Response to Covid-19

In 2020 DWP introduced teams to lead work on its approach to supporting vulnerable customers. As part of this, a network of over 30 Advanced Customer Support Senior Leaders (ACSSLs) were appointed, providing an escalation route for all DWP colleagues to refer to when a customer requires some form of advanced support, ensuring that these customers are signposted or referred to the support that they need

ACSSLs work with a range of external partners within their own geographical area, aligning support for vulnerable customers wherever possible. They have formed a network of robust links within local communities across England, Scotland and Wales that form an integral element of DWPs wider partnership agenda

Whilst DWP does not have a legal duty to ‘safeguard’, we absolutely recognise the positive impact that a collaborative approach can have when supporting vulnerable customers.  We continue to work across all internal teams and with our external partners to help to provide the support that customers require.

The impact of COVID-19 has been significant in terms of how Devon and Cornwall Police have had to adjust to safeguard the most vulnerable within our communities. Abuse and neglect have been less visible throughout the imposed lockdowns and we have had to adapt our use of technology and working practices with partners in order to protect vulnerable individuals.

Throughout the pandemic overall crime has reduced when compared to pre-pandemic levels with offences such as shoplifting, burglary, vehicle offences and violence with injury all reduced when compared to last year. However, there has been an increase in domestic violence, hate crime and drugs related offences.

Domestic Abuse continues to be a priority for the Force. We are encouraging the use of Evidence Led Prosecutions which is when the victim of domestic abuse decides not to support prosecution and police and prosecutors can consider whether it is possible to bring a prosecution without that support. We are raising awareness among staff and training is being developed. We are also raising awareness of the ‘Think Family’ approach to ensure Children and family members are considered when attending domestic abuse incidents.

Fraud and scams have increased during COVID-19 and we now have a dedicated Fraud Lead within our Investigation and Resolution Team who works closely with Action Fraud and our regional Economic Crime Department to identify trends and investigate fraud offences.

Rapid Review meetings were set up in April 2020 as the initial response to ensure that Rape and Sexual Assault victims were receiving the best service possible during lock down. This was a daily meeting, sharing information on referrals and ensuring sustainability during restrictions. Learning was shared with individuals and the force. We have also worked with our Sexual Assault referral centres (SARC) so that victims of sexual assaults have been supported throughout COVID 19 restrictions via the use of telephone consultations and videoconferencing.

We have recognised the impact COVID-19 may have on mental health. Our training materials for officers and staff, which provides an overview of Mental Health and Learning Disabilities are being updated, which includes classroom training and is part of the College's national policing curriculum.

Throughout this 20/21 period, the NHS Devon CCG Safeguarding Team has responded dynamically to support health providers and safeguarding partners in responding to the COVID-19 pandemic. The team:

• gained assurance from providers’ business continuity plans that safeguarding remained a priority whilst dealing with the pandemic.
• held regular meetings with provider safeguarding leads to gain assurance regarding safeguarding processes, discuss any issues, find solutions and share good practice, and for leads to gain support from each other and the designated teams.
• worked with safeguarding partners to gain assurance that adults at risk of abuse under the Care Act continued to be safeguarded and implement solutions to improve COVID secure safeguarding practice.
• coordinated the planning of the safeguarding response required for the Nightingale Hospital Exeter.
• continued to lead investigations into safeguarding concerns.
• supported the CCG and wider health system in responding to COVID-19 including participation in the mass vaccination programme and providing assistance to other teams.

During 20/21, NHS Devon CCG has recruited an additional safeguarding adult nurse to work alongside the Designated Nurses to support S42 enquiries, strengthened the Primary Care Safeguarding team including the recruitment of a Named Nurse and Named GP. The team provide support, advice and guidance to GP Safeguarding Leads to enable primary care teams to identify and respond to safeguarding needs. The CCG has also recruited a Domestic Abuse and Sexual Violence (DASV) Lead who is working with health providers across Devon to improve the response of health staff to DASV. This has included delivery of Train the Trainer sessions to enable staff to respond to both victims and perpetrators of abuse, sharing of strategies and policies, and funding of resources.

As some community services were stepped back or scaled down during the pandemic; undertaking Safeguarding enquiries remained a core responsibility that was maintained throughout by the Livewell Southwest Adult Safeguarding team. Similar to many other teams and agencies – the staff had to adapt to a changing situation with working from home, utilising remote working and technology being key to sustain a service and operate business continuity.

One of the significant changes that continues to work well involved the emergence of virtual multi-disciplinary meetings both for Safeguarding strategy and risk management. Historically it has been a challenge to synchronize other professionals/agencies around a table for a face to face meeting, there would be the time and co-ordination required to source a meeting room and venue, travel time and parking etc.; thus potentially creating delays to Safeguarding responses.

The pandemic and in particular the use of a MS teams platform has enabled a significant difference in how Safeguarding responses our now planned and the subsequent risk management of concerns undertaken. The feedback from the Safeguarding Team Managers/Staff is that a core multi-disciplinary team is more easily established (Police/Housing/Landlord/health professionals etc.) and that the volume and frequency of virtual meetings has significantly increased. The benefits of Safeguarding being operated by Livewell as a health and social care integrated provider is that during virtual meetings there have been occasions where we have been able to ask other professionals from other Livewell services to join the meeting or answer a specific question posed by the wider MDT group. Therefore from an efficiency perspective there are significant benefits to the established virtual meetings continuing; because it creates a more effective and cohesive response to Adult Safeguarding.

Online consultations have been supported by the Livewell Connect app that had been developed prior to the pandemic. Use of this app has proved beneficial as has been used to support Safeguarding assessments and action. For example concerns about equipment; a video consultation could take place with a therapy professional whilst the Social Worker was undertaking a home visit with the person.

Care homes; reduced professional visits and limitations on families visiting; suggests that the number of Safeguarding enquiries relating to concerns in a care home environment had decreased. At the early stages of the pandemic to reduce risk it was not unusual for Social Workers to be meeting a person in the garden of a care home or through a window in order to ensure that the person’s view/wishes were gathered and the rights promoted/protected as part any Safeguarding enquiry.

One example of where the pandemic indirectly provided protection and opportunity involved a person whom was experiencing long term domestic and psychological abuse from a partner. The person experienced control and coercion from their partner; being fully aware of the options to leave but choosing to remain living in an allegedly abusive environment. As a result of health deterioration the person required an admission to a care home. Due to Government restrictions and guidance surrounding family members visiting a care home environment – this is offered an opportunity for the person to have a period away from the abusive relationship. This gave opportunity for the Social Worker to develop a professional working relationship and trust with the person; away from the influence and coercion of their partner. The Social Worker was also able to engage the person with their wider family networks; where relationships had broken down because of the influence and control from the partner. The outcome being that the person decided to remain in a care home setting and end the relationship with their partner; the care home setting providing a protective factor and meeting the expressed outcome of the person within the Safeguarding process.

As a result of government restrictions & guidance where individuals/carers may previously had access to respite services/day services at the start of the pandemic; many of these services were closed or suspended thus putting more pressure on households and personal relationships. Some of these services may have previously offered protective factors. As restrictions ease – we are working with our Commissioner partners to understand availability of services moving forward.

Since 18 May 2020 the following number of Safeguarding enquiries undertaken related to: Domestic abuse (102) 12% and Psychological (54) 6%.

Interestingly the number of enquiries undertaken in relation to financial abuse is (114) 17% this may have links to income reduction and loss of employment linked to the pandemic; it is uncertain if this may have contributed towards levels of financial abuse towards vulnerable persons

Support to Care Homes

As a result of the direct impact of Covid on the health of staff and people within some local Care Homes, Livewell have developed a Care Home Liaison Team service, providing support to services where infection outbreaks have occurred. This has included staff and nursing support to maintain the care of services and also specialist support and advice in relation to prevention of infection and implementation of national guidance. Specialist deep cleaning teams have also been able to support some services where a rapid outbreak has occurred, providing advice, information training and practical support in order to maintain support to people, prevent further spread of infection and reduce disruption to the care for people where possible.

The National Probation Service moved from almost exclusively office contact to a model that prioritised face to face contact in the office for those deemed to be at high risk of serious harm to others, where there where domestic and safeguarding issues, homelessness, or where face to face was important for diversity reasons. Home visits were replaced by ‘doorstep’ visits. Groups linked with rehabilitation or offending behaviour could not be undertaken. The majority of contacts were remote usually by telephone. This also placed limitations on what could be offered in respect of wellbeing, support or monitoring. What has worked well shown by a local digital survey in June 2020 is the telephone contact especially to individuals who would otherwise be isolated. This included contact by programme facilitators in respect of emotional resilience and by the personality disorder pathway worker. Going forward the probation service will be more fluid in respect of type of contact which will now include more remote contact where this is seen as supportive, addressing equality issues, or where office visits are not required routinely. There will be an increase of home visits recognising the importance of working with family or significant others in adult safeguarding.

Probation practitioners report that in terms of contact such as with the adult social services team and adult safeguarding team this has remained good. The difficulty has lain in supporting vulnerable adults and signposting to services which might normally offer groups or drop in facility. It should also be said that the practitioner definition of vulnerable adults is a fairly wide one and unsurprisingly an increase in numbers is reported along with others who are seen as ‘falling through the cracks’. Practitioners are keen to look at how multi agency contacts could be improved to address the impact of the pandemic and its aftermath. Ideally co location or hub approach is seen as being more inclusive and better supporting wellbeing and safeguarding practices. Practitioners are facing an agency challenge when the national probation service integrates with the private probation companies in June 21 to form a united probation service. But it is hoped that this will lead to generating new ideas and ways of working which will enable better adult safeguarding practices in a multi agency setting.

We recognise that all communities and every aspect of both children and adult services have been affected by the Covid-19 pandemic, it has been an exceptional year for all of us. The Covid-19 pandemic has also disrupted professional and supportive services relationships with children, families, carers and adults with care and support needs.

Forced to stay at home during the pandemic, some families have reported a positive impact in spending more time with loved ones. In contrast, others have found the experience very isolating and lonely or feel unsafe. They raised further concerns about the impact on mental health and emotional wellbeing for all ages, and the resilience of families across the paid and unpaid workforce.

Strengthening leadership and partnership collaboration

During 2020/21, NHS England and NHS Improvement have been central to coordinated responses during the pandemic. Solid multi-agency leadership and strategic direction focused on improving our central coordinated efforts to gain clarity regarding the problem(s) needing to be tackled across our communities, to keep vulnerable citizens safe during the Covid-19 pandemic. We have set-up the first SW Regional Serious Violence & Contextualised Safeguarding (all ages) Data and Information Sharing Group, securing regional leadership and collaboration across PHE, policing, community safety partnerships, violence reduction units and local safeguarding partnerships, linking strategic priorities and Joint Strategic Needs Assessments for violence and abuse. The group have produced a SW Regional Serious Violence & Contextualised Safeguarding Information Governance Framework.

Early in the pandemic we restructured to deliver programmes of support through various groups, ranging from regional joint Covid-19 Gold calls, Health Outbreaks & Operational Pressures, Infection Prevention & Control (IPC), pathology, clinical cells, establishing care sector networks and the regional ethical referral groups, restructuring our regional safeguarding governance arrangements to improve collaborative data sharing and problem-focused analysis. This has provided core groups to oversee issues and challenges to keep citizens safe. In turn, we were supporting our communities including the care and independent sector, designated and named professionals for safeguarding, as well as the workforce supporting Nightingale hospitals, front line staff and individuals seeking guidance and advice, providing peer support for NHS volunteers, test and trace centres, swab test sites as well as mass vaccination sites.

Challenges

We continued to act as a key link between national, regional and local systems and practitioners and have been involved in the National Safeguarding Adults Network and working with both the Regional SW Safeguarding Adults Board Chairs and SW Safeguarding Adult Health Network, to tackle emerging or continued challenges.

Impact on assessments

The year has also been a year where health and social care assessments have been deferred nationally and in the SW region, placing further challenges for adults with care and support needs and families accessing Care Act assessments.

People eligible for NHS Continuing Healthcare (CHC) continued to receive support and case management by the systems CHC teams, despite the assessments of new referrals being stood down between 31st March and 31st August 2020, and with some CHC workforce redeployed to front line care. Our system CHC teams adapted processes, introducing supportive methods to continue to oversee the care of NHS CHC eligible people such as direct access telephone access and telephone support calls. Those people who needed urgent review of their care plans but were vulnerable and isolating, were supported using virtual technology allowing urgent reviews to continue to take place. Health and social care CHC teams worked in partnership strengthening relationships and communication, to ensure people who were unable to be assessed during the pandemic were discharged from hospital in a timely safe manner and supported people to stay at home preventing a hospital admission. Discharge hubs were established which allowed appropriate advice and sign posting using CHC workforce and social care workforce to support hospitals with the discharges linking to the community services available. This included the support of people in the final days of life wishing to go home from hospital or remain at home, supported with an adapted short form individual personalised care plan, using personal health budgets (PHB) to speed the process and pilot end of life PHBs .

A recovery and restoration programme for deferred NHS CHC Assessments and Care Act assessments commenced in October 2020, where health and social care joined to work on the outstanding assessments. Some systems found this very challenging when workforce had been redeployed, unable to return or increasing their workforce resulting in limited success. We worked on a regional recovery workforce plan engaging with Nurse returners offering webinars and pastoral support to return to nursing, gaining huge success leading to CHC teams increasing their workforce to meet the demand and allowing registered nurses to come back to the NHS.

We offered a Covid response call every week for CHC leaders across health and social care to strengthen communication, sharing national policy updates, encouraging peer engagement, sharing learning from practice and exploring new ways of working. We also arranged senior leadership ADASS and CCG Director of Nursing calls to ensure key messaging, cascade of policy information and joint working principles were maintained during the pandemic.

Keeping focus on specific people who have protected characteristics

Nationally and regionally we have also completed our Safeguarding Equality Impact Assessment, to ensure that the needs of people with protected characteristics, as well as those experiencing health inequalities, have been considered and actioned during the pandemic.

The increased vulnerability of people with a learning disability was identified early into the pandemic and reinforced by the LeDeR national review of deaths of people with a learning disability during the Covid pandemic. This report highlighted key actions that were felt to reduce the risks for this group of people. The majority of the suggested actions had already been considered and actions implemented, including the rollout of Restore 2 & Restore Mini, to improve early identification of deteriorating health by social care staff. The report did help to raise awareness across the wider health and social care community and led to increased senior leadership involvement and inclusion of people with a learning disability as a priority group.

Virtual working has improved the ability to network across systems and we have experienced increased collaborative working. An example of this is specialist learning disability services and primary care services with commissioners working together in a Call to Action to improve the uptake of Annual Health Checks for people with a learning disability. These checks are a good means of identifying health problem s early and ensuring the right support is being offered. In quarters 1 and 2 we saw a marked reduction in the number being provided however, following the Call to Action and excellent work in local areas, the number has increased to near or above last years number.

Direct Commissioning

We have been supporting the national work led by the National Quality Lead Nurse for Health and Justice, regarding safeguarding within the prison estate. A guide to wellbeing & safeguarding support in prisons is due to be published on the NHS Futures platform, and work is ongoing with Health Education England to design safeguarding training specific to prisons. This element of the work will commence in 2021/22 (May 2021).

Covid Oximetry in the secure and detained estate

The Direct Commissioning Health and Justice Team have supported the prisons across the SW including Dartmoor to have oximetry monitoring to support the earlier detection of (silent) hypoxia and further help the reduction in mortality and morbidity from COVID-19. All prisons in the SW can use the self-monitoring resource, which is equivalent of the oximetry @home programme.

Our SW NHS Safeguarding Workforce

In the summer of 2020, our NHS safeguarding workforce profile demonstrated over 55% of our safeguarding workforce is above the age of 50. Keeping citizens safe through workforce succession plans and securing opportunities to skill up the SW workforce has also been a key focus during 2020/21. Collaboration with Health Education England has resulted in a successful bid and subsequent development of a regional accredited safeguarding module, to commence Autumn 2021.

Some challenges for safeguarding adults with care and support needs remaining for 2021/22;

We seek to work collaboratively to improve service pathways for our most vulnerable members of society and their families, particularly children and young people with learning disabilities, special educational needs and disabilities and those who are moving into adult services.

We have planned a focus piece of work during 2021 to examine the pandemic’s impact on children in care and care leavers living in the South West.

Direct Commissioning are planning to roll out the RESTORE2 to recognise early soft signs of deterioration, both across the health care team and non- clinicians such as prison staff.

During 2020 - 21 the operational and strategic safeguarding teams continued to deliver a high quality service, having adapted well to the requirements to work remotely from home.  Risk assessments and equipment requirements were arranged early on in the period, and staff welfare and engagement were assured through twice daily online meetings and individual regular supervision, which continue. Managers were available throughout, and staff response to the consistently high demand and referral levels was, and continues to be exceptional.

In addition to core business, the operational team also supported commissioning teams who had needed to focus on Covid-19 response work and support for care providers. Furthermore, we began development of the work to coordinate the approach to those leading complex lives, and linked to this began a joint systemic review with Shelter and stakeholders to map systems and use learning to develop purposeful multi-agency activity models and cultural change.     

Multi-agency and multi-disciplinary safeguarding work and interface has been aided by the ability to arrange extraordinary or urgent meetings extremely quickly, due to the lack of accommodation and travel issues.  This will continue going forward for urgent meetings or those that do not require physical presence. The realignment of teams across agencies, as a pandemic response, has meant less visiting professional teams and redirection of resources generally, which has required effective and timely communication and negotiation at times, but overall has been supported by strong inter-agency relationships across the city.

We have seen a slight drop in our internal Safeguarding Alerts this year; this is likely to be due to our only completing exceptional, over the threshold visits due to C19. However, the concerning picture is they haven’t dropped that much; this leaves us concerned about what we will find when we resume full over the threshold visits. The graph shows a snapshot year on year comparison, Year to Date.

Neglect, self-neglect and domestic abuse remain our highest categories of safeguarding concern; with psychological and physical categories rising. All domestic abuse case numbers (i.e. not just for those with care and support needs) rose significantly in 2020/21 YTD; this has been reflected nationally. Sovereign initiated partnerships with Womankind and Mankind to provide additional support.

We chair the Housing Quality Network – Housing Safeguarding and Best Practice Group, and most organisations have reported a similar picture. One organisation saw a sharp increase in alerts but this is felt to be a result of investment in training and new posts. This group is looking at benchmarking and also initiatives to better engage tradespeople in the Safeguarding agenda amongst other things.

Sovereign are launching on the 7th May 2021 a new approach to the processing and recording of Safeguarding alerts. This digitised case management approach will significantly increase the richness of our data and reporting. We are also looking to capture both ‘big S’ (notifiable to LA Safeguarding teams) and also ‘little s’ safeguarding concerns (people in need of guidance or support), actions, and critically outcomes. We are also including data on mental health crisis, which is anecdotally rising. This data in turn allows us to inform our approach and enable continuous improvement.

Sovereign have recently appointed a new Safeguarding training provider to overhaul our face to face and e-learning offer ensuring more targeted training for specific roles. (e.g. contact centre, trades etc) We have mapped the competences framework against our training offer to assure ourselves we have covered the right bases for the right roles.

We continue to have challenges around substance misuse, safeguarding and fluctuating capacity, as well as not being made aware as a landlord where there are Safeguarding issues with a Sovereign tenant or family. This often feels like a missed opportunity – this is an organisational picture not a Plymouth specific observation.

During the pandemic University Hospitals Plymouth, like our partners, has re oriented operational priorities to manage the demands and challenges that the COVID-19 pandemic presented; this meant that the hospital closed its doors to planned admissions, surgery and visitors. Health partners worked together to ensure the continued safety of the people we serve, planning for the ethical challenges that may present from the outcomes of the virus modeling.  We were aware of the safeguarding implications for those who were no longer visible to us and other services, the potential for the increase in injuries both physical and emotional for those who were no longer free to leave abusive situations, and the potential for intimate terrorism and associated lasting harm. We remained mindful during this period of those individuals who would be at risk of harm from the imposed sanctions, for the afore-mentioned reasons, and for those who would not seek treatment.

As the pandemic progressed and the increase in infection rates grew, along with mutations of the virus, people began to access healthcare again. By this point we had re-oriented some of our services to a fully digital platform. This has been largely well received by those able to use technology, however we continue to listen to those people who felt unable to utilise services this way, and we continue to try to manage this in a way that keeps them safe. We have just had a full presentation at our Board with the attendance of a wonderful lady who helped us to see and hear the impact of digital exclusion. This may well become a safeguarding consideration as services march on with digital platforms for many arrangements and appointments for healthcare.

University Hospitals Plymouth is committed to continuing to care for people accessing services, and to work with partners to safely manage the needs of people we care for when we identify a safeguarding need.