Safeguarding Children & Adults Annual Report Summary
National COVID-19 pandemic implications on safeguarding efforts, updates on Telford Child Sexual Exploitation inquiry, training initiatives, performance monitoring, and improvements in healthcare services for children in care.
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PPQ /QC Agenda Item XX EXECUTIVE SUMMARY SHEET DATE: XXXX July 2020 Annual Report; Safeguarding Children, Looked After Children and Safeguarding Adults EXECUTIVE RESPONSIBLE: AUTHOR (if different from above): CCG OBJECTIVE: 1) Improvements in patient experience 2) Improving quality of primary care 3) Improvements quality of health outcomes with agree resources FOR: INFORMATION EXECUTIVE SUMMARY (Key points in report) The national COVID 19 pandemic lockdown came into effect on the 23rd March 2020 with major health and social care emergency planning implications including contextual safeguarding and serious pandemic public health risks. The CCG Executive Nurse and Safeguarding Team have contributed to both Shropshire and Telford and Wrekin Safeguarding Adult, Children and Looked After Children new Partnership boards and sub groups arrangements locally including the new adult safeguarding arrangements required by the two statutory safeguarding boards. National Working Together to Safeguard Children Guidance (2018) and Child Death Statutory Guidance (2018) new statutory requirements: http://www.gov.uk/government/publications/working-together-to-safeguard Child Sexual Exploitation (CSE) There is on going high media interest in Telford and Wrekin Child Sexual Exploitation (CSE) past and present multi- agency activity with Local Safeguarding Children s Partnership Board statutory partners all contributing to Telford Independent Inquiry Child Sexual Exploitation (IICSE). Tom Crowther QC is the appointed Telford inquiry lead with commissioning solicitors support. The Inquiry Terms of Reference for Telford have been completed after public consultation and circulated to provider agencies with privacy policies. Additional Inquiry victim counselling care services has been funded by Telford and Wrekin Partnership Board to support local survivors. The National Independent Inquiry Child Sexual Abuse Truth Project, It s Time to be Heard , locally is hearing from victims and survivors. Exploitation and Vulnerability safeguarding training is on-going provided by West Mercia Police to safeguarding board partners that includes adult and child protection, child sexual exploitation, county lines, domestic abuse, modern slavery and prevent radicalisation. TITLE OF PAPER: Zena Young Email: zena.young@nhs.net Audrey Scott-Ryan, David Coan, Kathy George, Paul Cooper, Maggie Braun and Maria Hadley Email: maria.hadley@nhs.net; a.scott-ryan@nhs.net; kgeorge2@nhs.net paulcooper2@nhs.net maggie.braun@nhs.net davidcoan@nhs.net DECISION PERFORMANCE MONITORING X This report outlines the safeguarding children and adult team performance activity from 1st April 2019 to 31st March 2020 across Shropshire, Telford and Wrekin. To advise the board on NHS commissioning and provider safeguarding performance activity across the health economy to improve the safeguarding outcomes for children and adults including looked after children. All recent Care Quality Commission (CQC), Ofsted, Joint Targeted Area Inspection (JTAI) and Serious Case Review, Safeguarding Adult Review reports findings progress is monitored monthly by the Clinical Commission Group (CCG) via Clinical Quality Review Meetings (CQRM) with NHS providers and relevant sub groups. Telford CCG Named General Practitioner (GP) for Safeguarding has set up a local GP forum that has met up twice with key themes identified for further local development such as updates on safeguarding adult and children referral processes/ identification of abuse/ thresholds/policies/procedures, Graded Care Profile 2 (GCP2) neglect and non accidental injury case issues and on going case discussions. Similarly when Shropshire CCG appointed a Named GP in 2020 they have replicated this structure with the first forum starting in July 2020. Oversight has continued over the last 12 months around provision of health services for children in care to ensure improvements in timeliness and data reporting, Positive achievements have been seen in the overall data for review health assessments of looked after children 0 18 years The Quality Lead
Key Performance Challenges, Quarter 1; 2019/20 Telford Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 15 IHAs out of 25 were seen in timescale in Q1. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Number of LAC Initial Health Assessments completed in 20 working days 57% A 77% M 44% J 80% Review Health Assessments Maria Hadley % of looked after children under 5 years with an up to date statutory health assessment 83% A 83% M 98% J 90% Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC Nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 89% A 89% M 95% J 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 95% A 93% M 84% J 80% 2
Key Performance Challenges, Quarter 2; 2019/20 Telford Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 15 IHAs out of 25 were seen in timescale in Q1 and 11 out of 31 were seen in timescale in Q2. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Number of LAC Initial Health Assessments completed in 20 working days 100% J 0% A 0% S 80% Review Health Assessments Maria Hadley % of looked after children under 5 years with an up to date statutory health assessment 91% J 90% A 96% S 90% Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 95% J 95% A 91% S 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 93% J 96% A 93% S 80% 3
Key Performance Challenges, Quarter 3; 2019/20 Telford Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 15 IHAs out of 25 were seen in timescale in Q1 and 11 out of 31 were seen in timescale in Q2. A total of 14 IHAs were seen out of 20 for Q3. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Number of LAC Initial Health Assessments completed in 20 working days 80% O 60% N 70% D 80% Review Health Assessments Maria Hadley % of looked after children under 5 years with an up to date statutory health assessment Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. Team are now completing all RHA s inclusive of 0-19 service so figures are stable in terms of the additional work. . 93% O 81% N 83% D 90% % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 97% O 89% N 91% D 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 91% O 86% N 83% D 80% 4
Key Performance Challenges, Quarter 4; 2019/20 Telford Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 15 IHAs out of 25 were seen in timescale in Q1 and 11 out of 31 were seen in timescale in Q2. A total of 14 IHAs were seen out of 20 for Q3. A total of 23 IHAs out of 26 were seen in timescale in Q4. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Number of LAC Initial Health Assessments completed in 20 working days 85% J 100% F 85% M 80% Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. Team are now completing all RHA s inclusive of 0-19 service so figures are stable in terms of the additional work. Nurse Specialist LAC on sick leave since March 2020;14 RHA s rescheduled for April 2020. Review Health Assessments Maria Hadley % of looked after children under 5 years with an up to date statutory health assessment 89.4% J 89% F 83% M 90% % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 96% J 95% F 90% M 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 84% J 81% F 76% M 80% 5
Key Performance Challenges, Quarter 1; 2019/20 Shropshire Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 18 IHAs out of 27 were seen in timescale in Q1. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Number of LAC Initial Health Assessments completed in 20 working days 61% A 83% M 62.5% J 80% Review Health Assessments Maggie Braun % of looked after children under 5 years with an up to date statutory health assessment 91% A 92% M 96% J 90% Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC Nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 82% A 88% M 95% J 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 73% A 81% M 91% J 80% 6
Key Performance Challenges, Quarter 2; 2019/20 Shropshire Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 15 IHAs out of 25 were seen in timescale in Q1 and 12 out of 26 were seen in timescale in Q2. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Number of LAC Initial Health Assessments completed in 20 working days 64% J 25% A 25% S 80% Review Health Assessments Maggie Braun % of looked after children under 5 years with an up to date statutory health assessment 93% J 97% A 91% S 90% Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 91% J 97% A 97% S 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 77% J 77.5% A 75% S 80% 7
Key Performance Challenges, Quarter 3; 2019/20 Shropshire Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 15 IHAs out of 25 were seen in timescale in Q1 and 11 out of 31 were seen in timescale in Q2. A total of 19 IHAs were seen out of 23 for Q3. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Numer of LAC Initial Health Assessments completed in 20 working days 100% O 80% N 71.4% D 80% Review Health Assessments Maggie Braun % of looked after children under 5 years with an up to date statutory health assessment 87.6% O 92% N 92% D Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. . 90% % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 90.3% O 91% N 95% D 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 84.6% O 87.9% N 86.5% D 80% 8
Key Performance Challenges, Quarter 4; 2019/20 Shropshire Looked After Children Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Q4 data Backing data has been made available this Quarter by SCHT; this determines rationale for a looked after child not receiving a review within 20 working days. A total of 15 IHAs out of 25 were seen in timescale in Q1 and 11 out of 31 were seen in timescale in Q2. A total of 14 IHAs were seen out of 20 for Q3. A total of 23 IHAs out of 32 were seen in timescale in Q4. Rationale is provided for all children seen out of timescale. New Actions: 2020 Escalation to DDLAC for any child outside of timescales. Escalation of cancellations to the DDLAC. Paediatric team to ensure there is enough appointments available for IHAs. Paediatric Secretaries to review that IHA paperwork is being completed and sent to the Local Authority in 20 working days. Continuing Actions: 1. Review children being placed OOA and the need for a health assessment to be completed. Review if children need to be brought back into area following risk assessment Initial health Assessments Dr Gregory Minnaar Number of LAC Initial Health Assessments completed in 20 working days 46% J 66% F 100% M 80% Review Health Assessments Maggie Braun % of looked after children under 5 years with an up to date statutory health assessment 90.4% J 93% F 93% M Backing data provided by SCHT at the end of each quarter to determine rationale around the figures provided. Continuing Actions: RHA continue to be reviewed and escalated in accordance with LAC processes. OOA concerns continue to be escalated to CCG. LAC nurse continues to review the backlog and escalate outstanding RHA's to professionals and OOA colleagues. CCG Designated Nurse continues to review the OOA requests and escalate outstanding RHA's. . 90% % of looked after children 5yrs to 16yrs with an up to date statutory health assessment 92.5% J 94% F 95% M 90% % of looked after children 16yrs to 18yrs with an up to date statutory health assessment 84% J 82% F 84% M 80% 9
Key Looked After Children Overall Quality Concerns Latest Concerns/Issues by provider Actions The Safeguarding Team are engaging the CCG where required to seek support / guidance around specific case issues. This is mainly when children are admitted regarding self-harm behaviours. The DNLACs and Nurse Specialists (LAC) engage where required to facilitate support around safe discharge and engage services / Providers where this is a hosted children placed in T&W / Shropshire. Shrewsbury and Telford Hospitals NHS Trust No concerns have been advised to Telford & Wrekin CCG / Shropshire CCG around children in care during the year. Robert Jones and Agnes Hunt Orthopaedic Hospital The dashboard and Local Quality Requirements for Looked After Children in Telford & Wrekin were reviewed for 2019 to 2020 / 2020 to 2021; this has now been agreed by Shropshire Community Health Trust following negotiations. The requirements have a main focus around quality and improved outcomes for children in care with the provision of health passports for children in care, quality assurance of health assessments and GPs contributing to health assessments; for 2020 onwards indicators remain unchanged. Key areas of reporting immunisations, dental data have been a continued challenge during this year; however reporting is now improved; this is being monitored via CQRM. SCHT recruited a Nurse Advisor for LAC in 2019 following receipt of CCG funds for them to complete all RHAs following removal of RHAs from the 0-19 contract which now only contains contribution to the monitoring of health plans. Following this additional work moved to SCHT; RHAs for children have been stable. Plans are in place for this to replicate across Shropshire during coming months. Telford Council, Shropshire Council and SCHT have continued to review system errors to ensure that both systems are reporting the same health data. 2018/2019 saw on-going discrepancies between both sets of data in relation to children with up to date health plans. This has significantly improved and SCHT are taking a lead role in providing challenge to data. COVID-19 has caused impact on LAC in terms of the vast majority of face to face contacts. Staff are working to guidance from the Community Prioritisation Plan in terms of current guidance. Shropshire Community Healthcare NHS Trust Health of Looked After Children Two Practitioners are now in post specifically working with Looked After Children. The Designated Nurse for Looked After Children (DNLAC) T&W CCG and the Designated Doctor for Looked After Children (DDLAC) ensure that support is offered around access to provision when required. Children from other areas who are hosted in Telford & Wrekin should be able to seamlessly access services within the area which they reside. The Operational Service Manager for the 0-25 service is reviewing pathways for Looked After Children, however is attending the Strategic Health of Looked After Children Group to ensure all partners receive updates in terms of access issues or concerns. COVID-19 has undoubtedly affected face to face contact of the vast majority of children. Midlands Partnership Foundation Trust Emotional Health and Wellbeing Service 0-25 (including delivery of routine services for Out of Area Children) Health of Looked After Children Working Together (2018) indicated further need for CCGs to have oversight of children's homes within the CCG footprint; a scoping exercise took place during Summer 2019 to look at this further; however delay of any further work was impacted due to COVID-19 and will remain a risk due to volume of homes across Shropshire. General 10
Looked After Children Key Improvements during 2019 / 2020 Sustained improvement in the completion of Review Health Assessment for Telford & Wrekin Looked After Children; despite expanding the remits of additional work for 0-19. Case Consideration Panel; process now in place to consider requirements of complex children in care; this has continued during 19/20. Improved communication with the Local Authority around data discrepancies. GP guidance around looked after children processes in place and data is reported on a quarterly basis to CQRM. GPs are now completing the EMIS template to feed into Review Health Assessments; data is now reported on a quarterly basis to CQRM. A significant piece of work has been undertaken to streamline the invoice process for children in care; this has resulted in a cost saving in Shropshire CCG; this is now being rolled out across Telford & Wrekin so that the processes mirror for continuity. Health Passports are being offered to Telford & Wrekin / Shropshire children in care. Exception reporting is consistently provided each quarter to evidence oversight and monitoring of children in care. Service specification and reporting requirements have been reviewed for 2020 onwards focusing on quality outcomes now data is more readily available. Regional work continues along with engagement from the DNLAC on the LAC Clinical Reference Group. A quality assurance process has continued between the Nurse Specialist LAC and the Designated Nurse LAC which takes place every quarter. 11
Looked After Children Focus for 2020 / 2021 To further understand the landscape of Residential settings in Telford & Wrekin / Shropshire. To support plans for robust service delivery around the 0-19 component of review health assessments; ensuring that Shropshire LAC service is not impacted by the movement of work to SCHT. To ensure that the restoration of workload in relation to COVID-19 for LAC Health is supported by national guidance from NHS England guidance. 12
Adult Safeguarding - Key Performance Challenges, RJAH 2019/20 Target or nation al rate Area and Local Lead Change from last period Headline issues/actions Indicator Q1 Q2 Q3 Q4 82% % number of staff receiving adult safeguarding training as part of their induction (within 12 weeks) Figures provided by RJAH. 7% - see notes 95% New Dashboard categories introduced for 2019/20 correspond with the Adult Safeguarding: Roles and Competencies for HealthCare Staff (2018). As a consequence some category information had not been previously captured and a review of training provision is ongoing 100% 100% 89% Level 1 Safeguarding Adult Training (3 yearly update) 85% 94% 97% 95% Robert Jones and Agnes Hunt Orthopaedic Hospital In respect of Level 3 training The trust have produced comprehensive performance review plans and actions to address this which have been fully shared with the CCG, these include an increase in the training resource with the commissioning of external training and a suite of actions to support an innovative training passport and an expansion in participatory training events. These are under regular review and the CCG have asked for a mitigation plan which includes the fact that all clinical staff are to complete level 2 training with a high level of compliance (94.72%) N.B. The Trust have asked the CCG to carry out an Assurance Review of Safeguarding The Roles and Competencies Document allows until 2021 for providers/organisations to be fully compliant with the competencies. 93% Level 2 Safeguarding Adult Training (3 yearly update) 95% 85% 90% 93% Local Lead for Adult Safeguardin g: Paul Cooper Level 3 Safeguarding Adult Training (3 yearly update) 3% - see notes 2% see notes Under review 5% 85% Level 4 Safeguarding Adult Training (3 yearly update) 50% 50% See notes 100% N/A If applicable. Level 5 training. Named Professionals See Notes See notes 100% N/A 13
Adult Safeguarding - Key Performance Challenges, RJAH 2019/20 (cont) Target or nation al rate Area and Local Lead Change from last period Headline issues/actions Indicator Q1 Q2 Q3 Q4 Mental Capacity Act /DoLs training (if MCA & DoLS training is done together) for frontline clinical staff. % of staff that have up to date training (3yrly) 85% 85% 87% 89% 87% Robert Jones and Agnes Hunt Orthopaedic Hospital DoLs training (if done separately) for frontline clinical staff. % of staff that have up to date training (3yrly) 87% 88% 85% 83% 85% Formal supervision to be established for lead professionals. Adult Safeguarding Lead Nurse has 1:1's with DON (Exec lead for Safeguarding) Local Lead: Paul Cooper No Compliance with safeguarding supervision requirements for Named Professionals within Safeguarding (Level 4). In respect of Prevent training all staff and volunteers receive WRAP ( level 3-5) therefore data for Basic Awareness is not captured. See note See note Y/N N/A % of staff up to date with Basic Prevent Awareness Training N/A 85% N/A N/A % of staff up to date with Prevent WRAP/e- learning Training 85% 84% 86% 86% 86% 14
Adult Safeguarding - Key Performance Challenges, 2019/20 Shropshire Community Healthcare NHS Trust. Target or nation al rate Area and Local Lead Change from last period Headline issues/actions Indicator Q1 Q2 Q3 Q4 Figures provided by SCHT % number of staff receiving adult safeguarding training as part of their induction (within 12 weeks) 100% 100% 100% 100% 100% New Dashboard categories introduced for 2019/20 correspond with the Adult Safeguarding: Roles and Competencies for HealthCare Staff (2018). As a consequence some category information had not been previously captured and a review of training provision is currently being undertaken by SCHT. Whilst the Roles and Competencies Document allows until 2021 for providers/organisations to be fully compliant with the competencies the CCG requested a Training update report for Q4 be provided, However this was delayed due to COVID 19. Report to follow outside of Quality, review and Monitoring Process Level 1 Safeguarding Adult Training (3 yearly update) 98% 85% 97% 97% 99% Shropshire Community Healthcare NHS Level 2 Safeguarding Adult Training (3 yearly update) 98% 85% 94% 93% 98% Local Lead for Adult Safeguardi ng: Kathy George Level 3 Safeguarding Adult Training (3 yearly update) Under review Under review Under review Under review 85% Level 4 Safeguarding Adult Training (3 yearly update) Under review . Under review Under review Under review 100% If applicable. Level 5 training. Named Professionals Under review Under review N/A N/A 100% 15
Adult Safeguarding - Key Performance Challenges, 2019/20 Shropshire Community Healthcare NHS Trust. (cont) Target or nation al rate Area and Local Lead Change from last period Headline issues/actions Indicator Q1 Q2 Q3 Q4 DoLs training figures are not currently recorded as provision is via an external provider this is to be rectified. Bespoke training has been delivered to all community hospital staff over Qs 2 & 3 All staff have access to safeguarding supervision when a safeguarding incident report is completed.SCHT has access to a suite of supervision methodologies supported by a supervision policy Lead nurses access external supervisors. All staff receive WRAP training. There is no training provision for basic prevent awareness Mental Capacity Act /DoLs training (if MCA & DoLS training is done together) for frontline clinical staff. % of staff that have up to date training (3yrly) 92% (MCA only) 93% 95% 85% 92% DoLs training (if done separately) for frontline clinical staff. % of staff that have up to date training (3yrly) Under review See note 85% See Note See Note Shropshire Community Healthcare NHS Compliance with safeguarding supervision requirements for Named Professionals within Safeguarding (Level 4). Local Lead: Kathy George Under review Under review Y/N See Note See Note % of staff up to date with Basic Prevent Awareness Training See note See note See note See Note 85% % of staff up to date with Prevent WRAP/e- learning Training 94% 93% 85% 90% 86% 16
Adult Safeguarding - Key Performance Challenges, 2019/20 Midlands Partnership Foundation NHS Trust Target or nation al rate Area and Local Lead Change from last period Headline issues/actions Indicator Q1 Q2 Q3 Q4 % number of staff receiving adult safeguarding training as part of their induction (within 12 weeks) 96% 97% 100% 98% 100% Figures provided by MPFT. . Level 1 Safeguarding Adult Training (3 yearly update) New Dashboard categories introduced for 2019/20 correspond with the Adult Safeguarding: Roles and Competencies for HealthCare Staff (20180 N/A N/A 85% 98% N/A Midlands Partnership Foundation NHS Trust Level 2 Safeguarding Adult Training (3 yearly update) In respect of Levels 3, 4 and 5 training the Trust has identified in Q3 that a training package has been built, and has been approved. It is anticipated to be rolled out in June 2020 See notes Local Lead for Adult Safeguardin g: Paul Cooper 96% 97% 85% 95% Level 3 Safeguarding Adult Training (3 yearly update) See notes The Roles and Competencies Document allows until 2021 for providers/organisations to be fully compliant with the competencies. See notes See notes See notes 85% See notes Level 4 Safeguarding Adult Training (3 yearly update) See notes See notes See notes 100% See notes See notes If applicable. Level 5 training. Named Professionals See notes See notes 100% 17
Adult Safeguarding - Key Performance Challenges, 2019/20 Midlands Partnership Foundation NHS Trust (cont) Target or nation al rate Area and Local Lead Change from last period Headline issues/actions Indicator Q1 Q2 Q3 Q4 DoLs training is incorporated within MCA Training and is not recorded separately Prevent Figures taken from Trust data Mental Capacity Act /DoLs training (if MCA & DoLS training is done together) for frontline clinical staff. % of staff that have up to date training (3yrly) 85% 98% 94% 95% 96% DoLs training (if done separately) for frontline clinical staff. % of staff that have up to date training (3yrly) Midlands Partnership Foundation NHS Trust See Notes See Notes 85% N/A N/A Local Lead for Adult Safeguardin g: Paul Cooper Compliance with safeguarding supervision requirements for Named Professionals within Safeguarding (Level 4) Yes Yes Y/N Yes % of staff up to date with Basic Prevent Awareness Training 97% 97% 85% 95% 96% % of staff up to date with Prevent WRAP/e- learning Training 92% 95% 85% 80% 90% 18
Adult Safeguarding - Key Performance Challenges, 2019/20 Shrewsbury and Telford Hospitals NHS Trust Target or nation al rate Area and Local Lead Change from last period Headline issues/actions Indicator Q1 Q2 Q3 Q4 % number of staff receiving adult safeguarding training as part of their induction (within 12 weeks) Data Provided by SaTH. CCG concerns about the delay have been escalated to the Trust. New Dashboard categories introduced for 2019/20 correspond with the Adult Safeguarding: Roles and Competencies for HealthCare Staff (2018). As a consequence some information had not been previously captured and a review of training provision in respect Safeguarding Level undertaken with a number of training modalities identified to support and enhance the face to face training provisions. Training in those areas not currently recorded was commenced in February 2020 but interrupted by COVID 19 which has impacted the ability to provide face to face training. However the Trust has been able to recently recommence this training in May 2020 The Roles and Document allows providers/organisations compliant with the competencies. 100% 89% 100% 95% 95% Level 1 Safeguarding Adult Training (3 yearly update) 91% 89% 85% 56% 100% Shrewsbury and Telford Hospitals NHS Trust category Level 2 Safeguarding Adult Training (3 yearly update) of has Adult been Local Lead for Adult Safeguarding: Kathy George 3 90% 90% 85% 81% 88% Level 3 Safeguarding Adult Training (3 yearly update) See Note See Note Under review See note 85% Level 4 Safeguarding Adult Training (3 yearly update) See Note 100% Under review 100% 100% Competencies until 2021 to be If applicable. Level 5 training. Named Professionals for fully Under review N/A N/A 100% N/A 19
Adult Safeguarding - Key Performance Challenges, 2019/20 Shrewsbury and Telford Hospitals NHS Trust Quarter 4 (cont) Indicator or nation al rate 14% Targe t Area and Local Lead Change from last period Headline issues/actions Q1 Q2 Q3 Q4 As identified within the previous narrative. Actions have been identified by SaTH to increase the training trajectory for MCA. A refreshed MCA/DoLS training has commenced however there has been some delay due to COVID 19 . SATH have employed a nurse trainer on a temporary basis to support the MCA/DOLS and Adult Safeguarding Training programme. The provision of and review of discrete MCA/DoLS training is a priority as this has been identified by CQC as an area of ongoing concern Prevent Data identifies that the Trust met the national training target at Q4 for WRAP Mental Capacity Act /DoLs training (if MCA & DoLS training is done together) for frontline clinical staff. % of staff that have up to date training (3yrly) 85% 13% 14% 21% Shrewsbury and Telford Hospitals NHS Trust DoLs training (if done separately) for frontline clinical staff. % of staff that have up to date training (3yrly) Under review 14% 85% 9% 14% Local Lead: Kathy George Compliance with safeguarding supervision requirements for Named Professionals within Safeguarding (Level 4). Under review Yes Y/N Yes Yes % of staff up to date with Basic Prevent Awareness Training 60% 72% 85% 71% 50% % of staff up to date with Prevent WRAP/e- learning Training 81% 90% 85% 77% 72% 20
Key Performance Challenges, Quarter 4 2019/20 Children Safeguarding Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Safeguarding Children Awareness Training (3 yearly update) Safeguarding Awareness Training Figures are provided separately by SaTH in training report and dashboard format. Level 1 91% 95% 85% Continuing Actions: The CCG Clinical Quality Review Meeting monthly with SaTH have requested a recovery training plan and maternity updates. Safeguarding advice and supervision continues to SaTH Named Professionals, Paediatric staff & other relevant staff. Peer Case Review occurs monthly with Designated/ Named/ Lead Safeguarding Doctors and relevant staff. New Director of Maternity and specialist safeguarding nurse appointed to assist with training. SaTH internal safeguarding meetings with CCG leads to recommenced in 2019. Interim Director of Nursing recruited. Specialist Named Doctors and Nurses for Safeguarding Training Level 4 100% Level 2 91% Shrewsbury & Telford Hospitals NHS Trust (as at end Qtr 4) Number of staff who have received Level 3 Children Safeguarding training for frontline / clinical staff. 80% 88% Local Lead: David Coan The CCG will continue to monitor the figures over Qtr 4, should the figures remain static or drop further an action plan in respect of meeting the identified target will be requested. Contingency training plans are in progress to increase figures. Single and multi-disciplinary audits work in progress. All specialist Named Safeguarding Professionals including Named Midwives are compliant relevant competency training. 21
Key Performance Challenges, Quarter 4 2019/20 Children Safeguarding Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Safeguarding Children Awareness Training (3 yearly update) Safeguarding Awareness Training Figures are provided separately by SCHT through quality monitoring reporting although this is not a specified requirement of the current dashboard format. Level 1 99.94% 100% 95% Level 2 93.10% Continuing Actions: The CCG will continue to monitor the figures in dashboards should the figures remain static or drop further an action plan in respect of meeting the identified target will be requested. In the last year training figures have increased due to forward planning. Shropshire Community Healthcare NHS Trust (as at end Qtr 4) Number of staff who have received Level 3 Children Safeguarding training for frontline / clinical staff. Specialist Named Doctors and Nurses for Safeguarding Training Level 4 100% Local Lead: Audrey Scott- Ryan 95% 95.00% Single and multi-disciplinary audits work in progress. Alert & LAC audits completed with SCHT policy and procedures updates. Safeguarding Lead and Named Nurse for Safeguarding Children are complaint relevant competency training, Safeguarding advice and supervision continues to CDOP lead nurse named nurse and relevant others. 22
Key Performance Challenges, Quarter 4 2019/20 Children Safeguarding Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Safeguarding Children Awareness Training (3 yearly update) Safeguarding Awareness Training Figures are provided separately by RJAH although this is not a specified requirement of the current dashboard format. The rag rating is still green as meeting required safeguarding targets. Level 1 92.80% 98% 85% Level 2 98.% Continuing Actions: Safeguarding advice and supervision continues to RJAH Named professionals and other relevant staff. Robert Jones and Agnes Hunt Orthopaedic Hospital (as at end Qtr 4) The CCG will continue to monitor the figures over Qtr 4, should the figures remain static or drop further an action plan in respect of meeting the identified target will be requested. Contingency training plans are in progress to increase figures. Number of staff who have received Level 3 Children Safeguarding training for frontline / clinical staff. Local Lead: David Coan 98% 95% Specialist Named Doctors and Nurses for Safeguarding Training Level 4 100% CQC Inspection good outcome. Record keeping audits work in progress. Safeguarding internal meetings with CCG on-going. 23
Key Performance Challenges, Quarter 4 2019/20 Children Safeguarding Latest Position Target or national rate Change from last period Area and Local Lead Headline issues/actions Indicator Un- validated Official Safeguarding Children Awareness Training (3 yearly update) All safeguarding training is delivered via elearning package and all staff are required to complete this training on an annual basis as appose to the recommended three yearly therefore compliance with this appears to be lower than it actually is if measurement against the three yearly requirement. Level 1 96% 90% 90% Level 2 96% Continuing Actions: The CCG will continue to monitor the figures over Qtr 4, should the figures remain static or drop further an action plan in respect of meeting the identified target will be requested. Contingency training plans are in progress to increase figures. Midlands Partnership Foundation NHS Trust (as at end Qtr 4) MPFT have recently reviewed and increased staff numbers for Level 3 Training (why dip in compliance). Also, due to COVID - 19 face to face training has been cancelled and under review to deliver safely using new technology methods to increase figures. Number of staff who have received Level 3 Children Safeguarding training for frontline / clinical staff. Local Lead: Audrey Scott- Ryan 85% 78% Specialist Named Doctors and Nurses for Safeguarding Training Level 4 100%. Safeguarding supervision to named professionals is provided in house. Single and multi-agency audits work in progress. 24
Key Adult and Children Safeguarding Quality Concerns-2019-20 Latest Concerns/Issues by provider Actions The Care Quality Commission (CQC) report to Shrewsbury and Telford Hospital Trust (SaTH) was published on 29th November 2018 and classed SaTH as inadequate which is a high quality and safety priority issue and on NHS organisational risk registers. CQC revisited SaTH March/April 2020. The National Health Service England Improvement Agency have been working in SaTH with staff to support key recommended service improvements. Shrewsbury and Telford Hospitals NHS Trust In Adult Safeguarding MCA and DOLs along with Safeguarding has been identified as a significant concern. The Trust implemented a short life working group to identify actions in terms of training requirements which informed the Action Plan. The CCGs Adult Safeguarding leads are working closely with the Trust s Associate Director of Quality, Governance and Risk to monitor progress. Additionally the CCGs undertook an audit of awareness levels for MCA/DoLs and Safeguarding in February 2018 reporting the initial outcome to the respective SAB s in March 2019. An ongoing programme of audit and assurance is scheduled in respect of training will take place over the coming year. T&W CCG lead embedded in SATH to support MCA and Adult Safeguarding service improvement review. An independent Review of how SaTH reviewed their learnt lessons from some neonatal deaths has been undertaken externally and the Secretary of State also appointed an Independent Senior Midwife to review maternity legacy cases and produce a report which is on-going. Healthcare Safety Investigation Branch (HSIB) are also in SaTH reviewing serious incidents cases since 12th November 2018. Shrewsbury and Telford NHS Hospitals (SaTH) are required to give frequent quality assurance maternity reports and maternity transformation action plan progress updates. Accident and Emergency continue to monitor children who self harm and complete safeguarding forms for patient notes. SaTH workforce RJAH are currently rated good for Safeguarding and have been working to enhance the safeguarding specialist team offer to the Hospital. The major challenge relates to the level 3 training requirements and an action plan has been agreed with the CCGs. A Safeguarding Assurance Review by the CCG is ongoing and will form the basis of an action plan in 2020. The ambition is to be outstanding in CQC Regulation 13 for safeguarding Robert Jones and Agnes Hunt Orthopaedic Hospital The national COVID 19 pandemic lockdown resulted in community staff deployment to key front line areas and restricted visiting via digital virtual methods only with weekly partnership meetings to ensure local children on high risk Child Protection Plan were still reviewed by health and social care. Health visitors and school nurses contract with Local Authority Public Health has been reviewed by children s commissioner, quality leads and designated safeguarding professionals and SCHT. To be re reviewed post COVID 19. Children safeguarding figures training plans over the last year have increased to over 90%. New statutory child death and safeguarding children changes are being implemented locally working with Shropshire and Telford and Wrekin local Safeguarding Partnerships and West Mercia colleagues (COVID 19 pandemic delayed meeting). The CCG Chair of CDOP continues to provide board reports and transformation plans. CDOP annual report completed 2019/20. Shropshire Community Healthcare NHS Trust 25 The national COVID 19 pandemic lockdown resulted in MPFT and CCG staff deployment to key front line areas and restricted visiting via digital virtual methods only with weekly partnership meetings to ensure local children on high risk Child Protection Plan were still reviewed by health and social care. The CCG continue to monitor MPFT Midlands Partnership Foundation Trust
Key Improvements during 2019/2020 Executive, Designated Children & Adult safeguarding leads contributed to new Statutory Partnership and COVID 19 Pandemic Guidance working with partner agencies to implement regulations locally; COVID 19 Pandemic safeguarding service delivery reporting with CCG/NHSE weekly escalation of local concern issues to inform of safeguarding themes and trends. Primary and secondary improvement in the completion of Safeguarding Referrals, Core Groups and Cases Conference Reports. GPs continue to complete Case Conference EMIS template to feed into Children Case Conference Reviews; Safeguarding Performance Dashboards & Contracts updates been completed to now include small service provider organisations; Serious Case Reviews, Learning Reviews, Domestic Homicide Reviews & Audit recommendations and action plans are monitored; Safeguarding quality service improvements in NHS provider organisations; Child Death Overview Panel (CDOP) annual analytical report with a reduction in local child deaths; Joint Targeted Area Inspection (JTAI) safeguarding completed overallgood with a key areas for improvement identified i.e. SaTH business case to raise capacity in safeguarding support; Review Telford & Wrekin Local Safeguarding Children s Partnership Board Early Help, Threshold & Family Connect Children Referral Form, policies and procedures; 26
GP Forum for Safeguarding Leads implemented providing peer support & training. Safeguarding Training Event (Level 3) well attended by GPs and nurses with good evaluations and feedback; Multi-agency quality assurance case file audits & NHS audits with providers done; Suicide Prevention and Accident Prevention strategies & action plans updated; 100% Safeguarding Supervision to local Named Professionals; Safer Sleep for babies advice to parents updated in parent held record books; Development of local maternity service plan to improve maternity outcomes and scrutiny. Safeguarding supervision training with NSPCC; Raising parental awareness in identifying foetal movements & Vitamin D usage; West Mercia Protocol Management of Sudden and Unexpected deaths in infants and children (SUDIC) updated; Both adult safeguarding leads have been embedded in SATH and RJAH (respectively) to review and provide safeguarding assurance reports for action in 2020-21 Significant enhancement in training and supervision to patient facing CCG colleagues in the Complex Care team Major contribution as a statutory partner - to the work undertaken to develop the new joint structures of the adult and children safeguarding boards Development of adult exploitation strategies working in Partnership with Statutory Safeguarding Boards 27
Focus on 2020/2021 To support restoration plans across the health economy post COVID 19 pandemic for robust safeguarding service delivery & speedy escalation of key adult, children and young people concern issues supported by national guidance from NHS England. To influence safeguarding policy, procedures & pathways to protect children and young people and prevent child death from national to local level; To work with Independent Inquiry Child Sexual Abuse Project locally; To further improve safeguarding maternity provision & support development; To further provide safeguarding children & adult advice, supervision, support and training; To complete Serious Case Review, Rapid Response Reviews and Learning Reviews/Audits in partnership to improve local safeguarding practice; To support the ongoing areas of improvement required in SATH based on the CCG review report To contribute to the key priorities of the key statutory partnership boards 28
