Safeguarding
“We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. We make sure we share concerns quickly and appropriately”.
The WSSAB was established in 2011 and is the statutory board that co-ordinates safeguarding adults work in West Sussex. It has always been independently chaired, which brings trust and rigour. The WSSAB sets out its expectations of members via its constitution and is responsible for developing and publishing its strategic plan setting out how as a partnership we will meet our safeguarding objectives. The WSSAB has five subgroups that deliver on its annual business plan and board priorities. The subgroups are:
The Board also publishes an annual report detailing how effective the its work has been. The most recent annual report can be accessed here. To support learning the WSSAB commissions a SAR for any case which meets the criteria as outlined in the Pan Sussex SAR Policy.
To ensure we better understand and learn from the lived experience of people in receipt of services, the SAR process fully engages with the adult, their family and friends. The WSSAB also utilises case studies and reports on customer feedback of safeguarding experiences for learning, and a customer interview formed part of our most recent SAR at the WSSAB 2024 conference. To share learning widely and effectively from our reviews and audits, all are published with accompanying learning briefings and podcasts, which are created by the Learning and Policy subgroup.
Recently the WSSAB has recognised a repeating theme in cases of self-neglect and is working with colleagues across Sussex, who have reported similar feedback from cases. WSSAB has commissioned and published a meta-analysis review which has also included analysis of self-neglect SARs by Brighton & Hove and East Sussex boards.
To ensure public awareness of what safeguarding is and how to report it, we have so far, shared leaflets and posters with all 75 West Sussex GP surgeries, 320 West Sussex Care homes and 180 domiciliary care providers.
The WSSAB has a bi-annual safeguarding self-assessment process, which includes challenge events. The events involve agencies summarising their self-assessment return and receiving challenge and feedback from the Independent Chair, statutory partners and other Sussex agencies. The self-assessment has RAG ratings of green (fully achieved with robust evidence for this and continual development), amber (actions in train but evidence of impact not yet evidenced) or red (not achieved given either that there are no actions in place). Following challenge meetings, agencies are provided with updates to their RAG ratings as agreed with them during the meetings to take forward actions to improve on these.
Following a Peer Review in 2018 that highlighted safeguarding as an area for development, a review was undertaken of our safeguarding approach. The outcome of the review was the creation of a Safeguarding Adults’ Hub (SAH). The SAH is co located with our Children’s Multi- Agency Safeguarding Hub (MASH) which includes officers from Sussex Police who work closely with the SAH.
The SAH receives all safeguarding contact via a portal and provides consistency of decision making. Decision making is underpinned by a pan-sussex threshold guidance document, which is designed to support professionals, partners, and providers, working with adults who have care and support needs to develop the identification and reporting of safeguarding concerns. It provides a framework for multi-agency partners to manage risk and to assist in differentiating between quality issues and safeguarding. Partners across the County are supportive of the threshold guidance.
The SAH provides a professional line where the team are available for consultation, clarification, and support for professionals in making a safeguarding referral. This is valued by agencies who are encouraged to utilise the service. Staff were positive about the Safeguarding Adults Hub team who are considered to be helpful and responsive, with clear policies and processes in place.
The SAH has an internal performance measure that tracks the timeliness of decision making where referrals are screened within 24 hours and fully triaged within 5 working days. Compliance with this measure is consistently good.
The SAH has positive working relationships with statutory services, care providers and wider partners, this enables initial enquiries to be carried out effectively applying the principles of safeguarding, keeping the person at the centre of the investigation, making safeguarding personal and gathering appropriate information to inform decision making. We are working to enhance services by employing a jointly funded nurse position from the NHS and are currently collaborating with the ICB to take this role forward.
The SAH also provides for the identification of themes and patterns in safeguarding and allows for early intervention and focus to be placed on matters arising through engagement with other services, both internal and external. For example, close working relationships with Sussex Police ensures that when joint working is required or further enquiry into potential criminal activity is necessary, this is expediated in a timely way. Similarly, having a single point for safeguarding referrals ensures that repeat submissions in relation to a provider or emerging themes regarding a provider can be easily identified and passed to the Safeguarding Enquires Team who manage provider concerns and delegated enquires.
In 2023/24, there were 2133 safeguarding concerns initiated. Of the concerns initiated, 1556 met the safeguarding criteria and proceeded to a safeguarding enquiry (known as a Section 42 enquiry). This year, of the concluded safeguarding enquiries, concerns regarding neglect and acts of omission accounted for 579 adults, financial abuse for 240 adults, and physical abuse for 194 adults. Together, these three categories total 1013 adults. Neglect and acts of omission have been the most reported form of abuse over the past six years. Of the concerns received, where the Section 42 criteria was met, those with physical support needs were the most likely to require an enquiry. This accounted for 457 adults. The next most common category was those who had no recorded support reason; this accounted for 368 adults.
We found that a number of referrals into the safeguarding pathway relate to quality concerns of commissioned care or where the referrer is seeking other services or support to manage risk. To ensure referrals via the correct pathway, a multi-agency task and finish group facilitated by the West Sussex Safeguarding Board met on three occasions to identify areas for improvement. The outcome of this work is:
Concerns in relation to care homes remains the most prevalent location for abuse in West Sussex, followed by people’s own homes. This is different to the national picture; however, the gap is closing as a result of effective multi-agency working via the Safeguarding Adults Board’s monthly Quality Assurance Safeguarding Information Group to consider and respond to emerging concerns in the provider market with timely intervention and support to providers.
In terms of the impact on risk for enquiries concluded, there were 617 adults where action was taken to reduce risk. There were 328 adults where the risk was removed, and 98 adults where actions were taken and the risk remained.
A quality risk report is presented at the WSSAB with detailed quarterly performance. In addition, ASCOF data and performance is shared at our Safeguarding Steering Group (SSG). The Assistant Director Safeguarding, Planning and Performance co-chairs the SSG with the Director of Adults and Health. The agenda has recently been refreshed to ensure a service-wide safeguarding approach with performance reports being scrutinised in relation to section 42 enquiries and provider concerns. The WSSAB Business Manager attends the SSG to update on SARs and resultant learning, audits and resultant learning.
Each year the WSSAB decide on Board priorities for areas where improvements are required. To determine priorities, the SAB look at findings and common themes from recent work, including SARs, safeguarding data, audits and surveys. Once the Board priorities are set, the SABs Quality & Performance Subgroup determines audits and surveys required, which is also informed by the WSSAB’s bi-annual self-assessment and challenge process. These processes focus on evaluating and reflecting on practice in the context of policy and procedure and to learn from experience to inform multi-agency practice development and strengthen multi-agency working. Following the conclusion of an audit or survey, a multi-agency action planning meeting is held to decide together on actions required to make improvements in the areas identified, which includes the promotion of learning resources.
Adult Social Care has a Quality Assurance Framework that outlines a Case File Audit cycle which includes audits for safeguarding matters. In addition, dip samples are conducted in both the SAH in relation to screening and triaging decisions, and the locality teams regarding section 42 enquiries. Audit activity is reported to the Safeguarding Steering Group and into the Performance, Quality and Practice Board. Opportunities are also regularly taken to discuss cases in reflective practice sessions.
The council has developed a strong strategic and operational response to managing provider concerns and failure. This was following a large-scale provider concern and police led investigation in 2018, which highlighted a lack of oversight and information sharing. There are also good links with our Resilience and Emergencies Team who provide support during a provider failure process.
In 2019 we strengthened the approach and support to providers. Our overarching operational provider concerns process was refreshed with a new strategic provider concerns group established when risk remained, and the associated risks cannot be sufficiently managed at the operational level. This group consists of senior leaders from across the safeguarding partnership include senior representative from Adult Services, Health, Sussex Police and includes commissioners, communications and representation from legal departments when required. The route of escalation is usually via the Quality Assurance and Safeguarding Information Group.
The Quality Assurance and Safeguarding Information Group was set up via the WSSAB to develop and maintain a single picture of the quality and safety of the local care market. The group meets monthly, co-chaired by representatives from the council and the ICB. The membership responds and takes preventative actions to known, potential and emerging risks in the provider market. It is attended by statutory partners and senior leads across the partnership.
To support these developments the Safeguarding Enquiries Team was established as a specialist operational response to work directly with individuals, providers, partners (contracts team, CQC, health, Sussex Police etc.) in the pursuit of understanding and reducing any risks through safeguarding planning, involving advocacy services (for example, POhWER, Mind) where necessary, and developing improvement plans. The benefits of the approach are scrutiny, intelligence gathering and support at various levels within the West Sussex care and support market. The team also oversees any delegated enquiries so that they have oversight of any increase in safeguarding or emerging themes.
The Quality Assurance and Safeguarding Information Group (QASIG) is a sub-group of the WSSAB which has been developed over the last three years to effectively monitor, report and evaluate intelligence across partner organisations with regards to safeguarding and quality concerns. It meets monthly with co-chairs of the Local Authority and ICB. There is a strong collaboration and commitment between members, which includes a range of health and social care leads (including commissioners), CQC, Police and Healthwatch. The sub-group plays a key role in prevention by improving the safety of services through early information sharing and multi-agency intervention and in doing so also, enables the group to develop and maintain a single picture of the quality and safety of the local care market. The work and intervention of this group can initiate action and support through joint visits, escalate to safeguarding provider concerns and/or contract monitoring and, involvement of CQC procedures where appropriate. It additionally monitors low and high reporting of safeguarding concerns resulting in further information being sourced from and support being given to individual providers (for example, by way of information, advice and provision of learning resources) and also, has an oversight of those organisations who are within the provider concern framework with active enquiries. This group has been successfully effective at supporting the provider market with both quality and safeguarding issues which, in turn, has created more effective safety measures in the partnership system, a contribution to lowering home closures in West Sussex and better outcomes and experience for care home residents. WSSAB’s QASIG has been of interest to other SABs nationally and we have shared our information and Terms of Reference to support.
In addition to the provider concerns process, safeguarding enquiries (s42) are undertaken by operational teams. This promotes and enhances ‘Making Safeguarding Personal’ (MSP) by involving professionals who may already know the person or are familiar with the context of where the person lives and the local community. Although not a formal requirement, we aim to complete safeguarding enquiries within a 60 day period and reports are made on performance on this timescale to the Safeguarding Steering Group. Challenges in meeting this expectation mostly derive from delegated enquiries, or when a matter is being addressed through the criminal justice system, however this is being monitored through the work of the Safeguarding Adults Quality Assurance Group.
Our safeguarding enquiries are person centred and strengths-based and our staff are able to identify any needs throughout the process. They are adept in undertaking Mental Capacity Act assessments and Best Interest Decisions and supervision is in place to ensure staff have support and guidance, as required. We are also focussing on legal literacy, in particular Human Rights in our approach to carrying out enquiries and in our decision making throughout the safeguarding system.
Staff throughout the service and in various levels of management are engaged in authorising DOLs applications which provides a comprehensive understanding of work in this area.
The community teams are also engaged in activities designed to ensure they are aware of emerging risks and any trends in criminal activity ensuring they can consider preventative work to minimise risks, whilst fulfilling our Care Act responsibilities and enhancing strengths-based assessments accordingly. Although questionnaires at the end of the safeguarding process are sent out to those we work with, the response rate is low but improving. Work is underway to ensure that feedback and the voice of people with lived experience of safeguarding embedded back into practice.
In addition, we are focussing on MSP as part of our audit cycle both through the WSSAB and internally in the service. Partners have also been encouraged to consider MSP through their own mechanisms to enable a partnership picture to emerge and be reported to the WSSAB, this was addressed through the WSSAB Challenge Events and actions for improvement have been put in place for all those participating in them.
As part of a Section 42 enquiry, adults are asked for their desired outcomes. In 2023/24, in total 751 adults expressed desired outcomes. Of the concluded enquiries this year, 410 adults had these fully achieved and 341 adults had these partially achieved.