Partners’ activity 2022 to 2023

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 the last year the Local Authority operational adult safeguarding team managed the continued increase in demand for their core remit, to receive and triage safeguarding concerns, cause s42 enquiries and support or onward referral for cases requiring an alternative response. In addition we continued to develop areas of special interest and expertise within the team; these include staff taking a leading role in work in areas such as strengthening links to agencies working with those leading complex lives, transition to adulthood, modern slavery, domestic abuse, and homelessness. To maintain and strengthen the adult safeguarding message, this year saw team engagement in the following areas:

Partnership working and Engagement

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

• Channel Panel and Prevent partnership meetings
• Domestic Abuse and Sexual Violence Partnership meetings
• Homelessness Prevention Partnership
• Commissioning, Quality and Safeguarding joint work in relation to Dom Care, Extra Care Housing and bed-based care provision
• progression of the Changing Futures development strategies and plan across all 4 strands – Workforce Development, Transition into Adulthood, Lived Experience and Digital Inclusion
• consistent chairing of and sustained support for the nationally recognised Creative Solutions Forum
• contribution to the Supported Housing Improvement Programme, particularly in terms of how providers keep people safe
• continued development of the Complex Lives system, relationship building and engagement with existing cross-sector services
• regular input to all levels of the adult safeguarding training delivery

Learning and Assurance

• contribution to the continued development of multi-agency Transitional Safeguarding work streams and fora.
• leading the development of multi-agency action planning for the PSAP Quality of Referrals audit
• significant involvement in HM Coronial processes, SAR Learning Events and related action plans
• attendance at service provider forums to facilitate specific information sharing and question and answer sessions on adult safeguarding
• management and co-ordination of whole service concerns for 12 services across Extra Care, Supported Living, Domiciliary Care, residential and nursing care home provision
• Regular attendance at the SW Adult Safeguarding Triage Network, sharing agendas, solutions and operational best practice

The South West (SW) Regional Safeguarding Team at NHS England continue to have sight of the Plymouth Safeguarding Adults Partnership (PSAP) papers however, as of July 2022 they no longer attend the PSAP meetings. Integrated Care Boards (ICBs), who formally replaced NHS Clinical Commissioning Groups (CCGs) on 1 July 2022, remain the statutory partners to the Safeguarding Adult Boards.

The SW Regional Safeguarding Team continue to have formal governance structures in place, as well as working relationships with ICBs and Safeguarding Partners. For example, the Assistant Director of Nursing (Safeguarding) & Regional Safeguarding Lead continues to attend the SW Regional Independent Chairs Network. The SW Regional Safeguarding Team also have quarterly one to one’s with the ICB Regional Chief Nursing Officers and or their deputies as well as other established meetings with the ICB Heads of Safeguarding and Designated Professionals. These are in addition to the SW Safeguarding Steering Group where the ICBs, the blended Regional Public Health representatives and CQC hold formal conversations to acquire updates, test intelligence, oversight and assurance and further opportunities for system challenges to be addressed. The NHS England SW Safeguarding Steering Group reports to the NHS SW Regional Quality Committee and the NHS National Safeguarding Steering Group.

Collectively, the governance structures, reporting requests and relationships in place provide levels of communication, assurance and reassurance around our SW population in respect of NHS safeguarding including the new Serious Violence Duty for ICBs and the wider exploitation workstreams. The information informs our key lines of enquiries at the annual ICB Safeguarding site visits where we produce and exchange intelligence about the local system and test known information. Following the visit, a summary letter is provided for the ICB Accountable Officers and ICB Safeguarding Teams which also informs the statutory ICB annual assessments carried out by NHS England of ICB systems.

We publish the NHS England South West Safeguarding Annual Reports (usually published in the autumn). This sets out our key achievements, key challenges for our seven ICB areas and key priorities for 2023/24.

The NHS England SW Regional Safeguarding Team and Devon ICB remain in contact for any matters that need to be discussed.

Domestic abuse investigation teams (Operation Moonstone) have been established across Devon and Cornwall, who in conjunction with partners support victims, providing specialist advice and safeguarding whilst targeting offenders. Plymouth has also been a pilot area for a sexual abuse investigation team (Operation Gemstone), which follows the best practice and methodology borne out of the Soteria Bluestone research nationally. This approach provides an enhanced understanding of the lived experience of victim-survivors experiences of rape and sexual assault, establishing 5 pillars defining what “good” policing practice looks like, which emphasises:

1. a suspect-focused investigation
2. the disruption of and challenging of repeat offenders
3. embedding a systematic procedural justice to victim engagement during the investigative process
4. an enhanced, specialised officer learning and development programme, sensitive to officer wellbeing joined up seamlessly with the challenges of rape and serious sexual offences (RASSO) complaints in force as well as academic evidence drawn from a variety of disciplines
5. using data-led, performance-savvy monitoring and evaluation of new investigative strategies and justice outcomes, to improve understanding of RASSO reporting and outcomes

This year has seen the launch of the LEPH link (Law Enforcement and Public Health Link). Again with Plymouth as the pilot area and accessible to each officer via their PDA it is designed to support front line officers with access to the public health information they need at the click of a button. During interactions it provides a bespoke Public Health resource to assist police officers to raise awareness, motivate and signpost people to help them to improve their health and wellbeing covering a wide range of issues.

Operation Night eye is the force's response to violence against women and girls within the evening and night-time economy. As well as the traditional high visibility policing, preventative action has been taken with specially trained officers deployed within key areas to identify predatory behaviour, with early intervention. A successful partnership bid for Safer Street 4 Home Office funding led by the University of Plymouth has facilitated the purchase of a mobile CCTV van which will provide a visible deterrent as well as capturing evidence to target offenders.

Healthwatch Plymouth is one of 152 local statutory organisations under the 2012 Health & Social Care Act.  One of our core functions is to talk to patients and the public about their experiences of health & social care services and present these voices to commissioners and providers to make services more effective in meeting patient needs.  As a result of this, Healthwatch Plymouth sits on several committees including the Plymouth Health and Wellbeing Board and the Plymouth Adults Safeguarding Partnership.

During our conversations with patients and relatives, we sometimes come across individuals who are vulnerable and maybe at risk.  As a result of this we will make a safeguarding alert if we have concerns for the individual’s safety or provide the individual with information about Adult Safeguarding and how to contact.

We also support the Partnership with communications of information through our Social Media, regular e-Bulletin and to our Healthwatch Assist Network of local groups.

In 2022 - 23, NHS Devon safeguarding adult safeguarding team has supported the ICB in discharging its statutory duties by attendance at, and support of, PSAP board and subgroup meetings.

NHS Devon continue to provide safeguarding level 3 training to ICB staff to complement the Health Education England L3 e-learning package.  

The team gains assurance of the safeguarding element of the services NHS Devon commission through attendance at those providers safeguarding governance meetings, regular meetings with provider safeguarding leads, and identification of both good and poor practice through the serious incident and case review processes (e.g. S 42, safeguarding adult reviews, domestic homicide reviews).

The learning from an HM Coroner’s Regulation 28 Prevention of Future Deaths report has been circulated to all healthcare providers and Safeguarding Adult Partnerships emphasising the link between self-neglect and the risks of developing sepsis through poor personal care. NHS Devon has incorporated SAR learning from across Devon, in particular regarding self-neglect and cross LA border commissioning, into training delivered to staff, in supervision, and to GPs via the GP forums, which remain well attended.  

The designated nurse has coordinated work between Devon and Cornwall Police and the health provider delivering services within the police custody suits to enable them to have access to the Devon and Cornwall Care Record (DCCR). This will enable more effective management of detainee’s healthcare whilst they are in custody in Plymouth and across the Devon and Cornwall Police footprint.

In November 2022, an NHS England safeguarding visit took place between the assistant director for nursing (safeguarding) & regional safeguarding lead, NHS England Southwest, and key strategic leads for safeguarding within NHS Devon. Feedback received highlighted that safeguarding remains a priority during times of pressure and change within the system, and noted improved relationships and workings between NHS Devon safeguarding and NHS Devon commissioning across the commissioning cycle.

The domestic abuse and sexual violence training and support programme for all GPs across the city is underway. This innovative programme helps GPs talk to patients about domestic abuse and sexual violence and offer referral into a specialist support service.

The NHS Devon MCA practitioner has been working to upskill NHS Devon staff, in preparation for the responsibilities under the Liberty Protection Safeguards arrangements. Due to this now being paused by the Government, NHS Devon continue to support identification of, and application for, community deprivation of liberty safeguards for those deprived of their liberty whilst receiving funded health care in their own homes. NHS Devon continues to support MCA leads in health providers across Devon through a network meeting for dissemination of information and relevant case law to enhance the MCA practice of frontline staff.

Livewell Southwest which 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.

In 2021 we have joined with University Hospital’s Plymouth (UHP) in an Integrated Care Partnership (ICP) that is pivotal in better supporting patient’s needs.

Our services are provided across Plymouth, South Hams and West Devon. The Director of Quality & Safety or Deputy attend the Plymouth Adult Safeguarding Partnership, Plymouth Children’s Safeguarding Partnership & Torbay & Devon Safeguarding Adults Partnership Board.

Livewell Southwest and Plymouth City Council continue to work in partnership in relation to Adult Safeguarding; there is a regular interface meeting that takes place bi-monthly to discuss Safeguarding themes/trends/pressures and high-risk cases where there are significant concerns. This interface meeting has proven useful in relation to sharing of information and understanding system pressures across both areas.  

Training

Over the last year we have focused on the implementing of Level 3 Safeguarding training which is a key factor in continuously improving safeguarding practice. The Safeguarding Adults Training Working Party continues, which offer opportunities to share learning and has been pivotal in implementing Level 3 Safeguarding Adults  training across our staff.

Our Professional Training Development team have been working on interactive face to face/virtual training with the Adult Social Care Safeguarding Team which will cover all key learning outcomes of level 3 that staff can access passport style, in additional to baseline e-learning to support a passport style approach to learning.

The health sector can make a positive contribution towards safeguarding those that might be less able to protect themselves from harm, neglect, or abuse. Central to effective safeguarding management are trustful and supportive relationships, based upon dignity and respect between patients, their families and healthcare staff. We therefore have a responsibility to be active and responsive ensuring people’s dignity and rights and meeting statutory duties to safeguard adults.

University Hospital Plymouth has a New Executive who holds the Safeguarding portfolio; Chief Nursing Officer Darryn Alcorn.  

Our integrated safeguarding service continued to evolve in 2023 and the model of a “Think Family” approach to safeguarding continued to be promoted across the Trust.

Safeguarding training was updated to highlight significant changes to the service such as the anticipated Liberty Protection Safeguards (LPS), this will now reorientate to continue to support staff with understanding Mental Capacity and policy updates included ‘Was Not Brought’ with an adult focus.

A total of approximately 550 staff across UHP have received face-to-face bespoke training from the safeguarding nursing team.

Plans for 2023 include the expansion of the midwifery community safeguarding team so the Continuity of Care model can be implemented. This will support more vulnerable women and those people who are pregnant and with robust supervision and escalation plans it will accommodate those not under the care of the vulnerable women’s team. Plymouth perinatal team have seen a recent increase in referrals and have increased their capacity to undertake interventions and assessments by 10% and in there has been investment in a perinatal mental health midwife.

UHP hosted a regional FGM study day which was led by University Hospitals Plymouth NHS Trust and in partnership with Devon and Cornwall Police, is arranged for the 24th of March in the Post Graduate Centre.

Safeguarding adult contacts and referrals for adults living complex lives and those at risk of harm continue to rise. Types of concern continue to trend Self-Neglect, Domestic Abuse and alleged Neglect and Acts of Omission in Care; that said, activity for subject-matter advice and enquiries for mental health and adult social care support are on the increase.

The commissioned “Hospital Homeless Team” continue to provide a 7-day service (albeit based off site, in the city).  Similarly, The Advocacy Service provide full-time personnel to support the Trust.

The CCG funded fixed-term funding (via the Ministry of Justice) for a dedicated hospital-based IDVA (Independent Domestic Violence Advocate) and this has been extended until March 2025. This will be audited to understand the level of need with a view to applying for funding for a permanent IDVA.

UHP supported and participated in Plymouth’s 16 Days of Action/Activism (25/11/2022- 10/12/2022) campaign, particularly poignant in remembering the murder of young Bobbi and the domestic homicide associated with the mass incident in the city.

Sovereign continue to provide services in the city and strive for excellence in the Safeguarding space and contribute well to the Plymouth agenda offering a housing voice.

Sovereign also founded a ‘Housing and Safeguarding Best Practice Group’ which Jon Cox (PSAP Member) chairs. This group has expanded to 18 Housing Associations (3 working in Plymouth). It has national reach and meets quarterly to benchmark data, share best practice, housing related learning from SAR/DHR/IMRs and influence the sector. The group has capped itself will be capped 20 associations to keep it effective but has regular enquiries from others wishing to join including 2 applications pending. The outputs and learning from this group benefit the PSAP agenda and debate drawing in knowledge from hundreds of local authorities.

Jon is keen to ensure that Safeguarding is considered in governments suggested new approaches to ASB – taking part as a panel member/SME at the Chartered Institute of Housings Roundtable event (May23) and also being asked to speak at the Westminster Insights Conference in (Sept 23). Jon is also a member of the DLUHC ASB Advisory Panel and has submitted a Plymouth based Safeguarding case example as best practice and potential publication.

We are LiveWest and we own and manage over 39,000 homes across the South West, from Cornwall to Gloucestershire and includes the City of Plymouth.

It is increasingly recognised that housing has a vital role to play in Safeguarding and picking up on signs of abuse, neglect, exploitation, self-harm, and the Covid-19 pandemic has focussed the significance of this.

Safeguarding is about protecting children, young people and vulnerable adults from abuse and neglect. At LiveWest everybody has the right to be safe no matter who they are or what their circumstance.

We look at safeguarding as everybody’s business, we employ 1,500 people and it is their responsibility to be aware of potential safeguarding situations, we take safeguarding seriously and have policies and procedures that help to identify and take action where we think a vulnerable person might be at risk.”

There are vulnerable people living across all of our homes. Working in partnership to safeguard vulnerable adults starts from within. Colleagues need to be able to identify safeguarding signs, including domestic abuse when they come across it in communities and households.

We have a dedicated Safeguarding Lead role who has responsibility for overseeing the concerns raised internally and advising on escalation to Adults or Children’s’ Safeguarding as required, then helping the case owners to work collaboratively with external agencies to provide safeguards to our residents who need to be safeguarded.

We have a Safeguarding Leads group, it is chaired by our Director of Supported Housing and includes leads from across our services including in-house maintenance teams. Often it is the tradespeople that have access to our households that are the eyes and ears of our organisation. They can pick up on signs that things are not quite right and flag to the safeguarding team.

During 22-23 we managed 624 cases across our entire geography, this was a 29% increase in reporting from the previous year. 73 of these cases were generated in Plymouth, and was a 47% increase on the previous year. Neglect, Self-Neglect and Suicidal Ideation were the most reported and working together with SORT, Police, ASC and CSC we supported a coordinated community response in safeguarding those identified.

At Plymouth Community Homes our Code of Governance requires that our Board are provided with regular assurance about safeguarding. Our update presented to Board this year included continuous improvement actions made during the year:

Following a review of the way we document safeguarding cases we completed a transfer onto a different system, with processes and procedures quality assured, and we updated our guidance and information for staff.

We continue to work closely with partners to ensure our safeguarding approach and practice is robust. Plymouth Community Homes are members of the HQN (Housing Quality Network) Housing and Safeguarding Best Practice Group, who have social landlord members from across the UK, and we meet quarterly to share good practice and lessons learnt from case work. We work with a range of partners including MARAC (Multi Agency Risk Assessment Conference) PDAS (Plymouth Domestic Abuse Service), the Domestic Abuse and Sexual Violence partnership (DASV), and the local authority Safer Accommodation Forum. We also meet regularly with the Police around Race & Hate Crime, the Safer Plymouth partnership, Community Connections and we engage with the Creative Solutions forum to help resolve challenging cases.
Working with Spectrum our commitment to delivering regular training for all our staff has continued with different training delivered to different roles. Safeguarding for Decision Makers, which includes content around the Mental Capacity Act, Safeguarding Overview, aimed at staff who are based in the community, and Safeguarding Awareness.

The Probation Service is committed to reducing re-offending, preventing victims, and protecting the public. As a service, safeguarding adults is integral to the work we do.

We recognise that whilst we work to protect vulnerable and at-risk adults from harm and exploitation by People on probation, a significant number of the probation population have their own vulnerabilities that in themselves also require safeguarding and focused intervention.

In recognition of the diverse needs of our people on probation , Plymouth Probation has recently developed specialist pod working, to address the specific needs of identifiable cohorts that will benefit from a more bespoke approach in order to safeguard themselves and others , these include Young adults, women and IOM. 

We work collaboratively with our partners to safeguard adults from harm through formal forums such as MAPPA, MARAC, Channel Panel, Child Protection and also through less formal forums such as multi-agency risk meetings, creative solutions and professional meetings. Within each we engage with statutory and non-statutory agencies to prevent victims and improve outcomes.

We ensure our workforce are kept up  to date with the most recent safeguarding processes and procedures via our own ‘inhouse’  adult  safeguarding training and also  by accessing  training from the local adult safeguarding board and other partner agencies.

As a learning organisation we actively contribute to and take learning from multiagency reviews such as Domestic Homicide reviews, MAPPA SCRs and Adult and Child safeguarding reviews. We also take learning from our own internal Serious Further Offence (SFO) reviews and HMIP Inspection outcomes to continually review and enhance our practice in safeguarding others. An example of national learning and practice change from a review is the mandatory safeguarding checks for all curfew sentences to ensure all persons at an address are kept safe.

• Devon and Somerset Fire and Rescue Service’s (DSFRS) Safeguarding Team’s main area of work focusses on the safeguarding of adults and children at risk whom our staff encounter out in the community whilst undertaking their duties. This could include those whose behaviours pose a fire risk in the home, those experiencing abuse or neglect, or those who are in need of extra support in their daily lives. Our Safeguarding Team work closely with firefighters who raise referrals for vulnerable individuals they come into contact with at operational incidents, and also with Home Safety Technicians who carry out Home Safety Visits, providing fire safety advice and equipment to reduce the risk of fire and serious incidents in the community.
• We encourage staff, through training and continual feedback, to maintain a sense of professional curiosity. We have adapted our internal safeguarding referral form to ensure that the voice of the individual is captured and to understand the importance of gaining consent. This ensures when we are making referrals through to Adult Social Care our referrals contain sufficient and relevant information.
• In recent months, DSFRS have set up a Strategic Safeguarding Board, which is made up of senior leaders within the organisation and is headed by the Chief Fire Officer to raise the profile of Safeguarding and push important pieces of work forwards. The board will hold the organisation to account and ensure any key issues or current topics are addressed, and that the messages are fed back to all departments.
• DSFRS have an extensive network of partnerships including social care, housing providers, care agencies, Police and other local authorities across the two counties. We work with our partners on a daily basis to share information of people at risk to ensure they have the opportunity to access the care and support they require. Our Safeguarding Team also attend multiagency meetings to highlight fire safety concerns that individuals have shown and offer advice as to how to best reduce these risks.
• We are now able to explore the option of providing additional bespoke equipment during our Home Safety Visits whereby a particular risk has been identified, for example air fryers that are a safer alternative to chip pan fryers.
• The DSFRS Safeguarding Team have realigned roles to specialise in specific areas relating to safeguarding including Domestic Violence and Hate Crime. In addition to this, the team have established links with Modern Slavery Partnerships and will share information at the earliest opportunity around any issues relating to Modern Slavery that might be identified within fire service activities with partner agencies to ensure the safeguarding of adults or children at risk.