Morecambe Bay CCG - Safeguarding and Children Looked After Annual Report April 2019 to March 2020

Contents

Introduction
Delivery of Statutory Safeguarding Functions
Developing and Strengthening Pathways & Services
Using Intelligence and Information to Inform Decisions
Influencing Partnerships
Impact of Covid-19
Summary and Forward Planning 

Report Contributors

Margaret Williams – Chief Nurse
Jane Jones – Head of Safeguarding
Kelly Short – Designated Nurse Adult Safeguarding, MCA and DoLS
Kirsty Byrne – Designated Nurse Safeguarding Children and Children Looked After
Jean Herbison – Designated Dr for Safeguarding Children, Children Looked After & CDOP
Amy Lee – Named GP for Safeguarding Children
Sess Sibanda – Named GP for Safeguarding Adults

Introduction

Purpose of the Report

Welcome to the Morecambe Bay CCG (MB CCG) Safeguarding and Children Looked After Annual Report.

This report describes the range of activities and developments that the safeguarding team have supported in designing and delivering effective safeguarding arrangements across the Morecambe Bay footprint. The report provides assurance to the Governing Body and members of the public that the CCG has fulfilled its statutory responsibilities to safeguard the welfare of children, adults and those children looked after.

The report will focus on the four key areas of our core business:
• Delivery of the Statutory Safeguarding functions
• Developing and Strengthening Pathways and Services
• Using intelligence and information to inform decisions
• Influencing Partnerships

The narrative throughout this report gives an overview and summary of assurance against statutory functions. Throughout our activity we have, and will continue to, promote a culture where the voices of children and adults are heard.

Over the last year we have focussed our work priorities on NHSE/I national priorities for Safeguarding and the priorities of the Lancashire and Cumbria Safeguarding Children Partnerships and Safeguarding Adult Boards. Our safeguarding activity takes in to account any national changes and local influences. Work has continued to drive the development of the Safeguarding Structure within the ICS to enable staff to deliver high quality effective care.

Our core business is to support vulnerable people by fully understanding the outcomes we want to achieve together and continually reflecting on how well we do things. We want to be able to work with our partners and be in a position to evidence the impact our work makes on the lives of children, young people and adults by keeping the individual at the centre of everything we do in order to:

• Keep them free from harm, abuse or neglect
• Protect their wellbeing and human rights
• Protect their health

The 2019/20 reporting period for this annual report preceded the Global Covid-19 pandemic, and hence a summary of the impact of this has been included.

This report will conclude by looking forward to the year ahead identifying key priorities for 2020-2021; this includes our plans to further strengthen the safeguarding arrangements across health and social care partnerships.

Over the last year we have focussed our work priorities on NHSE/I national priorities for Safeguarding and the priorities of the Lancashire and Cumbria Safeguarding Children Partnerships and Safeguarding Adult Boards.  Our safeguarding activity takes in to account any national changes and local influences.  Work has continued to drive the development of the Safeguarding Structure within the ICS to enable staff to deliver high quality effective care.

Our core business is to support vulnerable people by fully understanding the outcomes we want to achieve together and continually reflecting on how well we do things. We want to be able to work with our partners and be in a position to evidence the impact our work makes on the lives of children, young people and adults by keeping the individual at the centre of everything we do in order to:

  • Keep them free from harm, abuse or neglect
  • Protect their wellbeing and human rights
  • Protect their health

The 2019/20 reporting period for this annual report preceded the Global Covid-19 pandemic, and hence a summary of the impact of this has been included. 

This report will conclude by looking forward to the year ahead identifying key priorities for 2020-2021; this includes our plans to further strengthen the safeguarding arrangements across health and social care partnerships.

2018/2019 Priorities…

We have…

Monitor, assure and reduce impact when performance fails in order to improve quality (across commissioned services).

·        Sought assurance from organisations through the Safeguarding Assurance Framework

·        Provided wrap around support in collaboration with partner agencies during times of potential failure to reduce potential impact

Meet LeDeR Review timescales and engage in the recovery plan

·        Continued commitment to optimise timely learning, to influence positive change for individuals with learning disabilities across the health system. Positively addressed challenges through investment within the programme to improve local practice and deliver local system transformation.

Implement new Safeguarding Partnership arrangements

·        Provided Exec Level attendance at Partnership Board, as a strategic lead and expert across the health system

·        Influenced and directed the priorities of the partnership and successfully published the delivery plans

Implement new Safeguarding Partnership arrangements for Child Death Reviews (CDR)

·        Provided consistent attendance at Lancashire and Cumbria’s Child Death Overview Panels and drove transition arrangements

·        Led work across Lancashire to monitor assurance of providers compliance with the new guidance, whilst providing leadership support to our Acute provider

·        Directed work streams to strengthen Primary Care input in to CDR process

Realigning Designated and Safeguarding resource across the Integrated Care System

·        Designated Nurses led the ICS SG structure, which was recognised Nationally by NHSE as a blueprint for other areas

·        Designed and implemented robust governance and reporting structures within the ICS SG system, led by a Health Exec

·        Designed a portfolio model of working to strengthen health system input in to strategic and operational work streams

Continue to deliver CCG Core Statutory Functions at a time of significant transition

·        Strengthened the safeguarding expertise within the CCG through a revised leadership structure

·        Maintained robust oversight and assurance of organisations from which we commission to have effective safeguarding arrangements in place and delivery plans to mitigate any risks

Improve compliance with CLA assessments, develop pathways to improve delivery of CLA and ensure health outcomes contribute to Joint Strategic Needs Assessment (JSNA)

·        Continued to drive action plans to improve efficiency and compliance with health assessments and tracking systems

·        Provided consistent health expertise attendance at strategic groups

·        Driven improvements and shared good practice through the Health CLA Network meetings

·        Led on a system redesign to identify and tackle barriers and system challenges to improving outcomes for CLA

Support Primary Care Networks to ensure effective safeguarding arrangements are in place

·        Enabled a collaborative approach to support Primary Care Networks to work proactively, and to strengthen effective safeguarding arrangements, which is influenced from findings from GP Safeguarding Assurance Framework

Maximise learning from Serious Incidents and learning reviews including LeDeR, Child Death Overview Panel (CDOP), Safeguarding Adult Reviews (SARs) & Serious Case Reviews (SCRs)

·        Supported a positive learning culture across partnerships

·        Provided health expertise to reviews in order to maximise learning for the system

·        Made a commitment to ensure improvements to safeguard children and adults are driven from national to local level

Implement recommendations from both Adult and Children’s Intercollegiate documents

·        MBCCG Training Policy Framework ratified and implemented

·        Continue to seek assurance from CCG and providers that staff are suitably skilled and supported

·        Facilitated bespoke training in response to changes in legislation, local policies and updates from case reviews

Implement the reforming of MCA Amendment Bill – Liberty Protection Safeguards (LPS)

·        Work had commenced to implement and strengthen understanding of roles & responsibilities within the proposed changes within the Mental Capacity (Amendment) Act (2019) including the Liberty Protection Safeguards.  This was due to be implemented October 2020, however due to COVID 19 pandemic, this has been delayed until April 2022.

 1. Delivery of Statutory Safeguarding Functions

Safeguarding Leadership and Accountability

Accountability for Safeguarding rests with the Chief Officer of the CCG.  The safeguarding team is led by the Head of Safeguarding reporting to the Chief Nurse and Chief Officer.

The CCG safeguarding model incorporates the statutory safeguarding roles and a complimentary skill mix team. This includes a Designated Nurse for Adult Safeguarding, Designated Dr, a Designated and Deputy Designated Nurse for Children, Named GP’s for Safeguarding, Safeguarding & Quality Practitioners, a Safeguarding Project Support Officer and Project Support Administrative staff.  The reporting structure overleaf demonstrates the safeguarding governance arrangements.

Discharging Statutory duties for Safeguarding

Accountability

There is a clear line of accountability for safeguarding reflected in MB CCG governance arrangements, including statutory roles as described above.

At the time of writing this report we have achieved partial compliance against requirements of NHS Accountability and Assurance Framework and Sec 11 Audit, with non-compliance around policies and procedures as detailed below.

Policies & Procedures

Whilst policies are in place setting out a commitment and approach to safeguarding children and adults (including MCA), some of these require updating to reflect recent structural and legal changes. A task and finish group will look to update and standardise these across the ICS SG System.

New policies include Training Policy Framework.  The Primary Care GP sample policies on Adult, Children and Domestic Abuse have been updated and ready for practices to adopt.  The Care Home SG sample policy along with GP SG sample policy was updated to include North Yorkshire. 

Effective Supervision & TrainingGraph showing 89% compliance for Prevent A1 & L2, 93.9% for Adults L1, 100% for Adults L2, 91.5% Children L1 and 94.4% for Children L2

Ensuring that staff are competent to carry out their responsibilities for safeguarding through a culture of learning across the system through effective supervision and training.

In addition, we have facilitated:

A series of PLT events focussed on the MCA, Self-Neglect & Hoarding and DNACPR; with a high number of primary care staff in attendance.

The established GP Leadership Forums have covered a range of topics including; Safeguarding Adult Threshold Guidance; The Adult Intercollegiate Document; launch of the GP Safeguarding sample policy, the Training Framework Policy, and PREVENT and the role of the GP

Regulated Care & Domiciliary Champions events highlighting Falls Prevention, Sex - Capacity & Consent, Liberty Protection Safeguards and The Care Act and the role of Advocacy.

The Children’s SG Board in Cumbria held a “SG Children’s Fortnight”, whereby a series of events were held highlighting Child Protection, importance of wider community engagement.  Also an opportunity to inform of the new SG Partnership arrangements.

Safeguarding Governance Framework

Chart depicting the governance framework, starting from the top Governing Body, Membership Council, Quality and Improvement Committee, Safeguarding Leadership Meeting (links in with ICS Safeguarding System Designated Leads Meeting).

Safeguarding Assurance of Commissioned Services

Arrangements for safeguarding assurance for Morecambe Bay CCG with Commissioned services and providers has included assurance visits and quality reports, CCG Safeguarding Standards Audit, Section 11 Audit, and attendance at provider safeguarding performance and operational committees. There are negotiated arrangements to monitor key performance indicators (safeguarding outcomes), risk management and quality improvement initiatives with providers.

The SAF audit tool is distributed to CCG Commissioned Care Homes with Nursing, and also other Commissioned Services such as Acute Trust, Community & Independent Sector Mental Health (ISMH) Providers.

Audit demonstrated: Lack of robust Safeguarding Policies and Procedures
Actions taken: Provided example safeguarding templates to support and strengthen the development of policies.  Strengthened arrangements across Lancashire and Cumbria for RADAR and QPiP processes, so that concerns re quality are picked up early and partnership support is mobilised

Audit demonstrated: Lack of Compliance surrounding Training & Safeguarding Supervision
Actions taken:The Team have continued to provide educational opportunities and support through Safeguarding Champions Workshops.  Some topics include:

  • Falls Prevention
  • “Sex", Capacity & Consent
  • Care Act & Role of Advocacy
  • Supported improved quality of supervision arrangements

Audit demonstrated: Issues surrounding the Implementation of the Mental Capacity Act
Actions taken: The delivery of additional training in relation to MCA/DoLS, has been tailored to individual organisations.  Sessions facilitated by key partner agencies within the Local Authority and Hill Dickinson have presented training of the new proposed Liberty Protection Safeguards (LPS).  This is to increase knowledge and awareness of new responsibilities that the LPS will include.

Audit demonstrated: Overall Themes for Improvement
Actions taken:

  • Organisations need to ensure financial investment in safeguarding resources
  • Recruitment and retention pressures of registered nurses
  • Access to robust training and supervision.
  • Consistency in MCA/DoLS compliance.
  • CQC compliance and ratings

Learning from Safeguarding Incidents and Child Deaths

We continue to engage with both Cumbria and Lancashire Children’s Safeguarding Partnerships and Safeguarding Adults Boards through the work of the sub groups to disseminate and embed learning from reviews and share good practice. During this reporting period there have been 18 child deaths across the CCG footprint; 8 of those were expected death due to life limiting illness, prematurity or palliative care and 10 of those were unexpected including 2 apparent suicides. In all cases the deaths were appropriately investigated and families received bereavement support through our Acute provider.

Serious case reviews: 3
Multi-agency reviews: 3
Domestic homicide reviews: 1
LEDER reviews: 22
Safeguarding adult reviews: 1

There are two Serious Case Reviews for Children due to be published for the population of MB CCG footprint within the next reporting year and one that remains ongoing.

The three Learning Reviews have been completed within this reported period, all of which are for children in the South Cumbria area.

Within this reporting period we have been involved with Twenty Two LeDeR Mortality Reviews across the Morecambe Bay footprint.

Learning Disabilities Mortality Review (LeDeR) 

The responsibility of MBCCG is to ensure any learning highlighted within reviews improves the care & treatment of people with learning disabilities. In order to implement this MBCCG has oversight mechanisms to ensure consistency, quality and efficacy, in recording, allocation and completion of reviews, but also in the sharing and implementation of learning.

National guidance suggests that reviews are required to be completed within 6 month timeframe. Historically, this has presented a number of challenges, due to lack of reviewers, reviewer capacity & access to patient records. MBCCG, however, has made a commitment to positively address these challenges, with the investment & appointment of dedicated roles to support timely completion, to maximise learning opportunities to influence change and improve local practice and deliver local system transformation. MBCCG is leading on and working in collaboration with local partners within our ICP to develop a local Steering Group, to implement local learning from reviews.

Child Death Overview Panels

The team have maintained active representation on both Child Death Overview Panels; ICON (head trauma) and the Safer Sleep Campaign activity to improve practice and prevent future deaths has continued.

Sharing lessons through training, learning briefs, newsletters, briefing with teams and discussions of learning in supervision.

LeDeR Themes & Trends

The main themes of learning include:
• Missed opportunities to complete a holistic Annual Health Check.
• More robust flagging systems across health systems required
• Improved communication and information sharing with people with learning disabilities and autism
• Improved acess for reasonable adjustments
• Recognising the impact of inconsistent continuity of care.
• Strengthening of MCA and Best Interest processes.

Safeguarding Children

Number of children on a Child Protection Plan or Child in Need Plan

North Lancashire
Child Protection Plans: 107
Child in Need Plans: 174

South Cumbria
Child Protection Plans: 199
Child in Need Plans: 269

Over the last year the variance in numbers of those children in Lancashire and South Cumbria subject to a Child Protection or Child in Need plan is not significant.  We anticipate seeing a reduction in these over the forthcoming year in response to the partnership work to strenghten the Early Help offer, the implmentation of the Neglect startegies and the response to Hidden Harm.

Safeguarding Children Partnership Arrangements

As required by the Children and Social Work Act 2017, the new Safeguarding Children Partnership Arrangements have been published, consulted upon, implemented and adopted from the 29th September 2019 which includes a revised governance structure.  MB CCG have been influential working across the three Safeguarding Partnerships in the alignment of arrangements across our geographical footprint:

  • Cumbria
  • Lancashire
  • North Yorkshire

To ensure that the voice of children, young people and families is heard locally, arrangements have been put in place by both Cumbria and Lancashire for local operational groups which will drive safeguarding assurance activities and report to the strategic partnership group/board.

Looked After Children

Number of Looked After Children

Across the Morecambe Bay footprint in March 2020 we had approximately 731 Looked After Children; these include children placed in and out of area:

Looked After Children
North Lancashire: 476
South Cumbria: 255

Health Assessment and Redesign Pathway Project

Following Lancashire Local Authority Ofsted Inspection in 2018, a joint scoping project with health colleagues was developed to identify the barriers and system challenges affecting the compliance with the poor performance of Initial and review health assessments. 

A project and steering group was established, led by a partnership of Designated Nurse and Children’s Services, to drive improvement.  This included a scoping of cases awaiting health assessments and associated partnership action plan, strengthening or performance reporting and escalation plans, access to timely data and the development of an engagement pathway to ensure there is a health plan even when children refuse to attend.

Children’s Radar Group

To increase the care and safeguarding of looked after children placed in to private residential care provisions in Cumbria, a multi-agency group called Children’s Radar was created in June 2019.  This is chaired by the police with the support of MBCCG Designated Nurse and is well represented by multi-agency partners.

The group covers all children placed in private establishments whether local or not; referrals are discussed with relevant information shared and multi-agency support mobilised to respond to concerns that are raised where standards of care are not met or they have been breached.

Compliance with Statutory Health Assessments

Across the footprint compliance with health assessments remains variable due to a series of co-dependant multi-agency challenges, including notifications systems, capacity of staff and engagement of young people. Compliance at the end of March 2020 is as follows:

Initial Health Assessments on time
North Lancashire: 93%
South Cumbria: 53%

Review Health Assessments on time
North Lancashire: 98%
South Cumbria: 58%

Themes identified from statutory health assessments

Themes identified from statutory health assessments include emotional well-being, sleep support, smoking and substance cessation, sexual health needs, exploitation and missing from home, development checks as per healthy child programme and complex physical health needs.

Risks/gaps identified for LAC

  • Effective partnership working
  • Ongoing health service for those leaving care
  • Timeliness of health assessments
  • Immunisations for young people 16-18 years

MBCCG SG Team continues to work across the system to mitigate and address these risks and gaps.  This includes the publication of a Care Leaver Offer by both Lancashire and Cumbria County Council, which we have influenced to include a health component and signposting to services available to support care leavers.

Reducing Unwarranted Variation for Looked After Children (LAC)

The health system together with local authorities as ‘Corporate Parents’ should together have high aspirations to improve outcomes for these children and young people. NHS England have identified reducing unwarranted variation for Looked after Children as a key area of focus. Work is ongoing to reduce unwarranted for all LAC across the Lancashire and South Cumbria footprint.

The primary areas of unwarranted variation to be addressed in the forthcoming year are:

• Access to timely and quality health services regardless of where LAC are placed in the United Kingdom
• The health commissioning pathways to meet the statutory duties for all LAC are complex and there is no single service specification for delivery across the ICS and National footprint.
• Access to mental health services for LAC and care leavers.

Safeguarding Adults

Across the MBCCG footprint we have seen an increase in referrals, and an increase in those stepped up to a safeguarding enquiry. This is an improvement on last year, recognition of the awareness raising of the Local Authorities “Threshold Guidance” and tools needs to be noted.

Safeguarding Alerts
North Lancashire 2018-19: 1112
North Lancashire 2019-20: 1162
South Cumbria 2018-19: 1045
South Cumbria 2019-20: 1543

Number stepped up to a Safeguarding Enquiry
North Lancashire 2018-19: 402
North Lancashire 2019-20: 501
South Cumbria 2018-19: 746
South Cumbria 2019-20: 715

Mental Capacity Act/Deprivation of Liberty Safeguards (DoLS) & Liberty Protection Safeguards (LPS) 

The Mental Capacity (Amendment) Act 2019 received Royal Assent in May 2019. The Act introduces the Liberty Protection Safeguards (LPS) which will replace the current DoLS system. The intention was for the new LPS system to come into force on 1st October 2020. However, due to the current COVID pandemic, this date has since been pushed back until April 2022. Prior to this date a significant amount of work had commenced to ensure smooth implementation of the required changes. And continued strengthening of the MCA agenda.

 Leading on strengthening strategic oversight of MCA/DoLS within the CSAB and across the health partnership
 Delivered several MCA/DoLS/LPS Masterclass to the GP PLT Forums, which was facilitated by our Legal colleagues at Hill Dickinson.
 Delivered training following the development and implementation of the LSAB MCA Training Framework
 Involved with the implementation plan for the changes within the Mental Capacity Amendment Bill, and Liberty Protection Safeguards across the ICS.
 Delivered training to GPs on the principles of MCA in relation to Self-Neglect
 Contributed to the writing of an LPS Options Paper surrounding the implications of LPS and CCG responsibilities.
 Facilitated training to our Safeguarding Champions around Sex, Capacity & Consent.

2. Developing and Strengthening Pathways & Services

Key Successes across the Integrated Care System (ICS)

The team have worked closely with partners to develop and strengthen safeguarding pathways, response and services.  The below highlights some of the areas of good practice and achievements across each of the safeguarding priorities:

Information Sharing
Driven work to strengthen the provision of Primary Care reports to child protection conferences, utilising the use of EMIS for precise and timely information sharing.

Domestic Abuse (DA)
Influenced the ongoing Lancashire MARAC review to ensure effective implementation in the MB footprint, delivering key messages and increasing awareness to Primary Care through the Leadership Forums.

Liberty Protection Safeguards (LPS)
Influencing and strengthening the knowledge & understanding of local GPs & regulated care providers in relation to their roles & responsibilities within the proposed changes within the Mental Capacity (Amendment) Act (2019).  Therefore, encouraging a responsive & proactive approach.

ICS Safeguarding Structure
Lancashire and South Cumbria safeguarding ICS network identified nationally as an area to support the development of a transformational model of safeguarding across the Integrated Care System.

Exploitation
Key member of the Peer Review of Contextual Safeguarding within Cumbria as the health representative for the strategic group; strengthening the delivery of the multi-agency action plan across the health system. Influenced plans for a yearlong awareness campaign within Cumbria, to shape the offer and delivery for professionals.

Human trafficking and modern slavery
Active member of the Pan-Lancashire Anti-Slavery Partnership and key contact for the Cumbria Anti- Slavery Lead to strengthen the health response to modern slavery. 

PREVENT
Facilitation of PREVENT training to the GP Leadership Forum, promoting partnership working, and strengthening pathways.

Voice of Children and Adults

Examples of Engagement Activity includes:

Lancashire and Cumbria Safeguarding Partnerships ensure that we engage with families in any learning or Practice Reviews, and ensure their voices are heard through the Child Death Processes.

The voice of the child has been added as a standard agenda item to sub-groups and meetings to enable practitioners to showcase their engagement with Children and young People through the work that they do.

In line with the revised arrangements for Safeguarding, supported by the ICS SG Structure, local delivery and operational groups will be put in place to ensure key safeguarding priorities are delivered at every level.  This frontline operational group will capture the voice of the child and engage with children and families in various ways to inform the continuous development of services and approaches aimed at protecting children from harm and making positive differences to their lives.

As part of Quality and Safeguarding ‘walk round’ visits to providers, conversations are had with children and Young People to ascertain their views.

Patient stories have been presented to the CSAB Adult Safeguarding Board to ensure the experience and voice of the adult is heard.

The Boards and Partnerships routinely consult with and seek the views of family members in relation to case reviews and ensure their views are appropriately reflected.

MBCCG is involved with the LeDeR Review process, the main principle of which is to ensure the relatives of those who have passed away, have the opportunity to voice their experiences of the health and social care system.  This is to ensure improvements and areas of good practice can be disseminated and acted upon to improve patient care.

MBCCG works closely with People First in Cumbria and Pathways Associates (Community Interest Company) in Lancashire – both are independent companies empowering people with Learning Disabilities and Autism to have their voices heard, and ensuring we support people with a learning disability in genuinely coproducing the development and delivery of our strategies and plans.

3. Using Intelligence and Information to Inform Decisions

Multiagency Safeguarding Hubs (MASH)

The implementation of MASH teams in Cumbria and Lancashire has improved the sharing of information between agencies, helping to protect the most vulnerable children and adults from harm, neglect and abuse. Some of the partnership work achieved over the last year is summarised below:

Lancashire Partners 

  • MASH Operating manual updated to strengthen governance
  • Implementation of multi-agency thematic audits, with strengthened health input
  • Focussed work to implement Early Help pathways, including step down processes
  • Implemented access to health records
  • Success of sharing of domestic abuse incidents with schools 

Cumbria Partners

  • Targeted work to look at health data and performance, responding to areas of challenge
  • Health leadership input to case audit schedule
  • Recognition of effective partnership working in a focussed OFSTED visit
  • Enabled access to health information (CAMHS) by Hub staff

Regulated Care

MB CCG is a core member in the Soft Intelligence Meetings and Quality Improvement Process (QPIP) across Lancashire and South Cumbria.

Viability

Within this reporting period we have seen:

  • 2 Learning Disability residential providers entered the QPiP process
  • Both providers have achieved and sustained the required improvements to be removed from the process.
  • 1 Domiciliary provider went into insolvency. MBCCG alongside the LA supported a smooth transition of packages and staff to another provider.
  • 1 Residential Home closure which was supported by the Local Authority.

Key Achievements

  • Improving outcomes and proactive implementation of the RADAR processes across the MBCCG footprint.
  • Strengthened links with CQC
  • Driving the principles of the Safeguarding Champions, to positively influence a vision of improving outcomes, and patient safety for the population of MBCCG footprint.
  • Increased and improved compliance of the Safeguarding Assurance Framework

Strengthening the system

  • Implementation of a suite of policy templates to support providers to strengthen safeguarding arrangements, influencing accountability for safeguarding.
  • Driving a whole system approach within South Cumbria to strengthen assurances around the MCA/DoLS.
  • Responsive and collaborative approach to mobilising wrap around support for struggling providers.
  • Established and implemented a new partnership working arrangement with colleagues from North Yorkshire, to effectively support and gain assurance for regulated care providers within this area.

4. Influencing Partnerships

Inspectorate - Improvement Journeys

Lancashire County Council

Focused visit to Lancashire local authority children’s services

Lancashire County Council were subject to a focused visit of Children’s Services in November 2019.  The inspectors observed that the Council had accelerated the pace of improvement, with senior leaders responsive to external scrutiny from peer reviews and other partners. Senior leaders were developing a more robust audit framework, focusing on reducing high numbers of children in care and developing the workforce in a supportive work environment. Areas of improvement included the need for assessments of a consistently good standard, detailed action plans and timescales, direct work with children to ensure their voice is heard and management oversight of cases.  The Getting to Good Board continues to meet to drive the recommendations forward with improvements already being noted.

Cumbria County Council

LGA Peer Review of Contextual Safeguarding

Cumbria agreed to undertake a contextual safeguarding themed peer review with the Local Government Association (LGA).  The review focussed on Child Sexual Exploitation, Child Criminal Exploitation and Missing from Home and involved agencies across the multi-agency partnership through practice observation, focus groups and case audit. Priorities for action included need for improved leadership, strengthened assessments which reflect the voice of the child, support to workforce to recognise and respond to contextual safeguarding along with a refresh and launch of awareness across Cumbria.  Following this a Contextual Safeguarding Summit was held for partners to work together to address a number of key issues raised and develop a multi-agency strategy to address the recommendations, driven by operational delivery groups.

Cumbria County Council

Focused visit to Cumbria local authority children’s services

Cumbria County Council were subject to a focused visit of Children’s Services in August 2019.  The inspectors observed that the Council were continuing to make sustained improvements, particularly in relation to the Multi-Agency Safeguarding Hub, and in embedding our practice methodology (Signs of Safety) as well as outlining some areas for further improvement including our response to young people who present as homeless.  No ‘priority areas for action’ were raised as a result of this visit.

5. Impact of COVID-19

At the time of writing, we were facing an unprecedented time of the COVID-19 Pandemic, and so it felt pertinent to include a summary of the impact of this.

Safeguarding Designated Leads have continued to support acute, community, primary and regulated care services together with partners across the system in the most meaningful way possible. 

Maintenance of statutory safeguarding functions and provisions have remained the same throughout the pandemic as outlined in Statutory Guidance.  Recent additional legislation has enforced the need for safeguarding to be maintained as a priority, especially given the recognition that harm and abuse is now hidden.  There is an expectation that there will be a rise in demand relating to the care and support to children and young people and vulnerable adults who have experienced harm.

There has been acceptance of alternative processes of service delivery and decreased face to face contact with a number of vulnerable groups, including looked after children.  As we move in to the recovery/restoration phase, ‘normal’ service delivery is expected to resume and with this it is anticipated that we will see a surge in demand for safeguarding response across children and adult services, which includes: mental health issues; neglect; exploitation; disclosures of domestic abuse and disclosures of sexual abuse.

The CCG has maintained its statutory safeguarding responsibilities to ensure it receives assurance that services are meeting the increased demand and ensuring that commissioning arrangements reflect the needs of children and vulnerable adults. Assurance has been obtained regarding compliance during the COVID-19 pandemic and will continue through the recovery phase and beyond. In order to support this, a safeguarding assurance report was developed, the purpose of which is to:

  • Provide assurance that individual CCG statutory safeguarding functions are being maintained (or not) during the COVID -19 epidemic
  • Identify CCG / ICP risks and emerging ICS risks which can then feed into the Children’s Safeguarding Partnerships and Adult Boards - risk mitigation plans can then be developed at the appropriate system level to manage these effectively
  • Highlight what functions safeguarding leads / teams were undertaking during the COVID pandemic that were not statutory safeguarding responsibilities
  • Identify any areas of potential capacity / i.e. areas where capacity could potentially be released to support increasing health demand during this pandemic period as required
  • The lead health executive would provide an overarching view of the Pan Lancs and South Cumbria CCG’s statutory safeguarding compliance to share with NHS England / Children’s safeguarding assurance partnerships / Safeguarding Adult’s Boards etc.

There is also recognition that the Children’s Safeguarding Partnerships and Adult Safeguarding Boards play a role in seeking assurance around the increased demand on safeguarding and system service delivery, all of which requires a partnership approach.

6. Summary and Forward Planning

Summary

The information contained in this report demonstrates that the CCG has continued to ensure robust commissioning arrangements are in place for safeguarding and importantly our work with partners to support service development, delivery methods and governance arrangements. The need for continuous safeguarding improvement is set against a backdrop of austerity measures across all health and social care services, with the added complexities a Global Pandemic. Whilst there is an imperative to address gaps and meet the challenges of the changing landscape alongside indeterminate effects of Covid-19, it is important that we do not comprise progress across the spectrum of safeguarding services from early help through to protecting those who are most vulnerable.

Throughout the following months we will maintain the Safeguarding and Children Looked After statutory and business critical functions, putting in place additional strategic connectivity to support health agencies and work alongside partner agencies. Regular reviews of business continuity plans take place through meetings with providers, ensuring compliance with National Guidance and sharing of innovative practice. Recovery conversations commenced as a safeguarding system. We have developed a Lancashire and South Cumbria ICS Core System Safeguarding Offer for Covid-19 and continue to share core data for analysis with NHSE/I in order to identify and share safeguarding system themes and issues.

Over the forthcoming year we expect to be addressing:

  • Implementation of Lancashire’s New Family Safeguarding model
  • Quality improvement as a result of GP SAF
  • Implementation of the requirements of the DA Bill
  • Delivery of the priorities of the Safeguarding Adult Boards and Children’s Partnerships
  • Implementation of the Lancashire MARAC review
  • Further strengthen the response to exploitation in Lancashire and Cumbria
  • Receive and implement the Liberty Protection Safeguards

The safeguarding agenda is complex, and arrangements are frequently under review, often due to national drivers and local challenges. Safeguarding is multifaceted and continues to evolve in line with national policy, legislation and findings from learning reviews. The ever-increasing statute, statutory requirements and rapidly growing nature of the safeguarding agenda for vulnerable children and adults; places a continual increasing demand on resource. Despite this, the annual report demonstrates a wide range of activity to support and enhance safeguarding arrangements and we are extremely proud of these achievements over the last year, the priorities outlined below will support the CCG to continue to strengthen arrangements and where necessary mitigate current organisational and partnership risks.

Priorities for 2020-2021

Morecambe Bay CCG Vision
“To see a network of communities across Morecambe Bay enjoying great physical, mental and emotional well-being, supported by a health and care system that is recognised as being as good as it gets.”

Morecambe Bay Objectives – To achieve our vision we will deliver our triple aim:

  • Better Health – we will improve population health and well-being and reduce health inequalities
  • Better Care – we will improve individual outcomes, quality and experience of care
  • Delivered Sustainably – we will create an environment for motivated, happy staff and achieve our control total

During 2020-2021 the Safeguarding Team will contribute to these objectives and priorities by:

Delivering of the Statutory Safeguarding Functions

  • Achieve LeDeR Review timescales, and ensure implementation of learning across the health care system, utilising the new strategic implementation group. This will include Annual Health Checks
  • Embed the new Safeguarding Partnership arrangements, maintaining a focus on the key risk areas for children and agreed priority areas, implementing governance structures at a local level
  • Embed and seek provider assurance against the new Safeguarding Partnership arrangements for Child Death Reviews
  • Implement the Safeguarding Governance Model for Health across the Integrated Care System
  • Continue to deliver CCG Core Statutory Functions
  • Continue to strengthen the pathways to improve delivery of Looked After Children including the Care Leaver Offer, ensuring that health assessments are a positive and meaningful experience are completed in a timely way and reflect he voice of the child.
  • Strengthen arrangements for the Children’s RADAR, influence the implementation in Lancashire and develop a local offer for the Morecambe Bay footprint
  • Influence and strengthen understanding of roles & responsibilities within the proposed changes within the Mental Capacity (Amendment) Act (2019) including the Liberty Protection Safeguards.
  • Implement the “Recover & Restoration” plan following the COVID -19 pandemic.
  • Core members at CSAP & Safeguarding Adult Boards (SAB), to ensure leadership to effectively influence the system, and embed CSAP & SAB priorities.

Developing and strengthening Pathways and Services

  • Enable a collaborative approach to support Primary Care Networks to work proactively, and to strengthen effective safeguarding arrangements, which is influenced on findings from GP Safeguarding Assurance Framework.

Using intelligence and information to inform decisions

  • Maximise learning from Serious Incidents and learning reviews including LeDeR
  • Continue to identify emergent system risks through sharing intelligence, receiving assurance, and ongoing monitoring of contractual responsibilities.

Influencing Partnerships

  • Influence and strengthen understanding of roles & responsibilities within the proposed changes within the Mental Capacity (Amendment) Act (2019) including the Liberty Protection Safeguards.
  • Core members at CSAP & Safeguarding Adult Boards, to ensure MBCCG representation, and leadership to effectively influence the system.