Newcastle Safeguarding Adults Board Annual Report 2021-22

This page includes the content of the NSAB Annual Report 2021-22. You can download the full report below.

Introductions from our Chair and Cabinet Member

“Once again, I am privileged to introduce the Newcastle Safeguarding Adults Board’s (NSAB) Annual Report for 2021-22.

In writing a similar introduction 12 months ago, it was hard to envisage that Covid-19 would continue to impact on the work of the NSAB, both directly and indirectly. However, the challenges of the pandemic have not deterred the commitment, determination and ongoing contributions of partner organisations to the safeguarding of adults at risk in Newcastle. All agencies are “learning to live” with the virus and its implications and have embedded both new ways of working and good practice shared over the Pandemic period.

A significant area of Board focus in 2021-22 has been responding to the continued increase in safeguarding adults activity and closely monitoring the impact that this has had on the multi-agency safeguarding system. Board members are rightly concerned about the volume of safeguarding adults referrals that are being reported. All agencies continue to ensure that these referrals are being referred via the right pathways and that there are sufficient resources to meet demand . I pay tribute to the front-line staff who are responding effectively and resiliently. The NSAB will continue to carefully scrutinise the position into next year and take any further actions required. Find out more about local data .

In the last year the NSAB finalised a Safeguarding Adults Review (SAR) about Adult L. The death of an adult linked to abuse or neglect is always a tragedy, however the SAR gives agencies an opportunity to learn. The published report highlights both strengths in practice and areas where developments and improvements can be made. The NSAB is robustly monitoring an action plan which responds to the recommendations from the SAR and a lot of progress has already been made. Find out more about the Adult L SAR .

The Board has four sub committees who are critical in helping deliver the key objectives in the NSAB’s Strategic Annual Plan. They have continued to make significant progress which includes:

• The Improving Practice Committee producing guidance around financial abuse and work on responding to poverty.
• The Learning and Development Committee managing a successful transition to a new e-learning provider.
• The Missing, Slavery, Exploited Trafficked (MSET) Sub-Committee assisting in the development of resources and training around criminal exploitation.
• The Safeguarding Adults Review Committee co-ordinating a number of reviews which will enable further learning and improvement.

I am most grateful to the members of the sub-committees who dedicate their time, experience and enthusiasm, often in addition to their day-to-day roles. Find out more about the work of our sub-committees.

The Board’s Strategic Annual Plan for 2022-23 details what the NSAB aims to achieve in the coming year. Work will include updating multi-agency policy and procedures, an integral part of ensuring agencies work together to safeguard adults with care and support needs. Further clarifications around the introduction of the Liberty Protection Safeguards are eagerly awaited, this new national guidance will impact on several member agencies. The NSAB see these new safeguards as a lever for enhancing Mental Capacity Act practice more generally, all too often highlighted as an area of learning in SARs. The Board will continue to have a focus on Making Safeguarding Personal (MSP), ensuring that adults at risk are at the centre of all safeguarding adults enquiries.

An area of focus in Newcastle (and regionally) will be self-neglect – considering the findings of a local thematic review in this area, updating local practice guidance and working with North East colleagues to raise awareness of self-neglect and what can be done to help those at risk. The NSAB has a busy year ahead and remains ambitious in delivering on key priorities. Find out more about our plans for 2022-23 .

I would like to reiterate my thanks to all those who continue to make safeguarding adults happen in Newcastle – senior leaders, the NSAB and sub group members, front-line practitioners and volunteers – each and every one of you continue to prioritise safeguarding adults in your work. Your desire to ensure the safety and wellbeing of adults with care and support needs in Newcastle remains apparent.

I commend this Annual Report to you and encourage you to share it within your organisations and networks.

Vida Morris

NSAB Independent Chair

“As Cabinet Member for a Healthy, Caring City, it is my ambition that Newcastle residents are supported to live healthy, safe, independent lives. The Newcastle Safeguarding Adults Board’s annual report documents the work done by the partnership, and it’s member agencies, in support of this priority.

The lifting of Covid-19 restrictions did not result in a reduction in safeguarding adults activity in the City. It is reassuring to see that the NSAB is closely monitoring this position and it’s impact on the safeguarding adults system.

I continue to take a keen interest in the link between poverty and adult safeguarding. I see this continuing to be an area of importance for the Board in the coming year given the anticipated cost-of-living crisis and continued impact of government austerity cuts and welfare reforms. Poverty is more effectively mitigated by coordinated partnership responses; the NSAB is well placed to ensure there is a shared understanding of the complex challenges that residents face and help bridge the gap between financial advice, support, care, health and safeguarding.

I would like to finish by offering my deepest thanks to all those who continue to work determinedly and compassionately to keep the residents of Newcastle safe from abuse and neglect.

Councillor Karen Kilgour

Deputy Leader, Newcastle City Council and Cabinet Member for Healthy, Caring City

Who we are and what we do

The Newcastle Safeguarding Adults Board (NSAB) is a statutory multi-agency partnership responsible for safeguarding adults from abuse and neglect. There are a number of agencies represented on the Board, including the Council, Health Services and the Police. Our NSAB roles and responsibilities page has more information about the Board and it’s work.

Strategic Annual Plan

The Care Act 2014 requires all Safeguarding Adults Board’s to produce an annual plan that details how we will meet our objectives and how our member and partner agencies will contribute.

The achievements against our plan for 2021-22 are detailed in this annual report. Looking forward to our 2022-23 plan, we have used a variety of information sources to ensure our priorities reflect the needs related to safeguarding adults at risk. This has included using our local data, learning from cases and audit, results of agency self-assessments, and responding to national policy, guidance or legislation.

Delivery on some of our priorities for 2021-22 were impacted upon by Covid-19; where this was the case, actions have been carried forward into our 2022-23 plans.

Our Strategic Annual Plan 2022-23 includes the following action areas:

• Audit referrals to ensure Making Safeguarding Personal information is being included.
• Develop training and resources around domestic abuse and older people.
• Consider the local implications of ADASS/LGA Briefing on Carers and Safeguarding.
• Use creative methods of sharing key messages and resources with practitioners.
• Undertake a thematic review around self-neglect and update guidance and training in this area.
• Further understand MCA practice in Newcastle; share good practice and address any challenges highlighted.
• Maintain an overview of the implementation of Liberty Protection Safeguards (LPS).
• Work with Public Health to improve safeguarding adults responses to adults who use alcohol and drugs problematically.
• Understand and address the increased and sustained demand within the safeguarding adults system.
• Finalise the update of multi-agency NSAB policy and procedures.
• Addressing learning from Safeguarding Adults Reviews and any other relevant review processes e.g. Domestic Homicide Reviews.

Financial abuse

Financial abuse can be wide-ranging and complex. It can be difficult to identify and knowing where to go for help might be confusing for both the person at risk and those supporting them. Financial abuse accounts for a significant amount of the safeguarding adults enquiries undertaken in Newcastle. Financial abuse can have a serious impact upon a person, not only on their money or property but also on their overall wellbeing, physical and mental health.

With this in mind, the Improving Practice Committee set up a multi-agency group of practitioners to explore the issue further and produce guidance on identifying, preventing and responding to financial abuse. The guidance was launched in November 2021 as part of Safeguarding Adults Week.

The group also produced a poster and a short film which highlighted the key points from the guidance.

Key points in the financial abuse guidance

• Financial abuse includes having money, property, benefits or possessions stolen or misused; being defrauded or scammed.
• There are many different signs and indicators, and lots of professionals will have the opportunity to identify it, not just those working with people’s finances.
• Being aware of some of the risk factors can assist practitioners in taking proactive steps to prevent financial abuse occurring.
• Finances can be a sensitive and private topic but practitioners should try to talk to the person about concerns and what they want to happen next.
• We should be empowering and enabling people to use and manage their own finances and property safely. There are services and support available. The guidance includes a service directory of local and national services and support.
• Responding to financial abuse might involve taking immediate action to keep someone or their finances safe.
• Safeguarding adults procedures can be used where the person who is experiencing or at risk of financial abuse is an adult at risk.

Our local safeguarding adults data

The publication of national guidance around what constitutes a safeguarding adults concern and enquiry has led to what appears to be a reduction in safeguarding adults concerns. However, the NSAB continues to monitor the overall volume of initial safeguarding adults referrals made, which in 2021-22 was 14,861 (a 38% increase on the previous year).

Whilst the interpretation of some key measures has changed, overall activity required to respond to referrals remains the same. Addressing this increased and sustained activity within the safeguarding adults system is an important focus for the Board, particularly as a significant proportion of referrals do not meet the criteria for action under safeguarding adults procedures.

Whilst the highest number of safeguarding adults concerns were about people aged 18-64, when this data is compared to population totals for each age group, the prevalence of abuse/neglect increases the older a person is. The breakdown of age groups remains largely unchanged from the position reported in 20/21.

There was a high proportion of safeguarding adults concerns relating to adults whose Primary Support Reason (PSR) was unknown. This is felt to reflect the high number of concerns being referred about adults who do not have care and support needs or who were not known to Adult Social Care.

There is a slightly higher proportion of safeguarding concerns raised about women than men. This is reflected nationally and is consistent with historic reporting.

Neglect featured in 1,181 safeguarding adults enquiries and was the most common type of abuse that safeguarding adults enquiries were undertaken about. This was closely followed by self-neglect which featured in 979 enquiries.

The most common location of abuse remains the persons own home, however this decreased by 16%. In the last year, there have been increases in safeguarding adults enquiries related to abuse or neglect that was happening in a care home setting. It is important to highlight however that the location of risk is different to the source of risk and an increase in care home as a location does not necessarily equate to an increase in care staff as a source of risk. Service Providers were identified as the source of risk in 24% of enquiries compared to 19% in 2020-21.

In 87% of safeguarding adults enquiries risk was either removed or reduced. Audits have identified that the majority of cases where risk remains relate to cases involving adults who are presumed or assessed to have capacity to make decisions not to engage with an enquiry or to accept a level of risk.

In 72% of safeguarding adults enquiries, the adult at risk or their representative was asked what they wanted to happen as a result of a safeguarding adults concern being made. Improving this percentage and other Making Safeguarding Personal indicators remains a key priority for the NSAB.

In 35% of safeguarding adults enquiries, the adult at risk was deemed to lack mental capacity to make decisions about the concerns.

Homelessness and adult safeguarding

The Local Government Association and Association of Directors of Adult Social Services published “Adult safeguarding and homelessness: a briefing on positive practice” in 2020. This briefing highlighted that this was a complex area of safeguarding adults practice, requiring an integrated whole system response. The briefing highlighted the important role that Safeguarding Adults Boards have in seeking assurance on local policy and practice around safeguarding adults who are at risk of or experiencing multiple exclusion homelessness. In November 2021, the NSAB received a report from Newcastle City Council’s Active Inclusion and Commissioning Teams that provided such assurance.

There are a range of services and support available to people who are homeless or at risk of becoming homeless in Newcastle. Through partnership working it is the aim that there is: no rough sleeping; no B&B use; and no evictions into homelessness in Newcastle. Good quality accommodation and additional support have had positive results. Newcastle won the prestigious World Habitat Gold Award in 2020 for preventing homelessness and presented to the United Nations on the rights-based approach to preventing homelessness.

There are good relationships between those working in homelessness services and those working in safeguarding adults, this is both on the front-line and at a senior level. The workforce are well informed around safeguarding adults meaning that appropriate concerns are being raised and enquiries undertaken where required. There is a focus on prevention, including strong multi-agency working to keep improve a person’s safety and wellbeing with the aim of negating the need for action under safeguarding adults procedures. These key safeguarding principles will be used in the application of additional funding the city has secured to respond to homelessness.

Newcastle has a Homeless and Rough Sleeping Strategy 2020-2025 which is signed off at a Cabinet Level and progress is monitored via Quarterly Homelessness Reviews chaired by the Housing Portfolio Holder. Homelessness prevention has been agreed as priority by Collaborative Newcastle, further demonstrating the emphasis on joint working and accountability in this area.

Adults who are homeless can be very vulnerable, often having multiple and complex health and social care needs and being at risk of things like self-neglect, domestic abuse, criminal exploitation and physical abuse. There can also be cross-boundary complications. Cases involving homelessness are about so much more than resolving the person’s housing needs and we are lucky in Newcastle to have good relationships between agencies such as the Housing Advice Centre, YHN, supported accommodation providers, the Police’s Harm Reduction Team, CNTW’s Harm Minimisation Team, Changing Lives’ Multiple Exclusion Team and Community Safety. The safeguarding adults framework provides a robust multi-agency process for sharing information about risks and agreeing a plan to reduce or remove risk.

Safeguarding Adults Manager talking about their experience of homelessness and safeguarding adults.

Safeguarding Adults Review Committee

Adult L SAR

In 2021-22, the Safeguarding Adults Review (SAR) Committee finalised and published a SAR in relation to Adult L. Adult L was a 75-year-old woman who died from Covid-19 in 2020. The Review focussed on the care and events leading up to her death. Adult L had increasing care and support needs with several agencies involved to meet those needs. Adult L sometimes refused care which created concerns for agencies.

The report highlighted that there were many areas of good multi-agency working and good systems in place to safeguard and offer safe and effective care to Adult L. The author also highlighted the challenges that practitioners faced – the complexities of Adult L’s multiple health needs and her difficulty in accepting support in the context of a global pandemic. The Safeguarding Adults Review report includes the following areas for strengthening practice:

• Identifying and working with people who are alcohol dependent.
• Working with older couples where there is domestic abuse.
• Working with people who self-neglect, ensuring the promotion of and use of guidance and frameworks in this area.
• Multi-agency working, communication and the impact of the Covid-19 pandemic.

The NSAB have published the full report, an Easy Read version, a practitioner briefing and a briefing about learning from Covid-19 related to safeguarding adults. These can all be downloaded from the SAR pages of this website.

All of the recommendations made in the SAR have been accepted by the NSAB and an action plan has been developed in response. The SAR Committee will oversee progress against the action plan and report progress to the NSAB.

The SAR Committee continues to progress two further SARs which were referred in 2020-21. The first is anticipated to be published in Autumn 2022 and the second in 2023.

Two additional SAR referrals were received by the SAR Committee in 2021-22. Both referrals related to cases of significant self-neglect. The SAR Committee considered these cases and decided that they did not meet the criteria for a SAR. However, given the increasing number of self-neglect concerns being reported via local safeguarding adults procedures, as well as these and previous SAR referrals, the Committee proposed undertaking a thematic review into self-neglect. The review would look at what was working in well in identifying and responding to self-neglect, as well as what was challenging and if there was anything further that could be done to support front-line practitioners in this area.

Finally, SAR Committee members have been participating in a number of the Care and Health Improvement Programme (CHIP) webinars about SARs. The programme is a sector-led improvement initiative with the aim of sharing good practice. Newcastle were involved in delivering one of the webinars, highlighting the work of our regional SAR Champions who meet regularly to develop and improve practice around SARs. In 2021-22 the SAR Champions set-up the North East SAR Library (an online, searchable platform for SARs undertaken locally) and produced a North East SAR Quality Markers Checklist (a checklist to support SABs in undertaking good quality SARs).

SAR Committee priorities for 2022-23

• Oversee the action plan in relation to the Adult L Safeguarding Adults Review.
• Progress the two ongoing Safeguarding Adults Reviews.
• Co-ordinate a thematic review around self-neglect.
• Continue to implement the local action plan in response to the national Analysis of Safeguarding Adults Reviews. This will include a development session for SAR Committee members.

Improving Practice Committee

This year the Committee set up a task and finish group about financial abuse. This was following feedback from practitioners who said this was a complex and wide-ranging area where additional guidance and support would be welcomed. The group had representatives from across different agencies who worked together to produce guidance on identifying, preventing and responding to financial abuse. The guidance is primarily in relation to adults with care and support needs and is intended to complement the over-arching Newcastle Safeguarding Adults Board multi-agency safeguarding adults policy and procedures. However, many of the services, support and information detailed are universal and are available to all adults. The guidance was successfully launched in November 2021 during Safeguarding Adults Week. See page 7 for further information.

Safeguarding Adults Week is a national week of activity and awareness raising. For the last 3 years, the Improving Practice Committee have co-ordinated a programme of webinars. The webinars this year covered: the Disclosure and Barring Service; Financial Abuse; Newcastle Treatment and Recovery Service; Identification and Brief Advice (drugs and alcohol); Liberty Protection Safeguards; Cyber Protect; Self-Neglect and Criminal Exploitation. Key safeguarding messages were also co-ordinated across NSAB member agencies on social media. The week received so much positive feedback and interaction – we aim to replicate the same in November 2022.

Safeguarding Adults Week stats

• 439 people attended 8 webinars delivered by 17 presenters.
• 300% increase in Twitter mentions and 200% increase in @newcastle_sab mentions.
• 2,349 hits on our website during the week with 657 hits on 17th November alone – our best day ever.

The NSAB have a wealth of guidance available on safeguarding adults. The Improving Practice Committee has a key role in ensuring the guidance is regularly reviewed and up to date. This year the Committee updated the Abuse between Adults with Care and Support Needs Guidance. This review coincided with a case presentation involving an allegation of sexual assault by one care home resident to another. Case presentations are an important way for the Committee to understand key issues in front-line practice. Following on from the case presentation, the Committee invited the Sexual Assault Referral Centre (SARC) to discuss the services and support they offer. This helped inform the update to the Abuse between Adults with Care and Support Needs guidance.

The Committee has continued to focus on Making Safeguarding Personal (MSP). A dedicated performance scorecard in relation to MSP helps the Committee to delve deeper into some of the challenges for practitioners. It was good to find out that there was improved performance in key areas compared to previous years. In particular, the asking of a person or representative’s desired outcomes has improved to place Newcastle above national, regional and other statistical comparators. The Committee’s Audit Sub-Group are planning an audit around desired outcomes in early 2022-23.

Committee members began a review of the over-arching multi-agency procedures. This is in line with the three-year review period and will reflect any changes to operational practice due to Covid-19. This work will continue into 2022-23.

Learning and Development Sub-Committee

The Learning and Development Committee continued with their successful virtual multi-agency training programme in 2022. In line with public health guidelines and the continued prevalence of COVID -19 in our communities, there was no multi-agency face-to-face training delivered in the last year.

One key area of work has been further collaboration between the Committee and the work of the NSCP’s Learning & Improvement Group. This closer working relationship has facilitated the sharing of ideas, continuity of approach in appropriate areas and promoted access of staff to training provided by both partnerships. In the last year, the NSAB and NSCP re-commissioned the safeguarding e-learning offer available to the Newcastle workforce. Me Learning were selected as the new provider in December 2021. Five courses are offered (free of charge to anyone working or volunteering in Newcastle) – Safeguarding Adults Level 1 Basic Awareness; Safeguarding Children Level 1; Safeguarding Children Level 2; Mental Capacity Act Basic Awareness and Deprivation of Liberty Safeguards Basic Awareness.

The Committee has had an array of guest speakers over the year. Northumbria Police provided a short presentation on online safety, for staff within organisation’s and members of the public. This has led to a Task and Finish Group being set up to look at developing training in this area.

Key Learning and Development Committee stats:

• 2,553 participants on safeguarding adults training courses.
• 1,467 e-learning courses completed, with the most popular being Safeguarding Adults Basic Awareness (877 completions).
• 95% of participants on NSAB training rate it as good or excellent.
• 93% of learners felt that training would influence their practice.

As a result of learning from cases, the content of the Self-Neglect Workshop has been revised by colleagues from Adult Social Care, Your Homes Newcastle (YHN) and Tyne and Wear Fire and Rescue Service (TWFRS). In 2021-22, the revised workshop has been delivered to YHN staff and will be re-launched as part of the multi-agency programme in 2022-23. The training will be further reviewed in light of the ongoing work by the SAR Committee, and regionally, on self-neglect.

The Learning and Development Committee continues to seek assurance from partner agencies on the uptake of safeguarding adults training. Some agencies have needed to suspend aspects of their safeguarding adults training programmes during Covid-19. Agencies are aware of the need for their staff to access regular and up-to-date safeguarding adults training and hope to recommence their usual training strategies as soon as possible.

A further action has been to embed the York Judgement (PC & NC v City of York Council) and its impact on assessing mental capacity into all levels of safeguarding and MCA training. This judgement places an emphasis on assessing a person’s ability to make a decision first (the functional test) before confirming whether the inability to make a decision is as a result of an impairment or disturbance of the mind or brain (diagnostic test). It is important that our training reflects current case law and it will place us in a good position for changes brought about by the updated MCA Code of Practice when this is finalised.

The Committee continue to promote financial inclusion/anti-poverty training, supporting work to break the link between safeguarding and poverty.

Learning and Development Committee priorities for 2022-23

• Developing bite-size training resources using different approaches, including recorded webinars and short animations.
• Reviewing our MCA training offer to ensure it supports front-line practice and reflects changes brought about by the updated MCA Code of Practice and introduction of the Liberty Protection Safeguards (LPS).
• Continue with a task and finish group work to design and delivery a training course on online safety for adults.
• Offer training on domestic abuse and older people and financial abuse.
• Continue to quality assure single-agency safeguarding training and look to assist single-agency trainers by sharing resources and offering peer support.

Missing, Slavery, Exploited, Trafficked (M-SET) Sub-Committee

The year began with a reset of the Committee’s work and a review of the Strategic Delivery Plan. The plan reflects emerging trends around missing, slavery, exploitation and trafficking and aligns with the City’s Criminal Exploitation and Serious Violence Strategy.

One of the Committee’s key objectives is to increase practitioner confidence in recognising and responding to missing, slavery and exploitation concerns. Over the course of the last year, the Committee has produced a Criminal Exploitation and Serious Violence Flowchart. This two-page document outlines the different referral pathways and services available to support people at risk. It also gives key information about signs and indicators, good practice when responding to a person experiencing criminal exploitation and how concerns can be reported anonymously.

Another way in which practitioner confidence can be increased is via training opportunities. The Violence Reduction Unit (VRU) funded a training post within Adult Social Care for 2021-22 which allowed a greater co-ordination and delivery of multi-agency training around criminal exploitation, adversity and trauma-informed practice. There were just over 500 practitioners trained in the year, from a variety of different sectors including housing, care providers, children’s and adult social workers and community and voluntary organisations. Some of the training was co-delivered with presenters from Children’s Social Care, Northumbria Police and Edge North East adding their knowledge and experience to the content. The Committee have also promoted a number of nationally available online training e.g., on County Lines and the National Referral Mechanism.

It was a really informative course. With working in Children’s Social Care so long, I feel I had an awareness of adult safeguarding, but a very limited knowledge and a limited knowledge of the organised crime and exploitation. I found it very helpful in respect of a current case I have whereby I am involved with a very vulnerable young mum, and I have arranged a meeting tomorrow morning to discuss this with other professionals and agree a plan of support and referral to adult safeguarding.

Evaluation from participant on criminal exploitation training

The Committee have considered several national reports and briefings and considered their implications for Newcastle. This has included the Bridging the Gap report about transitional safeguarding. Newcastle featured in this report, highlighting the good practice that happens here as well as shining a light on how important the transition period from childhood to adulthood is in terms of safeguarding people at risk of exploitation. Another national report considered was The Multi-Agency Response for Adults Missing from Health and Care Settings, A National Framework for England. The Committee had already been involved in the development of a regional Missing Adults Protocol for Adults; the national framework was used as part of the annual review of the regional protocol which was updated in February 2022. In 2021-22 there were 1,794 missing adult incidents in Newcastle which related to 1,133 individuals.

The Committee understood that online exploitation was becoming an increasing concern, particularly as a result of the lockdowns. Northumbria Police had done work with schools and parents about keeping safe online in October 2021 which included information about cyber bullying and harassment, sharing of nude images and sexting and also sources of support. It was noted that the further work could be done with adults at risk in this area and this will be an area of work for next year.

The Exploitation Hub is key to the multi-agency response for those at risk. The work of the Hub was more closely aligned to MSET this year with the lead Detective Chief Inspector becoming a member of the Committee and regular reports being received on its continued development. The Hub also featured in a short video to promote Exploitation Awareness Day on 18 March 2022.

Criminal Exploitation Case Study

Northumbria Police’s Missing from Home Coordinators have played an active role in multi-agency safeguarding over the last 12 months in respect of young adults missing and linked to criminal exploitation and county lines. Last year saw the introduction of a Safeguarding Adults Manager into the Multi Agency Operational MSET (Missing, Slavery, Exploitation, Trafficked) meetings for children and young people. This has been a positive step to ensure a greater early awareness of young people as they transition into adulthood.

One such example involved a young male involved in criminal exploitation and county lines. He was picked up as an early transition case and professionals were introduced to his family at an early stage to build trust and a rapport. Mental Capacity Act assessments were completed by Adult Social Care completed MCA assessments and it was subsequently identified that he had an undiagnosed Learning Disability. These assessments informed subsequent agency responses in supporting the young person and keeping him safe from harm.

Agencies have worked together to ensure he has appropriate accommodation that meet his care and support needs. He also has a mentor and is participating in sporting activity. Whilst it has been difficult to remove all risks to the individual, there are now significant harm reduction plans and support in place. This example highlights the benefits of safeguarding adult representation in the operational MSET process and the importance of robust safeguarding transitions from childhood to adulthood.

Case study from Northumbria Police.

Safeguarding adults in care homes

In February 2021, the National Institute of Care Excellence (NICE) published guidance on Safeguarding Adults in Care Homes. The guidelines included recommendations on policy, training and culture. Care homes, commissioners and Safeguarding Adults Boards were encouraged to raise awareness of the guidelines, evaluate their current position and make improvements where required.

The Safeguarding Adults Unit and Commissioners from Health and Social Care undertook a benchmarking exercise based on the recommendations made in the guidelines. There was strong assurance around the arrangements in place in Newcastle:

• Care home providers demonstrate a high level of knowledge of awareness of abuse and neglect and an openness and transparency in reporting concerns on a multi-agency basis.
• Care home providers are a high referrer of safeguarding adults concerns and this is seen as a positive.
• Safeguarding is a core part of the standard contract.
• There are good relationships and networks between providers, commissioners, the Care Quality Commission (CQC) and safeguarding adults specialists.
• Care homes have access to free multi-agency safeguarding training and can have their in-house training quality assured.
• 89% of care homes in Newcastle have a good or outstanding CQC rating.

A presentation was given at the Care Home Provider Forum about the guidelines and managers were encouraged to use the baseline assessment tool to identify any areas where improvements could be made. Many of the recommendations in the guidelines are already covered within CQC regulations, contracts and local multi-agency safeguarding adults policies and procedures.

Alongside the guidelines, NICE published two quick guides:

• Creating a safeguarding culture; and
• Good practice in safeguarding training.

These guides were promoted with care home managers.

Partner agency perspectives

Northumbria Police

Protecting Vulnerable People is a force priority. To support this a Force Vulnerability Strategy was launched this year with four key pillars: Working Together, Our People, Leadership and Early Intervention and Prevention. The key aim is to protect and safeguard our vulnerable people and ensure perpetrators are targeted and prevented from re-offending and causing further harm within our communities. Harm Reduction Teams are now embedded across the force area and they will play a key role in tackling emerging issues identified with vulnerability, working with partners to adopt a problem solving approach.

Within the last twelve months a Force Harm Reduction Team have been appointed. They will oversee the implementation of our Force Early Intervention Strategy. The Strategy focusses on Building Community Resilience, Partnerships, Preventative Intervention and Our People.

In support of our strategy the force has a new out of court disposal team (TREAD team) who are looking at pathways to divert adult offenders from the criminal justice system. The team have pathways around training and education, substance misuse, 18-24 year olds and veterans.

To ensure that Protecting the Vulnerable is front and centre of our force response, force wide “Vulnerability Matters” training has been rolled out in the first quarter of 2022. This training will support officers to take a trauma informed approach to dealing with vulnerability and assist officers to identify vulnerable adults in the community.

The training focusses on equipping officers to better understand vulnerability by looking for clues, applying curiosity and ensuring our communications are in a supportive and empathetic way. The training includes an input from one of our MASH managers with specific guidance about how to submit a quality Adult Concern Notification (ACN) referral.

Bespoke training sessions are also being delivered in force around Vulnerability to our force control room call takers to enable them to recognise and respond to vulnerability at the first point of contact. In addition our newly appointed Sergeant and Inspectors in force are given an input on the Care Act and the categories of abuse so they can apply this learning in their team supervisions.

This year has seen the re-launch of the Multi-Agency Exploitation Hubs and the commitment of all six Local Authorities and Health to provide a coordinated approach to protect and safeguard those at risk of sexual, criminal exploitation and all aspects of Modern Day Slavery. Work in this area has been further enhanced by utilising a consistent force wide chair at the MSET Committee, allowing the sharing and join up of best practice in respect of all forms of exploitation. This chair has built links with both the Violence Reduction Unit and the Regional County Lines Coordinator who can build learning from national and regional practice into the local response.

Newcastle City Council

The Adult Social Care workforce continue to be front and centre of responding to the increased safeguarding adults activity in Newcastle. Social Workers and their Team Managers are responsible for screening all 14,861 safeguarding adults referrals received and co-ordinating the 6,941 Section 42 Enquiries that were undertaken in the year; assessing risks and ensuring there are plans in place to reduce or eliminate those identified risks. Additional resource has been put into the Adult MASH to assist with the continued increase in safeguarding adults concerns being referred.

In 2021-22, the Violence Reduction Unit funded a Social Care Assessment Officer post within the multi-agency Exploitation Hub to deliver awareness raising and training around criminal exploitation and serious violence. The post had a particular focus around sharing best practice and improving approaches to safeguarding young adults transitioning from children’s services. In total, 505 people received training, from a variety of different organisations and sectors. 176 Adult and Children’s Social Workers received a full-day’s Criminal Exploitation Training, which also included input from Northumbria Police and Edge North East. Training sessions also brought in trauma-informed practice and adverse childhood experiences.

There was cross-Directorate involvement in the development of the NSAB’s Financial Abuse Guidance. This included contributions from Adult Social Work, Trading Standards, Active Inclusion and Finance and Debt Recovery colleagues.

Newcastle City Council (alongside colleagues in YHN) celebrated getting White Ribbon accreditation in November 2021. White Ribbon is the global campaign to end male violence against women and girls. The Council has a series of goals and an associated action plan to change the behaviour and culture that leads to abuse and violence. New domestic abuse duties were placed on local authorities in 2021-22 which resulted in the establishment of the Domestic Abuse Local Partnership Board (DALPB). The Board has key duties around assessing and making arrangements for relevant accommodation-based services. The DALPB has also agreed a two-year strategy which includes some priorities that contribute to the safeguarding of adults with care and support needs.

Newcastle City Council played an active part in Safeguarding Adults Week. Public Health delivered a webinar on Identification and Brief Advice (drugs and alcohol), the Deprivation of Liberty Safeguards (DoLS) Team gave a presentation on the new Liberty Protection Safeguards (LPS) and there was a webinar on Criminal Exploitation. Messages were also shared via Newcastle City Council social media feeds and via internal communications.

The Association of Directors of Adult Social Services (ADASS) North East region have been pro-active around adult safeguarding in 2021-22. In April 2021 they funded a radio campaign about safeguarding adults. The campaign broadcast key messages on Metro Radio and TFM. The ADASS network have also been working hard on self-neglect, with a series of 7-minute guides and an animation planned for publication in 2022-23.

Across the wider Council workforce, the Corporate Safeguarding Training Group (CSTG) is responsible for ensuring that colleagues across Newcastle City Council have the knowledge, skills and confidence in relation to their safeguarding responsibilities. Over the past two years the CSTG embarked upon a programme of work to review the corporate safeguarding training offer and in doing so launched the Keeping Everyone Safe (KES) training modules. For the first time in the corporate safeguarding training programme the KES course brought together key messages in relation to safeguarding children, safeguarding adults, community safety, domestic abuse and Prevent under one banner. As of March 2022, 94% of colleagues who are required to undertake the training have done so.

Newcastle upon Tyne Hospitals NHS Foundation Trust

Despite the continued challenges the pandemic has presented and an overall increase in activity of 23%, high quality safeguarding practice has remained a priority for the Trust.

Multi-agency working remains a constant and important aspect of the team’s work, with cases continuing to demonstrate evidence of self-neglect, substance use and complex health needs. The team have continued to contribute to Multi-agency (MASH) discussions and multi-agency meetings throughout the region which is a fundamental and important part of the team’s work. Our involvement is not limited to the Newcastle Area and referrals/safeguarding activity supports individuals who live across the North East.

Over the last year we have focused on the sharing of learning which is key factor in continuously improving safeguarding practice. Safeguarding Communication Forums continue within the Trust which offer opportunities to share learning and openly discuss and debate practice. The sessions have evaluated well and have focused on a wide range of subjects and included the concept of professional curiosity, which remains an essential approach to safeguarding practice across the teams.

We have also been focusing on providing additional pro-active outreach work to some of our wards and departments. The purpose is to address any current concerns or questions, to provide informal teaching through conversation and provide monthly safeguarding supervision session. A pilot is in place across several areas but is evaluating well and this work will shape future Trust safeguarding practice in the year ahead.

Key contributions to the NSAB priorities have been the continued commitment to multi-agency working and participation in the NSAB Multi-agency Audit.

The Trust continues the further development of the application of the Mental Capacity Act. Work around this has included a service improvement project to explore challenges and enablers to the use of the Act and the development of local learning and outreach. The Trust has continued to recognise the challenges in the utilisation of the Mental Capacity Act and has linked with several regional agencies to focus on the transition to Liberty Protection Safeguards. This work has continued internally through the development and launch of an e-learning package and examination of challenges through action research.

Miss B lives in extra care accommodation, she has a learning disability and a number of physical health needs. Over several months, there are attempts to support Miss B to attend reviews as there are concerns she needs more urgent treatment and care. Miss B is now referred to safeguarding adults procedures. This is due to the following concerns:

– her health interventions have a growing urgency and Miss B has been unable to attend planned appointments and treatments.

– her tenancy is breaking down as there is evidence of self-neglect.

– there are concerns that Miss B is no longer engaging with services and spend very little time at home.

– the police are frequently called as the public are concerned for her safety and well-being.

– staff at her accommodation are seeing less and less of her and are reporting Miss B missing on many occasions.

Miss B requires two surgical procedures. Discussions focus on whether this can be planned together, which is agreed. This required coordination and planning in terms of support pre and post operatively. Through discussions, it becomes apparent that the key challenge to facilitating access to care, is locating Miss B and bringing her safely and respectfully to hospital. The team around Miss B are worried that there have been changes in her behaviour and a query around whether physical health needs may be causing Miss B discomfort or worry. The teams within the Hospitals Trust are contributing to the safeguarding process and linking with other partners to support attendance. Mental Capacity Assessments are conducted and Best Interest Meetings are held, with support from an Independent Mental Capacity Advocate (IMCA). Legal services are supporting Court of Protection Procedures and the very complex process of conveyance (transport) to hospital. The team recognizes that locating Miss B and transporting her to hospital from a public place, may lead to increased distress and there is a working hypothesis of options to ensure safety and dignity. The conveyance to hospital is the far greatest challenge as there are dilemmas for all involved. Ultimately Miss B was admitted to hospital, with a coordinated response and extensive reasonable adjustments. Flexible, supportive care and treatment was completed. The admission was longer than planned, however this allowed for continued multi-agency working to ensure safe discharge. Support to Miss B demonstrated the effective use of the Mental Capacity Act and Equality Act, and a flexible and tenacious response to self-neglect.

Self-neglect case study from Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle Gateshead Clinical Commissioning Group (NGCCG)

In July 2021, the NGCCG Safeguarding Team secured funding from NHS England to develop an Integrated Care System (ICS) wide pilot to develop forensic examination services for adults who present with unexplained or non-accidental injuries. The bid was successful and has been taken forward during 2021-22 and through to 2023. The funding has been used to:

• Develop Forensic Awareness training for GPs and clinical staff
• Fund a Forensic Examination Conference
• Deliver training for staff to undertake Forensic examination.
• Develop a knowledge hub /Resource hosted by the Faculty of Forensic and Legal Medicine.

During 2021 the NGCCG safeguarding team were instrumental in establishing and ICS wide Safeguarding Professionals Network. This has developed as the only forum in our area that is open to safeguarding (health) staff from both provider and commissioning organisations across health agencies. The Network is well established and well attended and has been recognised by NHSE and a key forum to support the development of safeguarding practice across the ICS.

A key achievement during 2021 was the implementation of a Local Enhanced Service Agreement (LES) with Primary Care which has been developed to ensure that GP Practices are appropriately reimbursed for the cost associated with support to multi agency working and safeguarding. This represents a step change in development of engagement and information sharing to support safeguarding practice with NGCCG being an early adopter of this approach within the region.

The Safeguarding Team have continued to develop online approached to training which has included building and developing an online resource of recorded training for Primary Care staff to access via the CCG’s intranet.

The NGCCG safeguarding team have been instrumental in establishing and ICS wide Safeguarding Professionals Network. This has developed as the only forum in our area that is open to safeguarding (health) staff from both provider and commissioning organisations across health agencies. The Network is well established and well attended and has been recognised by NHSE and a key forum to support the development of safeguarding practice across the ICS.

Search (Services for Older People)

As a small grass roots organisation providing support to local older people, we focus our attention on one area each year to try and make the a significant impact on prevalent issues. Over the past year we have worked with staff to raise awareness of self-neglect, our staff now have a new approach to working with people who have self-neglect issues and a pro-active approach to prevent missed health appointments. We secured a small grant to provide pamper and self-care packs to people which helped us start difficult conversations around self-care and washing.

The areas which Search has made the most significant contribution to NSAB priorities are

• Partnership- Close working with Social Care, Mental Health, and Hospitals to provide local solutions for older people in Newcastle’s West End.
• Prevention – at Search we have focused on prevention this year and we have seen a significant reduction in the number of safeguarding alerts which we have made.

Connected Voice

Connected Voice’s Advocacy service won the overall Outstanding Advocacy Service again at the National Advocacy Awards 2022. We were nominated by Gateshead Council for our safeguarding work to protect people from harm and abuse and Northumbria Police and Crime Commissioner for our Hate Crime Advocacy service. We have been awarded the national Quality Performance Mark and were assessed as excellent (including in the key area of safeguarding).

An in-depth Annual Report is provided for the Connected Voice Trustee Board on statistics and demographic data on people safeguarded in the year. For the period October 2020-September 2021, 95 people were supported around safeguarding. This related to 67 alerts, 28 concerns and 40 Section 42 enquiries.

Connected Voice’s On the Hoof News Bulletin has a specific section for safeguarding matters for people working in the voluntary, community and social enterprise (VCSE) sectors. Connected Voice deliver an Introduction to Safeguarding session for VCSE organisations in Newcastle and Gateshead. We have also been helping community groups adapt to online services and ensure continuity of delivery.

Connected Voice Advocacy have continued to campaign nationally around key legislation (Mental Health Act and Mental Capacity Act) and to ensure people’s Human Rights are upheld. This has been particularly important during lockdowns.

The service have contributed to a number of pieces of national research and consultations, including: Adult Social Care Reform, Equality and Human Rights Commission Review on Adult Social Care complaints and research into inpatient settings for people with a Learning Disability and Autism.

The Advocacy Charter includes ten commitments, one of which is safeguarding. Advocates play a key role in ensuring many of the key principles of safeguarding are met. Advocates work shoulder to shoulder with people to ensure decisions are person centred, person led and compliant with the Mental Capacity Act. They also have a scrutiny role, ensuring that service providers are acting lawfully when working with vulnerable people.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW)

During COVID-19 pandemic, there was a directive from NHS England for all crisis services to provide a 24/7 universal crisis response. In direct response to this, CNTW reviewed current working practices and introduced a Universal Crisis Team (UCT) model across Newcastle and Gateshead. The development of the UCT is part of the national long term plan and Community Mental Health Transformation agendas, and will provide parity of service provision across the age range for those experiencing a mental health crisis.

The Individual Placement and Support (IPS) Employment Support service works across Newcastle, supporting people receiving community care and treatment from the CTT and EIP teams to pursue their paid employment ambitions.

Historically people with Serious Mental Illness (SMI) have lacked evidence-based support in relation to employment, often assuming their only option is to claim benefits. However CNTW and CCG’s have invested heavily in the IPS Service in order to address this, viewing unemployment as a serious risk to long-term health and good employment as a health outcome to which we all aspire and to which everyone should have access as a fundamental right.

Support provided from the IPS team includes:

• help getting or keeping a job
• employment rights
• benefit entitlement
• employment opportunities

In addition to supporting people into sustainable, good employment the Trust has been working with the Money and Pensions Service (MAPS) to create a financial wellbeing tool that can be used by any healthcare professional to assess the impact of finance circumstances on a person’s health and then facilitate accredited, independent financial support for the person.

The hypothesis is that financial health has a significant impact on physical and mental health, so by understanding financial health we will be better able to assess and treat mental health difficulties.

Development of this tool began in 2020 but it has never been more pertinent given the accelerating cost of living crisis and the demand for mental health treatment and support.

The Trust are currently engaged in an evaluation of the tool and will publish the findings once the trial concludes. The ambition is that financial wellbeing tool will form part of core assessments across health services, supporting people using services and the teams providing care and treatment to build a holistic picture and rapidly involve accredited, independent financial experts or direct to high quality self-help.

Changing Lives

One of the key developments this year at Changing Lives has been developing a Peer led Reflective Practice model to help staff emotionally manage complex safeguarding cases. The Gibbs Reflective Cycle is central to our model.

Being a trauma informed and trauma responsive organisation means we care and support for our staff as we care for and support the people accessing our services. At Changing Lives we want to work towards a culture where all staff understand the importance of self-reflection and that everyone has access to a reflective space on a regular basis. Accessing Reflective Practice should be a core and fundamental part of how we operate across Changing Lives services and departments, and it should be made accessible on a consistent basis, to all staff.

The Changes Lives Safeguarding Annual Plan has just been drafted and covers all of the six safeguarding principles, and they are the key headings in our plan.

The Safeguarding Governance group receives performance reports at each meeting with more frequent exception reporting if concerning patterns or trends are identified. These include Serious Untoward Incidents, training reports and regular updates about the MASH developments.

Well, for me this is about the organisation stating we want to encourage you to take time out and use reflection as not only a learning tool. But also as a safe space to try and make sense of some of the complexities we work with, so that we don’t carry that baggage around…self-care is how you survive!

Reflective practice gives not only us as individuals the tools to help respond to the many changes we face during our working day, it also helps us with decision making, managing our emotions, creating productive relationships. It also demonstrates that Changing Lives is taking the opportunity and embracing the view, that if you take care of your staff, they will take care of your business”

Changing Lives Peer Led Reflective Practitioners

In 2021-22, the NSAB was chaired by Vida Morris. The NSAB would like to offer thanks to Neil Baird, Mick Mangan, Natalie Caush and Sue Kirkley for their contributions to safeguarding adults and who all stepped down as NSAB members this year.