FOR DISCUSSION

Protecting Vulnerable People: Safeguarding Annual Report 2014/15

Page 1 of 23 Q&S Committee Meeting 10 December 2015

Agenda Item 4.2

QUALITY AND SAFETY COMMITTEE 10 DECEMBER 2015

AGENDA ITEM 4.2

PROTECTING VULNERABLE PEOPLE ANNUAL REPORT 2014/15

Report of

Executive Director of Nursing

Paper prepared by

Head of Safeguarding Executive Director of Nursing

Purpose of Paper

To present the Annual Report for Safeguarding activity 2014 – 2015.

Action/Decision required

To approve the Annual Report and endorse the priorities for 2015/16.

Link to the Health and Care Standards 2015

Standard 2.7 Safeguarding adults and children

at risk

Standard 3.1 Safe and Clinically Effective Care

Standard 3.5 Record Keeping

Standard 4.1 Dignified Care

Standard 7.1 Workforce

Link to Health Board’s

Integrated Medium Term Plan

Truly integrated care centered on the needs of

the individual

Acronyms and

abbreviations

As identified in the report

Report of

Director of Nursing

FOR DISCUSSION

Protecting Vulnerable People: Safeguarding Annual Report 2014/15

Page 2 of 23 Q&S Committee Meeting 10 December 2015

Agenda Item 4.2

PROTECTING VULNERABLE PEOPLE ANNUAL REPORT 2014/15

Introduction

This annual report serves to inform the Health Board of the ongoing

safeguarding activities undertaken in relation to Safeguarding Children,

Young People, Looked After Children, Safeguarding Vulnerable Adults and

Domestic Abuse and Harm for the period 2014 – 2015, together with the

priorities identified for 2015-16. This complements the previous reports for

this period on Deprivation of Liberties Safeguards, Care Home Governance

and Adult Protection all of which have been presented to Executive Team

and the Quality and Safety Committee during 2015.

It is a priority for the Health Board to safeguard vulnerable people in accordance with legislative frameworks, principles and core values:

The Children Act 1989

Children Act 2004

Social Services and Wellbeing (Wales) Act 2014

‘In Safe Hands’

All Wales Child Protection Procedures

Interim Adult Protection Policies & Procedures

The Multi Agency Public Protection Arrangements (MAPPA)

The Domestic Abuse Strategic Agenda.

Domestic Abuse, Honour Based Violence frameworks

Modern Day Slavery, Forced Marriage, Trafficking, Female Genital Mutilation and Counter Terrorism are key strategic target areas for the safeguarding

agenda and they all influence and have an impact on both Adult Protection and Child Protection.

This report has been compiled with reference and information obtained from a number of reports identified within the Safeguarding Reporting

Framework which assumes a human rights based approach and promotes fairness, respect, equality, dignity and autonomy, known as the FREDA

principles.

FOR DISCUSSION

Protecting Vulnerable People: Safeguarding Annual Report 2014/15

Page 3 of 23 Q&S Committee Meeting 10 December 2015

Agenda Item 4.2

The report informs the Board of the ongoing safeguarding activities

undertaken by the PTHB in relation to Safeguarding Children, Young People, Looked after Children (LAC), Vulnerable Adults and Domestic Abuse for the

period 2014/15.

The main elements contained within this report are divided into themes and

cover:

The national context for the provision and development of

safeguarding children, young people and vulnerable adults;

The local context for the provision and development of the

safeguarding agenda;

The local issues in relation to guidance, including risks, gaps and

priorities;

Local data, where available, in relation to Child Protection, Looked

after Children, Domestic abuse and Multi Agency Public Protection

Arrangements (MAPPA);

Training data in relation to Child Protection and Adult Protection;

Priorities for 2015/16 including action underway.

The report highlights the areas where compliance is challenged and

identifies the priorities for 2015/16.

Recommendation

The Board are asked to approve the Annual Safeguarding Report and

endorse the identified priorities for action for 2015/16.

Report prepared by: Presented By:

Pauline Galluccio Rhiannon Jones Head of Safeguarding Service

(Adults and Children)

Director of Nursing

Rhiannon Jones

Director of Nursing

4

The Safeguarding Children, Young People & Safeguarding Adults

Annual Report 2014/15

1. Introduction

This report serves to inform the Health Board of the ongoing safeguarding activities undertaken in relation to Safeguarding Children, Young People,

Looked After Children, Safeguarding Vulnerable Adults and Domestic Abuse and Harm for the period 2014 – 2015, together with the priorities identified

for 2015-16. This complements the previous reports for this period on Deprivation of Liberties Safeguards, Care Home Governance and Adult

Protection all of which have been presented to Executive Team and the Quality and Safety Committee.

It is a priority for the Health Board to safeguard vulnerable people in

accordance with legislative frameworks and principles and core values:

The Children Act 1989

Children Act 2004

Social Services and Wellbeing (Wales) Act 2014

‘In Safe Hands’

All Wales Child Protection Procedures

Interim Adult Protection Policies & Procedures

The Multi Agency Public Protection Arrangements (MAPPA)

The Domestic Abuse Strategic Agenda.

Domestic Abuse, Honour Based Violence frameworks

Modern Day Slavery, Forced Marriage, Trafficking, Female Genital Mutilation and Counter Terrorism are key strategic target areas for the safeguarding

agenda and they all influence and have an impact on both Adult Protection and Child Protection.

This report has been compiled with reference and information obtained from

a number of reports identified within the Safeguarding Reporting Framework which assumes a human rights based approach and promotes

fairness, respect, equality, dignity and autonomy, known as the FREDA principles.

2. Purpose

5

This report serves to inform the Board of the ongoing safeguarding activities

undertaken by the PTHB in relation to Safeguarding Children, Young People, Looked after Children (LAC), Vulnerable Adults and Domestic Abuse for the

period 2014/15.

The main elements contained within this report are divided into themes and

cover:

The national context for the provision and development of

safeguarding children, young people and vulnerable adults;

The local context for the provision and development of the

safeguarding agenda;

The local issues in relation to guidance, including risks, gaps and

priorities;

Local data, where available, in relation to Child Protection, Looked

after Children, Domestic abuse and Multi Agency Public Protection

Arrangements (MAPPA);

Training data in relation to Child Protection and Adult Protection;

Priorities for 2015/16 including action underway.

3. National Context

The Health Board has a statutory duty to make arrangements to safeguard

and promote the welfare of children under Section 11 of the Children Act 2004 and is a statutory member of the Safeguarding Children’s Board under

section 13 of the Act. It is imperative for the Health Board to safeguard vulnerable people in accordance with the legislative framework of the

Children Act 1989/2004 and All Wales Policies and Procedures for the Protection of Adults at Risk.

During this period Safeguarding has been undergoing a period of change and consultation on a number of significant activities:

The Social Services & Well Being (Wales) Act (2014). From April 2016 this places Adult Protection on a statutory footing, making it a

statutory duty to safeguard, report, protect, co-operate and share information to protect adults from abuse. The regulations set out the

establishment of regional Safeguarding Children’s Boards and Safeguarding Adult’s Boards. It also establishes a National

Safeguarding Board.

The Counter Terrorism and Security Act (2015). From July 2015 this

places a legal duty on PTHB to have all staff trained in PREVENT. The

aim of the Prevent strategy is to reduce the threat to the UK from

6

terrorism by stopping people becoming terrorists or supporting

terrorism.

Violence against Women, Domestic Abuse and Sexual Violence Act

(2015). This ensures a focus across the public sector on the

prevention of these issues, protection of victims and the support for

those affected by such issues. The National Training Framework is

currently out for consultation and includes 6 levels of training from

awareness raising and practical guidance, to strategic planning and

leadership.

Modern Day Slavery Act (2015) which strengthens law enforcement

powers to tackle modern slavery and increase protection for victims.

It includes Slavery and Trafficking Prevention and Risk orders, and

introduces an Independent Anti Slavery Commissioner. There will be

agency Safeguarding Leads, Regional Multi Disciplinary Panels and

changes to the National Reporting Mechanism.

Cordis Bright have published a review of the implementation of the

Child Practice Review Framework, and the ongoing activities relating

to Safeguarding Adult Practice Reviews

The Safeguarding Children NHS Network was established following

recommendation made by Professor Sir Aylward (Safeguarding and

Protecting Children in NHS Wales, 2010, 6.5). It provides an

environment for Health Boards, NHS Trusts and the Safeguarding

Children Service to work together in recognising common issues,

developing solutions and achieving healthcare standards to better

safeguard children. It provides a bridge between strategies and

arrangements at local level and national policy developments to

support NHS Wales, LHBs and Trusts in fully discharging their

responsibilities for safeguarding children.

The Welsh Government and the Chief Nursing Officer has agreed a

nationally recognised Annual Audit named “Quality Outcomes

Framework”. PTHB has undertaken the yearly audit and this has been

published anonymously. The 2014/15 audit was submitted in

November 2015 and the next report will be published in the new year

with the details of the Health Boards/Trusts submissions.

4. Local Context

4.1 Powys Teaching Health Board : Leadership for Protection and Safeguarding

7

The leadership for protection and safeguarding is delegated by the Chief

Executive to the Executive Director of Nursing. PTHB has established a ‘Protecting Vulnerable People Group’ in order to develop a clear, deliverable

strategy for improving the ability to protect vulnerable people in line with

the Annual Plan and legislative frameworks. This group is chaired by the Executive Director of Nursing and has key leads from across the

organisation as part of its membership. There are 2 operational fora for Child Protection and Adult Protection which will continue to work on the

plans for Child Protection, Adult Protection and Domestic Abuse across the Health Board.

4.2 PTHB Safeguarding Service

From an infrastructure perspective, there are some dedicated posts to

safeguarding, however it is essential to emphasise that safeguarding is a key responsibility for all staff at every level of the organisation.

Head of Safeguarding Service (Adults and Children) - Pauline Galluccio;

Named Midwife for Child Protection - Cate Langley

Specialist Nurses Safeguarding Children - Angela Wragg and Raquel Bennett Senior Nurse Adult Protection/Care Home Governance - Noreen O’Connor

Named Doctor for Child Protection - Dr Ingrid Prosser Specialist Nurse Looked After Children - Mary Morton

Specialist Health Practitioner Looked After Children - Gail Morris Named Doctor Looked After Children and Adoption - Dr Rachel Lindoewood

The Health Board has placed Safeguarding on a strong strategic footing

ensuring that robust systems and processes are in place to Safeguard Children & Vulnerable Adults who are at risk of harm, exploitation and,

where abuse has occurred, to support the victim both as a service user and employee.

The infrastructure in PTHB has been strengthened in order to improve the

way in which all staff work with each other to protect vulnerable people

whether in a hospital or community setting. This has included training Adult Protection Investigators, improved use of the Datix system for highlighting

safeguarding issues and the ongoing development of the safeguarding team who are contributing locally, regionally and nationally on Safeguarding

issues, ranging from of Child Protection, Adult Protection, Looked After Children, Domestic Abuse, Deprivation of Liberty Safeguards, MAPPA,

Domestic Abuse, FGM, Modern Day Slavery / Trafficking, Child Sexual Exploitation.

4.3 PTHB Safeguarding Adults and Children Meetings

8

There are 3 main groups within the Health Board whose terms of reference

were formally agreed by the Quality & Safety Committee and assures the Board of their responsibilities.

Safeguarding Vulnerable People Group Safeguarding Adults Operational Forum

Safeguarding Children Operational Forum

The Terms of Reference and aims of the meetings is to:

Ensure the organisation complies with section 28, 27(2) (a) (b) and

section 25 and section 31 of the Children Act 2004;

Ensure the organisation has arrangements in place under section 11

Children Act 2004;

Ensure the organisation complies with safe recruitment and monitoring

arrangements following Disclosure & Barring Service (DBS) guidance

Ensure the organisation complies with the Protection of Vulnerable

Adult Policy/and Strategic Guidance;

Provide leadership, commitment and operational support to the

Safeguarding Process;

Facilitate Health Board compliance with external standards; good

practice guidance; and legislation;

Manage an on-going process of self assessment and improvement

against the Health and Care Standards and Quality Outcomes

Framework, to enable the annual self-assessment submission;

Ensure that recommendations made by internal and external reviews

are considered and acted upon;

Ensure that there are agreed standards and policies in place for

safeguarding Adults and Children and that all staff are aware of their

responsibilities.

The Reporting Framework is designed to support the Safeguarding agenda

and ensure both statutory activities and reporting arrangements are aligned to the corporate reporting framework for the Health Board and is entwined

with the statutory multi-agency agenda.

5. County /Regional context

PTHB continues to work in partnership, particularly with Powys County

Council, in safeguarding children and young people and vulnerable adults. PTHB plays its full role in the Powys Local Operational Group

(PLOG – safeguarding children) and the Powys Adult Protection committee.

9

PTHB is has been working in partnership regionally to progress the

regionalisation agenda set out in the Social Services and Wellbeing (Wales) Act. The Mid and West Wales Safeguarding Children’s Board

(CYSUR) became fully functional in June 2014 with strong governance

arrangements underpinning its work . Progress with the Regional Adult Protection Board is being made with ongoing discussions over the next

few months. The CYSUR does present a challenge for Powys due to it’s geographical distance and difficulty with active attendance.

6. Review of actions and priorities 2014/15

Action Plan Status

1. Review of the Child Protection Training Strategy to incorporate all elements of

safeguarding including Child Protection, Adult Protection, Domestic abuse, UNCHR and

PREVENT

complete

2. Workforce Development Unit to provide data in order to monitor compliance with training.

complete

3. Review of Safeguarding policies in line with new formats

complete

4. Audit of full engagement with the Wales Safeguarding Childrens NHS Network

January 2014

5. NHS Wales self assessment Quality Outcomes

Framework

Completed

Sept 2014

6. Yearly audit of Child Protection supervision complete

7. Training for Investigators of Adult Protection

cases

complete

8. Audit the implementation of the Deprivation of

Liberty Safeguards action plan for the

implementation of the Cheshire West Judgement.

ongoing

9. Review the reporting Framework to include

Deprivation of Liberty to Protecting Vulnerable People Group.

ongoing

10. DoLS paper to be presented to Executive

Team

May &

August 2015

11. Review of policy relating to parents of children

with mental health / learning disabilities

Delay due to

mental health

standards

10

working group

12. Regional Safeguarding Boards - full engagement and participation, identify

membership at a corporate and operational level, and agree the governance

arrangements.

Complete for Regional

Safeguarding Children’s

Board but adults board

not yet

established

13 Improve Adult and Child Protection training

compliance at all levels

Variable

compliance

7. Child Protection

7.1 Numbers of the Child Protection register

Powys County Council have established a central referral system for referrals in relation Adults and Children called Powys People Direct. There

has been an increase in referrals from April 14 - March 15 and an increase in Child Protection Registrations. This is being monitored by Powys Local

Operational Group (PLOG).

March

2012

March

2013

March

2014

Quarter 1

14/15

Q 2

14/15

Q 3 Q 4

Children

on the CPR

75 80 60 75 87 111 104

Per

10,000 population

28 31 24 29 34 44 41

7.2 Child Protection Registration (CPR)

The majority of children are on the Child Protection Register for emotional abuse.

30.6.14 30.9.14 32.12.14 31.3.15

No of CPR 75 87 111 104

Emotional Abuse

47% 45% 51% 43%

Neglect

31% 24% 15% 34%

Physical Abuse

7% 16% 22% 12%

Sexual Abuse 5% 8% 7% 6%

11

Physical and

Sexual Abuse

0 5% 4% 4%

Neglect and

Physical Abuse

11% 1% 1% 2%

Neglect and

Sexual Abuse

0 0 1% 1

Gender

Male

59% 60% 65% 59%

Female 41% 40% 35% 41%

Age

Under 1 16% 13% 6% 9%

1-3 16% 18% 25% 20%

4- 6 15% 17% 17% 19%

7-11

13% 16% 21% 25%

12-15 33% 27% 26% 24%

16 plus 7% 8% 5% 3%

Over 18 months

on CPR

0 0 0 4%

Children with

disabilities

0 6% 6% 7%

7.3 Re registrations within 12 months

Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15

Powys 8 2 0 3

There were no looked after children on the CPR 31st March 2015.

7.4 Factors affecting parenting

Parenting factors Q 4 2014/15

Domestic abuse 54%

Mental Health 43%

Substance misuse 27%

Alcohol misuse 24%

Contact with risky adult 16%

Learning disability 0%

YP substance/ alcohol misuse 0%

Long term neglect 0%

12

Other 11%

8. Procedural Response to Unexpected Deaths in Children (PRUDiC)

PTHB is responsible for notifying the All Wales Child Death Review Team of

any death of a child within their area. Powys implemented the PRUDiC guidance in April 2011.

To date Powys has had 14 unexpected deaths in children, the majority of

these are road traffic accidents. Powys PRUDiC health practitioners are the Specialist Nurses for Safeguarding Children. The Wales Child Death review

team reviews all child deaths in Wales and undertakes specific work when

there are trends in certain areas. A Child Death Review Steering Group has been established to provide strategic advice and directional guidance to the

Child Death Review and facilitate stakeholder engagement. The Head of Safeguarding Service represents the Health Board and Powys Safeguarding

Children on the steering group

There was one unexpected child death that resulted in a PRUDiC meeting between April 2014 and March 2015. This was the death of a baby in July

2014, where co-sleeping was a factor.

9. Child Practice Reviews

From the 1st January 2013 the new Child Practice Review Framework: Improving Safeguarding and Protection replaced the Serious Case Review

process. Statutory guidance Protecting Children in Wales - Guidance for

Arrangements for Multi-Agency Child Practice Reviews has been published which replaces Chapter 10, Serious Case Reviews in Safeguarding Children

2006 – Working Together under the Children Act 2004. There have been no Child Practice reviews since the introduction of the guidance, though

several cases have been reviewed locally and Multi Agency Professional fora have been held locally which have covered Serious Case Reviews and

anonymised cases for learning. 2 cases were referred to the CYSUR CPR panel but the panel felt that they did not fulfil the criteria for a Child Practice

Review.

9. Child Protection Medicals

The Head of Safeguarding audits the number of child protection medicals notified to the Safeguarding Team each year This will not be the total, as

there may be some undertaken by other areas who have not notified the

Powys Safeguarding Team.

Between April 2013 and March 2014, there were 10 notified Child Protection medicals. 8 were physical and undertaken by Powys Paediatricians and 2

13

were child sexual abuse. 1 was undertaken at the SARC in Telford and the

other was undertaken in a DGH by a Powys Paediatrician.

Between April 2014 and March 2015, there were 36 notified Child Protection

medicals, 29 were physical abuse and 7 sexual abuse. 4 of these were undertaken in the SARC in Telford, 1 in Swansea, 1 Cardiff and 1 DGH by

Powys Paediatrician.

9.1 Sexual Assault and Referral Centre (SARC)

The Police and Crime Commissioner has provided funding for a sexual assault and referral centre to be based in Newtown, Powys. Prior to this

victims of sexual assault had to travel out of county

10. Safeguarding Children & Young People Supervision

The Child Protection Supervision Strategy was developed to provide a consistent standardised approach and awareness across the organisation

and includes adhoc supervision and advice for all employees (medical and

nursing), contractors and volunteers. The standardised supervision process is perceived positively by both supervisors and supervisees, and is audited

and reviewed yearly.

The Royal College of Paediatrics and Child Health recommend that Child Protection Peer Review is undertaken by paediatricians. Child Protection

Peer Review Meetings are well established.

10.1 Audit Child Protection Supervision January 14 - December 14

An audit of Child Protection Supervision has been undertaken and is based on the information kept on child protection clinical supervision by the

Specialist Nurses for Safeguarding children. It refers to the number of formal 1-1 supervision sessions undertaken and does not include group

supervision, telephone or informal advice. The supervision is undertaken by

the Specialist Nurses for Safeguarding Children.

Practitioners are advised to access supervision on a six monthly basis. If there are children on the CPR then practitioners are advised to seek

supervision three monthly (PTHB Child Protection Supervision Policy).

Responsibility lies with the practitioner to organize the supervision sessions unless there is a specific request from The Head of Safeguarding or the

practitioner’s line manager. The following table shows the number of practitioners seeking 1-1 supervision:

14

Practitioners

on database

Number of

Practitioners

Jul14-Dec

14

Jan14-

Jun 14

Over 1 year since

formal supervision

session

Health

Visitors

37 29 5 3

School Nurses 20 15 1 4

IFST HV 1 1 0 0

Total 58 45 6 7

The figures do not accurately reflect staff changes, staff who have retired

or are on maternity or sick leave.

The supervision records indicate that 51 (88%) practitioners out of 58 accessed individual Child Protection supervision during 2014. The Specialist

Nurses for Safeguarding Children undertook 101 formal individual supervision sessions in 2014.

11. Multi Agency Public Protection Arrangements (MAPPA)

The Criminal Justice Act 2003 (“CJA 2003”) provides for the establishment

of Multi-Agency Public Protection Arrangements (“MAPPA”) in each of the 42 criminal justice areas in England and Wales. These are designed to

protect the public, including previous victims of crime, from serious harm by sexual and violent offenders. They require the local criminal justice

agencies and other bodies dealing with offenders to work together in

partnership in dealing with these offenders.

MAPPA offenders are managed at one of three levels according to the extent of agency involvement and the number of different agencies involved. The

great majority are managed at level 1 (ordinary agency management). This involves the sharing of information but does not require multi-agency

meetings. The others are managed at level 2 if an active multi-agency approach is required (MAPPA meetings), and at level 3 if senior

representatives of the relevant agencies with the authority to commit resources are also needed.

MAPPA level 2 meetings are held in Powys, and level 3 are either in Powys

or Carmarthen. Current attendance at all these meetings from the safeguarding team is 100%

The supervision of MAPPA work is carried out by the Strategic Management Board (SMB) in each area. It has a range of governance-related functions,

including monitoring performance, ensuring anti-discriminatory practice, measuring compliance with the MAPPA Key Performance Indicators (KPIs),

15

and producing the annual MAPPA report. The PTHB Representative is the

Head of Safeguarding.

12. Domestic Abuse

Domestic Abuse, Violence against Women, and Sexual Violence are key

strategic target areas for the Safeguarding agenda. This strand also consists of other areas associated with vulnerability that include Counter

Terrorism PREVENT, Child Sexual Exploitation, Human Trafficking, Honour Based Violence (HBV) Female Genital Mutilation (FGM) and Forced Marriage

(FM). The Domestic Abuse, Violence against Women, and Sexual Violence agenda has a direct impact on both Adult Protection and Child Protection.

Precise figures for the number of girls and women who have undergone, or

who are at risk of FGM, in the UK, are hard to establish due to the secrecy surrounding the practice. The absence of targeted training and identifiable

reporting systems (to date) has rendered the gathering of any quantifiable data difficult. To date, there has been 1 women who was a victim of FGM

in Powys which was over 4 years ago. There is an all Wales NHS

safeguarding meeting regarding the pathway for FGM.

Action: Implement and audit the activity and reporting compliance against Female Genital Mutilation

12.1 Multi Agency Risk Assessment Conference (MARAC)

MARAC guidance requires monthly meetings in each Local Authority area to

manage and co-ordinate multi-agency protective measures for victims of Domestic Abuse. PTHB is a committed and established partner in the

MARAC process. There are 2 Domestic Abuse Multi Agency Risk Assessment Conferences (MARAC) held in Powys per month, one in North Powys and

one South Powys. The Specialist Nurses Safeguarding Children attend these meetings on behalf of the Health Board, and there is representation from

Adult Mental Health from the respective Health Boards.

MARAC meetings are multi agency victim-focused meetings where agencies

share information on the highest risk cases of Domestic Abuse across the Heath Board footprint. A safety plan for each victim is created and the

development of trusting relationships particularly between the statutory agencies is crucial to the effectiveness of the process.

During the last financial year there was an increase in cases discussed from

202 in 2013/14 to 258 in 2014/15. The referrals from Health practitioners increased from 8 in 2013/14 to 13 in 2014/15.

12.2 Domestic Violence Disclosure Scheme (DVDS)

16

On 8 March 2014, the Domestic Violence Disclosure Scheme (DVDS) was rolled out across England and Wales. Also known as Clare's Law, the process

enables the disclosure of information to allow individuals to make informed

choices about whether to proceed with a relationship if they find out their partner has a history of violence.

12.3 Domestic Violence Protection Orders

Domestic Violence Protection Orders are a new power introduced by the

Crime and Security Act 2010, and also came into force in England and Wales on the 8th March 2014. These orders are issued by the Police and

Magistrates and enable the police to implement protective measures for a victim in the immediate aftermath of an incident of domestic violence where

there is insufficient evidence to either charge a perpetrator or protect a victim by imposing bail conditions. The order stipulates that the perpetrator

does not return to the residence and does not contact the victim for a period of 28 days. The advantage of these orders are that the immediate threat of

further violence can be addressed and further safety measures put into

place for the victim and any children of the family.

13. Hate Crime

PTHB contributed to the consultation event in relation to the national Hate Crime Framework set up by Welsh Government. The framework was

developed by involving Statutory and Voluntary Partners across Wales. There continues to be a national focus on driving the Hate Crime agenda

forward to include two recommended levels requiring support:

1) Low level, persistent incidents that may not constitute crimes, but have a profound impact on the victim;

2) Complex cases, who may be identified as “vulnerable” or “high risk”, and for whom a MARAC approach may be required.

14. Modern Day Slavery/Human Trafficking and Sexual Exploitation

The Human Trafficking Victim Referral Pathway has been endorsed by the PTHB. The pathway identifies a system that directs referrals into the

referral process via a third sector partner, BAWSO. A training programme to accompany the Human Trafficking Victim Pathway has been developed

and agreed by the Strategic Board for the Modern Day Slavery Board. National and regional work is being undertaken in relation to Child Sexual

Exploitation and a regional task and finish group have developed a CSE strategy for Dyfed Powys. Significant work has been completed in relation

to ‘children who are in care’ in relation to a ‘Missing Risk Assessment’ which is an on line tool completed by the Residential Home and identifies children

who are at high risk of going missing from care.

17

Action: Implementation of CYSUR CSE Strategy

15. Looked After Children

15.1 Looked after children placed by Powys Local Authority.

Children who are in care are one of the most vulnerable groups within our society and at the end of the financial year there was 128 looked after

children. This is a decrease from the previous year. This may be due to

many factors as the children on the Child Protection Register has not decreased, and had an increase over the year. The legal process due to the

Public Law outline the time that children are in the care system is lessened, where there are alternative plans in place for them, for example adoption.

The following chart shows the number of children who are looked after by

Powys Local Authority

Powys LAC placed in

county

Powys LAC placed out of

county

Total number accommodated by

Powys Local authority

Q4 (31.3.15) 90 38 128

Q4 (31.03.14) 111 41 152

15.2 Total number on Specialist LAC team Caseload

0 50 100 150 200 250 300 350

Q1

Q2

Q3

Q4

2014-15 average

2013-14 average

Q1 2015

POWYS LAC

COLA

18

The majority of health assessments are undertaken by the Specialist LAC

Team. Health Visitors are the main practitioner for children under 5 and are

best placed to undertake their statutory health assessments, where

possible. Community Paediatric Nurses, Specialist Nurses for Learning

Disability and School Nurses in Special schools also complete LAC health

assessments. During Quarter 4 there was a vacancy within the safeguarding

team, and the School Nurses undertook more Health Assessments than in

previous months. Gail Morris, Specialist Health Practitioner, Looked After

Children has now commenced within the team.

The current compliance of Powys LAC registered with a GP is 100%. Dental

attendance is encouraged once child becomes LAC but we are unable to

ascertain those who have / have not attended in the time prior to becoming

LAC.

A recent inspection from CSSIW Looked After Children (LAC) Inspection enabled an holistic view of the services we provide to our looked after

children. The verbal feedback stated that our ‘Corporate Parenting’ was

judged as strong with commitment evident from members. They were able to see we held high aspirations for our LAC and it was evident that on the

ground there was good multi agency working between social care workers, the LAC education co-coordinators, LAC health team and housing officers.

This enabled the inspectors to appreciate lots of examples of best practice undertaken within Powys. Also given the geography of Powys some of the

challenges we face and manage on a daily basis whilst continuing to strive to meet the complex needs of the children we work with was evident.

15.3 Children from other Local Authorities

There are also additional complexities in relation to Looked After Children,

especially children who are placed from other Local Authorities. These

children are placed in Powys in small residential settings with complex needs and present an additional challenge on resources in relation to risk

assessment and management. When these children come into Powys a ‘best interest visit’ is undertaken by the Specialist Health team for Looked After

Children, as unfortunately, there is very little information regarding their health needs or mental health needs prior to placement.

The population of these children is very changeable, a high number of these

children live in residential accommodation with 27 places in the North and 20 places in the South of the county. In addition there are 2 residential

assessment units where the turnover is high. Often children arrive with complex needs which require immediate attention (such as prescribing

arrangements, mental health problems, self harm and other risk taking behaviours) but leave within 3 months.

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The numbers at quarter 4 for these children has also reduced between 2014

and 2015:

Q4 31.03.15 118

Q4 31.03.14 149

The majority of these children have complex health and social needs and utilise a lot of resources within health and also from the police and Local

Authority. There are also a number of children living in Independent Foster Care placements within Powys. In a number of cases there is a breech of

regulations as no notification of placement is received within Powys in a timely manner. Also there is no planning to ensure that their health care

needs can be met. Some of these young people have very high level needs and require CAMHS / Specialist Services and are challenging.

From April 2014 to March 2015 there were 10 strategy meetings and 9

professional strategy meetings in respect of children from other Local Authorities, compared to 1 strategy for Powys LAC and 2 professional

strategy meetings.

Powys hold an Independent Provider Forum for Vulnerable Children living away from home, where the children’s care providers and other agencies

can meet to discuss current issues of concern and it is also a forum for providing training and updates.

15.4 Participation / Feedback

The LAC Team are continually looking at ways to improve the experience

for Looked After Children and Young People in Powys in their health assessment and when involved with other health professionals. A postcard

is currently being developed to capture the views of the COLA population. The CYPP Participation and Feedback form is not appropriate for this

population and as such The LAC Team are now looking at producing a form that will better capture the views and feedback from these cohorts.

16. Safeguarding People at Risk Training

16.1 Training: Safeguarding Children

Following the Welsh Governments acceptance of the recommendations by Professor Sir Mansel Aylward in his report “Safeguarding and Protecting

Children in NHS” (2010) Welsh Government commissioned an Expert Working Group to consider the recommendations specific to training. It was

decided that “Safeguarding Children and Young People: Roles and

Competencies for Health Care Staff Intercollegiate Document - September 2010 updated 2014, would be the definitive reference point for deciding the

relevant levels of training for all staff. Training requirements as set out in

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the PTHB Training Strategy (2014) are based on this guidance. The

guidance sets the requirement for Level 2 as being a minimum requirement for non-clinical and clinical staff that have some degree of contact with

children and young people and/or parents/carers

. The current ESR system of capturing compliance figures has attached

required competencies to each role within PTHB. The same competencies for Level 1 & 2 are attached to all employees regardless of their role. To

distinguish between clinical and non clinical roles would involve a considerable amount of work.

This PTHB Training Strategy includes Adult Protection, Child Protection,

Domestic Abuse, PREVENT and Children’s rights.

16.2 Training: Adult Protection

Despite a robust training strategy, e-learning packages, multi agency and

single agency training being offered. The levels of staff compliance remains

poor. 9.07 % in February 2015. Without relevant training a risk exists of poor recognition and response to abuse in vulnerable groups.

Action:

1. To work in collaboration with Workforce and

Organisational Development to improve training

compliance and recording.

2. To link Domestic abuse, UNCHR. PREVENT, Deprivation

of Liberty Safeguards and Mental Capacity Act with Adult

and Child Protection

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17. Key Objectives for 2015 – 2016

Action Plan Status

1. Review the Terms of Reference and all Forums and

Sub-Groups aligned to the Safeguarding People at Risk reporting Framework

2. Implement and audit the activity and reporting

compliance against Female Genital Mutilation

3 Ratify the CYSUR CSE strategy

4 Audit the implementation of the Deprivation of Liberty

Safeguards Action Plan for the implementation of the Cheshire West Judgement

5 Review the governance and reporting framework and annual time scales of reporting from the Safeguarding

People at Risk of Harm Sub-group to the Board.

6 Ratify and implementation of the Domestic Abuse,

Violence against Women and Sexual Violence E-learning (Level 1) Training Package

7 Implementation and audit activity against Health and

Care Standards, Quality Outcomes Framework (QOF) Safeguarding Children Network, Regional

Safeguarding Boards audit, and Section 28 Audit with an Improvement Plan identified arising from the action

agreed at the Star Chamber.

8 Full engagement with the implementation of the Social

Services and Wellbeing Act 2014 at National, Regional and Local level including the activities and

membership at the Regional Safeguarding Boards

9 Endorse the National Training Package for Adult Protection and implement the E-learning Level 2 (Adult

Protection) across North Wales.

complete

10 Review and enhance engagement with Primary and

Community Care Service provision and Independent

Contractors

11 Review, audit and implement recommendations from

the Learning Events, and the Statutory Guidance of Adult Practice Reviews, Child Practice Reviews and

Homicide Reviews

Quarterly

12 Audit and Review Clinical Supervision activity for key

groups

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13 Review arrangements for Deprivation of Liberty

Safeguards in relation to administrative support and the Best Interest Assessors

14 Receive from each identified area an annual Safeguarding Report to evidence:

Governance Arrangements; Training needs analysis and training data;

Incidents and recommendations from

Adult/Child/Homicide Review; Safeguarding Datix Incidents;

Evidence to comply with National, Regional and Local audit activities;

Annual Action Plan with evidenced compliance

Review the reporting Framework to include Deprivation of Liberty to Protecting Vulnerable

People’s Group.

Continue to work with PCC on the integration of Safeguarding.

Identified New Risks

Risk – Training compliance

The Training compliance data remains an identified risk. Concerns have been raised regarding the methods of data collection and the

inconsistent approach to the identification of a Training Needs Analysis to support the Corporate Training Agenda.

Action:

This risk has been identified through the reporting framework

of the Safeguarding Forums Linking Deprivation of Liberty Safeguards (DOLS), Mental

Capacity Act, PREVENT, Domestic abuse, MAPPA with Adult and Children’s Safeguarding training

Implementation of the Safeguarding Training Strategy

Engagement with Safeguarding meetings

Localities and Directorate teams continue to provide limited

engagement with the Safeguarding meetings. This risk was also identified in the Annual report of 2013-2014.

Action:

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Review of terms of reference and membership Align the operational fora with the PVPG and combine adult and

child protection.

12 Conclusion

The last 12 months have been intense and have preoccupied the

Safeguarding Team associated with the number of Reviews, Inspection Reports and Legislation which have a direct impact upon

the safeguarding agenda. Staff training remains key to raise awareness and still has someway to go to meet the overall level of

compliance.

The Social Services and Well Being Act 2014 will have the additional impact on Adult Protection when implemented in 2016, and the

definition of ‘Adult at Risk ‘will have a significant impact upon Multi-agency and Single-agency activity.

The complexity and increase in the National, Regional and Local agenda continues to challenge the clinical resources. This includes

the Safeguarding Children Agenda and the Domestic Abuse and Harm Agenda and continues to demand resources to support multi-agency

activities, with a recognised increase in complexity and severity of the harm and abuse experienced by victims.