Partners’ activity 2023 to 2024

The operational adult safeguarding team have carried out a number of innovations to improve the service this year:

• A move to a new database and procedure system in June 2023, ensuring more efficient management of demand.
• The adult safeguarding advice line went live in September 2023, designed to provide advice and support for decision making in safeguarding referrals. This has been well received by callers and resulted in raised awareness of criteria and an improvement in the quality of referrals. 
• As a response to recommendations in local and national Safeguarding Adult Reviews, we developed a new response to concerns regarding self neglect. Following triage and risk assessment we now endeavour to visit the person within 48 hours to further inform the response and provide support as appropriate.
• We continued to develop monthly review meetings to ensure links between the PCC safeguarding team and the ‘front door’ team and the Adult Frailty pathway in Adult Social Care.
• As a response to high levels of referrals not meeting the criteria for a statutory safeguarding response, we reviewed, redesigned and relaunched our online referral form for professionals in February and March 2024.
• Partnership and inter-team working has been strengthened during the year 23/24 including operational and strategic links to:
  • The Violence Against Women and Girls (VAWG) and Domestic Abuse and Sexual Violence (DASV) agendas and workstreams
  • Channel Panel and Prevent Partnership
  • Multi-agency Risk Assessment Conferences (MARAC)
  • PCC Corporate Parenting group
  • Adolescent safety planning and transitional safeguarding (which has now developed into transition pathway development)
  • Support for the PCC Contact Centre
  • Support on Domestic Homicide Review panels

Strategically, along with corporate work, we have

• continued to chair the cross-City, multi-agency Strategic Safeguarding Leads network
• continued to support and attend local, regional and national networks
• provided central resources and chairing for PSAP and its sub groups
• reviewed and maintained the adult safeguarding webpages and multi-agency adult safeguarding guidance
• contributed to preparation for the CQC Assurance Framework visit in partnership with colleagues from Livewell Southwest, led work to develop a streamlined, integrated adult safeguarding pathway. The project delivery group, formed from practitioners and managers from both organisations in early 2024, have developed terms of reference and a delivery plan. Future work will focus on consultation and testing of the ‘as is’ and ‘to be’ models.

In terms of the wider Devon & Cornwall force, following several Safeguarding Adult Reviews that highlighted the need for early identification of risk we now have introduced a process within our Central Safeguarding Team whereby repeat low grade Public Protection Notices (PPNs) are flagged for a review. A PPN is an information-sharing document that records safeguarding concerns about an adult or child. PPNs are shared with partner agencies to inform a multi-agency response. Now, if an individual has 3 or more low grade PPNs submitted within a 3 month period, it is flagged for review so that officers can assess whether risk is escalating or whether, by looking at the incidents in a wider context, rather than as isolated incidents, the risk level should be raised and more proactive safeguarding measures taken with partners.

In terms of support to the PSAP, the Partnership Superintendent for Plymouth has acted as the executive lead for a Safeguarding Adult Review (SAR), providing senior independent oversight of the process and content. In addition, the Criminal Case Review Unit have contributed significantly to a number of SAR panels, acted as standing members of the SAR Sub-group, and with other staff positively represented the Police and PSAP at SAR learning events.

We have developed and cascaded out to the Devon and Somerset Fire and Rescue Service (DSFRS) a Tier 1 Safeguarding Training Package for all staff across the organisation to complete to increase knowledge around safeguarding and ensuring clear and robust safeguarding processes are embedded throughout the organisation. This is the first time all staff have been required to complete safeguarding training and we are now building on this and developing a comprehensive training strategy in addition to a competency framework.

Example supports the core legal requirements under the Care Act (Big S):

We continue to work with numerous partners across Devon and Somerset and we continue to carry out Home Safety Visit for adults at risk. We deliver a comprehensive ‘Trigger Point Awareness Package’ to partners to ensure they are aware of the signs to look out for that might mean someone is at risk of having a fire. This ensures we receive referrals at the earliest opportunity and can signpost individuals to support or raise safeguarding referrals where necessary if someone is at risk of having a fire.

DSFRS have been working hard to embed the safeguarding culture within the organisation, including the provision of ‘Speak Up Guardians’ which provides staff with an opportunity to raise concerns about inappropriate or unethical behaviour that may have safeguarding implications. DSFRS also have a Whistleblowing Policy and an Allegations Management procedure. DSFRS have established a Safeguarding Steering Group Meeting involving key stakeholders across the organisation to ensure safe practices including Safer Recruitment and other procedures are in place and adhered to.

Examples support the wider preventative system (Little s)

Our DWP Vulnerable Customer teams (VCT) continue to support customers and maintain strong links with adult safeguarding services. Below are case examples of what partnership working has achieved:

Claimant KP approached us to request a food voucher because he was hungry and said his family kept his benefit money, weren’t feeding him regular meals and regularly locked him in his flat. He said he was afraid of his family and didn’t know what to do to get out of the situation. A safe-guarding referral was submitted, an urgent multi-agency meeting requested, and Plymouth City Council provided emergency accommodation.  Adult Social Care (ASC) allocated a social worker, subsequent assessments identified capacity issues, significant health conditions and a learning disability. The VCT sorted KP’s benefits, prevented 3^rd party access, removed the 3^rd party bank account, and arranged for weekly payments. KP struggled to live in the temporary accommodation and went to live with a different family member, but this was unsuccessful. ASC arranged sheltered supported accommodation with a package of care. KP is now managing his benefits and able to budget due to weekly payments of his benefit and he is aware of the local support available. Having multi-agency support enabled KP to escape from the situation he was in and with support he was able to make his own life choices – KP has since flourished and is safe & well.

Vulnerable homeless lady BC lived in her car, she granted consent to make a duty referral for homelessness to Plymouth City Council, but didn’t trust social services and medical professionals and declined all offers of support and signposting to local homeless support services. BC was on the standard allowance with no health-related benefits in payment. After a few months we noticed a decline in her appearance and behaviour; she was dirty, lost weight, was wearing unsuitable clothes and started talking erratically. We highlighted the benefits of engaging with other services like Adult Social Care and her GP, and she agreed. We completed a safeguarding referral, but ASC had trouble locating the person, because she had 8 alias names. A social worker was assigned and a multi-agency meeting was arranged and chaired by ASC, attendees were local Community Police, her GP, Rough Sleeping Team, Community Connections Housing Officer, support worker from Shekinah and our Vulnerable Customer team. At this meeting professionals raised concerns for her wellbeing and agreed there was significant risk to her life due to the onset of winter if she remained in her car. BC was offered emergency accommodation, medical support provided to start Universal Credit health journey, local Police agreed keep a distant eye out for her car, Shekinah support worker was able to provide food, blankets and warm clothing. BC was offered social housing and she was supported in the accommodation by her social worker. Appropriate benefits were awarded on the evidence provided by her GP and Social Worker. Unfortunately, BC has since left the social housing accommodation due to ‘bad spirits and monsters’ and is back living in her car.

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.

We have been pleased to join colleagues in Plymouth City Council to begin to develop a streamlined and integrated adult safeguarding operational pathway. This involves staff from both organisations joining in partnership to develop a single process to remove handover points from the current process and create a single safeguarding journey from referral to enquiry completion.

We have developed a new audit process for our adult safeguarding work, in which the safeguarding team and team manager have engaged very successfully. This involves consistently auditing completed Safeguarding Enquiries for quality assurance purposes and taking learning, both positive and in areas for improvement.

• Since January 2024 there have been 39 audits completed relating to completed Section 42 Safeguarding enquiries. The expectation being for a minimum of 4 per month.
• Learning so far includes:
• Need for more clear recording of feedback to referrer
• Enquiry completion time, known area for improvement
• Evidence of other professional or person involvement, was generally very positive, including that from care providers, District Nursing team, housing, drug and alcohol team, community mental health team.
• Evidence of action taken around immediate risk is very positive, all Good or above.
• continued work with PCC Safeguarding team around audit work being undertaken by the Principle Social worker and Senior Practitioner.

Brief case study

• P is 27 years old, living with Mum, their current boyfriend and ex-partner in the same household.
• P has a learning disability, which contributes to P not being able to protect themselves from experiencing abuse from others.
• Reported concerns relating to psychological abuse, financial abuse and domestic abuse in the household. The relationship dynamic in the household was reported to be volatile; as all parties are in a relationship together, P witnessing negative aspects of this situation.
• Care provider was key in providing accurate information in relation to the safeguarding concerns.
• Reported concerns include ‘belittling’ and ‘shouting’ at P, manipulation of P’s finances, P likely witnessing domestic abuse in the household, P coerced to witness self-harm by mother.   
• Safeguarding enquiry commenced, multi-agency approach/Safeguarding strategy meeting held to discuss concerns.
• P was assessed as lacking mental capacity in regard to the safeguarding process, IMCA assigned to support P in expressing their views and wishes.  
• P expressed a wish to leave the family home and a best interest decision was made by a social worker.
• Creative approach undertaken to facilitate a change of accommodation into temporary respite provided by the existing care provider, maintaining continuity of care arrangements which was important for P.
• This enabled onward assessments of P’s care and support needs outside of the family environment and development of a risk management plan to support identified risks such as contact from family.
• Legal arrangements applied for the management of financial affairs. Long term accommodation being explored.
• P’s presentation and overall wellbeing has improved, P indicates they feel ‘safe and happy.’

Throughout 2023/24, the NHS Devon Safeguarding team have remained active members of the PSAP SAR subgroup and panels and the Assurance subgroup.

The work of the team was recognised locally in 2023 with a West Country Women’s Award for the Head of Safeguarding’s work to combat violence against women and girls. This was in recognition of the work she had done in Devon to improve how GPs and hospitals respond to people who have experienced domestic abuse or sexual violence.

In February 2024, an NHS England Safeguarding Visit took place. The meeting highlighted the significant system leadership changes during the year including the new ICB Chief Executive, Interim Chief Nurse and new Deputy Chief Nurse arrangements. Some of these changes have been mitigated by a stable NHS Devon safeguarding team who have been able to provide consistency to the safeguarding partnerships. Safeguarding remains a priority in the NHS despite the continued extreme pressures on the health system.

Following NHS Devon taking on delegated responsibility for dental, ophthalmic and pharmaceutical services (POD) in April 2023, the safeguarding team have worked closely with the Collaborative Commissioning Hub to support the design and delivery of POD services. To support all aspects of the implementation of the Mental Capacity Act (MCA), the NHS Devon MCA lead continues to lead a Devon wide network that supports MCA leads in Trusts to share practice and resources. Through the training and supervision of staff, the NHS Devon Safeguarding Team raise awareness of the learning identified through Safeguarding Adult Reviews and promote good practice such as professional curiosity, and the recognition of self-neglect and hidden harm.

Plymouth Community Homes is fully committed to partnership working and principles of adult safeguarding and this can be demonstrated in this case study:

Mrs C moved into sheltered housing with PCH 4 years ago. Mrs C has a range of vulnerabilities and is resistant to engaging with professionals. Over time she has received a lot of support from the Housing with Support Officer (HSO) to maintain her tenancy, keep her home safe, maximise her income, manage her physical health, mental health, and substance misuse.

Mrs C was admitted to hospital following a fall in her property in December 2023 and was discharged home at the end of January 2024. Mrs C had declined support from Age UK on discharge, but as the HSO was visiting regularly to check on Mrs C’s welfare they were able to establish very quickly that Mrs C was not coping and was at risk of self-neglect.  The HSO was also concerned that Mrs C continued to be a fall risk due to her reduced mobility and COPD. The HSO raised a safeguarding alert to the local authority and dealt with the immediate risk by arranging for a food parcel and GP referral. The HSO liaised with the GP and the Pharmacist to ensure that medication is delivered to the property on time. Mrs C has misplaced several pendant alarms within her home which have been replaced promptly and Mrs C reminded frequently about the importance of wearing it. The HSO continues to visit weekly to monitor the safety of the property and check on Mrs C’s welfare, and has worked closely with Age UK, adult safeguarding, health agencies and Adult Social Care to support Mrs C to achieve positive outcomes which mean that she is safe.  These positive outcomes for Mrs C and the successful partnership working have been possible because the PCH HSO has a relationship of trust with Mrs C that has been built up over the years she has lived at the scheme, as well as with the other agencies involved.  

University Hospital Plymouth NHS Trust’s integrated safeguarding service continues to advance the ‘Think Family’ model, delivered through a trauma informed lens. In 2023-24 the integrated children and adult safeguarding team maintained high visibility across the Trust to support staff recognition and response to concerns. To keep our workforce skilled to the correct levels, in keeping with the intercollegiate document, educational training opportunities are readily available in a blended approach that suits the needs of all staff whether patient facing or as part of our support workforce.

In addition, we have promoted, participated in, and showcased the importance of safeguarding restorative supervision with ‘drop-in’ clinics and forums whereby ‘champions’ can access subject expert advice, as well as opportunities for staff to reflect, recalibrate and recover from the various experiences encountered in the course of an exceptionally busy provider setting.

Safeguarding adult contacts and referrals continued to rise, and this highlights the additional work undertaken by the team safeguarding our patients. Types of concern continued to trend in line with the national picture, self-neglect, domestic abuse and alleged neglect and acts of omission in care. Activity for advice and enquiries for mental health and adult social care support have also seen an increase this year. Working together with the Hospital Homeless Service and Health Inclusion Pathway teams we are in the process of creating a complex lives hub. This will enable us to hold and manage the collective risks for our complex communities accessing acute health services here at the acute hospital.

The fixed-term funded Health Independent Domestic Violence Advocate (IDVA) and the hosted Advocacy Service Independent Mental Capacity Advocate (IMCA), deliver assurance of UHP’s commitment to improving outcomes for people using our services. Moreover, there is a collegiate response for those at risk from domestic abuse and those in need of advocacy with strong partnership arrangements to support these agendas. We support a focus on the voice of those who use our services and have had a direct experience of ‘hospital’ safeguarding. Increasing legal literacy and knowledge around the statutory duties to refer continues to be a piece of work that support frontline clinicians in recognising safeguarding concerns. The following is just one example to demonstrate the difference the safeguarding team makes.

 A continuing area of concern relates to patients who are self-neglecting. It is vital that we work with our system partners to identify, refer, and participate in the care management and risk reduction of this cohort.

A gentleman was found sleeping rough in hospital grounds having fled an honour-based violence situation. Safeguarding services undertook robust supportive measures that resulted in an out-of-county placement securing his safety. Whilst an acute hospital is not the optimal place, the safeguarding team were and are increasingly adept at ensuring immediate security plans are put in place to prevent further harm/criminal acts, to adults with care and support needs at risk of harm.

As a housing representative on the Plymouth Safeguarding Adults Partnership (PSAP) and Head of Tenancy Sustainment for Sovereign, it felt important that learning flowed in and out of the partnership from a broad church of Registered Housing Providers (RP’s) working across Plymouth. There wasn’t really the forum to do this regularly and with any real impact; I felt a regular meeting of RPs would be beneficial to Plymouth and the RP members alike. I started the group with 6 members, 4 of which worked in the SW/Plymouth area. The Group has over time expanded to a capped 25 RP members and has national reach. The Group meets quarterly to discuss/develop best practice and share useful information, we have also put out several Safeguarding articles in sector press and I’ve spoken at several conferences. The impact for Plymouth is that now the PSAP benefits from the learnings coming out of a national forum but also that most of its main housing provider organisations are represented on the group. In 2023, I was honoured to win the Partnership Award at the National Safeguarding Adults Boards Excellence Awards for my work in developing this group after being nominated for this by PSAP. AS an organisation we fell that this reflects our commitment to the core principles of adult safeguarding – Partnership, Prevention and Protection.