Hampshire County Council

Adult Social Care Policy Review Committee Item 7

28 September 2005

Annual Report on Adult Protection Arrangements

Report by the Director of Adult Services

How the conclusion in this report fits with the Corporate Strategy

Robust Adult Protection arrangements impact on the delivery of the following Corporate Aims

Aim 1 - maximising life opportunities by ensuring that vulnerable people are not subject to abusive practice.

Aim 4 - building strong and safe communities: people need to feel that the arrangements do offer protection to those who are vulnerable.

Aim 5 - improving services.

Aim 6 - developing councillors and staff

The amendments to the policy and the training programme ensure that both services and staff are in a position to respond positively and effectively.

1.

Background

1.1

Following the publication of `No Secrets' in 2001, Hampshire County Council, Portsmouth City Council and Southampton City Council agreed to work in partnership to establish a Multi Agency Management Committee, covering all three Social Services Departments.

1.2

The next section of the report is common to each authority's annual report and focuses on the strategic development of the approach to protecting vulnerable adults. The remainder of the report focuses on action within Hampshire.

2.

Multi Agency Management Committee Report - 2005

2.1

The Multi Agency Management Committee has a wide range of organisations represented on it. The terms of reference and membership at June 2005 are set out in Appendix 1.

2.2

Over the past year a number of initiatives have been developed and/or finalised:

2.2.1

Leaflets for service users and staff have been printed and distributed. They are also available on the website. Demand for the leaflets has been high.

2.2.2

The common training strategy which is now operating across the three Local Authorities and across agencies has gathered momentum. Details of developments in each Local Authority area will be set out in more detail in each Authority's own annual report.

2.2.3

A requirement for Local Authorities, set out in `No Secrets' (2000) is to annually review and revise the policy and procedures. The Multi Agency Management Committee have signed off the required amendments for 2004 / 2005 and the revised document will be available in July 2005. This will be available on organisations' websites for ease of access by providers, staff and the public. There is evidence that the general public and service users have accessed the documents on the website.

2.2.4

Templates for in-house policy frameworks for provider services which are also on the website have been updated to keep abreast of national developments.

2.2.5

The Multi Agency Management Committee looks at issues which arise in practice and which often require a broad and consistent response across agencies.

2.2.6

The Committee has been made aware of national events and developments so that information about these can be disseminated within each agency. Examples are the Protection of Vulnerable Adults List (POVA List) and the heightened media awareness around the Comic Relief campaign on elder abuse in March 2005.

2.3

The Multi Agency Management Committee aims to enhance collaboration and partnership across agencies and sectors in order to protect vulnerable adults from abuse.

2.3.1

Relationships between Hampshire Police and Local Authority partners have been strengthened. Joint training has taken place. A system to collect statistics on adult protection within Hampshire Police has been developed and came into effect on 1^st April 2005. A strategy for future training priorities is being developed along with ongoing discussions as to which specific police officers are best placed to focus on adult protection as part of their role in the longer term. Feedback from training of Independent Sector providers has highlighted an enhanced response from Hampshire Police in adult protection situations over the past 12 months.

2.3.2

Independent sector providers and the voluntary sector are well-represented on the Multi Agency Management Committee and have played an active part in promoting awareness of adult protection in their sectors as well as an awareness of national developments such as the Protection of Vulnerable Adults List. They have taken a substantial role in ensuring the success of training across these sectors. As a result this training has developed considerably. HCA is committed to training for its members in this area of work and plays an active part in the Multi Agency Management Committee. It is clear that abusive practice has no place in residential care.

2.3.3

The Commission for Social Care Inspection continues its membership of the Multi Agency Management Committee. It has contributed to the revision of the adult protection policy and begun to look at the potential for strengthening links in practice in tackling abuse. It is hoped that this will develop in 2005/6.

2.3.4

Involvement from Health colleagues on the Committee has begun to develop and Trusts are now beginning to look at how to promote adult protection in their organisations as well as training implications. There is still no involvement from the Strategic Health Authority.

2.3.5

Housing representation has not developed during the past year although individual Housing Authorities are engaging in adult protection work. As a result, a meeting with strategic housing managers is scheduled to address the absence of Housing on the Multi Agency Management Committee.

2.4

A great deal of work has taken place throughout the last year both strategically and locally. Work on adult protection will continue to gather pace in 2005/06 and local responses are included later in this report.

2.5

The Multi Agency Management Committee is providing a focal point and framework for strategic development, whilst enabling each authority to pursue issues relevant to them. The adult protection agenda continues to grow and gather pace.

2.6

It has been agreed between the three local authorities that the chairing of this group will be rotated annually each financial year. The authority chairing will be responsible for the annual report of the committee and any changes to the policy and guidance.

3

Working together to protect vulnerable adults from abuse in Hampshire

3.1

There has been significant progress in developing an effective response to the issue of the protection of vulnerable adults from abuse in Hampshire in 2004/05.

3.2

Hampshire County Council Social Services Department continues to make a valuable contribution to the Multi Agency Management Committee for adult protection. Glyn Jones, County Manager, has chaired this group.

3.3

Within Hampshire, there is an internal Social Services Department adult protection steering group which assists in implementing the strategy locally and ensures that adult protection remains a significant focus on this Department's agenda. Membership of this group has set up local adult protection action groups (LAPAGs) along PCT boundaries. There are seven such groups which enhance multi-agency working on adult protection and which ensure that local practice issues are fed into the Multi Agency Management Committee (see appendix 2 for details of steering group membership.) County Council Members are most welcome to attend these local groups. Contact details for Chairs of these groups are attached at appendix 5.

3.4

The 2000 Department of Health mandatory guidance "No Secrets: Guidance in Developing and Implementing Multi-Agency Policies and Procedures to Protect Vulnerable Adults from Abuse", sets out the main elements which local authority Social Services Departments must include in coordinating local strategies for implementing the policy and procedures and for sustaining a high level of commitment to the protection of vulnerable adults in practice. The Multi Agency policy and procedures have again been substantially updated and form the basis of effective joint working.

4.

Training

4.1

Internally the training strategy continues to develop and there has been growth both in numbers of staff trained and the range of courses available. In total 1292 staff have been trained in 2004/05 with a further 42 Mental Health staff undergoing training. (See appendix 3.)

4.2

Hampshire County Council Social Services Department continues to support training in the independent sector, working with Hampshire Care Association and Hampshire Domiciliary Care Association. Train the Trainer training continues and a total of 176 trainers have been trained from care homes and from domiciliary care agencies during 2004/05. During this year a need was identified for training for managers in these settings and these courses are now underway. To date one course has taken place and a further 11 courses for managers are scheduled. Further Train the Trainer courses are also scheduled.

4.3

Hampshire County Council SSD has also supported ROCC in undertaking Train the Trainer training with representatives from organisations in the voluntary and not-for-profit sector. To date 187 participants from 91 organisations have been trained. In 2005/06 the focus of the training will move away from Train the Trainer to direct training to respond to expressed need. Six sessions are scheduled for the coming year.

4.4

Seven joint seminars were held for police detectives and social services managers and senior practitioners. These were run jointly by Hampshire Police and Hampshire County Council Social Services Department. These have been very successful in enhancing mutual understanding of roles and developing positive working relationships.

4.5

Some training has taken place within Hampshire Partnership Trust and discussions are underway to extend this.

4.6

A workshop event was run by Hampshire County Council Social Services Department for health trusts across the County in February 2005. At this event Hampshire County Council Social Services Department offered to support Health Trusts in raising awareness of adult protection issues and in developing their training strategies. A number of Health Trusts have since begun to take up these offers of support.

4.7

There is consistency in all of the above training in terms of training materials used and quality and experience of trainer.

5.

Monitoring the prevalence of abuse in Hampshire

5.1

Statistics for the year 1 April 2004 to 31 March 2005 show a significant increase in reporting of Adult Protection concerns. These are set out in Appendix 4 to this report. The statistics produced for 2003/2004 showed 191 incidents of suspected abuse for which a monitoring form was completed by Social Services Department staff. For 2004/5 the number of incidents recorded are 413. This reflects both an increase in awareness of the issue of abuse of vulnerable adults and greater consistency in staff within Social Services completing the monitoring forms.

5.2

There is no doubt that this increased reporting has meant a considerable increase in the workload for care management which does have capacity issues. Also we need to refine the monitoring to reflect work undertaken when whole homes are under scrutiny . This will be followed up with County Managers during the coming year.

5.3

Some significant trends from these statistics are as follows:

5.3.1

In 2003/2004 there were similar numbers of reported cases of abuse in the learning disability and older persons sectors. In 2004/2005 there is a much greater discrepancy between the two sectors with 205 reported cases in the older persons sector compared with 115 in the learning disability sector. This is to be expected in view of the comparative populations.

5.3.2

In both 2003/2004 and 2004/2005 the most commonly reported type of abuse is physical abuse and the next most common is financial abuse. In 2004/2005 there are significant variations between care groups in the incidence of different types of abuse (see table 12 appendix 4). For example 59 older people were subject to financial abuse compared with 19 individuals from the learning disability sector. Conversely there are 21 reported incidents of sexual abuse in the learning disability sector compared with 5 such reports in the older persons sector. Out of a total of 76 reported cases of neglect 52 of those were recorded in the older persons sector.

5.3.3

Since April 1^st 2004 Hampshire have been collating information relating to the location in which the abuse occurred. Out of a total 413 reported cases of abuse 202 took place in residential or nursing care homes with 151 reported cases taking place in an individual's own home. In table 17 (appendix 4) it can also be seen that of those being investigated as abusers of vulnerable adults, 156 were paid carers as opposed to 93 who were relatives.

5.3.4

Recent research by Action on Elder Abuse on calls to their helpline over a six and a half year period (just over 10,500 incidences of abuse reflected in telephone calls) showed a different picture with 64% of calls relating to abuse in a person's own home and 23% in care homes. In Hampshire when we extract the figures for older people alone there are 51% of calls relating to abuse in residential and nursing care homes and 36.5% relating to abuse in a person's own home. This underlines the case for the adult protection training which is being supported in care home settings in Hampshire where the emphasis is on both prevention and intervention.

5.3.5

The numbers of planning meetings and case conferences recorded as held under the adult protection procedures are significantly lower than the recorded number of suspicions. There were 413 recorded incidents of suspected abuse with 209 planning meetings held and 102 case conferences held. This is surprising and is an area which requires attention. During this year this trend has been noted and one action has been to increase the time available between planning meetings and case conferences as set down in the revised policy and procedures due out in July 2005. This will reduce the temptation to roll the two meetings into one when in fact a planning meeting should make plans to investigate the concerns whilst a case conference should meet to decide upon necessary actions following those investigations.

5.3.6

In terms of information on outcomes, this needs to be further refined and work is in progress to achieve this. However what is clear is that a range of agencies are now involved in investigating suspected abuse of vulnerable adults and that a significant amount of work is being undertaken alongside the Police in this area of work (table 4 appendix).

5.3.7

Information in table 11 (appendix 4) relates to the source of referrals of abuse of vulnerable adults. It is clear that there is significant awareness of the issue of abuse of vulnerable adults in the care provider sector as of the total referrals 44% came from care home or domiciliary care providers.

5.4

A case audit is planned during 2005/06 to assist our understanding of qualitative aspects of this work.

5.5

In order to fulfil our duties under the Race Relations Amendment Act, we have instituted monitoring and reporting arrangements so we can report on the impact of the implementation of this policy on black and ethnic minority communities. Work during this year will be to analyze results to see whether there is any disproportionate impact on minority ethnic communities. The information that is collected on those allegedly abused includes information on Social Services area and ethnic origin. This work will inform training needs for staff and services.

6.

Raising awareness of adult protection

6.1

Leaflets for service users; the general public and front line staff have been developed and widely distributed. There is a steady stream of requests for further leaflets, including leaflets in Braille and other languages. A press release was published in December which was followed up by requests for radio interviews which were given. A publicity strategy has been in place for the past six months to ensure continuing focus on raising awareness. The strategy includes a rolling programme of articles in internal and external publications.

6.2

Links continue with agencies who can both work to prevent abuse and to provide services where abuse has taken place. These include Victim Support; Hampshire County Council Trading Standards and Hampshire's Domestic Violence Co-ordinator. Community Safety Partnerships continue to be encouraged to take on board the issue of Adult Protection and in one or two of the partnerships Adult Protection features in the draft strategy for 2005-08. The Adult Protection Co-ordinator will engage in further work to encourage this in all Community Safety Partnerships.

6.3

Financial abuse is an area of abuse which was singled out as requiring particular guidance in the House of Commons Health Select Committee Report June 2004. Work has begun in Hampshire led by the Adult Protection Officer and Receiverships Manager to engage a wider range of agencies and individuals in producing guidance on preventing and intervening in situations of financial abuse of vulnerable adults. It is anticipated that this work will be completed during 2005/6 and will raise awareness of a broad range of partner agencies to the issue of abuse in the process.

6.4

Local Adult Protection Action Groups (LAPAGs), based on the former 7 PCT areas, continue to raise awareness in local areas. In the coming year multi agency workshops are planned in each of the groups.

6.5

Following on from the presentation of last year's report, a number of members of PRC indicated their wish to be involved with the LAPAGs, which was facilitated.

6.6

Local Authority Social Services Departments were required to take a lead in raising awareness of the Protection of Vulnerable Adults (POVA) List when it was introduced in July 2004. We have continued to do so and to advise partner agencies on the implications and mechanics of this process.

7

Future Developments and Priorities

7.1

To respond to the requirements of new legislation which is relevant to adult protection situations, including:

7.1.1

the Sexual Offences Act 2004

7.1.2

the Mental Capacity Act 2005 and plans for its implementation in 2007

7.1.3

the Domestic Violence Crime and Victims Act and to ensure the effective use of this and all relevant legislation in enhancing the protection of vulnerable adults.

7.2

To ensure that adult protection issues are taken into consideration in direct payments arrangements.

7.3

To engage with colleagues in the Supporting People Team to ensure a high level of awareness of adult protection issues in these settings.

7.4

To further develop the work already underway with Health Trusts in terms of training and integrating adult protection into other existing processes for protection of vulnerable adults (including Serious Untoward Incidents processes; contracting; disciplinary).

7.5

To further develop links with Hampshire Police.

7.6

To ensure the engagement of colleagues in the Adult Mental Health Sector in the adult protection agenda and in training.

7.7

To work with Commission for Social Care Inspection to have a facilitated joint workshop for managers and Inspectors.

7.8

To study the impact that the increase in adult protection work is having within care management teams and to report on these findings.

7.9

To report on work related to the Impact Assessment in next years Annual Report.

8

Financial implications of Adult protection work

8.1

Care Management Time

The increase in activity is equivalent to 9.5 Full time equivalent Care Managers and one Team Manager at a cost of £367,415. This has to date been entirely absorbed by current care managers adding to the pressure of their work.

8.2

Training

The local Authority has a mandatory role to support and stimulate training across agencies. Details of the training activity for both internal training and that in partner organisations; namely Health, the police and the independent and voluntary sectors, is outlined in section 4 of this report.

The following gives the cost of this training and identifies the primary sources of funding:

Internal Training (see section 4.1) refers to training for staff at all levels in the Department as set out in appendix 3. The cost of this training in 2004/2005 was £38,000 met from social services training budget.

Independent and voluntary sectors (see section 4.2) focuses on providers of residential, nursing and domiciliary care who contract to provide services to Hampshire Social Services. The cost of this training totalled £15,000 of which £10,000 was met from the National Training Strategy (NTS) Grant allocation in the social services training budget. The remaining £5,000 was generated as income from the individual providers as their contribution to the training strategy. Hampshire Care Association and Hampshire Domiciliary Care Association invested significant time in developing the strategy and provided the administrative support in delivering the programme.

Voluntary Sector (see section 4.3) focussed directly on the voluntary sector organisations within Hampshire. The cost of this training was £9,500, of which £5,000 was met from the NTS grant allocation in the social services training budget, and £4,500 as income from individual organisations as their contribution to the training strategy. ROCC invested significant time in developing the strategy and provided the administrative support in delivering the programme.

Note: The NTS grant was intended to support training of social care staff across the statutory, private and voluntary sectors to meet the workforce development requirements of the National Minimum Standards. Although ring fencing of all grants was removed in 2004/5 a commitment was retained within the social services training budget to support the intentions detailed in the LASSL (2004) 26.

Hampshire Police Training (see section 4.4) targeting senior key operational staff across social services and Hampshire Constabulary. The cost of the training was £1000 of which £500 was met from social services training budget and £500 from Hampshire Constabulary. The staff costs associated with delivery of the training was resourced equally by both parties.

Health Trusts (see section 4.6) The Hampshire & IOW Workforce Development Confederation have provided short term funding to develop joint training opportunities across health and social care services with adult protection as one agreed priority.

Recommendation(s)

That:

1

PRC are asked to note this report.

Adult Protection SSD Training Directory Courses 2004/05

Adult Protection Courses from April 1st 2004 - March 31st 2005

Numbers of courses delivered

Numbers of delegates

AP Basic Awareness

32

815

IN HOUSE SESSIONS

34

AP Detailed Awareness

18

241

AP Assessment and Investigation

6

97

AP Developing Investigation Skills

5

75

AP Manager's Development

3

27

AP Minute Taking

3

37

Total number of adult protection training courses delivered in 04/05

101

Total numbers of delegates who attended training in 04/05

1292