1 Annual Report for Safeguarding Children and Vulnerable Adults ...

The Pentium 4 ArchitectureInteresting Features in Pentium 4• A special trace cache is used to hold predecoded IA-32instructions, which are translated into RISC-likemicrooperations for out-of-order execution• Allows up to 126 microoperations to be outstanding indeep-pipelined execution queues, including 48 loads, 24stores, and integer and floating-point operations over 7functional units, simultaneously.• The FP units also handles the MMX (multimedia extension)ans SSE2 instructions. The functional pipelines executedynamically with multiple issues• Other interesting features include ILP, speculation, registerrenaming, dynamic scheduling for OOO execution, and inorderretirement, etc.August 29, 2007, Kai Hwang http://GridSec.usc.edu9August 29, 2007, Kai Hwang http://GridSec.usc.edu10Innovative Processor Featuresin Modern Processors:• Use data or instruction prefetching techniques• Use speculative load and speculative branchahead of store instructions• Use predicated instruction execution• Use EPIC (Explicit Parallelism InstructionComputing) architecture like the Itanium(IA-64 architecture)Innovative Processor Featuresin Modern Processors:• Compiler optimization from small basicblocks to bigger blocks• Extending compiler from local to globaloptimizations• System In a Chip (SIC) architecture• Chip MultiProcessor (CMP) architectureAugust 29, 2007, Kai Hwang http://GridSec.usc.edu11August 29, 2007, Kai Hwang http://GridSec.usc.edu12

5.5 As previously discussed Shropshire’s Inspection has already taken placeand there is an expectation that Telford & Wrekin’s inspection will take placewithin the next few months. The Inspection process is expected to follow thesame processes as for the Shropshire Inspection unless governmentchanges.5.6 In line with the VASB policies and procedures, including the Association ofDirectors of Adult Social Services (ADASS) Safeguarding Standards: Selfassessment, an audit tool has been devised by the Interim Deputy Director ofNursing and Quality to specifically review board assurance aroundsafeguarding vulnerable adults systems, governance arrangements, trainingand staffing and partnership arrangements in relation to safeguardingvulnerable adults, the audit tool is included in Appendix II. The sameprinciples were applied to this audit as in the Care Quality Commission’sreview of NHS organisation’s compliance against current children’ssafeguarding legislation. An action plan is currently being developed toaddress the gaps identified in the audit, progress will be monitored throughthe local Safeguarding Committee.5.7 The West Midlands Quality Review Service have recently undertaken aquality peer review on the care of vulnerable adults in acute hospitals, allpatients in acute hospitals may be vulnerable and deserve the highestpossible quality of care. Some groups of patients are, however, particularlyvulnerable and may be less able than others to voice their wishes and anyconcerns. These groups include people with learning disabilities, mentalhealth problems or dementia, victims of neglect or of sexual or domesticviolence, and those people who are particularly frail or nearing the end of theirlife.5.8 The aim of the review was to improve services for people throughout theWest Midlands including:• Patients and their families and carers will know more aboutservices and what they can expect.• Commissioners will have better service specifications.• Service providers and commissioners will work together toimprove service quality• Quality review visits will give an independent view of servicequality• Reviewers will learn from taking part in review visits.• Good practice will be shared• Service providers and commissioners will have betterinformation to give to CQC.5.9 The assessors spent the day in the Trust on the 5 October 2011 reviewingevidence that had been produced in preparation for the visit, met with theleads for safeguarding and improving care, specialist clinical advisors and thenominated Executive Lead Director for Safeguarding. The assessors alsovisited the wards and departments and were able to talk to staff regarding thecare of vulnerable adults in our care. The results of the inspection will bepublished in November 2011.Annual Safeguarding Report 20114

6.6 Bond Solon a Health Care Legal company has also recently providedMental capacity training within the Trust for the newly appointed Centre Chiefsand Executive team. It is planned that other senior staff groups will alsoundertake this training in the near future.7. CHILDREN SUBJECT TO A CHILD PROTECTION PLAN7.1 All children who are subject to a child protection plan in Shropshire,Telford & Wrekin are flagged by the Named Nurse onto the Trust’s patientadministration system (SEMA) There are approximately 300 children withalerts at any one time.7.2 If a child attending either of the Trust’s A&E Departments has a childprotection plan in place, even when there are no safeguarding concerns withthe presentation, a Safeguarding form is completed and sent to the NamedNurse who then writes to Children’s Social Care to advise them of the child’sattendance for their records.7.3 All unborn babies who have been made the subject of a child protectionplan are also highlighted on the Trust administration system.8. VULNERABLE ADULT REFERRALS8.1 The table below includes the number of Adult Safeguarding referrals thatthe Trust has received in the reporting period April 2010 to March 2011.8.2 83 referrals were instigated by the Trust and in the same reporting period20 referrals were made against the Trust.Report Information Adult Protection referralsAdult Protection referrals 1 st April 2010 – 31st March 2011 = 103 (RSH 55 PRH 48)Month Total Instigated by Against the Trust Outcomes against theTrustTrustApril 5 3 2 NS X2May 5 3 2 NS X2June 4 4 0July 8 8 0Aug 9 8 1 NS X1Sept 11 10 1 NS X1Oct 7 7 0Nov 13 11 2 NS X 2Dec 6 5 1 SUB X1Jan 10 7 3 NS X 2 INC X 1Feb 12 7 5 NS X 3 INC X 2March 13 10 3 NS X 2 INC X 1Annual Safeguarding Report 20117

The referral substantiated against the Trust was both concerning discharge planningincluding lack of information to relatives/carers and external agencies including socialservices and care homes. Actions have now been put in place by the ward involvedincluding an improvement in documentation. Transfer letters are now checked by theco-ordinator before the patients leave the ward and a copy is maintained in the patientsmedical records for reference. All adult protection referrals against the Trust have beenin the category of Neglect /Omission of care.Key:S = Substantiated (Neglect / Lack of Care)NS = Not SubstantiatedINC = InconclusiveOG = Ongoing investigation8.3 As the Adult Safeguarding agenda continues to gather speed at Nationallevel and with the continued awareness raising which is happening dailyacross the Trust, it is recognised that further resource is needed to supportthe current adult safeguarding lead to continue to successfully deliver thiscomplex and valuable agenda. A recent decision has been made to provideinterim support to the Adult Safeguarding Lead for a 6 month period whilst areview is undertaken of the service and a business plan prepared.9. NEW POLICIES and NICE GUIDANCE9.1 During the last 12 months, the following NICE guidance has beenpublished:• CG 89 - When to suspect child maltreatment• CG 115 - Alcohol dependence and harmful alcohol use• PH 30 - Preventing unintentional injuries among under 15s in the home9.2 Any NICE guidance that affects children is first presented to the PaediatricGovernance for confirmation that SaTH is compliant with any changes whichare required in clinical practice, if they affect safeguarding they are alsopresented to the Safeguarding Committee. Copies of CG89 were issued to allwards for inclusion in their Safeguarding Folder, all Orthopaedic Surgeonsand Paediatricians were issued with a copy. The guidance is raised andshared as part of Group 2 (level 2 and above) training.9.3 CG 115 formed the basis of the Trust’s alcohol policy. This policy currentlydoes not consider children under the age of eighteen. The Named Nurse isworking with the Matron for Emergency services to adapt the policy to adaptthis gap.9.4 As a Public Health policy PH30 does not directly affect hospital staff, butthe newly devised Shropshire Accident Prevention Strategy working groupincludes an Emergency Consultant from RSH as well as the Named Nursewithin the membership. This new strategy will be incorporated into training forGroup 3 and above.Annual Safeguarding Report 20118

9.5 Some policies have required updating in the last year as well as thewriting of some additional new policies. A brief outline is given below:• Self Harm: was updated as part of the recommendations of theShropshire Serious Case Review (SCR).• Domestic Abuse: two policies, one concerning staff who may be thevictims of Domestic Abuse and the second policy is to support staffdealing with patients who may be victims.• The Trust’s Safeguarding Children Policy is due to be updated at theend of 2011 and is currently being modified to take into account thenew policies.10. SERIOUS CASE REVIEW AND INTERNAL MANAGEMENT REVIEW10.1 A Serious Case Review (SCR) is required when abuse or neglect of achild has occurred and the child has died or has been seriously harmed andthere is cause for concern, as to the way in which multiagency teams haveworked together to protect the child.10.2 Since January 2011 the Trust has been involved in one SCR and oneManagement Review. A Management Review is conducted when the criteriafor a SCR is not met but it is felt by the SCR panel that there are lessons to belearned about how staff in one single agency worked rather than howagencies have worked together. The Management Review was for Telford &Wrekin Local Safeguarding Children Board (LSCB) and the SCR was forShropshire Local Safeguarding Children Board.10.3 Recommendations from both reviews have been addressed and policyand practice has changed as a result.11. LOCAL SAFEGUARDING CHILDREN BOARD AND PARTNERSHIPWORKING11.1 The LSCB’s in Shropshire, Telford and Wrekin have the lead role in coordinatingand improving services to safeguard children and young people inour area.The LSCB key responsibilities are to:• Provide the strategic lead in the continued development of Child ProtectionServices• Co-ordinate and scrutinise local agency arrangements for safeguardingchildren• Ensure the effectiveness of the other agencies’ agreements for safeguardingchildrenAnnual Safeguarding Report 20119

• Ensure that safeguarding is planned within all service developments• Ensure that lessons are learnt from every child’s death and serious incidentand those families are provided with appropriate support when a child dies• Promote safeguarding prevention strategies to minimise the requirement forprotection.The LSCB has high level membership from all agencies across the localeconomy. The Trust representative on both LSCBs is the Executive Lead forSafeguarding.11.2 Each LSCB has various subgroups which are outlined below:• Serious Case Review Panel• Child Death Overview Panel• Training and Development Sub Group• Policy and Procedures Sub Group• Domestic Violence ForumMembers of the Trust’s Safeguarding Children Team are included in themembership of the above groups and provide feedback to the Trust’sSafeguarding Committee.12. SUMMARYSaTH is fully committed to improving child and adult safeguarding processesacross the organisation and has a vision to safeguard all children andvulnerable adults who may be at risk of harm. Processes are empowering andperson centred, preventative and holistic and we will continue to deliver thesafeguarding agenda encompassing a multi agency and partnershipapproach. The governance arrangements for child and adult safeguarding willbe more robust and systems will be put into place to allow for effectivemonitoring and assessment of compliance against locally agreed policies andguidelines.Shrewsbury and Telford Hospital (SaTH) continues to work hard in developingprocesses and systems that ensure that people using the service, staff andothers who visit the hospital are as safe as they can be and that risks areeffectively managed.As professionals we will continue to deliver the Child and Vulnerable AdultSafeguarding agenda, encompassing a multi-agency and partnershipapproach. The Governance arrangements for Children’s and AdultsSafeguarding will be more robust with improved Level 1 training coverage andsystems will be put in place to allow for effective monitoring and assessmentof compliance against locally agreed Policies and Guidelines within ClinicalCentres.Annual Safeguarding Report 201110

The known influences and policy drivers that are likely to be the focus of thesafeguarding team for the forthcoming year are described below:To continue to provide attendance at LSCB sub-groups and the HealthGovernance Safeguarding Group and develop practices, andcontributing to the development of a multi agency training strategy andprocedures.To continue to provide in-house local guidance to compliment LSCBprocedures, protocols and practice guidelines.To ensure that SaTH continues to adhere to the recommendations forstaff training in child protection procedures.Continue communication between the Shropshire Community Trustand the Acute servicesTo participate in Child Death Overview Panels.To maintain the existence of the Safeguarding Steering Group formedin response to Lord Laming’s recommendations in 2003.To continue to work with the Human Resource department in ensuringCRB checks and “Managing Allegations against Staff” policy andprocesses are adhered toTo continue to ensure that staff adhere to the training programme,including child and adult protection awareness, Mental Capacity Actand the Deprivation of Liberty Safeguards.Continue to engage with people at risk of abuse, their family, carers,relatives and external agencies.Annual Safeguarding Report 201111

Appendix IMUNRO RECOMMENDATIONS GOVERNMENTRESPONSERecommendation 1:Initial and core assessmentsshould be scrapped andreplaced with a single, ongoingassessment listing decisions tobe made.Accepted1 )The government willmake full revision ofWorking Together toSafeguard Children and TheFramework for theAssessment of Children inNeed and their Families.TIMELINE1) By July 20122) By December 2011Recommendation 2:Unannounced inspectionsshould examine thesafeguarding performance ofother agencies as well aschildren's services.2) The government willimplement an interimamendment to WorkingTogether to SafeguardChildren to removeassessment deadlines andthe distinction between initialand core assessments.AcceptedOfsted intends to have anew local authorityinspection framework inplace, following aconsultation in July 2011.By May 2012Recommendation 3:Inspections should also look atoutcomes and how children'swishes and experiences shapeservices provided.AcceptedOfsted intends to have anew local authorityinspection framework inplace, following aconsultation in July 2011.By May 2012Recommendation 4:A combination of nationallycollected and locally publishedperformance data should beused.Accepted1) The government willconfirm what will be on thelist of locally publishedperformance information.2) The government is aimingfor publication of the suite ofnew nationally collectedperformance information.1) By December 20112) By May 2012Annual Safeguarding Report 201112

Recommendation 5:Each Local SafeguardingChildren Board (LSCB) shouldsubmit an annual report to theChief Executive and Leader ofthe Council, and (subject tolegislation) to the local Policeand Crime Commissioner andthe Chair of the health andwellbeing board.AcceptedThe government will identifythe appropriate legislativevehicle.As soon as practicableRecommendation 6:Local safeguarding childrenboards should assess localoutcomes, including theeffectiveness and value formoney of early interventionservices and multi-agencytraining.Recommendation 7:The role of the director ofchildren's services and the leadmember for children's servicesshould be protected fromdepartmental mergers.Recommendation 8:Research is needed on theimpact of health reforms onpartnership working in childprotection.Recommendation 9:LSCBs should use a systemsapproach to serious casereviews (SCRs) and Ofsted’sevaluation of SCRs should end.Accepted in principleThe government will publishan amendment to WorkingTogether to SafeguardChildren regarding the roleof local safeguardingchildren boards inmonitoring effectiveness ofearly help and protectiveservices.Accepted in principleThe government will consultformally on revised statutoryguidance on the director ofchildren's services (DCS)role and the lead member.Accepted in principleThe Department of Healthand the Department forEducation will work withNHS bodies, localauthorities, professionalbodies and practitioners topublish a joint programme ofwork.Further considerationneededThe government willconsider evidence andopportunities for usingsystems reviewmethodologies for SCRsand options for developingthe national resourcesrecommended.By December 2011By autumn 2011By September 2011Second half of 2011Annual Safeguarding Report 201113

Recommendation 10:Councils should have a legalduty to provide enough earlyintervention services.Recommendation 11:The Social Work Reform Board'sprofessional capabilitiesframework should specify thosequalities needed for child andfamily social work.Recommendation 12:Employers and higher educationinstitutions should work togetheron student placements.Accepted in principleThe government will decidewhether there should be astatutory duty for localauthorities in relation toearly intervention and, if so,what form it will take.AcceptedThe professional capabilitiesframework and CPDframework, developed bythe Social Work ReformBoard, will include childspecific skills and learningand be implemented.Accepted1 ) The government expectsthe College of Social Workto develop plans fordesignated approvedpractice settings andteaching organisation statusand to consider the merits ofstudent units.By September 2011By autumn 20121) By December 20122) By summer 2012Recommendation 13:Local authorities should reviewand redesign the ways in whichchild and family social work isdelivered, drawing on evidenceof effective interventions andhelping social workers useevidence based practice.2) The government will buildpartnership arrangementswith employers and highereducation institutions.AcceptedLocal leaders will undertakeself-assessment,considering whether childand family social workservices are appropriatelyconfigured so that they meetthe needs of children andfamiliesAt a locally determinedpaceAnnual Safeguarding Report 201114

Recommendation 14:Local authorities shoulddesignate a principal child andfamily social worker.Accepted1) The government expectsmost local authorities tohave chosen to designate aprincipal child and familysocial worker.1) By April 20122) By July 2012Recommendation 15:A chief social worker should becreated in government.2) The government expectsthat all local authorities "willhave chosen" to designate aprincipal child and familysocial worker.Accepted in principleThe government plans for achief social worker tooversee children's andadults' services to beimplemented.By late 2012Annual Safeguarding Report 201115

APPENDIX II1. SHREWSBURY AND TELFORD NHS HOSPITAL (SATH) MEETS STATUTORYREQUIREMENTS IN RELATION TO CRIMINAL BUREAU CHECKSIDENTIFY LEVEL OF COMPLIANCE BY PLACING A TICK IN THE CORRESPONDING BOX &PROVIDE RELEVANT EVIDENCE1.1 All staff working with vulnerable adults have an enhanced Criminal Records Bureau(CRB) disclosure.Fully compliantNON – COMPLIANT BUT WORKINGTOWARDS STANDARD (GIVE % OF STAFFWORKING WITH VULNERABLE ADULTSWITH ENHANCED CRB AND OUTLINEACTIONS BEING TAKEN)Non compliant and no plans in place toachieve standard (give % of staff working withvulnerable adults with enhanced CRB)Human Resources CRB check policy no.34Section 6.5 – requires reviewPolicy and guidelines attached1.2 All staff with access to persons in receipt of health services in the course of theirnormal duties to have a standard CRB disclosure.Fully compliantNon – compliant but working towards standard(give % of staff with access to persons inreceipt of health services having had astandard CRB; outline actions to be taken toachieve standard)Non compliant and no plans in place toachieve standard (give % of staff with accessto persons in receipt of health services havinghad a standard CRB)The Trust does not use a standard CRBdisclosure for staff only enhanced. There isno expiry on the CRB and have spoken toHR, a new enhanced CRB would berequested if a member of staff waspromoted or a change in their roleWill be taken forward with HR as part ofaction plan2. VUNERABLE ADULTS PROTECTION POLICIES AND SYSTEMS ARE UP TO DATE ANDROBUSTIDENTIFY LEVEL OF COMPLIANCE BY PLACING A TICK IN THE CORRESPONDING BOX &PROVIDE RELEVANT EVIDENCE2.1 There is a system for flagging vulnerable adults for whom there are safeguardingconcernsFully compliant – system in place (describesystem)No system currently in place but action planbeing developedPolicy and procedure available on SATHintranet section 8.5 also a referralform(appendix 2)Annual Safeguarding Report 201116

No system and no plans in placeFlowchart has been developed withguidance from West Mercia Police –adultprotection and adult protection ShropshireCouncil (attached)Adult protection policy including referralattached.(appendix 2)2.2. ALL STAFF ARE MADE AWARE OF SAFEGUARDING VULNERABLE ADULTS POLICIESAND PROCEDURES FOR SHROPSHIRE, TELFORD AND WREKINFULLY COMPLIANT: DESCRIBE HOWSTAFF ARE MADE AWARE OF AND HAVEACCESS TO POLICIES ANDPROCEDURES; OUTCOMES FROM ANYAUDITS ON ADULT PROTECTIONPROCEDURES ETCNon compliant but action plan in place toensure standard met; outline processes to beput in place.Non compliant and no plans in place.Procedure is included in the AdultProtection training. ( Statutory for all patienthandlers)2.3 Safeguarding Vulnerable Adults Policy & Procedures (or set of policies andprocedures) include a process for following up referrals to adults social careFully compliant: provide an up to date versionof the policy/ procedure (where it forms part ofa wider policy please identify the relevantsection in red.)Non- compliant but policy/procedure in processof being developedNon compliant: no plans in place to developguidanceAll adult protection referrals are directed tothe relevant social services, which in turnhave a strategy discussion with the police.A decision is then made as to who will leadthe investigation -sections 8.6 and 8.7 ofthe AP policy2.4 Safeguarding Vulnerable Adults Policy (or set of policies and procedures) includes aprocess for dealing with vulnerable adults who are at risk from domestic abuse, physical,sexual, verbal or psychological abuse and has a clearly defined process for recognising/acting on concernFully compliant: provide an up to date versionof the policy/ procedure (where it forms part ofa wider policy please identify the relevantsection in red.)Non- compliant but policy/procedure in processof being developedNon compliant: no plans in place to developguidanceSATH policy Section 7 and 9 of the APpolicyAP policy for SATH is in line with the multiagencypolicy for Shropshire and Telfordand Wrekin. For review 2012Annual Safeguarding Report 201117

2.5 Safeguarding Vulnerable Adults Policy (or set of policies and procedures) includes aprocess for ensuring that all patients are routinely asked about any caring responsibilitiesFully compliant: provide an up to date versionof the policy/ procedure (where it forms part ofa wider policy please identify the relevantsection in red.)Non- compliant but policy/procedure in processof being developedNon compliant: no plans in place to developguidanceAdmission documentation ( PatientDemographics Document) page 2 includeshome circumstances and page 6 section13.2 is a screening tool for a Social Workreferral2.6 Safeguarding Vulnerable Adults Policy (or set of policies and procedures) includes aprocess for following up vulnerable adults who miss outpatient appointmentsFully compliant: provide an up to date versionof the policy/ procedure (where it forms part ofa wider policy please identify the relevantsection in red.)Non- compliant but policy/procedure in processof being developedNon compliant: no plans in place to developguidanceThis will form part of action plan anddiscussions will commence with VASB2.7 Safeguarding Vulnerable Adults Policy (or set of policies and procedures) include aprocess for handling suspected fabricated induced illnessFully compliant: provide an up to date versionof the policy/ procedureNon-compliant but policy/procedure in processof being developedNon compliant: no plans in place to developguidanceThis will form part of action plan anddiscussions will commence with VASB2.8 Safeguarding Vulnerable Adults Policy (or set of policies and procedures) includesclear guidance on managing allegations against staff and volunteers working withvulnerable adults in line with national and local safeguarding board guidanceFully compliant: provide an up to date versionof the policy/ procedureNon- compliant but policy/procedure in processof being developedNon compliant: no plans in place to developguidanceAP policy attached section 11, and 11.1Whistle blowing policy HR05 section 1.2Disciplinary procedure attachedFollowing the Adult Protection process, anddiscussion with senior members of staffand also to include Whistle blowing policyHR05 section 1.2Annual Safeguarding Report 201118

2.9 Safeguarding Vulnerable Adults Policy (or set of policies and procedures) includesclear guidance on how to respond to a disclosure from a vulnerable adult, which includesa confidentiality policy and procedureFully compliant: provide an up to date versionof the policy/ procedure (where it forms part ofa wider policy please identify the relevantsection in red.)Non- compliant but in process of beingdevelopedNon compliant: no plans in place to developguidanceSATH adult protection policy andprocedures includes confidentiality section122.10 Safeguarding Vulnerable Adults Policy (or set of policies and procedures) include aprocess for resolving cases where health professionals have a difference of opinionFully compliant: provide an up to date versionof the policy/ procedure (where it forms part ofa wider policy please identify the relevantsection in red.)Non- compliant but in process of beingdevelopedNon compliant: no plans in place to developguidanceSATH adult protection policySection 102.11 Relevant to walk-in centres: Vulnerable Adult policy (or set of policies andprocedures) includes a process or protocol that outlines when walk-in centre staff shouldcheck whether a vulnerable adult is subject to a vulnerable adults protection planFully compliant: provide an up to date versionof the policy/ procedure (where it forms part ofa wider policy please identify the relevantsection in red.)Non- compliant but policy/procedure in processof being developedNon compliant: no plans in place to developguidanceNA3. TRAININGIDENTIFY LEVEL OF COMPLIANCE BY PLACING A TICK IN THE CORRESPONDING BOX &PROVIDE RELEVANT EVIDENCE3.1 All eligible staff have undertaken and are up to date with safeguarding training at level1. (Level 1 training aims to ensure all clinical and non clinical staff understand whatconstitutes vulnerable adult abuse and know what to do if they have concerns a adult isbeing abused)Annual Safeguarding Report 201119

Fully compliant; all clinical and non clinical staffhave accessed level 1 training within last threeyears; provide evidence of training plans andcopy of safeguarding training strategyNon compliant but action plan in place: state %of workforce (clinical and non clinical) havingaccessed level 1 training within last 3 yearsand provide copy of training strategy andoutline action to be takenNon compliant – no action plans / trainingstrategy in placeAll patient handlers to attend adultprotection training (statutory E course)Training numbers March 2010 – 2011 =43%Adult protection training is part of statutorytraining. 1672 members of staff (patienthandlers trained) We currently have 3486members of staff who are patient handlersTraining outline attached3.2 Is the Trust planning to undertake a review of its training arrangements within the next6 months to ensure they take account of emerging messages from the national review ofadult safeguardingYes Training reviewed annually by Training and Development ManagerAnnual Safeguarding Report 201120