting in Common

Quality and Safety

Committee

Lancashire

SAB’s & CSAP

Quality assurance

and improvement

for regulated care,

domiciliary and

supported living

(RADAR, QIP)

Regional and

National

Safeguarding

meetings

Safeguarding

Contractual

Compliance of

Commissioned

Providers

NH

S E

ngla

nd &

NH

S Im

pro

vem

ent

GP Clinical

Director for

Safeguarding


Safeguarding Assurance of Commissioned Services

The Safeguarding Children, Young People and Adults at Risk in the NHS: Safeguarding Accountability and Assurance Framework (2019) replaced Safeguarding Vulnerable People in the Reformed NHS – Accountability and Assurance Framework. It sets out clearly the safeguarding roles and responsibilities of all individuals working in Providers of NHS funded care settings and NHS Commissioning Organisations. There is a distinction between Providers’ responsibilities to provide safe and high-quality care, and Commissioners’ responsibilities to assure themselves of the safety and effectiveness of the services they have commissioned.

Safeguarding assurance arrangements within the CCG and commissioned services utilise a number of methods to support triangulation of information. The team are involved in attending Safeguarding Boards/Committees of the larger Provider Services. In addition to the attendance at quality assurance visits across regulated care settings, where there is involvement in the Quality Performance Improvement Process. Arrangements are also in place to monitor key performance indicators along with the triangulation of themes from learning reviews, customer feedback and complaints. An annual safeguarding audit/self-assessment submission is completed by commissioned services as part of the contractual process to support with monitoring of safeguarding arrangements. It is expected that supporting evidence is provided and a RAG rating is used. An action plan is developed with areas for improvement as required. In March 2020, during the initial phase of the pandemic; monitoring of the safeguarding audits were relaxed as per National Guidance. The safeguarding team commenced bi-weekly meetings with key Health Providers to enable opportunities to share intelligence, identify emergent risks and allow an increased opportunity for supervision and support. The chart below highlights themes from the range of Commissioned Services and actions taken to strengthen safeguarding arrangements, during the reporting period.


Audit Highlights… Actions Taken…

Compliance with Safeguarding Training

• Training SOP guidance reviewed for Primary Care to raise awareness of the safeguarding training requirements outlined in the Intercollegiate Guidance Documents

• Delivery of targeted training to Primary and Regulated Care

• Worked collaboratively with Providers regarding Prevent Level 3 compliance rates

Implementation of the Mental Capacity Act

• Sharing and cascade of best practice resources

• Supporting Providers to access LSAB MCA standardised resources

• Access to sample policies

Overall Themes for Improvement

• Access to supervision policies and arrangements

• Use of best practice policy templates

• Making Safeguarding Personal

• PIPOT compliance

• Strengthened information sharing pathways

• Introduction of a Looked after Children Resource Pack

Areas of Good Practice…

• Clinical coding of risk on patient’s records to include vulnerability

• Safeguarding leads identified

• Strengthened information sharing processes

The CCG safeguarding team will continue to support areas for improvement, including sharing learning from Child Safeguarding Practice Reviews, Safeguarding Adult and Domestic Homicide Reviews.


Learning from Reviews

The CCG continues to engage with both the Adult Boards and Child Safeguarding Assurance Partnership through the work of the Child Safeguarding Practice Reviews (formerly known as Serious Case Reviews) and Safeguarding Adult Reviews (SARs). Whilst there have not been any Safeguarding Adult or Domestic Homicide Reviews during 2019/20 for West Lancashire, relevant learning from reviews across the County have been captured and shared across Commissioned Service areas. There has been a particular focus on compliance with valid consent and the MCA including self-neglect. In addition to challenges with accessing Mental Health Services, which in turn has impacted on patient experience and risk; this has led to a piece of work around shared care between Primary Care and Mental Health Services. A particular West Lancashire case referred into the SAR sub group involved older siblings residing together who were self-neglecting; with evidence of significant hoarding. Sadly, the brother died triggering a SAR referral and identifying the sister at continued risk. The Self-Neglect Framework was utilised, which supported engagement with the sister with decluttering. Good practice was demonstrated by the GP by allowing professionals to meet the patient at the surgery as she was reluctant to allow anyone in the house, other than the Environmental Health representative. The intervention did not change her lifestyle however the risks were reduced through a multi-disciplinary team approach. Further information on the Lancashire Safeguarding Adult Reviews can be found here

Child Safeguarding Practice Reviews

Subsequent to the implementation of the Children Safeguarding Partnership Arrangements September 2019; the criteria for undertaking Child Safeguarding Practice Reviews (formerly known as Serious Case Reviews) was applied and a new process introduced for agreeing Rapid Reviews. In light of the pandemic, Serious Case Reviews and Child Safeguarding Practice Reviews were being placed on hold following joint communication relaxing timescales from the Child Safeguarding Practice Review Panel and Department for Education. All cases that required Rapid Reviews would continue to be prioritised. There were two reviews ongoing during the reporting period; Child LN and Child LU both were delayed due to parallel proceedings. A new review was commissioned during the reporting period Child LV. Lessons learned are a key part of any review; a Lancashire Serious Case Review, Child LL published during the reporting period highlighted the need for improved information sharing between services. To ensure that decisions for referrals into the Multi-Agency Safeguarding Hub are

http://www.lancashiresafeguarding.org.uk/lancashire-safeguarding-adults/resources/safeguarding-adult-reviews.aspx


informed by all key health information; a pathway has been developed to support information sharing with Primary Care to inform cases whereby a health assessment is being undertaken. Other key learning themes include:

• Supporting older children, highlighting the vulnerability which age itself can present

• Co-ordinating support for young parents

• Safer sleeping processes

• Responses to domestic abuse for under the age of 18 years

• Further information Lancashire Child Safeguarding Practice Reviews can be found here

Child Death Reviews The Child Death Review Partners are required to operate in line with the requirements of the statutory guidance Working Together to Safeguard Children (2018) and Child Death Review: Statutory and Operational Guidance (England) 2018. Progress has been made in establishing the future governance and reporting arrangements for the Child Death Overview Panel (CDOP). The Sudden Unexpected Death in Childhood protocol (SUDC) has been updated to reflect legislative changes and statutory guidance. A consultation process has taken place to include all stakeholders and it is anticipated the protocol will be launched early in the new reporting year. Since April 2019, there have been 36 unexpected child deaths. Co-sleeping figures are reported to be down from 13 the previous year to seven during 2019/2020. Although this is positive, it is evident that co-sleeping and placing babies in unsafe sleep environments continues to be a contributory factor in a significant number of deaths. Sharing lessons through training, learning briefs, newsletters, briefing with teams and discussion of learning in supervision, the CCG has maintained an active representation at CDOP. Campaigns to improve practice and prevent future deaths have included ICON (head trauma) and the Safer Sleep Campaign.

http://www.lancashiresafeguarding.org.uk/media/1114/Learning-Brief-LL-Final.pdf


Safeguarding Children

Number of children on a Child Protection Plan Preston CCG

There has been a reduction in children and young people whom are subject to child protection plans within West Lancashire. This is reflected in a down ward trend across Lancashire over the reporting year.

A peer review in 2019 challenged Lancashire County Council’s thresholds, that there were too many child protection plans leading to closer scrutiny. There has been specific work to look at thresholds to reduce the numbers of children and young people on child protection plans; concentrating on interventions with families; using strength based approach.

There is close monitoring of re-referrals rates. Assurance has been given that there is improved management oversight and no children are being left a risk.

75 37

1368

836

0

200

400

600

800

1000

1200

1400

1600

01 March 2019 01 March 2020

Number of children on a Child Protection Plan

West Lancashire

Lancashire


Looked after Children

Numbers of Looked after Children

Compared to the previous year there is a slight reduction for both Lancashire and West Lancashire in the numbers of Looked after Children. There has been work undertaken in respect of children on the edge of care and increased scrutiny with the establishment of Care Planning Panels. Unfortunately, this downward trend has not been sustained into 2020/2021.

Health of Looked after Children CCG responsibilities to support Looked after Children are mandated through the Children’s Act (1989, 2004) and ‘Promoting the Health and Wellbeing of Look after Children (2015); both of which set out a duty to comply with requests from the Local Authority in support of their statutory requirements for the completion and quality assurance of health assessments. In addition, CCGs have a duty to ensure that there is sufficient commissioned resource to meet the health needs of the local cohort of Looked after Children and Care Leavers. The Children and Social Work Act 2017, introduces the Corporate Parenting Principles for Local Authorities and key partners for Looked after Children and Care Leavers up to the age of 25 years. The underpinning goal of the seven principles is to act in the best interests, and promote the health and well-being of those children and young people to support them through to adulthood and achieve independent living and economic independence. The CCG commission Initial Health Assessments (IHAs), which are undertaken by Community Paediatricians (up to the age of 16 years). IHA’s for children over the age of 16 are undertaken by a Safeguarding Lead for General Practice. Review Health Assessments (RHAs) are predominately carried out by School Nurses and Health Visitors. Virgin Care was commissioned to provide the 0-19 service by the Public Health Directorate of the Local Authority from April 2019. The co-ordination and quality assurance of all health assessments is included within the specification for the CCG Enhanced Looked after Children Service commissioned by the CCG.

Lancashire

2095

West Lancashire CCG

125


Compliance with Statutory Health Assessments

Up to date health assessments for West Lancashire at the end of March 2020 is 84.6%. The compliance with IHAs remains variable across Lancashire due to a series of co-dependent multi-agency challenges, including notifications systems, capacity of staff and engagement of young people.

There was an anticipated initial decline in performance for RHAs during the initial transition period to Virgin Care. Access to health electronic record systems and information sharing agreements has now been resolved.

Health Assessment and Redesign Pathway Project

Following an Ofsted Inspection in 2018, a Joint Scoping Project with health colleagues was developed to identify the barriers and system challenges affecting the compliance and performance of initial and review health assessments for Looked after Children. A Looked after Children Steering Group was formed to address the issues identified and a project established. The Permanence and Children in Our Care (PCIOC) Board is represented by Pennine CCG and has oversight of this piece of work. The CCG’s Deputy Designated Nurse represents at the Lancashire and South Cumbria Looked after Children Professionals network meeting. Health and the Local Authority hold joint responsibility for the Health Assessment Redesign Project. The aim of the project is to strengthen governance, pathways and processes to improve the timeliness and quality of health assessments across the County.

Working closely across Lancashire and South Cumbria ICS, the CCG has supported improvements through the work of the Health Assessment Redesign Project, these include:

• A partnership action plan being driven by Lancashire Steering Group

• Participation in multi-agency launch events

• Increased scrutiny undertaking a deep dive into the outstanding health assessments

• Streamlined the IHA pathway to support timely requests

• Engagement pathway developed to ensure there is a health plan even when children refused to attend

• Ensuring there is health provider representation at the recently introduced Permanence Panels, offering a health contribution to decision making


Themes Identified from Health Assessments Themes identified from statutory health assessments include emotional well-being, sleep support, smoking and substance cessation, sexual health needs, exploitation and missing from home, development checks as per the Healthy Child Programme and complex physical health needs. Risks/gaps identified for Looked after Children:

• Ongoing health service for those leaving care

• Timeliness of health assessments

• Immunisations for young people 16-18 years

• Access to Looked after Children and Care Leavers Mental Health Services The CCG safeguarding team continues to work across the system to mitigate and address these risks and gaps. The introduction of a Looked after Children resource pack for Primary Care further supports this agenda.

Reducing Unwarranted Variation for Looked after Children The Health System together with Local Authorities as ‘Corporate Parents’ should together have high aspirations to improve outcomes for these children and young people. NHS England has identified reducing unwarranted variation for Looked after Children as a key area of focus. Work is ongoing to reduce unwarranted for all Looked after Children across the Lancashire and South Cumbria footprint. The primary areas of unwarranted variation are:

• Access to timely and quality health services regardless of where Looked after Children are placed in the United Kingdom

• The Health Commissioning Pathways to meet the statutory duties for all Looked after Children are complex and there is no single service specification for delivery across the ICS and National footprint.

• Access to Mental Health Services for Looked after Children and Care Leavers The CCG has commissioned Kooth.com, a 24/7 online counselling and support service which is free to young people aged 11-16 years to increase accessibility to emotional and mental health support.


Safeguarding Adults The Local Authority retains the responsibility for overseeing a safeguarding enquiry and ensuring that any investigation satisfies its duty under Section 42, to decide what action is necessary to protect the adult and to ensure that such action is taken when necessary. Safeguarding alerts received by the Local Authority teams across the CCG footprint has indicated a similar volume seen in the previous reporting period. This area of focus will continue to be a priority into the next reporting year to understand themes and trends and raise awareness of learning across the system. The data shows that there is still a high percentage of safeguarding alerts which are able to be stepped down from a Section 42 enquiry and managed locally through existing systems and protection plans without the need for a formal Section 42 enquiry. The data below identifies the total number of alerts received which are processed to a safeguarding enquiry and percentage of total alerts substantiated.

Safeguarding Alerts

Number of Safeguarding

Alerts received by LCC per District

Alerts Progressing to a Safeguarding

Enquiry

% of Alerts that Substantiated

Chorley and South Ribble 1,807 756 26%

Preston 1,429 636 27%

West Lancashire 770 314 27%

Lancashire 10,364 4,413 28%

Referral Alerts and Sources received across Lancashire with themes outlined below:-

2019/20 Percentage of Alerts Across Lancashire

• 36.4% from social care staff • 31.7% from health staff • 9.2% classed as 'other' • 9.5% from family members • 5.5% from police

2019/20 Main Themes of Alerts Across the CCG Footprint

• Neglect and Acts of Omission (32.1%) • Physical Abuse (15.8%) • Emotional/Psychological Abuse (21.0%) • Financial Abuse (13.7%) • Domestic Abuse (9.2%)


Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS)

The CCG safeguarding team has played a crucial role in gaining assurance that the principles of the MCA are implemented and embedded across the health care system: Key areas of focus include:

• Leading on strengthening strategic oversight of MCA/DoLS within the LSAB and across the Health Partnership

• Adopted and implemented the ADASS Court of Protection Tool within the CCGs for the Midlands and Lancashire Commissioning Support Unit. (MLCSU)

• Facilitated targeted learning around MCA and DoLs across Regulated and Primary Care

• Led on the development and implementation of the LSAB MCA Training Framework

• Worked in partnership with UCLAN to develop a training package for senior staff on MCA in line with the Adult Roles and Competencies Intercollegiate document

• Led on the development of best practice guidance on restrictive practices

• Led on the development of a suite of MCA Audit Tools which can be used across the LSAB Partnership

• Identification of service gaps around Executive Capacity and development of best practice resources

• Led on the implementation plan for the changes within the Liberty Protection Safeguards. There has been a significant increase in DoLS referrals and applications granted in the reporting period. The Covid-19 pandemic has resulted in a reduced capacity to respond with demand exceeding capacity and statutory timeframes not being met. A standardised prioritisation tool remains in use to ensure the more complex cases are processed and a recovery plan is in place. The Local Authority DoLS team are supported by independent Best Interest Assessors to support in the management of the backlog of cases.

Lancashire DoLS Activity

Q1 Q2

Q3

Q4

2018/2019

2019/2020

Number of DoLS Referrals 1253

1238

1385 1428 3,879 5304

DoLS Authorisations Granted 257

250

234 264 595 1005


Liberty Protection Safeguards

Since the implementation of the Mental Capacity Ammendment Act (2019) the team have been preparing for the implementation of the Liberty Protection Safeguards (LPS) initially due in October 2020, but delayed until April 2022, due to the Covid-19 pandemic. The LPS will replace DoLS and give the CCGs new responsibilities to authorise a deprivation of liberty for the purpose of care or treatment. Over the reporting year a scoping exercise has been undertaken to determine total number of patients affected. The next steps include the development of a delivery model for implementation across the changing health landscape. The team have also contributed to a number of Multi-Agency Learning Briefs to support the implementation of the LPS across the Regulated Care sector.

Best Practice Initiatives On behalf of Lancashire and South Cumbria CCG’s and in partnership with Lancashire Constabulary; the CCG safeguarding team was successful in receiving funding to support the 999Reunite project; an initiative that returns people with conditions such as Dementia or Alzheimer’s back to their home should they go missing. The funding has purchased 3000 fobs and wristbands which use Near Field Communication which is also fitted to most smartphones. The benefits of the system include the user being able to place the mobile over the ‘LOGO’ where it will display an emergency contact person’s name and mobile number. Next steps include the development of media resources for Primary Care and Community Health Services to raise awareness both to professionals and the public about the scheme with arrangements to launch the project across the ICS.


2 Developing and Strengthening Pathways & Services

Changing the Landscape of Safeguarding The team have worked closely with partners to strengthen safeguarding responses in relation to the changing landscape for safeguarding, our activity has included

Information Sharing Work completed with Primary Care to strengthen information sharing with Local Authorities. Use of Team net and Safeguarding Champions Model. Ensuring that lessons learned from Serious Case Reviews are embedded in Practice. Pathways established to ensure GP’s are aware of those with additional vulnerabilities, or at risk of abuse or neglect.

Domestic Abuse Domestic Abuse Policy for Primary Care updated Awareness raising through training and forums. Representative at Lancashire MARAC review.

Mental Capacity Act and Deprivation of Liberty Safeguards

Portfolio leadership of MCA across the ICS and strengthening strategic and operational oversight of MCA/DoLS within the CCG localities. Adoption and implementation of the MCA ADASS Prioritisation Tool within the CCG localities and Commissioning Support Unit.


Neglect The Lancashire Neglect Strategy 2019-21 supports a multi-agency commitment to better identify children experiencing neglect, and more joined up support for families to improve the outcomes for children and young people.

Prevent Worked with Provider organisations in ensuring their Prevent compliance training rates were achieved. Assisted in the delivery of the Multi-Agency Action Plan to ensure the health needs of families are met. Launch of the Royal College of GP’s E-learning on Prevent regarding the signs of radicalisation on the NOTICE, CHECK and SHARE approach.

Human Trafficking and Modern Slavery

Portfolio lead across the ICS and contribution to the review of the national NHS Standard Contract consultation. The CCG is an active member of the Pan-Lancashire Anti-Slavery Partnership to strengthen the health response to modern slavery. Development and launch of a modern slavery toolkit and shared nationally.

http://www.lancashiresafeguarding.org.uk/news/neglect-strategy/


3. Using Intelligence and Information to Inform Decisions

Multi-Agency Safeguarding Hubs (MASH) Implementation of MASH Teams in Lancashire has improved the sharing of information between agencies, helping to protect the most vulnerable children and adults from harm, neglect and abuse. The CCG commission specialist health input into the MASH processes. Key highlights of the Partnership work achieved over the last year is summarised below:

Lancashire Partners

• The re-design of Adult MASH based on the systems thinking model

• Strengthening of Early Help Pathways

• Information Governance agreement and Memorandum of Understanding updated and signed off

• Review of the public health approach to high risk domestic abuse

• Introduction of Operation Encompass for Domestic Abuse information sharing with schools

• Consolidation of Information sharing pathways and processes with Primary Care

Regulated Care

During the Covid-19 response the CCG safeguarding team has significantly led and supported developments and interventions within the Regulated Care sector. This has resulted in a substantive increase in workload for the safeguarding team. Areas identified for additional support have included Mental Capacity Act implementation, knowledge and compliance, access to suitable training and Covid-19 swabbing and testing. The Safeguarding Champions Model has provided a direct opportunity for engagement, collaborative working and to strengthen skills and knowledge. A suite of training has been made available for all Partners to support MCA understanding and compliance within the CCG footprint. Ongoing support has been made available for struggling providers linking with key partners with specific expertise. The safeguarding team is represented on the RADAR and Quality Improvement Process (QPIP) across the CCG localities


The chart below highlights key achievements and areas for improvement. Strengthening the system

Themes for improvement

Key achievements

Viability

Provision of educational opportunities and support through the Safeguarding Champions Workshops

Leadership and management oversight

Developed and supported the implementation of the QPIP process across the CCG footprints

Within the reporting period there has been one care home supported by the QPIP process

Safeguarding and quality proactive visits, to improve safeguarding standards across the sector

Quality of care and support planning and risk management

Care Home Champion Model sessions reduced to bi-annual due to improvements in understanding of safeguarding skill and knowledge

The Provider has now achieved and sustained the required improvements from the QPIP and remain on the RADAR

Strengthening practice through the use of action planning via the safeguarding Assurance Framework Audits

Recruitment and retention of Registered Nurses

Input into the Domiciliary Care Providers Champion Model

Development of a number of policy templates to support Providers to strengthen safeguarding arrangements

Lack of access to robust training and supervision

Strengthening MCA arrangements within the CCG footprints via targeted learning and development of resources

Inconsistency in MCA/DoLS implementation


Safeguarding Board Reforms

Under the Children and Social Work Act 2017, Local Safeguarding Children Boards (LSCBs) will be replaced by Safeguarding Partners. Under the new legislation, the three agencies identified as key Safeguarding Partners are Local Authorities, Chief Officers of Police and CCGs who now have equal and joint accountability. Responsibilities for Adults remain unchanged in line with the Care Act 2014.

The CCGs are required to work within the Safeguarding Partner arrangements which include the below Local Authorities:

• Lancashire

• Blackburn with Darwen

• Blackpool Each Local Authority, Constabulary and CCG will remain responsible for fulfilling its own statutory and legislative duties to safeguard and promote the welfare of children. To inform the proposals, CCG representatives have been engaged in significant work streams to transition to the new arrangements. New local arrangements have been implemented since the 29 September 2019 and the previous Safeguarding Children’s Boards have ceased to exist. The new Safeguarding Partnership arrangements have been published and are available via the CCG websites in line with the legislative requirements. A key implication has been highlighted around the CCGs having equal and joint responsibility along with two other key partners Police and Local Authority. This has resulted in the need to develop a strong Health Governance Structure to support the new arrangements.

Lancashire and South Cumbria Designated Network has been provided an opportunity of leading on a Transformation Safeguarding Model in response to legislation and changes across the health landscape, working closely with NHS England, which would also support the new Safeguarding Children Partnership arrangements. The work undertaken has been recognised nationally in respect to collaborative safeguarding work in response to the safeguarding reforms and whole system change.

The CCG presented the model at the 6th National Safeguarding Conference; ‘Reforms to Reality’ on behalf of the Lancashire and South Cumbria CCGs. It was anticipated by sharing experiences and the journey; it would enable others to explore the best ways of influencing

4. Influencing Partnerships


system transformation across health, ensuring safeguarding remains a principle and visible cornerstone of change. A live streaming facility was made available online https://safeguarding.nhsconference.com/ Sharing of the journey continued as following the Conference; a podcast/video presentation of the system leadership work was developed which can be viewed here: in addition to a webinar question and answer session; both have been recognised nationally and will support with encouragement and engagement of local systems across the Country.

Inspectorate – Improvement Journeys An Ofsted inspection of Children’s Services in June 2018 found significant improvements and progress since 2015 and awarded an overall judgement of ‘requires improvement’. A focus visit has since been undertaken in November 2019, where the Inspectors looked at the arrangements for achieving permanence. Improvements were noted with a strong focus on developing the workforce and new systems/tools to scrutinise the quality of the work being implemented. Areas for improvement focussed on improving assessments, plans and management oversight of the child’s records to reduce drift and delay. The CCG will continue to represent at Lancashire’s Getting to Good Board.

Lancashire Family Safeguarding – A Whole System Change

Lancashire County Council has been successful in obtaining £6 million to fund Strengthening Families, Protecting Children Scheme. The model for Lancashire ‘Lancashire Family Safeguarding’ includes intervention through Partners to enable more families to be supported. The new way of working has been pioneered by Hertfordshire County Council in 2015 and has since been extended to other areas of the County. Research has shown the scheme has the potential to reduce the number of children involved in care proceedings. A wide range of Partners are now being made aware of the development of the Lancashire Family Safeguarding in Partnership Programme, which will include the development of Multi-Agency teams to deliver support direct to families. The model is planned to ‘go live’ October 2020.

https://safeguarding.nhsconference.com/

https://www.youtube.com/watch?v=VFqUuZbFWCE


Summary The information contained in this report demonstrates that the CCG’s safeguarding responsibilities are maintained whilst meeting the challenges of the changing landscape. It also draws attention to the work with Partners to support safeguarding service development, delivery methods and governance arrangements. A key area of work has been to support the development of the Safeguarding Health Governance Structure across the ICS to enable a system wide consistent approach. This supports the statutory changes in the Children and Social Work Act (2017), which led to a revised publication of Working Together (July 2018). The new Children Safeguarding Partnership arrangements may pose some challenges going forward; a move to equal partnership with the Local Authority and Constabulary; the changes will impact significantly on the responsibility and accountability of CCGs. This is a key opportunity for Health to take a pro-active role in influencing the new safeguarding arrangements. Whilst there is new legislation to navigate there is a chance for Strategic Health Commissioners to influence how services are commissioned to improve outcomes, ensure the adult and child’s voice is heard and they remain at the centre of decision making. The safeguarding agenda is complex, and arrangements are frequently under review, often due to national drivers and local challenges. Safeguarding is multi-faceted and continues to evolve in line with national policy, legislation and findings from learning reviews. The ever-increasing statute, statutory requirements and rapidly growing nature of the safeguarding agenda for vulnerable children and adults; places a continual increasing demand on resource. Despite this, the Annual Report demonstrates a wide range of activity to support and enhance safeguarding arrangements. In light of the current pandemic, it is uncertain of what the next twelve months will bring. It is anticipated that that there will need to be an increased focus on hidden harms, social isolation and ‘pressure cooker families’ due to the impact of the national lockdown restrictions. Some developments may need to be placed on hold, however it is hoped that the newly developed health governance arrangements will significantly strengthen both an ICS and ICP Partnership based approach to safeguarding. The priorities outlined below will support the CCG to continue to strengthen arrangements and where necessary, mitigate current organisational and partnership risks.


Priorities for 2020-2021

The CCG safeguarding team’s key priorities will continue to be met into 2020/2021. Safeguarding statutory critical business functions are being maintained at this time. Collaborative working will be essential to support implementation of the new reforms including the introduction of the Liberty Protection Safeguards. The safeguarding team will continue to engage in work streams to improve quality, strengthen safeguarding arrangements and where necessary mitigate organisational and partnership risks. The Transformational Model of Safeguarding provides an opportunity to consider new ways of delivering the functions of the Designates role across the ICS to maximise system expertise and improved outcomes. Work will continue on developing the Safeguarding Model to strengthen safeguarding arrangements across the ICS through more effective, safer services, with a focus on patient experience and outcomes. During 2020-2021 the safeguarding team will contribute to the safeguarding priorities by: Ensuring CCG Safeguarding arrangements are in place

• Continue to deliver the CCG core statutory safeguarding functions

• Continue to contribute and influence the Safeguarding Partnerships and Boards

• Ensuring robust CCG safeguarding governance and reporting processes are in place

• Strengthening collaborative safeguarding work in response to the safeguarding reforms

Development and maintenance of high quality standards of safeguarding practices across the health system:

• Support Primary Care Networks to ensure effective safeguarding arrangements are in place

• Realigning Designated and Safeguarding resources across the ICP and ICS

• Monitor, assure and reduce impact when performance fails in order to improve quality (Regulated Care)

• Improve compliance with Looked after Children statutory assessments, develop pathways to improve service delivery and reduce unwarranted variation

• Maximise learning from Serious Incidents and Learning Reviews

• Agreement of a delivery model for the introduction of the Liberty Protection Safeguards Commissioning of safe services:

• Ensure safeguarding is appropriately considered and referenced in all stages of the Commissioning cycle

• Continue to ensure that safeguarding compliance is a requirement of performance monitoring