Partners’ activity

As lead agency for adult safeguarding in the city, we have continued to provide strategic and operational oversight and support for the safeguarding system, and business management and resources to the Plymouth Safeguarding Adult Partnership (PSAP). In addition we manage, deliver and administrate the PSAP multi-level adult safeguarding training programme.

Throughout 2021 to 2022 the Council operational adult safeguarding team went above and beyond their core remit to receive and triage safeguarding concerns, cause s42 enquiries and support or onward referral for cases requiring an alternative response. We have been developing areas of special interest and expertise within the team; these include staff taking a leading role in work linked to areas such as work with those leading complex lives, transition to adulthood, domestic abuse, and homelessness. To maintain and strengthen links to the adult safeguarding message, this year saw team engagement in the following areas:

Partnership working

Regular attendance and participation in the following forums and working groups:

• Channel Panel
• Domestic Abuse and Sexual Violence
• Housing Prevention Partnership
• Commissioning, Quality and Safeguarding partnership working in relation to Dom Care, Extra Care Housing and bed-based care
• Progression of the Changing Futures development strategies and plan across all 4 strands – Workforce Development, Transitions into Adulthood, Lived Experience and Digital Inclusion
• Housing Need Analysis with PCC Commissioners for people with profound and complex needs
• Consistent chairing of and sustained support for the Creative Solutions Forum
• Support for an Extra Care Housing provider following devastating storm damage

Engagement

• conclusion of a joint systemic enquiry in partnership with Shelter, Adult Social Care and social landlord consultation with PCH, presented to the Homeless Prevention Partnership
• development of the Complex Lives system, relationship building and engagement of existing services with the Changing Futures agenda

Learning and assurance

• developing Transitional Safeguarding working arrangements informed by the ‘Bridging the Gap’ guidance.
• development of learning outcomes from the Self Neglect audit
• management and co-ordination of whole service concerns for 12 services across Domiciliary Care and Bed Based Services

Examples of good practice and partnership working include:

Operation Lingo – In 2021 Police identified information suggesting there was a risk of violent crime towards women who were on street sex workers in Plymouth, and an operation was set up to mitigate that risk. An important part of the operation was community engagement; Neighbourhood Police Teams identified more needed to be done to build trust and confidence between sex workers and local police, to aide crime reporting and sharing of intelligence. An outreach team (and a SARC representative) work two evenings a week and a Plymouth Partnership Sex Work Group who meet to scope emerging trends and safeguarding risks and develop a partnership response. In one case, a PCSO has been recognised for excellent work and building trust with the sex workers, without which police would have been completely unaware of an individual who posed a specific risk to the sex workers.

Devon and Cornwall Police have developed a partnership with abortion clinics to improve the flow of information and intelligence by training staff within the clinics to spot the signs of adult sexual exploitation/human trafficking and have created an effective reporting mechanism into the police. It is in its infancy at the moment but has been piloted in another police force and had really positive outcomes.

The force has launched ‘60 second safeguarding’ videos – the first one is on professional curiosity – this is a training tool for our frontline staff and spans both adult and child safeguarding.

We have developed a system for the flagging of repeat green VIST referrals and sharing that information with partners so that risks can be picked up at an earlier stage to prevent escalation.

Through Safer Plymouth, the Community Safety Partnership, police have been involved with the Changing Futures Programme, led by Plymouth City Council. Plymouth is one of only 15 areas awarded the funding, from the Department of Levelling Up, Homes and Communities (formally MHCLG) and the National Lottery, and has been awarded £2.4 million across three years. The Changing Futures Programme seeks to deliver whole system transformation for people experiencing multiple disadvantage including homelessness, substance use, domestic abuse and sexual violence and perpetrator work.

The Probation Service has worked hard to work in a multi-agency way to safeguard adults and address offending behaviour to prevent re-offending in the future.  The following are some good practice examples to highlight this.

Mr C has convictions since 2017, including harassment of his ex-partner and breach of restraining order. For the latter he usually receives short custodial sentences and is supervised by the probation service under a licence and then a longer period of post sentence supervision. He has now been diagnosed with vascular dementia; Adult Social Care have been involved for several years as well as city’s safeguarding teams. Initially it was hoped that he would be able to maintain his home with support but this proved too difficult. His behaviour and lack of co-operation means that he can be released as homeless and his confused state and ill health has led to hospital admissions. The police are fully aware of this vulnerable adult, and professionals have worked together to try and obtain supported accommodation, which provides some stability for a while, although the pandemic has been a particular challenge. His is a progressive condition but what has been important is the way professionals work together and with him to try to provide the best outcomes possible given his difficult life journey, as well as working to protect the public and specific adults.

Person X was in prison, and remained in custody for a number of months following a Parole Board decision to release.  The Probation Practitioner and Prison Offender Manager highlighted the situation and a professionals meeting was called within 12 hours to explore progression. It transpired that the individual remained in prison due to the absence of a Care Act assessment which was required in order to assist a decision regarding Approved Premises placement and any support needs. A prison based Care Act assessment was agreed to be undertaken within 3 working days and a plan devised to actively progress towards release.  Management from Probation and Adult Social Care worked in partnership to arrange staff to progress and are involved in professional meetings.

J is subject of a Community Order for 12 months with requirements of Alcohol Abstinence and Monitoring for 6 months and Rehabilitation Activity Requirement of 15 days.  J has not coped well on the Order and was breached for non-compliance.  When this was concluded and he re-engaged there were concerns for his presentation.  He missed appointments, appeared confused, and his cognitive state was unclear as he did not appear to be under the influence of substances when he attended.  He was encouraged to engage with his own GP but failed to do so.  Attempts were therefore made to link him with the doctor who attends the Probation Office once a week.  He failed to attend one appointment, following which during a face to face supervision appointment, a decision was made for him to see the doctor the following day.  He did attend and the doctor was able to undertake an assessment, diagnosing Korsakoff’s Syndrome (alcohol related dementia), and that his mental state was deteriorating significantly despite him stating everything was fine.  The multi-disciplinary discussion was key in understanding the situation with this man and facilitating onward referral to Adult Social Care, the outcome of his assessment is awaited.

Livewell Southwest CiC (LSW), was founded in 2011 as an employee-led community health and social care enterprise. This means we are a not-for profit organisation which re-invests all revenue back into the services we provide, and the communities we serve.

Last year, much of our strategic, planned work was disrupted by coronavirus while we, quite rightly, focused our minds and workforce on delivering what was needed on the frontline.

Even in the face of adversity we have been presented with the opportunity to innovate and improve across the breadth of our organisation.

For example, over the last year we have joined forces with University Hospital’s Plymouth (UHP) in an Integrated Care Partnership (ICP) that is pivotal in better supporting patient’s needs.

Celebrating our achievements in 2021

Covid Housebound Vaccination Team

Livewell was asked by NHS Devon CCG to support primary care and the whole system by bringing together a group of trained vaccinators to provide Covid booster vaccinations for people who are housebound in their home and care homes, including care home staff. Work included everything from building an amazing administration team to process the referrals, setting up the IT system, checking records to review the Covid vaccinations status of the team, and booking patients in, through to requesting vaccination nurses, undertaking their e-learning, training to get their vaccination competencies signed off with support of the team at Home Park who were very welcoming. Great collaboration for the benefit of our community

Adult Frailty and Specialist Physical Health Services

Establishment of the Livewell Referral and Support Service for all referrals, enabling people to make direct contact to receive advice and signposting. To date the service has supported two thirds of contacts directly, with one third referred onwards to other service(s).

LSW appointed care provider for the short term care centre at the William Patricia Venton Centre (WPVC) and working in partnership with PCC and Age UK.

Mental Health and Wellbeing Services - Plymouth

Establishment of the 24/7 mental health First Response telephone service.

Excellent partnership working, in particular with Devon and Cornwall Police, the Emergency Department (ED) and our Liaison Psychiatry service at Derriford hospital to support people in a mental health crisis, including the development of Alternative to ED (AED)

Focus on the empowerment of service users, families and carers, through the implementation of Triangle of Care in Liaison Psychiatry and increasing peer support worker roles in our community mental health services.

Implementation of the Autism and ADHD service developments.

In 2021, the NHS Devon CCG safeguarding adult safeguarding team developed and rolled out a level 3 safeguarding adult training package. This provides information about local safeguarding processes and complements the Health Education England L3 e-learning package. This training is available to all healthcare providers in Devon including general practices and independent hospitals.

Despite operational pressures due to COVID, general practices have maintained good attendance at the quarterly GP safeguarding leads fora and training sessions. The fora have focused on learning from Safeguarding Adult Reviews, including supporting people who self-neglect, implementing the Mental Capacity Act, and contributing to safeguarding enquiries.

NHS Devon CCG holds regular safeguarding meetings with the independent health provider network and has worked with partners and providers across Plymouth to make good progress to meet the needs of people experiencing domestic abuse and sexual violence. There is now a dedicated specialist worker based within University Hospital Plymouth (UHP) supporting both staff and patients affected by domestic abuse. Staff within UHP and Livewell Southwest have taken up training opportunities to increase their confidence and skill in responding to disclosures of abuse. The commissioning of a domestic abuse and sexual violence training and support programme for all GPs across the city are underway, and expected to roll out from April 2023. This innovative programme will help GPs talk to patients about domestic abuse and sexual violence and offer referral into a specialist support service. Along with Plymouth City Council and other partners across the Peninsular, NHS Devon CCG are pleased to have been selected as NHS England’s first Sexual Violence Trauma Pathfinder site. This three year funded programme will enable us to build on feedback received from people across Devon, and examine how sexual violence support for adults can be improved and expanded.

Annual Safeguarding Report Summary 2021/2022, for Local Safeguarding Adult Boards

3 Key Achievements:

• NHSEI Regional Safeguarding Team successfully completed meetings with safeguarding professionals and senior leaders from each of the 7 Integrated Care Systems (ICSs) with a focus on system governance and readiness for ICS transformation.
• To support succession planning and professional development of our safeguarding workforce, we have funded three training and development opportunities. This also included an opportunity for a small number of safeguarding health staff employed by Local Authorities to access e.g. Public Health Nurse Safeguarding leads. This offer comprised of two University level courses (a safeguarding module funded by a successful bid to Health Education England and the second module with a focus on supervision). The third is a wider flexible continued professional development opportunity.
• The Regional Data Set & Information Governance Reference Group completed its main task and has developed and published the South West Regional Serious Violence and Contextualised Safeguarding Information Governance Framework 2021

3 Key Challenges:

• The delays in the Liberty Protection Safeguard (LPS) consultation and lack of communication about the revised timeline and implementation posed a real challenge to planning and resource management.
• Ensuring the South West region maintained a good oversight of safeguarding statutory reviews to ensure we are maximising learning opportunities from themes arising whilst working national colleagues to implement a new IT solution.
• Maintaining momentum on regional safeguarding work programmes requiring collaboration with local NHS systems during period of extreme operational pressure where frontline services and Covid vaccination programmes were a national and local priority.

3 Priorities for 2022/23:

• Supporting the transformation of CCGs to Integrated Care Boards ensuring safeguarding statutory functions remain central with good governance arrangements. Alongside this, strengthening safeguarding assurance in line with a new national assurance tool and framework.
• We have appointed a NHSEI Regional LPS Clinical Lead for 18 months. They will develop a detailed implementation plan for the NHS to work in collaboration with other system partners to deliver a successful implementation of LPS for the South West.
• Evaluation of the various multiagency projects we have financially supported in 21/22, in conjunction with our multiagency partners to measure impact and monitor outcomes for the Southwest population and its workforce.

Case example of safeguarding as part of multi-agency success in tenancy sustainment

Mr A has no surviving family and has significant mental health issues, a history of alcohol abuse and complex physical health issues. Whilst living at a PCH sheltered scheme he had significant episodes of depression and attempted suicides, prompted by issues of abandonment and feeling people didn’t care. Over a number of years he has been hospitalised for mental health concerns and for attempting to take his life several times, and had frequent episodes of alcohol abuse and stock piling medication. PCH raised a safeguarding concern in regard to his self-neglect.

Due to his not feeling safe and settled, PCH worked with him to consider a ‘new start.’ The Housing with Support Officers worked with colleagues and partners to support the offer of a move, practical arrangements, and engagement with other agencies. Partnership working was undertaken with the safeguarding team, mental health and support services, and support was provided to apply for Warm Home Discount, and with benefits including referral to the Financial Inclusion Service within PCH.

He now works with external mental health support agencies and is engaged with community mental health services. He engages well with several of his neighbours, helping in the garden and discussing the plants with neighbours and staff. He has been on holiday independently, has abstained from alcohol use for a considerable period, and his overall quality of life is much improved.

The Care Act recognised Housing providers as key partners for the first time. As Operational Lead for Safeguarding for a Housing Association with over 135,000 residents and as a housing representative on the PSAB I have keen understanding and appreciation of this. Appropriate housing and related services have a key part to play in the prevention, identification and resolution of safeguarding Issues. Many housing providers struggle with, as one SAR author put it, ‘navigating the knife edge of doing too little and doing too much’ in this arena. There are also key themes that emerge across local authorities in terms of inconsistent process and practice (e.g. inclusion, feedback) which are helpful to understand challenge and influence.

Sovereign have founded a ‘Housing and Safeguarding Best Practice Group’ which I chair. This group of 13 Housing Associations (3 working in Plymouth) with national reach meets quarterly to benchmark data, share best practice, housing related learning from SAR/DHR/IMRs and influence the sector. The group has capped itself at 13 associations to keep it effective but has regular enquiries from others wishing to join. We intend to begin disseminating some of the thematic learning to the wider sector over the next 12 months.

UHP continues to prioritise adult safeguarding as core to its business and values. We have restructured our service to ensure we have greater governance to deliver on our patient and public protection plan. A great deal of work has and continues to take place in terms of training, with national recognition and acknowledgement of partnership working with multi-agency statutory and non-statutory agencies> Many of these relate to strategic safer-city plans in terms of addressing the issues around hidden harm, legal literacy, violence against women and young girls, especially in the context of COVID 19. Conversely, new training opportunities, including accredited courses and modules, have enabled our specialist safeguarding workforce to continue to develop, and address succession planning. Level 3 statutory Safeguarding Adults training is now on the Trust mandatory framework, underpinned by the Intercollegiate Document, and the allocated staff groups are being encouraged to attend (notwithstanding operational pressures) a suite of training offers.

Other strategic innovations that have similarly progressed during 2021-2022 relate to the improved access of subject-matter expert services. We now have a Independent Domestic Violence Advocate (IDVA) funded by the Ministry of Justice, and can, with confidence, provide evidence for improved outcomes for people experiencing domestic abuse and violence.  Similarly, our statutory duty to refer, as a health service provider, those who are homeless (or at risk of) to our commissioned hospital homeless team enables us to keep our citizens across the county safe by securing accommodation on discharge. Systems now in place also allow for the exercise of professional curiosity and for appropriate action both reactively and proactively to be taken.

UHP are ready to navigate the revised Mental Capacity Act legislative framework Liberty Protection Safeguards, and are ready to embrace the responsibilities brought by Responsible Body status. New identified acute general hospital powers are part complete, with a new team ready to secure the protection of safe, legal deprivation, when needed by those people using our services.