Safeguarding Adults Board 6 th Annual Conference Adult Safeguarding and the NHS Alison Knowles Commissioning Director NHS England, West Yorkshire

Who are we?

NHS England is an independent body, at arms length from the government, with an annual mandate to improve health outcomes for people in England. We: 1. provide national leadership for improving outcomes and driving up the quality of care 2. oversee the operation of clinical commissioning groups 3. allocate resources to clinical commissioning groups 4. commission primary care, national public health programmes and specialist services for the general population. We also commissions services for people serving in the armed forces and for people within the criminal justice system. Clinical commissioning groups (CCGs) have taken on most of the functions of PCTs. CCGs commission planned hospital care, urgent and emergency care, community services and mental health and learning disability services.

What is NHS England’s role in safeguarding? The Mandate sets NHS England a specific objective of continuing to improve safeguarding practice in the NHS, reflecting also the commitment to prevent and reduce the risk of abuse and neglect of adults. We deliver this by oversight of safeguarding systems and governance, including how Safeguarding Boards are working. We seek assurance from CCGs regarding the services they commission (eg assurance standards, monitoring implementation of serious case review improvement actions etc) We have specific responsibility regarding our directly commissioned services, ensuring that we’re driving up the quality of safeguarding through commissioning and working closely with providers regarding any improvements required. We do this in collaboration with CCGs, local authorities, providers, voluntary sector, CQC, Monitor, NHS TDA and many more…. the stronger our partnerships, the stronger our safeguarding system.

What is the CCG’s role in safeguarding? CCG commissioning responsibilities stretch across healthcare for older people, people with dementia, people with learning disabilities and people with mental health conditions – in primary, community, secondary and social care settings. CCGs will have (subject to the Care and Support Bill) a statutory duty to participate in Safeguarding Adults Boards (SABs), working in partnership with local authorities, NHS England, CQC and others. CCGs need to have: plans to train staff in recognising and reporting safeguarding issues a clear line of accountability for safeguarding, properly reflected in governance arrangements a safeguarding adults lead and a lead for the Mental Capacity Act, supported by the relevant policies and training. CCG’s responsibilities explicitly include ensuring that they commission safe services for those in vulnerable situations, including effective systems for responding to abuse and neglect of adults in vulnerable situations and effective interagency working.

NHS safeguarding work is led by Sue Cannon, Director of Nursing NHS England (West Yorkshire). The programme in our first year covered: Quality assuring the NHS contribution to safeguarding incident reviews Monitoring (and managing, for directly commissioned services) implementation of actions from SCRs and incidents Learning from safeguarding incidents in West Yorkshire Building safeguarding capacity and capability in primary care. Establishing safeguarding assurance process (minimum standards) Co-ordinate safeguarding leadership across the NHS commissioning system through the safeguarding forum. Supporting NHS England safeguarding board members Our 2013/14 programme in West Yorkshire

What have we achieved? Publication of national “Safeguarding Vulnerable People Accountability and Assurance Framework”, NHS England 2013 Publication of Standard Operating Procedures for Managing Safeguarding Serious Incidents across West Yorkshire Establishment of safeguarding forum across five local authority areas and ten CCGs Establishment of primary care leads and training programme Meta-analysis of learning and improvement actions for primary care

Learning for Primary Care Looked at 6 IMRs for safeguarding and 3 domestic homicide reviews. Seven lessons: 1. Understanding vulnerability factors eg dementia and learning disabilities 2. Seeking to identify vulnerability – missed opportunities to pro-actively identify risk 3. Recording and flagging vulnerability in records – over-reliance on IT flagging systems and low level of reliance on clinical judgement and practice 4. Maintaining engagement – contact and communication when vulnerable people may fail to keep appointments 5. Sharing information and concerns – information governance and sharing information 6. Multi-agency working – knowledge about local resources and services 7. Leadership – need for a named GP role particularly in adult safeguarding.

Next steps Understand the implications for NHS of the statutory role for Adult Safeguarding Boards Look at clinical leadership of adult safeguarding in general practice Strengthen training programme for GPs and practice nurses Develop a carer assessment tool to support vulnerable people in the community Develop a set of good practice protocols (what to do when….) Develop a general practice assurance template Utilise opportunity from changes to adult social care responsibilities to explore safeguarding in prison and secure settings. What else?