ITEM 6

HEALTH AND ADULT SOCIAL CARE COMMITTEE

12 MARCH 2018

Safeguarding adults referrals: numbers of concerns raised and progression to a Section 42 enquiry

Report Author: Phil Jones Head of Assessment and Safeguarding MKC Victoria Collins, Service Director Adult Services MKC

EXECUTIVE SUMMARY:

In December 2017 the Department of Health/NHS Digital published the Safeguarding Adults Collection (SAC) annual report, England 2016/17. The SAC records safeguarding activity relating to adults aged 18 and over with care and support needs in England. The report presents information about adults at risk for whom safeguarding concerns or enquiries were opened during the reporting period 1 April 2016 to 31 March 2017. The published data suggested that in only 10% of all safeguarding adult concerns received progressed to a safeguarding enquiry. This report provides detail on the context with regard to the published SAC figures for Milton Keynes, the issues that were highlighted by the SAC and the plans of how to respond to these.

Milton Keynes Context

Section 42 of the Care Act states that safeguarding enquiries should be made where a person has needs for care and support; is experiencing, or at risk of, abuse or neglect; and as a result of their care and support needs, is unable to protect himself or herself against the abuse or neglect or the risk of it. Between April 2016 and March 2017 Milton Keynes safeguarding adults team received 2445 safeguarding concerns.

In MKC safeguarding alerts are submitted directly via an on-line referral form to the Multi- Agency Safeguarding Hub (MASH) where they are then screened by a qualified social worker. The safeguarding adults team screen all referrals based on the Care Act criteria to determine the level of risk and the required timescale for further safeguarding enquiries. A recent internal audit of this area confirmed that systems and processes in place at Milton Keynes Council are robust. Of the 2445 safeguarding concerns received 10% progressed to a formal Section 42 safeguarding enquiry.

When comparing Milton Keynes to other areas, we have a larger number of safeguarding concerns raised than many other areas. The average number of concerns reported by Milton Keynes statistical neighbours was 40% fewer than in Milton Keynes. Raising a concern in Milton Keynes is easy; our website allows the public or professionals to do so in minutes. Some organisations make all their referrals to adult services through raising a safeguarding concern even though many are not safeguarding concerns related to abuse or neglect but are people requiring more general care and support. We do not pre-screen safeguarding concerns which are about more general care and support and ask them to use another route to access help. 1

Whilst our ‘conversion rate’ is very low at 10%, it needs to be seen in the context of the overall number of safeguarding concerns received.

It is important to note that of those safeguarding concerns received that do not progress to a formal safeguarding enquiry, action is still taken ranging from a referral to a social work team where the person concerned is already known to us, or work with a care provider to change a care plan. Lower level concerns often result in us providing advice, guidance or signposting to another service or organisation. The full range of outcomes of all safeguarding concerns received in the period are published in the 2016/17 Milton Keynes Safeguarding Adults Annual report: http://mkscb.org/wp-content/uploads/2017/12/fv_MKSAB-Annual-Report-2016-17.pdf.

A review by the Safeguarding Adults Manager and the Adults Information Performance Officer established that during 2016/17 we made greater use of our ability to delegate the responsibility to carry out a Section 42 investigation to another organisation such as the NHS or a provider organisation these included:

 Concerns that were dealt with via a partner agency’s Human Resources policy and procedure.  Concerns that were delegated to another agency to complete the enquiry (e.g. a care home provider).  Concerns that were referred as possible serious incidences to the NHS and subsequently managed by the NHS.

In 2015/16 we delegated responsibly 67 times rising to 143 times in 2016/17. In 2016/17 we did not include these external investigations in our SAC submission even though guidance indicates that we could do this. Had these investigations been included this would have increased the conversation rate to 18%.

The actual number of individuals involved in a Section 42 safeguarding enquiry in Milton Keynes was 240. When an age standardisation is applied by Department of Health/NHS Digital (standardisation is a technique used to allow populations to be compared when the age profiles of the populations are quite different) the figure for Milton Keynes is 143 per 100,000 population. This places Milton Keynes 28th out of 152 council areas.

Individuals involved in Section 42 enquiries per 100,000 by age standardised rates Age standardised rate Council (Per 100,000 population) The Council of The 32 Kirklees Council 36 Worcestershire County Council 53 Warwickshire County Council 56 Council 58 Devon County Council 62 Derbyshire County Council 64 London Borough of Bromley 64 Dorset County Council 67 Council 69 71 Cheshire West and Chester Council 72 County Council 72 2

London Borough of Merton Council 77 Cumbria County Council 84 London Borough of Barnet 85 London Borough of Hillingdon 85 County Council 96 Sefton Council 99 London Borough of Greenwich 100 Council 110 London Borough of Lewisham Council 111 Surrey County Council 121 Borough Council 125 Corporation of The City of London 133 London Borough of Wandsworth 134 Council 139 Milton Keynes Council 143 Council 146 Gloucestershire County Council 150 Wakefield Council 150 London Borough of Hammersmith and Fulham 150 County Council 152 Walsall Metropolitan Borough Council 153 Sandwell Metropolitan Borough Council 153 Bolton Metropolitan Borough Council 156 Council 163 Hartlepool Borough Council 163 Westminster City Council 168 Council 168

Next Steps

The Safeguarding Adults’ Team Manager undertaking a review of the safeguarding processes, the purpose of this will be to ensure that:

 Referrals are appropriately routed to social care teams where appropriate.  Relevant professionals across health and adult social care have appropriate training and understand the alert and referral process.  That the case management system captures all Section 42 enquiries accurately and robustly.

Reducing referrals that should not be forwarded to the safeguarding adults team will bring the Milton Keynes process into line with that of other local authorities and is likely to result in a higher percentage of alerts that go through to the Section 42 enquiry stage.

The recent successful recruitment of the safeguarding adults team manager and the planned recruitment of a deputy team manager has increased management oversight of the screening processes. Additional social work and customer liaison officer staff will be based in the MASH to support the screening processes.

3

Safeguarding Adults Thresholds, Guidance and Working with Partner Agencies

The East Midlands ADASS Safeguarding Adults’ Network (EMSAN), of which Milton Keynes is a member, will be collectively reviewing thresholds and guidance across the region to deliver consistency or response.

The review and audit have shown that the safeguarding procedures in Milton Keynes are robust and appropriate, it is the application of these processes that needs to be addressed, this was evidenced by a recent internal audit that determined that the systems and process in place at the MASH were robust. New guidance in relation to responding to safeguarding referrals and processes is being produced led by the Safeguarding Adults’ Programme Board. This work will include a review of the electronic referral form. The revised form will help the individual referrer differentiate between a safeguarding matter and a general social care enquiry.

The way we manage safeguarding concerns and the number progressing to Section 42 enquiries has already been agreed to be a focus of the Safeguarding Board during the first part of 2018. This will be explored by the Board through a range of qualitative audit and other quality assurance activities in order to better understand the local position compared to other areas.

4