A review of findings from the 2013-14 Safeguarding Adults at...

A review of findings from the 2013-14 Safeguarding Adults at Risk Audit Tool – self assessment as carried out by London Safeguarding Adults Boards.

Stephan Brusch Marian Harrington

Deborah Klee February 2015

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Contents Page 1.0 Introduction 3 2.0 Background 3 3.0 Findings 4 3.1 Overview 4 3.2 Summary of findings against each outcome 5 4.0 Conclusions and Recommendations 14 Appendix one

Responses by organisation 18

Appendix two Responses by locality

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Appendix three Support and Challenge Event

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1.0 INTRODUCTION This report brings together the self assessment audit results for 2013/14 on arrangements in place to safeguard adults, from 112 organisations across London including, NHS Trusts, Foundation Trusts, Local Authorities, Police, Fire and Ambulance services, Community and Voluntary organisations, Prisons and Probation services. The report was commissioned by NHS England London and is supported by the London Chairs of Safeguarding Adult Boards network. Analysis of data was provided by NHS England. The purpose of this report is to:

• Identify the outcomes that safeguarding adult boards are finding the most challenging so that resources and help can be targeted at addressing these issues.

• Share notable practice of what seems to be working well The self-assessment audits reflect the views of the organisation’s completing them. Some will have assessed themselves more generously than others. For example, organisations that are reflective, insightful and striving for improvement may have scored more outcomes as red and amber than an organisation that is less aware of where it needs to improve The limitations of this audit as an objective assessment must therefore be recognised. This report gives an overview of findings and then the results under each outcome. Results by agency, locality and Borough can be found in appendices one, two and three. Some examples of notable practice are given under each outcome. Appendix four outlines different approaches taken by SABs to maximize the learning from the self-assessment audits. A set of templates and tools (in Word) will be circulated to Board Chairs with this report. The report concludes with some recommendations for all organisations, CCGs and NHS England (London), Public Health and Specialist Commissioning and local SABs. 2.0 BACKGROUND In 2012 Strategic Health Authorities asked all Primary Care Trusts (PCTs) and NHS and Foundation Trusts to complete a self assessment audit on the arrangements that they had in place to safeguard adults, the Safeguarding Adult Assessment Framework (SAAF). This was to prepare for the implementation of the Health and Social Care Act 2012 which would result in PCTs and Strategic Health Authorities (SHAs) being abolished and responsibilities being shared by Clinical Commissioning Groups (CCGs) and NHS England. The self-assessment audits were intended to be a stock-take that would help CCGs to quickly identify issues that needed attention. Safeguarding Adult Boards (SABs) were asked to ‘sign off’ the audits. In some parts of the country, notably Essex and Solllihull, SABs used the SAAF to carry out a SAB audit with all partner organisations completing a self-assessment. This approach was adopted in London. NHS England and the London Chairs of SABs network adapted the original SAAF audit tool. In 2013/14 a recommendation was made by NHS England and the London Chairs of SABs network that SABs consider using the adapted tool to carry out a Board audit.

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3.0 FINDINGS 3.1 Overview There were outcomes where over 80% of organisations felt that they were doing well and scored themselves as green, see table one below. Guidance and procedures for complaints and allegations being in place was not surprisingly something that organisations felt was in place (85%). Many organisations (85%) reported that they had a senior member of staff that was accountable for safeguarding adults. However, a review of audits returned found that there were a few organisations where this was a person at tier three or below in the organisation. Some CCGs and health trusts also had a named GP or doctor for adult safeguarding. Eighty-three percent of organisations felt that they demonstrated the principles of person-centred care (F1). However sixty percent reported that they did not involve service users in identifying the outcomes that they wanted as a result of safeguarding interventions. What is meant by person-centred care and how this relates to Making Safeguarding Personal( a requirement of the Care Act 2014 )to ensure a focus on the outcomes that a person wants from safeguarding, will be a challenge for SABs in 2015. The commitment of organisations to the SAB is an outcome that eighty-one percent of organisations felt that they had met. The outcomes where organisations felt that they needed to improve were less consistent, although there were some recurring themes. Safeguarding training for staff was an outcome that fifty-seven percent of organisations felt they needed to improve. An understanding and appropriate application of the Mental Capacity Act was an outcome where 69% of Foundation Trusts, 64% of NHS Trusts and 69% of Local Authorities recognised that they needed to improve (appendix ..). Fifty-three percent of organisations did not have a staff supervision policy that supports safeguarding. However, this outcome was interpreted in different ways by organisations. Table two below shows a breakdown of the green, amber and red scores against each of the outcomes. Table one – Percentage of green, red and amber scores for all organisations Pan-London Organisations

Outcomes with highest proportion of green ratings Number Percent C4 Guidance and procedures for complaints and allegations 99 85% A1 Senior staff member accountable for safeguarding 100 83% F1 Principles of person centred care 95 83% A3 Board commitment to Safeguarding 100 81% Outcomes with highest proportion of red and amber ratings Number Percent

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D4 Raising alerts and multi-agency partnership working 56 52%

F4 Involvement of service users in strategic approach to safeguarding 60 56%

C3 Staff safeguarding training 66 57% C2 Staff supervision policy supports effective safeguarding 60 53%

Table two – overview of scores against outcomes for all organisations

0% 20% 40% 60% 80% 100%

Board commitment to SafeguardingRobust and safe recruitment procedures and practices

Guidance and procedures for complaints and allegationsReporting of adult safeguarding concerns

Culture of opennessStaff feedback

Attendance at Safeguarding Adults BoardPolicy and procedures for information sharing

Principles of person centred careSenior staff member accountable for Safeguarding

Organisational commitment to SafeguardingSafeguarding policies and procedures

Quality assurance processes identify outcomesLegal advice for safeguarding and MCA

Commissioning agreements reflect safeguarding…Equality monitoring mechanisms in place for service users

Commissioned services have contracts to comply with…Commissioned services adhere to NHS standard contract

Staff supervision policy supports effective safeguardingStaff safeguarding training

Understanding and application of MCA principlesInvolvement of service users in strategic approach to…Raising alerts and multi-agnecy partnership working

Safeguarding information available to adults at risk and…

Proportion of Foundation Trusts in London with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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3.2 Summary of findings against each outcome

Outcome A: Leadership, strategy, governance and organisational culture. A1 The organisation has a senior staff member who has received training in Adult Safeguarding, and where appropriate, Prevent and who has responsibility to ‘champion’ safeguarding throughout the organisation. They keep Senior Managers informed of all issues relevant to safeguarding and promoting wellbeing. They have sufficient time and training to carry out this role. The senior staff member may be the designated individual to whom concerns about an adult at risk are reported or there may be an additional role in the organisation for this purpose. This person will have a job description reflecting this specific role.

• The majority of organisations had a senior staff member with responsibility for safeguarding.

• Most NHS trusts had a board member with responsibility for safeguarding adults in addition to a senior staff member with responsibility.

• Several audits reported that board members had not had safeguarding adult training • The London Ambulance Service has identified representatives for all SABs but

attendance at boards and local reporting is not consistent across London Good practice example

• Several CCGs had a named GP responsible for safeguarding adults and a few trusts had a doctor as a clinical lead.

A2 the organisation is committed to Safeguarding Adults and promoting wellbeing and this is explicitly reflected in the organisation’s mission statement/guiding principles as well as in strategic documents. The organisation is able to evidence how it is implementing the strategic aims of the boards safeguarding strategy.

• Many organisations reported that they needed to update policies to reflect organisational change or other factors such as including MCA and DOLs or PREVENT.

• Several organisations reported that safeguarding adults needed to be reflected more widely in corporate plans, the organisation’s mission and values and stronger links made with other policies.

• A few organisations reported that service users views were not taken into account in commissioning services.

Good practice example

• A privacy and dignity audit is routinely carried out by service users

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A3 There is demonstrable commitment at Board level to Safeguarding Adults. Governance arrangements make relevant connections to support identification of organizational concerns relevant to safeguarding (such as complaints and serious incident reviews). The service has a system for reviewing alerts and referrals which is integrated with complaints and serious incident reviews. Etc.

• Links between complaints, serious incidents and safeguarding was assessed as amber or red in many of the audits reviewed.

• NHS hospital trusts recognised the need to review the interface between safeguarding, serious incidents and complaints and the processes in place.

• The need for guidance was raised in one audit, another pointed out that safeguarding is not included in the NHS SI reporting template

• There seemed to be a lack of clarity about what should be in place and how the interface would work effectively.

• Several organisations reported the need to improve the process for recording, alerting and investigating pressure sores.

• Specific issue for prisoners need to be addressed such as the threshold for statutory intervention on safeguarding and tracking prisoners when there are safeguarding concerns and they have left prison. Generic safeguarding training does not address issues faced by staff in prisons.


• An agreed protocol for developing and delivering principles of best practice and a supporting governance process and screening tool in relation to Safeguarding and Pressure Ulcers – for the Borough

A4. The organisation evidences candour and openness internally and in its relationship to the Board. It identifies challenges to this open culture and puts plans in place to address these.

• Several organisations identified the need to improve openness by reviewing whistle blowing, supporting staff to raise concerns and ensuring appraisal systems assessed values and behaviour towards openness.


• Duty of Candour and CQRM meetings ensure that providers are regularly challenged clinically on the quality of services they provide.

A5 ‘The organisation ensures high quality legal advice is made available to staff on both Safeguarding Adults and the Mental Capacity Act including making available to managers and staff regular updates from the Court of Protection

• This outcome received the highest number of amber and red responses for this section. The majority of audits reviewed did not meet this outcome.

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• Statutory organisations and some of the larger providers said that they had access to legal advice but this was not made available to staff.

• In several cases statutory organisations felt unable to disseminate information due to vacant posts in safeguarding adults

• Community and voluntary organisations did not always have access to legal advice, particularly the smaller ones.

• In some organisations legal advice was available to staff but there were not regular updates.

• The need for more training and advice on MCA and DOLs was raised by several organisations.


• One NHS hospital trust provides legal MCA master classes twice a month and regular newsletters for staff from the trust’s legal firm.

Outcome B: The organisation’s responsibilities towards adults at risk are clear for all staff and for commissioned services. B1 Organisational policies make reference to Safeguarding Adults and ‘Prevent’ where applicable. There are specific organisational policies and procedures in place reflecting your organisation’s responsibility to safeguard and promote the wellbeing of adults at risk. These reflect and cross refer to the SSAB Multi Agency Procedures, Information and Guidance. They include clear lines of accountability, from an individual employee up to the most senior person in your organisation and this is shown diagrammatically. They include reference to the importance of keeping accurate records as well as guidance to support staff in this. This in turn links in to the organisation’s policy on sharing information

• Most organisations felt policies and procedures needed to be updated or reviewed because of changes in organisational arrangements, or legal changes such as the MCA/DOLS ruling and the Care Act 2014.

• Not all policies refer to safeguarding • Most organisations did not have clear lines of accountability in diagram form • Most organisations recorded that information sharing protocols required review while

some had no information sharing protocol at present. One trust reported that their information sharing protocol made no reference to safeguarding


• Safeguarding decision tool to support decision making and safeguarding escalations

B2 Where services are commissioned, agreements reflect the requirement between commissioners and providers to have regard to the need to safeguard, and promote the wellbeing of people who use services. Invitations to tender, contracts and contract monitoring reflect this and reflect relevant standards and regulations.

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• There were some good examples of the inclusion of safeguarding within contracting. There were issues about embedding and monitoring safeguarding consistently across health and social care

• Safeguarding KPIs are monitored in NHS contracts and some organisations had additional KPIs for adult safeguarding

• One Trust was conducting a scoping exercise on use of sub-contractors who provide catering, portering and security

• Several organisations were conducting an audit of their contract monitoring arrangements

• New contracts need to include wellbeing. B3 All commissioned services have contracts which require that services can demonstrate that the Mental Capacity Act is complied with. Examples of how contract monitoring addresses this are shared with the Safeguarding Board when requested

• Most organisations recognised the increased requirements expected of them by the recent Supreme Court judgement

• Commissioners reported that this needs to be included in contracts to ensure MCA and DOLS compliance. The NHS standard contract does not include MCA/DOLS

• Providers reported they have not been asked to report on compliance with MCA by commissioners

• Many organisations did not have a policy on MCA/DOLS or they had a policy which needed review.

• Several organisations reported that compliance with MCA needs auditing

Good Practice Example

• One organisation had commissioned a specialist service to gauge user/carer experience of MCA

B4 All NHS commissioned services are adhering to the NHS standard contract under service conditions 32 in relation to ‘Prevent’.

• Most organisations reported this as an area which required improvement • Prevent needed to be included in safeguarding policies though this was an example of

good practice in one area • There were significant issues about accessing and rolling out training and a lack of

intelligence on the extent to which PREVENT is embedded in providers training and practice

• Contracts need to be monitored to ensure adherence to PREVENT • Smaller contracts need to be reviewed to check that safeguarding arrangements are a

requirement including MCA/DOLS and PREVENT • Several organisations reported having a PREVENT lead officer

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Outcome C: The organisations approach to workforce issues reflects a commitment to safeguarding and promoting the wellbeing of adults at risk.

C1 Your organisation has robust and safe recruitment procedures and practices in line with guidance from the Adult Safeguarding Board. This includes: policies on when to undertake checks and the level required with the Disclosure and Barring Service; the responsibility for all staff in relation to safeguarding, and promoting wellbeing is stated within all job descriptions; professional standards in relation to safeguarding are underlined; induction standards include the need to ensure new staff are made aware of their responsibilities to Safeguard Adults at Risk and promote wellbeing

• No organisations reported issues with DBS checks apart from Housing where there are issues about whether posts are eligible for a DBS check

• Job descriptions were mentioned as needing revision, with some organisations saying safeguarding is not mentioned in job descriptions or job descriptions need to better reflect safeguarding responsibilities

Good Practice Example

• All JDs include safeguarding statements

C2 The organisation’s staff supervision policy supports effective safeguarding. Your organisation has a policy that sets out the frequency that employees in contact with Adults at Risk receive regular supervision and an appraisal. All staff have regular reviews of practice to ensure they improve over time and are competent to carry out their safeguarding responsibilities. Discussion on safeguarding issues is specifically facilitated in supervision so that staff feel able to raise concerns and are supported in their safeguarding role.

• Most organisations expressed concerns about whether safeguarding was included in supervision.

• Outcomes of safeguarding training reviewed in supervision, better identify those who would benefit from safeguarding supervision and reflective practice

• Organisations reported they needed a supervision policy or to ensure safeguarding supervision is included in the policy

• There were issues identified about the inclusion of safeguarding within clinical supervision

• In some organisations the framework to asses competency in safeguarding and MCA is not integrated into supervision and appraisal systems

Good practice examples

• Supervision policy for volunteers • Use of Bournemouth competencies in supervision • Competency in safeguarding pilot to be evaluated and rolled out Trust wide

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C3 All staff working with Adults at Risk should receive training appropriate to their role to ensure competence to meet the needs of Adults at Risk of harm and to respond to safeguarding concerns. This will include training on the Mental Capacity Act and (where relevant) Prevent and also equality and diversity issues. A framework to assess competency in Safeguarding and the Mental Capacity Act is integrated into existing supervision and appraisal systems

• Some organisations reported that there is no specific framework to asses competency around safeguarding

• Several organisations were developing competency frameworks and safeguarding training strategies

• Several organisations said there was a need to review areas which need more advanced safeguarding training

• Training for GPs was identified as an issue particularly MCA and PREVENT • This was the area which generated most areas for improvement • There were issues with availability of PREVENT training with many organisations

reporting an inability to access any training • WRAP training needs to be reviewed as training film not fit for purpose • Several organisations were developing competency frameworks and safeguarding

training strategies • Staff ability to asses capacity needs to be assessed • No guidance or signposting mechanisms on assessing and recording capacity • No guidance on identifying best interest decision maker • Most organisations identified a need to strengthen training re MCA

Good Practice Examples

• FAQ poster on MCA/DOLS produced • Trust is designing an app/tool to disseminate MCA/DOLS information and guidance so

staff have 24/7 access using smart phones or tablets • A staff leaflet on DOLS safeguarding and a business card with numbers to report

safeguarding concerns • Prevent is being incorporated into an Induction book for all new staff and in mandatory

training • A trust worked with 2 local authorities to provide teaching to social workers on pressure

ulcer prevention and care

C4 Your organisation has written guidance & procedures for handling complaints and allegations against staff and this is clearly accessible to staff. This includes a whistle-blowing policy and a culture that enables issues about safeguarding and promoting the wellbeing of Adults at Risk to be highlighted and robustly addressed. It includes appropriate referral to the Disclosure and Barring Service. Your organisation has a code of conduct for staff working directly with adults at risk, concerning acceptable and unacceptable behaviour including discrimination and bullying.

• Most organisations reported having whistleblowing policies

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C5 Your organisation takes steps to ensure that information is obtained from staff about their experience of working in the service, including the practice of exit interviews. This information is used by the organisation to make improvements. Note down in the comments/evidence section key messages and improvements arising from this

• Exit interviews were not always carried out • Analysis of outcomes not as robust as it might be and the outcome of these were not

always acted upon

Outcome D: Effective inter-agency working to safeguard and promote the wellbeing of adults at risk.

D1 Your organisation is represented at the Safeguarding Adults Board and/or its sub-groups. Frequency and participation during attendance at Board meetings and subgroup meetings is noted. The Board representative reports back to the right level in the organisation ensuring that the broader organisation engages with the partnership and its objectives.

• There were few areas for improvement identified here. The main issue were voluntary sector care providers and prisons not being represented on Boards, attendance at Board sub groups and dissemination of information from the Board.

D2 The organisation evidences its engagement and transparency with the partnership in Safeguarding Adults in appropriately recognising and reporting Adult Safeguarding concerns to the Local Authority for coordination of response. It engages appropriately in multi-agency efforts to prevent and intervene in safeguarding concerns (attendance at strategy meetings/case conferences and finding effective outcomes); The organisation evidences that action plans from SCRs - nationally and locally - drive improvement internally and across the partnership. There is evidence that internal action plans/learning e.g. from SI’s, SCRs, complaints, are shared with the Board to facilitate learning across the partnership. This will include triangulation of data that will inform decision making.

• The main issue identified here was learning from serious case reviews and serious incidents

• Serious case reviews were not always followed up and there was a need to support partner agencies and share learning;

• CCGs do not have a mechanism for sharing summaries of complaints and SIs (from providers) and actions with the Board

• An acute trust reported they need to improve in relation to evidencing that action plans from SCRs nationally and locally and SI’s are shared with the board

• There was a lack of evidence that learning from national serious incidents is implemented locally .There is a need to triangulate information on SI and safeguarding issues

• Review STEIS to incorporate Safeguarding concerns • Many agencies reported a lack of feedback on outcomes following a safeguarding

referral

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Good practice examples

• Care Forums to disseminate and discuss information on good practice with care providers

• Lessons learnt log disseminated across the group • The service has systems in place to collate and audit safeguarding alerts, referrals,

incidents and complaints • Work currently being undertaken to integrate complaints and incidents with the

safeguarding adults quality assurance • Partnership work to develop a Hoarding Protocol, which was launched April 2014 • CCG runs a successful pressure ulcer forum that welcomes local agencies and care

home attendance

D3 Your organisation has policy/ procedure/guidance setting out clearly the process and principles relating to sharing information across agencies. The protocol is in accordance with the SSAB Multi Agency Procedures, Information and Guidance. All relevant staff are trained in applying this including in the context of Safeguarding Adults. Local and national learning from Serious Case Reviews informs learning about the principles to be applied

• Very few organisations reported having information sharing protocols which are fit for purpose

• There is need for further practical training and exercises needed around information sharing

• A need for the development of clear standards of recording information and sharing of information about safeguarding issues within the Confidential Social Information Log.

• The need to triangulate information on SI and safeguarding issues • Work currently being undertaken to integrate complaints and incidents with the

safeguarding adults quality assurance • Review STEIS to incorporate Safeguarding concerns • Many agencies reported a lack of feedback on outcomes following a safeguarding

referral Good Practice Examples

• Work undertaken to help staff translate information sharing principles into practice D4 Your organisation can demonstrate active engagement with raising alerts and multi- agency partnership working for ‘Prevent’, including supporting the ‘Channel’ process (‘Channel’ is a key element of the Home Office’s ‘Prevent’ strategy and is a multi-agency approach to safeguarding children and adults from being drawn into committing terrorist-related activity).

• Very few organisations could evidence active engagement with PREVENT • PREVENT referrals are not recorded within Department of Health Safeguarding Adults

Return

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Good Practice Examples

• One organisation is scoping and reviewing whether there is under reporting given no PREVENT alerts since implementation of the protocol

• The safeguarding team conducts research and shares information with respect to Channel referrals with the Channel Manager

• A dashboard is being developed which will incorporate a method for monitoring PREVENT compliance

Outcome E: Addressing issues of diversity Your organisation records gender, age, disability, faith, sexuality, language and ethnicity of service-users where a safeguarding response is necessary/offered. This is used to inform safeguarding strategy. There is only one criteria in this section, so fewer negative responses. However, a significant number of organisations said that they did not collect information on diversity and several of those that did, did not use it to inform practice or influence strategy.

Outcome F: The services can demonstrate that people who use services are informed about safeguarding adults and empoweres within the organisation’s response to it.

F1 The principle of person-centred care is at the heart of the organisation’s practice.

• The majority of organisations identified the need for improvement in achieving person-centred outcomes.

• Several organisations identified the need to capture the experience of people who use safeguarding services

• Specific areas were mentioned by some, eg. risk assessments, enhancing involvement of family, user involvement in the quality assurance process.


• An aid memoire has been created for the staff to ensure they are reminded about individual involvement and/or appropriate advocacy.

F2 The organisation demonstrates a clear working understanding and competence in applying the Mental Capacity Act and of the core principles within it.

• Nearly all organisations identified areas for improvement against this criteria. • This included:

The need to develop staff skills in applying the MCA in practice Raising awareness of the MCA and DOLs with staff, carers and adults at risk Using documentation to evidence MCA application Audits of practice to see if MCA and DOLs is understood

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Contracts and contract monitoring to include use of MCA and DOLs • A particular challenge for prisons:

Supporting prison staff to use MCA and raising awareness IMCAs not always available in prisons F3 Your organisation has written information available to Adults at Risk and their families about Safeguarding Adults including who to contact if they are concerned about an Adult at Risk. Arrangements are in place to support those for who English is not their first language. Information is provided in a range of formats and languages.

• The majority of organisations identified a need to improve access to information on Safeguarding Adults

• Several organisations had no written information at all for patients and families. Good practice example

• Several organisations used language line and one of these routinely offered access to interpreters.

• The LAS issued all staff with pocket communication guides to help them communicate with people who have communication difficulties for example people with a learning disability or who are deaf.

F4. Your organisation takes steps to ensure that information is obtained from individuals who use your service about what outcomes they wish from the safeguarding process and whether they have received this. Their experience is recorded and the organisation learns from it. Individuals who use services and their carers/families also influence and inform more broadly the development of the organisation’s strategic approach to safeguarding and related agendas And F5. Within your organisation’s quality assurance process and its practice there is a strong outcome focus identifying the outcomes that those that use the services expect, having been consulted on these and those outcomes that were achieved. Criteria F4 and F5 are reported together as there was little reported on achieving outcomes apart from the need for this to be a high priority for the coming year.

• Nearly all organisations identified achieving an outcome focus as an area for development.

• The majority of organisations are not currently recording outcomes that people want or using these to influence service delivery.

• A significant number of organisations were starting to develop outcome focused approaches and a number of these made reference to the Making Safeguarding Personal Programme.

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Good practice examples • The inclusion of Making Safeguarding Personal forms within the Council’s safeguarding

process 4. 0 Conclusion and Recommendations This review gives a snapshot of the 112 organisations that shared their audits with NHS England. It identifies some of the issues that SABs consider to be most challenging. These include:

• A shared understanding and appropriate application of the Mental Capacity Act by all partners

• Safeguarding training, evaluating the impact of training and including supervision within staff supervision

• Including safeguarding within all contracts when commissioning services • Updating policies and procedures to take account of the Care Act • Raising alerts and multi- agency partnership working

Recommendations Pan London (all organisations)

• Findings of the audit ought to be considered at all pan London Groups such as LSAN, Safeguarding Adult Board Chairs, Dignity Group and Quality Surveillance Group to ensure that work plans and future objectives address some of the current challenges (red amber scores)

• Issues that are of interest should be reflected in the refresh of the Pan London policy and procedure

• NHS England will ensure that all lessons are fed back to the relevant networks to share learning

• All job descriptions should include safeguarding statements • Staff exit interviews should be conducted and findings analysed • Supervision policies should be reviewed to include safeguarding • Safeguarding policies should be reviewed to ensure they are compliant with Care Act

2014 CCG and Local Area Teams

• NHS England should use the findings to work through its CCG assurance system and to work with Direct commissioners to ensure that lessons learned are better embedded in the commissioning system

• NHS standard contract should include safeguarding, MCA/DOLS • PREVENT training responsibilities to be clarified by NHS England

Foundation Trusts

• Monitor should take note of findings and use them to inform their role in quality by assuring themselves that robust governance structures are in place

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NHS Trusts

• Trust Development Agency should take note of findings use them to inform their role in quality by assuring themselves that robust governance structures are in place

• To clarify and strengthen systems for reporting Serious Incidents when they are potentially Adult Safeguarding concerns.

Public Health and Specialist Commissioning

• Public health and specialist commissioning should adjust their quality assurance mechanisms to ensure that lessons are learned

Prisons • Achieve clarity on thresholds for statutory intervention and safeguarding and tracking

prisoners with safeguarding concerns when they have left prison Local Safeguarding Adult Boards (SABs)

• SABs should take account of findings and benchmark their own work against other London SABs to see where they might learn from others.

• Local partnerships should identify mechanisms for analysing information to assist early identification of safeguarding issues

• SABs should ensure lessons learnt from serious incidents and safeguarding adults reviews are disseminated

• To ensure information on adult safeguarding is accessible to all parts of the community recognising diversity.

• To make use of the LGA/ADASS Making Safeguarding Personal resources to achieve an outcome focus

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Appendix One Responses by organisation The audit results are reported below by agency for; NHS trusts, Local Authorities, voluntary sector, emergency services, public health commissioning, and specialised commissioning NHS Trusts

Outcomes with highest proportion of green ratings Number Percent C1 Robust and safe recruitment procedures and practices 21 95% C4 Guidance and procedures for complaints and allegations 21 95% A4 Culture of openness 20 91% D1 Attendance at Safeguarding Adults Board 20 91% Outcomes with highest proportion of red and amber ratings Number Percent C2 Staff supervision policy supports effective safeguarding 15 68% C3 Staff safeguarding training 15 68% F2 Understanding and application of MCA principles 14 64% D4 Raising alerts and multi-agency partnership working 12 57%

0% 20% 40% 60% 80% 100%

Robust and safe recruitment procedures and practicesGuidance and procedures for complaints and allegations

Culture of opennessAttendance at Safeguarding Adults Board

Senior staff member accountable for SafeguardingOrganisational commitment to Safeguarding

Commissioning agreements reflect safeguarding requirementsPrinciples of person centred care

Board commitment to SafeguardingPolicy and procedures for information sharing

Staff feedbackSafeguarding policies and procedures

Reporting of adult safeguarding concernsLegal advice for safeguarding and MCA

Commissioned services have contracts to comply with the MCAEquality monitoring mechanisms in place for service users

Commissioned services adhere to NHS standard contractQuality assurance processes identify outcomes

Safeguarding information available to adults at risk and familiesInvolvement of service users in strategic approach to safeguarding

Staff safeguarding trainingRaising alerts and multi-agnecy partnership working

Understanding and application of MCA principlesStaff supervision policy supports effective safeguarding

Proportion of London NHS Trusts with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Local Authorities

Outcomes with highest proportion of green ratings Number Percent A1 Senior staff member accountable for Safeguarding 11 85% A3 Board commitment to Safeguarding 11 85% D2 Reporting of adult safeguarding concerns 9 82% Outcomes with highest proportion of red and amber ratings Number Percent F2 Understanding and application of MCA principles 9 69%


F5 Quality assurance processes identify outcomes 8 62%

0% 20% 40% 60% 80% 100%

Senior staff member accountable for SafeguardingBoard commitment to Safeguarding

Reporting of adult safeguarding concernsOrganisational commitment to Safeguarding

Equality monitoring mechanisms in place for service usersCommissioning agreements reflect safeguarding requirements

Culture of opennessLegal advice for safeguarding and MCA

Safeguarding information available to adults at risk and familiesStaff supervision policy supports effective safeguarding

Safeguarding policies and proceduresStaff safeguarding training

Guidance and procedures for complaints and allegationsAttendance at Safeguarding Adults Board

Policy and procedures for information sharingPrinciples of person centred care

Robust and safe recruitment procedures and practicesRaising alerts and multi-agnecy partnership working

Commissioned services have contracts to comply with the MCAStaff feedback

Quality assurance processes identify outcomesCommissioned services adhere to NHS standard contract

Involvement of service users in strategic approach to safeguardingUnderstanding and application of MCA principles

Proportion of London Local Authorities with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Voluntary Sector Organisations

Outcomes with highest proportion of green ratings Number Percent F1 Principles of person centred care 12 100% C4 Guidance and procedures for complaints and allegations 12 92%

B2 Commissioning agreements reflect safeguarding requirements 10 91%

Outcomes with highest proportion of red and amber ratings Number Percent B1 Safeguarding policies and procedures 6 50% F5 Quality assurance processes identify outcomes 5 50% C2 Staff supervision policy supports effective safeguarding 6 46%

0% 20% 40% 60% 80% 100%

Principles of person centred careGuidance and procedures for complaints and allegations

Commissioning agreements reflect safeguarding requirementsRobust and safe recruitment procedures and practices

Culture of opennessCommissioned services adhere to NHS standard contract

Senior staff member accountable for SafeguardingBoard commitment to Safeguarding

Reporting of adult safeguarding concernsOrganisational commitment to Safeguarding

Equality monitoring mechanisms in place for service usersCommissioned services have contracts to comply with the MCA

Raising alerts and multi-agnecy partnership workingAttendance at Safeguarding Adults Board

Policy and procedures for information sharingUnderstanding and application of MCA principles

Involvement of service users in strategic approach to…Legal advice for safeguarding and MCA

Staff safeguarding trainingStaff feedback

Safeguarding information available to adults at risk and familiesStaff supervision policy supports effective safeguarding

Safeguarding policies and proceduresQuality assurance processes identify outcomes

Proportion of London voluntary sector organisation with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Emergency Services

Outcomes with highest proportion of green ratings Number Percent A3 Board commitment to Safeguarding 6 100% A4 Culture of openness 5 100% D1 Attendance at Safeguarding Adults Board 6 100% D3 Policy and procedures for information sharing 6 100% Outcomes with highest proportion of red and amber ratings Number Percent A5 Legal advice for safeguarding and MCA 3 100% C3 Staff safeguarding training 4 80% C1 Robust and safe recruitment procedures and practices 3 50%

0% 20% 40% 60% 80% 100%

Board commitment to SafeguardingCulture of openness

Commissioned services have contracts to comply with the MCAAttendance at Safeguarding Adults Board

Policy and procedures for information sharingSenior staff member accountable for Safeguarding

Organisational commitment to SafeguardingSafeguarding policies and procedures

Guidance and procedures for complaints and allegationsReporting of adult safeguarding concerns

Understanding and application of MCA principlesSafeguarding information available to adults at risk and families

Quality assurance processes identify outcomesCommissioning agreements reflect safeguarding requirements

Commissioned services adhere to NHS standard contractStaff supervision policy supports effective safeguarding

Staff feedbackRaising alerts and multi-agnecy partnership working

Equality monitoring mechanisms in place for service usersPrinciples of person centred care

Involvement of service users in strategic approach to safeguardingLegal advice for safeguarding and MCA

Robust and safe recruitment procedures and practicesStaff safeguarding training

Proportion of London emergency service organisations with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Public Health Commissioning

Outcomes with highest proportion of green ratings Number Percent A3 Board commitment to Safeguarding 9 100% C4 Guidance and procedures for complaints and allegations 8 100% F1 Principles of person centred care 8 89%


Outcomes with highest proportion of red and amber ratings Number Percent

B3 Commissioned services have contracts to comply with the MCA 3 75%

A4 Culture of openness 6 67%

F3 Safeguarding information available to adults at risk and families 6 67%

0% 20% 40% 60% 80% 100%

Board commitment to SafeguardingGuidance and procedures for complaints and allegations

Principles of person centred careAttendance at Safeguarding Adults Board

Commissioning agreements reflect safeguarding requirementsQuality assurance processes identify outcomes


Robust and safe recruitment procedures and practicesEquality monitoring mechanisms in place for service users

Staff feedbackReporting of adult safeguarding concerns

Policy and procedures for information sharingInvolvement of service users in strategic approach to safeguarding

Commissioned services adhere to NHS standard contractSafeguarding policies and procedures


Understanding and application of MCA principlesLegal advice for safeguarding and MCA

Staff supervision policy supports effective safeguardingCulture of openness

Safeguarding information available to adults at risk and familiesCommissioned services have contracts to comply with the MCA

Proportion of Public Health Commissioned organisations with Red, Amber and Green self-assessment ratings for safeguarding outcomes

23

Specialised Commissioning

Outcomes with highest proportion of green ratings Number Percent


F1 Principles of person centred care 9 100% F2 Understanding and application of MCA principles 9 100% Outcomes with highest proportion of red and amber ratings Number Percent D1 Attendance at Safeguarding Adults Board 8 89% D3 Policy and procedures for information sharing 6 67% A2 Organisational commitment to Safeguarding 5 56%

0% 20% 40% 60% 80% 100%

Commissioning agreements reflect safeguarding requirementsPrinciples of person centred care

Understanding and application of MCA principlesSenior staff member accountable for Safeguarding

Safeguarding policies and proceduresCommissioned services have contracts to comply with the MCA

Robust and safe recruitment procedures and practicesGuidance and procedures for complaints and allegations

Culture of opennessCommissioned services adhere to NHS standard contract

Legal advice for safeguarding and MCAStaff supervision policy supports effective safeguarding

Staff safeguarding trainingStaff feedback

Reporting of adult safeguarding concernsQuality assurance processes identify outcomes

Board commitment to SafeguardingEquality monitoring mechanisms in place for service users

Raising alerts and multi-agnecy partnership workingInvolvement of service users in strategic approach to safeguarding

Organisational commitment to SafeguardingSafeguarding information available to adults at risk and families

Policy and procedures for information sharingAttendance at Safeguarding Adults Board

Proportion of Specialised Commissioning organisations with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Appendix two Responses by locality Audit results are recorded by locality to show, North Central and East London, North West London and South London Organisations in North Central and East London

Outcomes with highest proportion of green ratings Number Percent C4 Guidance and procedures for complaints and allegations 32 84% A3 Board commitment to Safeguarding 35 83% A4 Culture of openness 31 82% Outcomes with highest proportion of red and amber ratings Number Percent C3 Staff safeguarding training 21 58%



0% 20% 40% 60% 80% 100%

Guidance and procedures for complaints and allegationsCulture of openness

Board commitment to SafeguardingLegal advice for safeguarding and MCA

Principles of person centred careSenior staff member accountable for Safeguarding

Policy and procedures for information sharingOrganisational commitment to Safeguarding

Commissioning agreements reflect safeguarding requirementsEquality monitoring mechanisms in place for service users

Reporting of adult safeguarding concernsRobust and safe recruitment procedures and practices

Safeguarding information available to adults at risk and familiesQuality assurance processes identify outcomes

Attendance at Safeguarding Adults BoardStaff feedback

Safeguarding policies and proceduresCommissioned services adhere to NHS standard contract

Staff supervision policy supports effective safeguardingUnderstanding and application of MCA principles

Staff safeguarding trainingInvolvement of service users in strategic approach to safeguarding

Raising alerts and multi-agnecy partnership workingCommissioned services have contracts to comply with the MCA

Proportion of NCEL organisations with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Organisations in North West London

Outcomes with highest proportion of green ratings Number Percent A1 Senior staff member accountable for Safeguarding 22 96% C1 Robust and safe recruitment procedures and practices 22 96% C4 Guidance and procedures for complaints and allegations 22 96% F1 Principles of person centred care 22 96% Outcomes with highest proportion of red and amber ratings Number Percent B4 Commissioned services adhere to NHS standard contract 13 65%


C3 Staff safeguarding training 14 61%

0% 20% 40% 60% 80% 100%

Senior staff member accountable for SafeguardingRobust and safe recruitment procedures and practices

Guidance and procedures for complaints and allegationsPrinciples of person centred care

Staff feedbackReporting of adult safeguarding concerns

Board commitment to SafeguardingCulture of openness

Attendance at Safeguarding Adults BoardLegal advice for safeguarding and MCA

Equality monitoring mechanisms in place for service usersQuality assurance processes identify outcomes

Organisational commitment to SafeguardingPolicy and procedures for information sharing

Safeguarding information available to adults at risk and familiesCommissioning agreements reflect safeguarding requirements

Safeguarding policies and proceduresStaff supervision policy supports effective safeguarding

Understanding and application of MCA principlesCommissioned services have contracts to comply with the MCA

Raising alerts and multi-agnecy partnership workingInvolvement of service users in strategic approach to safeguarding

Staff safeguarding trainingCommissioned services adhere to NHS standard contract

Proportion of NWL organisations with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Organisations in South London

Outcomes with highest proportion of green ratings Number Percent C4 Guidance and procedures for complaints and allegations 42 86% F1 Principles of person centred care 37 82% A1 Senior staff member accountable for Safeguarding 40 82% Outcomes with highest proportion of red and amber ratings Number Percent

F3 Safeguarding information available to adults at risk and families 30 68%

F2 Understanding and application of MCA principles 28 62% C2 Staff supervision policy supports effective safeguarding 29 59%


0% 20% 40% 60% 80% 100%

Guidance and procedures for complaints and allegationsPrinciples of person centred care


Board commitment to SafeguardingAttendance at Safeguarding Adults Board

Culture of opennessCommissioning agreements reflect safeguarding requirements

Robust and safe recruitment procedures and practicesStaff feedback

Safeguarding policies and proceduresReporting of adult safeguarding concerns

Policy and procedures for information sharingCommissioned services adhere to NHS standard contract

Equality monitoring mechanisms in place for service usersLegal advice for safeguarding and MCA

Commissioned services have contracts to comply with the MCAQuality assurance processes identify outcomes


Staff supervision policy supports effective safeguardingUnderstanding and application of MCA principles

Involvement of service users in strategic approach to safeguardingSafeguarding information available to adults at risk and families

Proportion of SL organisations with Red, Amber and Green self-assessment ratings for safeguarding outcomes

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Appendix three Results by Borough It is important to note that the self- assessment scores are subjective and that a high rating of red and amber scores is not necessarily a reflection of poor practice; neither is a high rating of green scores an indication that an organisation is doing well. These scores must be treated with caution. Local area footprints RAG scores by area The self-assessment results of CCGs, Local Authorities, NHS Trusts and other voluntary, emergency, Public Health commissioned and specialised commissioning services were combined per area to create a local area footprint. The RAG score is an aggregate score created by allocating 1 point for every amber rating and 2 points for every red rating, taking the sum of these points for each area and dividing the result by the number of organisations in that area who submitted a self-assessment. A higher RAG score indicates more amber and red ratings.

Islington

Central London

CamdenCity and

Hackney

West London

LambethWandsw orth

Southw ark

Tow er Hamlets

New ham

Lew isham

Greenw ichHammersmith

and Fulham

Brent

Ealing

Richmond

Waltham Forest

Kingston

Merton

Sutton Croydon

Bromley

Bexley

Barking and Dagenham

Haringey Redbridge

Hounslow

Havering

Hillingdon

Harrow

Barnet

Enfield

RAG Score

4 to 66 to 88 to 10

10 to 1212 to 19

Area Number of organisations

Outcomes with highest proportion of red and amber ratings

Barking and Dagenham

4 Robust and safe recruitment procedures and practices Attendance at Safeguarding Adults Board Policy and procedures for information sharing Understanding and application of MCA principles

Barnet 4 Commissioned services adhere to NHS standard contract Involvement of service users in strategic approach to safeguarding Raising alerts and multi-agency partnership working

Bexley 1 Staff supervision policy supports effective safeguarding Staff safeguarding training

Brent 1 Staff supervision policy supports effective safeguarding Involvement of service users in strategic approach to safeguarding Commissioned services have contracts to comply with the MCA

Bromley 3 Board commitment to Safeguarding Understanding and application of MCA principles

Camden 3 Understanding and application of MCA principles Staff safeguarding training Commissioned services adhere to NHS standard contract Safeguarding information available to adults at risk and families Commissioned services have contracts to comply with the MCA

Central London (Westminster)

1 Staff safeguarding training Commissioned services adhere to NHS standard contract Commissioned services have contracts to comply with the MCA Involvement of service users in strategic approach to safeguarding Commissioning agreements reflect safeguarding requirements Safeguarding policies and procedures

City and Hackney 4 Raising alerts and multi-agency partnership working Commissioned services have contracts to comply with the MCA Involvement of service users in strategic approach to safeguarding Reporting of adult safeguarding concerns Equality monitoring mechanisms in place for service users Quality assurance processes identify outcomes

Croydon 7 Understanding and application of MCA principles Staff feedback Safeguarding information available to adults at risk and families

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Outcomes with highest proportion of red and amber ratings Legal advice for safeguarding and MCA

Ealing 5 Commissioned services have contracts to comply with the MCA Staff safeguarding training Commissioned services adhere to NHS standard contract Involvement of service users in strategic approach to safeguarding Quality assurance processes identify outcomes Staff supervision policy supports effective safeguarding Organisational commitment to Safeguarding Equality monitoring mechanisms in place for service users Board commitment to Safeguarding

Enfield 4 Involvement of service users in strategic approach to safeguarding Board commitment to Safeguarding Raising alerts and multi-agency partnership working Attendance at Safeguarding Adults Board

Greenwich 8 Raising alerts and multi-agency partnership working Staff safeguarding training

Hammersmith and Fulham

4 Involvement of service users in strategic approach to safeguarding Legal advice for safeguarding and MCA Commissioned services have contracts to comply with the MCA Commissioned services adhere to NHS standard contract

Haringey 3 Commissioned services have contracts to comply with the MCA Staff safeguarding training Staff supervision policy supports effective safeguarding

Harrow 3 Raising alerts and multi-agency partnership working Commissioned services adhere to NHS standard contract

Havering 2 Attendance at Safeguarding Adults Board Staff safeguarding training Staff supervision policy supports effective safeguarding

Hillingdon 3 Raising alerts and multi-agency partnership working Staff safeguarding training Staff supervision policy supports effective safeguarding Commissioned services adhere to NHS standard contract Understanding and application of MCA principles Safeguarding information available to adults at risk and families

Hounslow 4 Staff safeguarding training Safeguarding information available to adults at risk and families

30


Outcomes with highest proportion of red and amber ratings Safeguarding policies and procedures

Islington 5 Safeguarding information available to adults at risk and families Safeguarding policies and procedures Staff supervision policy supports effective safeguarding Involvement of service users in strategic approach to safeguarding Understanding and application of MCA principles Commissioned services have contracts to comply with the MCA Quality assurance processes identify outcomes

Kingston 3 Staff supervision policy supports effective safeguarding Commissioned services have contracts to comply with the MCA Staff safeguarding training

Lambeth 1 Staff supervision policy supports effective safeguarding Understanding and application of MCA principles Raising alerts and multi-agency partnership working Safeguarding information available to adults at risk and families

Lewisham 5 Raising alerts and multi-agency partnership working Staff supervision policy supports effective safeguarding

Merton 3 Staff supervision policy supports effective safeguarding Understanding and application of MCA principles Involvement of service users in strategic approach to safeguarding

Newham 3 Raising alerts and multi-agency partnership working Organisational commitment to Safeguarding

Redbridge 6 Staff feedback Quality assurance processes identify outcomes

Richmond 3 Raising alerts and multi-agency partnership working Staff supervision policy supports effective safeguarding

Southwark 4 Involvement of service users in strategic approach to safeguarding Safeguarding information available to adults at risk and families

Sutton 7 Safeguarding information available to adults at risk and families Staff supervision policy supports effective safeguarding Equality monitoring mechanisms in place for service users Legal advice for safeguarding and MCA Reporting of adult safeguarding concerns

Tower Hamlets 2 Safeguarding information available to adults at risk and families Raising alerts and multi-agency partnership working

Waltham Forest 4 Staff safeguarding training Wandsworth 5 Involvement of service users in strategic approach to

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Outcomes with highest proportion of red and amber ratings safeguarding Commissioned services have contracts to comply with the MCA Safeguarding information available to adults at risk and families

West London 2 Involvement of service users in strategic approach to safeguarding Commissioned services have contracts to comply with the MCA Staff safeguarding training Commissioned services adhere to NHS standard contract Commissioning agreements reflect safeguarding requirements

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Appendix Four Support and Challenge Events. Some Safeguarding Adult Boards held a half-day or full day workshop to present and discuss the findings from the self-assessment audits. The completed audits were used to help the Board get an overview of the safeguarding adult arrangements in place across the locality identifying:

• Strengths, to facilitate the identification and sharing of good practice. • Common areas for improvement where organisations can work collaboratively

with support from the Board. • Single agency issues that need to be addressed. • Partnership issues that may need to be addressed by the Board.

The Challenge and Support event was intended to facilitate this process by helping organisations to identify good practice that might be shared and identify areas for improvement. Common issues for organisations emerged. These were used by some SABs to inform the SAB strategy and/or business plan. Some of the SABs that took this approach included: Barking and Dagenham Sutton Southwark Greenwich Croyden Camden Islington The SABs took different approaches to facilitating a Challenge and Support Event. Southwark Safeguarding Adult Board Board Audit – Challenge and Support Event June 2014 All partners sent in a completed self- assessment audit a month before the challenge and support event took place. The rating of each organisation against the outcomes and criteria was collated onto a spreadsheet using red, amber and green. This provided a quick check to see where most organisations were doing well and areas that were presenting a challenge to partners.

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Each partner was asked to prepare for the day by planning a presentation of no more than five minutes on three things they were doing well and three things that they needed to improve. The presentation were to be verbal – no power point presentations. On the day the room was organised so that partners from the same sector sat together. For example, health providers on one table, emergency services on another. Presentation were given by each of the organisations on one table. This was followed by questions from each of the tables in turn. Time was given between presentations for the tables to prepare questions together following discussion. At the end of the event some key issues were identified for the Board’s attention. Each of the partner organisations also had actions. Carrying out a Challenge and Support Event with more than one Board Enfield SAB invited the Haringey and Barnet SABs to join them in an audit challenge and support day. Enfield Safeguarding Adults Board held a learning and challenge day in March 2014. To improve the joined up approach and given some partners work across authorities, both Haringey and Barnet were invited to complete this with us. Barnet accepted and there were some members from Barnet in attendance on the day. This will now form part of the quality assurance framework for the Board. The Boards expect to hold this day every two years. Bournemouth and Poole SAB and Dorset SAB carried out a joint Board Audit Challenge and Support day in February 2015. These Boards share the same Independent Chair. A consultant was commissioned to facilitate the event. The learning that emerged was relevant to both SABs and was used to inform business plans. The advantages of holding a Support and Challenge Event with neighbouring SABs are: Pools information on experience of working with organisations that span more than one SAB. Reduces duplication of effort for organisations such as health trusts who work with more than one SAB Local Authorities can learn from each other. Shared cost of organizing and facilitating the event. Some of the disadvantages are: The event will take longer and so a full day is needed.

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The focus may be broad rather than picking up very specific local issues. Camden and Islington challenge and support event 2014.

On Friday 21st March 2014, Camden and Islington Safeguarding Adult Partnership Boards (SAPBs) joined together for a joint challenge and support morning. To facilitate networking, learning and cross-fertilisation of ideas, Board members were grouped onto tables according to the sector they operated in, and not according to geography – see attached sector based groups document. The morning consisted of presentations, sector-based exercises, and whole group discussion and a networking lunch – see attached agenda.

Prior to the event, each agency was asked to complete a safeguarding adults self-audit template (using the NHS SAAF) and submit this to their Board by the end of Feb 2014. The ratings in the self-audits were then analysed using the attached template to give an overall result for both boroughs, and a result for each borough separately. This information was brought together into a headline presentation to kick-start the challenge and support event.

Following this, each table was given an easily-digestible summary of the self-audit results for each organisation and for their sector overall - highlighting the areas of strength and areas for development. This facilitated a discussion on each sector-based table both to explore further the areas of strength and to provide challenge and support for each organisation on the areas of development.

Each sector-based group was asked to provide feedback to the whole meeting, and following each feedback presentation time was allowed for the whole meeting to offer challenge and support (including questions to dig deeper, and offers of good practice/ help) to each sector. At the end of these presentations, a facilitated discussion took place to identify the common themes arising from the morning and to agree any actions to move the agenda forward. The discussion, conclusions and actions were recorded and circulated by a note-taker, and a survey monkey was used to ask Board members to provide feedback on the event. This showed that 100% of the attendees found both the audit tool and the event to be useful, and found it valuable to bring Islington and Camden together and to work in sector-based groups. Feedback included:

Presentation of headline messages

Template for collating results from all partner’s self- assessment ratings.

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Extending the audit to providers of services not represented on the SAB

Some SABs found inventive ways of including providers of services not represented on the SAB

• Greenwich worked with community and voluntary organisations and providers of social care.

• Southwark worked with GPs • Sutton are working with housing providers

Greenwich Community and Voluntary Organisations Greenwich Action for Voluntary Service exists to provide a strategic leadership role in representing and building the capacity of Voluntary and Community Organisations in Greenwich. As the Voluntary and Community Organisations (VCOs) representative on the Safeguarding Adults Board, we wanted to make the safeguarding audit experience both positive and straightforward for leaders of local VCOs working with adults and older people. We therefore took a ‘needs based’ approach to assess organisations’ requirements around safeguarding adults as opposed to an ‘audit’ approach, and changed the wording (not the meaning) of the statements, so they could be easily understood by people of most backgrounds and literacy levels. We encouraged organisations unable to attend an event carrying out the assessment, to complete it on line via survey monkey. (link here) This enabled us to bring a representative sample of the needs of the sector to the safeguarding adults board for action. Link for Survey Monkey https://www.surveymonkey.com/s/YWNM6ZZ Greenwich Social Care Providers To audit the safeguarding approaches of social care providers we sent a short questionnaire to home care agencies and residential care homes in the borough for completion. The questionnaire asked the providers about the presence of safeguarding champions in their organisations, lines of accountability around safeguarding, the promotion of wellbeing, complaints and exit interviews amongst other things. It provided ideas for change within different organisations. We conduct telephone spot checks every week to check service users and the quality of services/support they are receiving and the results fed into the audit,

https://www.surveymonkey.com/s/YWNM6ZZ

https://www.surveymonkey.com/s/YWNM6ZZ

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particularly around dignity and respect. The audit prompted additional questions to be asked in our regular telephone spot checks including service user awareness of providers’ complaint policy and asking whether service users’ services had been ‘spot-checked’ by the provider. S afeguarding is also a standing item at all contract m onitoring m eetings. Southwark GPs Southwark launched the Safeguarding adults assessment tool in primary care and received returns from 25 out of 44 practices. These audits have formed a baseline for primary care and we are using this baseline to identify the training and support needed going forward. We have shared the results of the audits with practices at the quarterly practice visits. We identified through the audits a need for further awareness raining around MCA and have a protected learning event schedule for 16 April which all practices are attending, plus social care, community and acute nursing colleagues. We have the deputy head of the BMA Ethics Committee, Consultant Psychologist from SLaM and a Lawyer from Care and Health Law giving presentations. In addition we will be doing table top exercise working through MCA and audit safeguarding scenarios. Sutton Housing Providers Sutton are including housing providers by asking them to complete a self- assessment audit. Housing providers are invited to attend a regular meeting with local authority commissioners to network and share good practice. Adult safeguarding will be the main topic at one of these meetings. The completed audits will help to identify the support housing providers might need in safeguarding adults.

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