Waltham Forest Safeguarding Adults Board

Waltham Forest Safeguarding Adults Board Annual Safeguarding Report 2015 - 2016

Report author: Fran Pearson, WFSAB Independent Chair Date: November 2016

1 Section 1: INDEPENDENT CHAIR'S INTRODUCTION

1.1.1 Well-being, prevention and adult protection - balancing our new roles

The year covered by this report was a significant one for adult safeguarding. The Care Act came into force on 1st April 2015 and made Safeguarding Adults Boards (SABs) statutory for the first time. The Act gave new and much-needed status to the task which all of us in the Waltham Forest SAB (WFSAB) feel passionately about - keeping adults who are at risk safe, and preventing harm. Underpinning the Act is a wider duty for local councils and their partners to promote wellbeing for adults who need support. This is welcome from the point of view of Safeguarding Adults Boards, but means we have to be clear in Waltham Forest about keeping a focus on protecting adults who are at risk, while at the same time developing prevention and well-being strategies with adults who have care and support needs.

1.1.2 The Care Act sets out the three core duties for Safeguarding Adults Boards. They have to:

 Develop and publish a strategic plan setting out how they will meet their objectives and how their member and partner agencies will contribute  Publish an annual report detailing how effective their work has been  Commission Safeguarding Adults Reviews (SARs) for any cases which meet the criteria.

1.1.3 Government guidance gives Safeguarding Adults Boards (SABs) more detail on what the government expects from the SAB Annual Report. This report for Waltham Forest is the first one written since the Care Act came into force, and the aim is to follow the guidance as closely as possible.

As soon as is feasible after the end of each financial year, a SAB must publish a report on:

• What it has done during that year to achieve its objective

2 • What it has done during that year to implement its strategy • What each member has done during that year to implement the strategy.

1.1.4 Section 118 of the Care Act Guidance adds:

The SAB must produce an annual report. This annual report must clearly state what both the SAB and its members have done to carry out and deliver the objectives and other content of its strategic plan.

Specifically, the annual report must provide information about SARs that the SAB has arranged which are ongoing or have reported in the year. The report must state what the SAB has done to act on the findings of the SARs or, where it has decided not to act on a finding, why not.

1.1.5 The annual report on the plan should set out how the SAB is monitoring progress against its policies and intentions to deliver. The SAB should consider the following in coming to its conclusions:

 Community awareness of adult abuse and neglect and how to respond

 What individuals who have experienced the process say

 What front line practitioners say about implementing policies and procedures

 Feedback from Local Healthwatch, people who use care and support and carers, community groups, advocates, service providers and other partners

 How successful adult safeguarding is at linking with other parts of the system, for example children’s safeguarding, domestic violence, community safety

 The effectiveness of training carried out in this area and analysis of future need

 How well agencies are co-operating and collaborating.

The report is meant to be a document that can be read and understood by anyone. It is therefore critical that the report is in plain English and free from jargon and acronyms as far as possible. Most SABs are likely to publish reports on their websites. SABs should consider making the report available in a variety of formats including easy read. SABs will need to establish ways of publicising the report.

The annual report must be sent to:

• The chief executive and leader of the local authority which established the SAB • Any local policing body that is required to sit on the SAB • The local Healthwatch organisation

3 • The chair of the local health and wellbeing Board.

How well did we do?

This report is written by the Independent Chair, and my aim is that the report is the place where people easily find information about the impact that the BoardWaltham Forest SAB has had. It is also my assessment of the effectiveness of the way organisations in Waltham Forest work, individually and together, to protect adults who are at risk. As a format I have adapted some work done for children's safeguarding Boards about what makes an effective Board, and the report is organised into sections based on those headings.

1.2 Summary of effectiveness

1.2.1 In summary, my assessment is that as a Board, we prioritised work to tackle cross-cutting and "Think Family" issues that affect adults at risk at the expense of consistently analysing some of the available data and asking the right questions, for example at the end of the previous year, the Board members agreed to stop receiving regular reports about some of the most vulnerable adults with learning difficulties, and to delegate the reporting for that to another forum. By the end of the year, issues about this group of service users began to appear, illustrating that the Board had not been curious or questioning enough.

1.2.2 We used a December Board meeting for a joint session with the Safeguarding Children Board looking at cross-cutting issues and where work could be better connected from 2016-2017 onwards. This was a fruitful discussion that resulted in agreement for a single panel, the ‘One Panel’, to look at the commissioning of Safeguarding Adults Reviews along with Serious Case Reviews where a child has been seriously harmed or died and abuse is suspected, as well as Domestic Homicide Reviews where someone has been killed by a partner or relative. A joint Learning and Improvement group across all four strategic partnership Boards in the borough was also agreed, like the 'One Panel' for case reviews, this was to start work in April 2016.

1.2.3 Many adults at risk are part of families, and all should be part of local communities. Waltham Forest has led the way in England in developing "Think Family" work and in connecting the priorities and delivery of its strategic Boards. The benefits of this will begin to be seen in 2016-2017. However, a substantial number of issues that 4 affect adults at risk of abuse are quite specific and require a focused response from the SAB.

One of these issues is the care provided by professionals in nursing homes, residential care homes, hospital, and to individuals in their own homes. The care sector in Waltham Forest is huge and the SAB does not understand the safeguarding implications of this well enough. This is a priority for 2016 -2017 but was not sufficiently addressed in 2015- 2016.

1.2.4 Mid-way through the year, Board members agreed to refocus our priorities to look at falls and pressure ulcers in more detail, but the work on "Think Family" and cross- cutting areas such as domestic violence, self-neglect and exploitation overtook the safeguarding issues related to care delivery. Previously the Board had looked at indicators - a set of data that was in quite an early stage of development but which gave Board members the basis for a discussion on some of the care issues mentioned above. With one Board meeting taken over for "Think Family" business and wider strategic partnership discussions, that data was not seen by the Board for six months. An audit by Mazars, commissioned by the local authority, confirmed this.

1.2.5 Where the Board was stronger was in its analysis and leadership of work on Mental Capacity. As the data for 2015-2016 shows, Mental Capacity and especially the related assessment to authorise Deprivation of Liberty Safeguards, has become a huge area of work related to safeguarding. Local practice and the support for this through the Board was strong. Linked to this, was the Board's leadership around Making Safeguarding Personal - the practice of putting an adult at risks’ wishes at the centre of decision-making about safeguarding. This became more embedded into practice in Waltham Forest during the year, as identified by a local authority audit of practice. The picture remains mixed though in terms of practice in Waltham Forest. This is not untypical and is reflected in the first piece of national research into this area - the "Making Safeguarding Personal (MSP) Temperature Check". What has been insufficient though is leadership by the Board on this issue, so "Improving Practice" is, quite rightly therefore, one of the Board's priorities for 2016-2017, and this is a chance to lead and champion Making Safeguarding Personal more strongly. The third linked area is that of how the Board brings the voices of adults at risk into its business, and uses those voices to influence its work. Users' voices were part of events that reached over 500 professionals in Waltham Forest during 2015-2016 - a workshop day on staying safe in the community, and a "Think Family" conference, organised jointly with the Children's Safeguarding

5 Board. However, the Board has also quite rightly made its third priority for 2016-2017 one around raising safeguarding awareness, which along with its other two priorities, reflects how much work we know there is still to do to put adults at risk at the centre of all we do.

1.3 How this report is structured:

1.3.1 In order to follow the Care Act guidance and to try and create a report that begins to measure the impact we have had as a Board, I have adapted some work done in the past by the Chairs of children's safeguarding Boards, and organised the report under the following headings:

What does the Board's information tell us and how well does the Board use this information?

What is safeguarding practice like in Waltham Forest? And what does this mean for service users?

How effectively is the Safeguarding Adults Board working?

How well is the Safeguarding Adults Board influencing the three other strategic partnerships in order to tackle issues that need a wider response than just that of our Board?

How strong was the Board's work plan for 2015- 2016? And how well did the Board use the views of adults at risk to assess if it was improving outcomes for service users?

Do Board members challenge each other sufficiently so that it is part of the Board's culture to hold each other to account?

Does the Board take relevant learning and make sure it reaches frontline practitioners?

Does the Board provide high quality multi-agency training and evaluate the effect this training has on practice?

Can the Board provide evidence that it's improving outcomes for adults at risk in Waltham Forest?

6 Is the Waltham Forest Safeguarding Adults Board visible to local residents, including publishing an analytical annual report?

1.3.2 I hope you find this report an interesting read. I will be sharing it with the organisations and individuals that the Care Act requires. However if you would like myself, or one of the Board members, to come and present it to any organisations or community groups in Waltham Forest, we would be really pleased to do this. If you have any comments on the report you can also send them by email to Suzanne Elwick, Head of Strategic Partnerships in Waltham Forest, [email protected].

I would like to thank the small professional team that has supported the Board and myself during 2015-2016. John Binding has combined being Head of Adult Safeguarding with organising the Board, and Diane Collings has taken the minutes and supported the Board on top of her role with the Safeguarding Adults Team. This has been a huge ask, and arrangements to support the Board have recently changed in recognition of this.

Fran Pearson

Independent Chair

7 Section two - CONTEXT

2.1 A timeline of the Board's year:

February 2015 Development day March 2015 Confirmation of our priorities 1st April 2015 The Care Act comes into force April 2015 Whipps Cross Hospital is put into special measures September 2015 Mid year meeting - review and refocus of priorities October 2015 Barts Health Safeguarding Summit October 2015 Self-audit of safeguarding practice by statutory organisations November 2015 Think Family Conference for 300 practitioners November 2015 Deep Dive by NHS England on effectiveness of Waltham Forest Clinical Commissioning Group Safeguarding December 2015 Staying Safe in the Community event for 200 practitioners February 2016 Strategic Partnerships Executive set up February 2016 The executive group (now 'Business Management Group’) relaunched March 2016 Launched an updated Safeguarding Adult Review policy and relaunched a Safeguarding Adult Review Group March 2016 Safeguarding Adults Review commissioned - 'Lucy'

2.2 Context - the borough in which we work

2.2.1 Waltham Forest is an outer London borough of contrasts: vibrant, extremely diverse, and with a population that changes and moves all the time. It has significant areas that feel much more akin to an inner city area - dense population, poor and overcrowded housing provided by private landlords, and a substantial number of people living in local authority or social housing. However, it also has areas where the price of property has risen considerably, faster than the average salary, meaning local families cannot afford to stay here. Median annual earning for a Waltham Forest resident working full time is still less than the London average.

8 The borough has a large local hospital, Whipps Cross, which generations of some families in Waltham Forest have used, and feel strongly about. It has a stable Labour administration in the council, with longstanding plans for the borough and how to engage local people in these. It is a young borough with a higher proportion of children than many other parts of England with child safeguarding issues that the Safeguarding Adults Board needs to be ready to respond to as these young people transition into adulthood. Some of these issues are: Child Sexual Exploitation (CSE), the effect of gang activity and membership, female genital mutilation, mental health problems for children and young people, and the effects of living in families where children are neglected and exposed to parental drug and alcohol misuse, domestic violence and the effects of living with parents who have mental health problems. For children with disabilities, a transition team between adult’s and children's services has been in existence for some time in recognition of the support required at this point in a young adults’ life.

2.2.2 Waltham Forest is also home to a large number of adults with needs and vulnerabilities that could put them at risk. Unlike nearby boroughs that are closer to the centre of London, Waltham Forest has a strikingly high number of care homes (65 - in figures presented to NHS England's Quality Surveillance Group by Waltham Forest Clinical Commissioning Group in August 2016). These tend to be in the less densely developed northern parts of the borough. Understanding the safeguarding issues in this sector is a key task of the Safeguarding Adults Board, as is understanding our role and relationship with other London boroughs, as a proportion of adults in care in Waltham Forest are not from the borough. This issue was explored in the one Safeguarding Adults Review that the Board commissioned during 2015-2016 and will be discussed in more detail later in the annual report. For more information on this and other key demographic information, please see Appendix 1.

9 2.3 The Board's Priorities for 2015-2016

WALTHAM FOREST SAFEGUARDING ADULTS PARTNERSHIP BOARD – DELIVERY PLAN 2015 - 2016 WF SAB Principle 1: We will foster a culture of curiosity around the Board and adult safeguarding

What will be different? Impact measure – evidence of progress

Implementation of Care Act is All local policies are in place understood and each subgroup and Relevance and effectiveness of local policies is agency is clear about their role in this tested out during 2015-16

Safeguarding leads are identified in all organisations and their work informs the Board’s understanding of local risk The Board will have a user Menu of user engagement options from subgroup engagement model agreed and test adopted by Board it out during 2015-16 Each aspect of the menu is tested out and evaluated

The Safeguarding Service User Forum / Group has a remit and a link to the Board with resources to make it work Users will be more consistently Plain English summary of issues and decisions influential in the Board’s work made at SAB to give to people who use services and carers

Templates for Board reports will include a statement about the extent to which users have influenced the report

The Board will begin to co-produce work with service users

To work collaboratively with advocacy services to

10 incorporate and establish views of the service user The Board will own and follow up on Board workshops, or meeting structure, to enable issues identified by SARs full discussion

Annual Report includes the Board’s response to any Safeguarding Adults Review from 1st April 2015

Workshops for Board on findings from any SARs commissioned and completed during the year

Scoping and commissioning of any new SARs is delivered through new joint arrangement with Children’s Serious Case Reviews subgroup

The development of a Learning and Development framework which builds upon the above objectives. The Board will have its own website Communications work with Board staff and Independent Chair to scope and carry out this work The Board will continue to lead and Further development of an approach that links to champion the development of a risk enablement multi-agency fire prevention strategy Development of an approach that is based on using learning from local cases and understanding of self-neglect locally and makes from the 2014/15 Serious Case the most of the new Neighbourhoods directorate Review at London Borough of Waltham Forest (LBWF), and builds on work done at North East London Foundation Trust (NELFT) The Board will influence the selection Early involvement in Joint Strategic Needs of priorities for the Health and Assessment Wellbeing Strategy Continued advisory role at Health and Wellbeing Board

11 The Board will tackle cross-cutting The Board will work closely with SafetyNet to safeguarding issues through joint address some of the tensions between public working with the Safeguarding protection and Making Safeguarding Personal Children Board, SafetyNET, and the Violence against Women and Girls Strategy to be Health and Wellbeing Board further developed across SAB / Safeguarding Children Board (SCB)/ Health and Wellbeing Board and Community Safety Partnership

PREVENT becomes a cross-cutting workstream for the four Strategic Boards The Board invites the Metropolitan Police to give presentation, and then promotes and tests out understanding of new responsibilities for human trafficking and modern slavery

Think Family strategy and approach agreed and applied. This will include transition services.

12 2.4 What does the Boards’ information tell us and how well does the Board use this information?

Summary:  Analysis and collaboration takes place: for example regular meetings between Care Quality Commission (CQC); local authority; and local NHS colleagues to share concerns; and a high risk’ meeting initiated as well during 2015-2016: but the board does not use this data • Focus on strategic partnerships meant reporting of the dashboard slipped (Mazars audit) but the board has agreed that the dashboard is due for further development • In common with other safeguarding adults' boards, we stopped taking direct reports on one of the most vulnerable groups of adults - those with Learning Disabilities who form a particularly 'at risk' cohort in assessment and treatment centres, and at distance from their families and networks in Waltham Forest – during 2015-2016. The board recognised this gap has planned new arrangements for 2016-2017 • The statutory partners did complete a Self Audit, as agreed across London SABs, and the responses to some of these were tested out by a volunteer group of Board members and the Chief Officer of Healthwatch

2.4.1. WALTHAM FOREST SAFEGUARDING ADULTS 2015/6 DATA ANALYSIS

• There has been a 22% decrease in number of safeguarding adults concerns received in 2015-16 (859 compared to 1096 in previous year). However, there has been a process issue with recording, so there is a question mark over the data, which has since been addressed.

‘The types of risk for Concluded Section 42 Enquiries which are most commonly reported continue to be neglect and acts of omissions and physical abuse. The greatest number of reports of harm came from residential care staff.

2015/16 2014/15 2013/14 2012/13 2011/12 2010/11 2009/10 2008/09 2007/08 2006/07 859 1096 1216 1207 555 428 377 349 203 152

13 2.4.2 What does happen around the care sector however, and where Waltham Forest has led the way in London, is a longstanding meeting to look at concerns about care provision as soon as they are known. This involves the regulatory body for care - the Care Quality Commission, the Adult Safeguarding Team based at Waltham Forest council, and the contracts team from the Council. During 2015-2016 a 'high risk' weekly meeting was also set up to assess new concerns, and this now includes the NHS Clinical Commissioning Group.

2.4.3 Information from these different meetings is only part of the data about safeguarding that is available in Waltham Forest. The Clinical Commissioning Group monitors safeguarding at health provider organisations, the biggest of which are Barts Health (for Whipps Cross Hospital) and the North East London Foundation Trust (NELFT), which provides Learning Disability and Mental Health Services. Before 2015- 2016, at most of its meetings, the Board reviewed a dataset or 'dashboard' which brought together the measures that were thought to give the best intelligence about how well adult safeguarding was being delivered in Waltham Forest. There was also a report to each Board up until 2015-2016, looking at the specific needs of one of the most at-risk groups of adults following the safeguarding scandals exposed at Winterbourne View Hospital in 2010 - adults with learning disabilities and those with very high levels of need who were in hospital settings. During 2015-2016 the reporting of the dashboard slipped - this was due to the Board focusing time and attention on getting its relationship with other strategic partnerships right. The Board also unknowingly created an additional risk as a result of its decision not to take data about adults with learning disabilities at each meeting. This was debated, and there was a decision that the reporting would happen via a different regular meeting that involved health and social care colleagues. It seemed an appropriate decision at the time, but by the end of 2015-2016 a specific issue showed that with this group of adults at risk, the Board was not sighted on what it needed to be. Changes are under way to bring the relevant information to the Board.

14 2.5 What is safeguarding practice like in Waltham Forest? And what does this mean for service users?

Summary: • We gained insights into services for people with learning disabilities: the board commissioned its first SAR; • The SAR panel generated other cases including a Serious Incident review, in collaboration with mental health trust • CQC inspections and incidents involving care homes – there was recognition that we need to find ways of keeping the board sighted on these, and this has been implemented • Examples from service users were brought to the Think Family conference in November 2015 and to an event on Staying Safe in the Community • The adult safeguarding user group has yet to be reinvigorated and re-established, and this may be overtaken by wider work on engaging residents of Waltham Forest in the work of all the strategic boards.

Comment from Independent Chair: The board's priorities for the following year, 2016-2017, were chosen to address the limitations of the board's work in 2015-2016 in systematically gathering and using the views of residents. Already the report on Lucy has helped focus the board's attention on adults with a learning disability. Shortly after the end of the 2015-2016 year, the board recruited lay members for the SAB and have subsequently recruited more. Not only is this a reminder of what diverse and committed residents there are in the borough, but it is also an opportunity to engage different and new groups of residents in the work of the board by using the skills of our lay members.

2.6 Using Safeguarding Adults Reviews to inform our understanding of practice and then improve it - Safeguarding Adults Review "Lucy"

Section 44 of the Care Act sets out when a SAB should carry out a SAR. During the year, three cases were referred for discussion by the One Panel. One did not meet the criteria, another was the subject of a Serious Incident Review by a local NHS organisation, who helpfully agreed to incorporate into their internal review the comments of some housing workers; and finally the case of Lucy met the criteria and was agreed as a SAR.

15 Lucy has learning disabilities and lives in a residential care setting. She was physically assaulted six times over a seven week period by a fellow resident. The Care Act Guidance suggests how a SAB might go about organising a review so that the Board and its partners get as much learning from it as possible and use an approach best-suited to each case. Consequently we chose a methodology that looked at our wider local safeguarding systems rather than just at Lucy's case. The review was focused on a small number of research questions and was completed in three months, which is considerably faster than many SARs.

2.5.4 The four findings about our local system were:

 Professionals across the partnership are not using historical information to inform and influence their decision making for adults with learning disabilities who have challenging behaviour. The result is that each incident is responded to individually and the accumulative risk is then not recognised.

 Professionals are desensitised to aggressive behaviour which results in the minimisation of the impact of violent behaviour by and to people with learning disabilities and the potential safeguarding implications.

 Police are not routinely invited to adult safeguarding strategy meetings or seen as part of the multi-agency safeguarding partnership due to other professionals viewing their role as being solely crime- investigation focused. (This is also links with Finding 2).

 Professionals do not fully understand the role of statutory advocacy services in supporting adults at risk in key decisions affecting their well-being, with the result that adults are risk are left without their wishes and feelings known/articulated.

2.5.5 The methodology invites Boards to consider questions about local adult safeguarding systems. The Board did this at its September 2016 meeting and learning from "Lucy's" case helped influence decisions about dignity in care which was the theme for that particular Board meeting. The report is now published.

16 2.6 Deprivation of Liberty and the Mental Capacity Act - another lens through which the Board has been able to see practice

The sub group of the Board that deals with mental capacity has worked consistently during the year. Mental capacity and quality of practice around it is an area where the Board has an overview of what goes on in Waltham Forest. Linked to mental capacity as a safeguarding issue, is the authorisation of Deprivation of Liberty Safeguards (DoLS) - a distinct function and one that has grown and required substantial extra resources. This was because in March 2014 a Supreme Court judgment (known as “Cheshire West”) widened the definition of deprivation of liberty to a considerable extent. The practical implications have been significant and Local Authorities all over the country have struggled to cope with the huge increase in the number of cases. In 2014/15, the first year after Cheshire West, the London Borough of Waltham Forest received a total of 658 DoLS applications. The figures below for 2015 - 2016 make clear the continued scale of the changes.

Care Home Hospital Total Applications Received in 15/16 561 536 1097 Applications pending from 14/15 131 17 148 Authorised 337 111 448 Not Authorised 30 24 54 Deceased (Ass. Not Completed)) 36 62 98 Discharged (Ass. Not Completed) (of Care Homes 79 short-term respite) 125 328 453 Application Withdrawn (Ass. Not Completed) 17 16 33 Pending Assessment (at end of 15/16) 147 12 159 TOTAL Applications processed with 692 553 1245

17 2.6 How effectively is the Safeguarding Adults Board working?

Summary: • The Mazars audit identified some process issues, all rectified and largely the result of letting ‘business as usual’ slip due to a special joint meeting with children's safeguarding board in December 2015 • The Business Management Group and SAR group were reinvigorated at end of year, although the work of Board remained shared between only a small number of people – new shared workstreams will address some of this in 2016-2017 • Attendance is variable • A Strategic Partnerships Unit and dedicated support is however a very significant and welcome step achieved during the year.

Comment from Independent Chair on what has been achieved

2.6.1 A number of areas where the Board should be more effective but is not, arise from levels of engagement with the Board that are strikingly lower than the Safeguarding Children's Board which I also chair. During the year, the SAB and SCB began to meet on the same day with a short lunch break in between, to see if this helped some members to attend. At the end of the year, after discussion with Board members, it was agreed to discontinue this, as senior managers required for both Boards were almost all finding it impossible to set aside a whole day. In 2016-2017 the Strategic Partnerships Executive is already listening to and responding to concerns that a relatively small number of senior officers are spending an unhelpfully high proportion of their time attending meetings associated with the strategic partnership Boards in Waltham Forest. However, a letter asking partner organisations of the Board about financial contributions that they might make, went unanswered by all but one agency - giving the impression that there is still some way to go for agencies in Waltham Forest to give the SAB the priority it requires.

2.6.2 However, at time of writing, engagement, attendance and holding each other to account at the SAB has improved consistently in 2016-2017 so far.

2.7 How well is the Safeguarding Adults Board influencing the three other strategic partnerships in order to tackle issues that need a wider response than just that of our Board?

18 Summary: • Think Family event was a joined up conference that promoted a whole -family approach to safeguarding to 300 professionals from both adults' and children's services • Considerable steps were taken in strategic and cross-cutting work and agreement about how to manage it – evidenced by debate at the other Boards and at the Strategic Partnerships Executive

Comment from Independent Chair from the Independent Chair:

Substantial and consistent progress was made in this area during 2015-2016. In 2014/2015, a bid was submitted to the Department for Education on behalf of the Safeguarding Children Board in Waltham Forest, which secured over £100, 000 of Innovation Funding to progress our Think Family work. A large piece of this was about setting priorities, having objectives that complemented each other, and one support team, for the four Strategic Partnership Boards in Waltham Forest. These are the Safeguarding Children's Board; the Safeguarding Adults Board; SafetyNet (the Community Safety Partnership), and the Health and Wellbeing Board. The Chairs of the Boards have met all year to progress this work and own the big cross-cutting safety issues that affect adults at risk in the borough. CSE and neglect have been referred to above, but domestic violence is the other major piece of work for which we are trying to give clear tasks to each Board in order to reduce its impact. The Boards are supported now by one team - the Strategic Partnerships Unit, and Waltham Forest is leading the way in embedding this innovative approach to joined up working.

The One Panel was set up with careful thought and negotiation during 2015-2016. It receives all referrals for statutory safeguarding reviews: Serious Case Reviews, Safeguarding Adults Reviews and Domestic Homicide Reviews. The aim is to bring equal expertise and consistency to the commissioning of all these. So far the One Panel has received three referrals all which were for Safeguarding Adults Reviews - and all of which I have agreed meet the criteria. This means that in next year's annual report, as well as completing the analysis of what we achieved with ‘Lucy's’ review, we will have at least three more Safeguarding Adults Reviews to report on.

Learning from what works well, the old executive group of the SAB was disbanded and a new arrangement put in place, again consistent across all four strategic partnerships, of 19 Business Management Groups based on the model used by the SafetyNet Community Safety Partnership. Although in early days at time of writing, these are each chaired by a senior representative from a different partner organisation, and we are very well served by our NHS Clinical Commissioning Group colleague in relation to the SAB Board. The forward planning of agendas and purposefulness of Board papers is already stronger thanks to the Business Management Group.

20 2.8 How strong was the Board's work plan for 2015- 2016? And how well did the Board use the views of adults at risk to assess if it was improving outcomes for service users?

Summary • The work plan was overambitious • The Board recognised this at the SAB September 2015 meeting and refocused on falls, pressure ulcers and neglect. This was too late in the year to have impact but has left the work better placed for 2016-2017 • Users have been heard in some individual practice (local authority auditing) but not influenced the Board directly

Comment from Independent Chair on what was achieved:

This year has seen partners being able to build on a strong base to embed the Think Family approach in Waltham Forest. The Think Family conference reached 300 professionals from across all agencies. Certainly my own observation at time of writing is that compared to other safeguarding partnerships, the concept of Think Family and the practice that goes with it, is more firmly rooted in Waltham Forest than many other places. It is backed up by a written approach to practice, and from the local authority perspective, one of the major strategies for the council is to commission and deliver services that support families as a whole so that Think Family is one of the things that defines Waltham Forest by 2020. This approach is mirrored in the other partner agencies.

21 2.9 Do Board members challenge each other sufficiently so that it is part of the Board's culture to hold each other to account?

Summary:  There was positive external assessment of how the NHS Clinical Commissioning Group holds other parts of the health safeguarding system to account, which reflects how things feel around the Board • At Board meetings, accountability and challenge from members is limited by turnover of members and a tendency for board members to delegate SAB attendance to other members of their organisation. • Re-establishing the Business Management Group at end of 2015/2016 provided a renewed steer to the Board, but unfortunately 75% of the representatives who helped give the business management process its new purpose then moved role very shortly afterwards, so 2016-2017 has been about creating a new group - and the early signs are that this is beginning to shape the board's reports and make all business more purposeful.

Comment from Independent Chair on what has been achieved:

Assessment of the accountability for safeguarding across the health system came in the Deep Dive by NHS England, which looked at the Clinical Commissioning Group's (CCGs) ability to support and monitor the health provider organisations in the borough. In November 2015 our local NHS Commissioners, Waltham Forest CCG, were assessed, as were all CCGs in London, on the effectiveness of their safeguarding support and assurance for the local health economy. The CCG was very positively evaluated by NHS England and all the London safeguarding Boards were given a Red, Amber or Green rating based on a range of assurance criteria. Our CCG and Board were assessed as Green, which fits with my perception of the support the Board receives from Waltham Forest CCG.

Barts Health, one of the absolutely key partners in adult safeguarding work, was placed in special measures at the start of the year. The Board asked Barts Health to provide regular updates to the SAB, recognising that, if one part of the safeguarding system is in difficulty, then there are implications for the rest of us, and that a Board needs to balance accountability with support for multi-agency safeguarding work. As resources shrink, this is an approach that I want to continue during 2016-2017.

22 2.10 Does the Board take relevant learning and make sure it reaches frontline practitioners? Does the Board provide high quality multi-agency training and evaluate the effect this training has on practice?

Summary • The board is good at doing this through large events: Think Family November 2016 (300 attendees); Staying Safe in the Community (200+ attendees) • But work in individual organisations to share messages with practitioners is insufficiently understood by Board • As we commission increasing numbers of Safeguarding Adults Reviews there will be a challenge for the Board not just in getting the learning out to professionals, but also in demonstrating that practice has changed as a result • A new Learning and Improving Practice Forum across strategic Boards in Waltham Forest will assist with this

Comment from Independent Chair on what has been achieved: This is one of the most pressing areas of development for the board. The reach of two large safeguarding conferences and the quality of their content was not in doubt. Professionals who attended these events completed evaluations, and at the "Think Family" event were asked to reflect later in the year on what impact the messages of the day had made on their individual practice. However this has not been followed up in a systematic way.

Large events aside, the board has not shaped or commissioned a multi-agency adult safeguarding programme to reflect its priorities. The numbers of adult safeguarding practitioners who attended the large events provide some reassurance, as does the provision of various specified levels of adult safeguarding training within the organisations that are required to provide this for their staff. Some of this data is reported to the board, for example in updates from Barts Health - but the development of a Learning and Improvement Framework based on the model that Safeguarding Children's Boards have to put in place, would be an ideal framework and process to borrow.

23 2.11 Can the Board provide evidence that it is improving outcomes for adults at risk in Waltham Forest?

Summary:

 Evidence in this area is strongest around Mental Capacity work, but case file audits in adult social care and the beginnings of work to ask service users fi their outcomes were achieved through safeguarding, mean that the board will be in a stronger position to comment on outcomes in 2016-2017 and this has to be our collective task  Looking ahead to 2016-2017, the board has chosen to have considerably fewer priorities and greater focus. The work to develop those priorities has included agreeing what outcomes the board sees as the significant ones for each area.

Comment from Independent Chair on what has been achieved: The board's priorities for 2016-2017 are outcome-focused, and purposely chosen based on learning from 2015-2016 about the challenges of keeping this focus at board level. During 2015-2016 work has been reported to the board that provides some evidence about improving outcomes. This includes:  user videos at the Think Family conference with adults speaking about the positive changes that safeguarding had brought to their lives  feedback from provider organisations  the annual safeguarding data

Waltham Forest Safeguarding Adults Board Priorities 2016-2017

Priority 1 Raise Safeguarding Adults Awareness (post Care Act 2014)

Priority 2 Promote and embed "Dignity in Care Charter"

Priority 3 Champion and embed an "Improving Practice" framework, starting with the Mental Capacity Act 2005

Appendix One – Waltham Forest Facts and Figures

24 Statistics about the borough are available on the Waltham Forest website (www.walthamforest.gov.uk), the following figures were accessed on the 31st January 2017.

Local facts and figures  Waltham Forest is home to an estimated 271,200 residents and 104,000 households. This is 3,150 residents more than last year and a gain of 13,000 since the 2011 Census.  The median age of residents is 34 years compared to the UK average of 40 years.  Our borough is one of the most diverse areas in the country. 48 per cent of residents are from a minority ethnic background.  The top five countries of origin for residents born overseas are Pakistan (8,200), Poland (8,200), Romania (4,300), Jamaica (4,200) and India (4,200 people).  93 per cent of the 9,940 enterprises in Waltham Forest micro businesses employing fewer than 10 people.  More than 135,000 working age residents (73.1 per cent) are in employment whilst the unemployment rate is down to 6.4 per cent.  The average annual earnings for full-time working residents increased 4 per cent from 2015 to 2016 and is currently at £30,900, but is still lower than the London average of £33,800.  The average house price in the borough as of April 2016 was £424,700, an increase of 25 per cent from the same time last year  Waltham Forest is currently ranked 35th most deprived borough nationally according to the 2015 Index of Multiple Deprivation (an improvement from 15th most deprived in the 2010 edition).  Life expectancy in Waltham Forest is similar to the England average – 79.4 years for men and 83.8 years for women  As many as 37,600 residents said in the census that their day-to-day activities are limited because of their health. This is 15 per cent of residents compared to 18 per cent nationally. 

25 Appendix Two

2015 to 2016 Safeguarding and Mental Capacity / Deprivation of Liberties Safeguards Data

WALTHAM FOREST SAFEGUARDING ADULTS 2015/6 DATA ANALYSIS

1. Year on Year concerns received:-

2015/16 data analysis presented a 22% decrease on last in the number of safeguarding adults concerns received. An investigation was carried out and it was found that a process issue had occurred, which has since been rectified.

2015/16 2014/15 2013/14 2012/13 2011/12 2010/11 2009/10 2008/09 2007/08 2006/07 859 1096 1216 1207 555 428 377 349 203 152

2. Concerns received and progressed / not progressed:-

Due to the 22% overall decrease on last year this has impacted on all 2015/16 overall figures.

+/- 2015/16 2014/15 % Progressed 448 566 -21% Not Progressed 411 530 -22%

Total 859 1096 -22%

3. Concerns Progressed by adult at risk service group:- Concerns progressed through the safeguarding process has also decreased on last year by 21%. It is to be noted people identified as having ‘Physical Disabilities’ has increased by 59% whereas ‘Other Vulnerable Adults has decreased. This is mainly due to the change in the recording methods.

2015/16 2014/15 + L/Disabilit y 76 101 - Mental Health 146 160 - Other Vul. Adult 0 166 - Physical Disability 220 138 5 Substance Misuse 6 1 5 Total 448 566 -

4. Concerns Progressed by adult at risk Age Group:-

26 As per the 2014/15 data analysis, 2015/16 data informs us that people in the 18 – 64 age group remains the group with the highest number of safeguarding referrals (Section 42). The second highest group is again as per 2014/15 people in the 85 – 94 group.

2014/1 2015/16 +/- % 5 18-64 176 210 -16% 65-74 63 71 -11% 75-84 87 129 -32% 85-94 108 135 -20% 95+ 14 21 -33% Total 448 566 -21%

5. Concerns Progressed by adult at risk Gender:-

As per previous years ‘Females’ remains consistent in being the highest number of safeguarding concerns received.

2015/16 2014/15 +/- % Male 187 228 -18% Female 261 338 -23% Total 448 566 -21%

6. Concerns Progressed by adult at risk Ethnicity:-

As per previous years ‘White’ ethnicity remains consistent in being the highest number of safeguarding concerns received.

2015/1 +/- 2014/15 6 % - White 309 381 19% 15% Mix Heritage 15 13 + - Asian 41 68 40% - Black 75 85 12% - Other 7 15 53% - Not Stated 1 4 75% - Total 448 566 21%

27 7. Concerns Progressed by type of alleged harm:-

The data analysis informs us that ‘Neglect & Physical Harm’ remains the highest types of harm reported.

2015/16 saw the implementation of the new Care Act, which identified four new categories of harm under safeguarding adults to be recorded.

2015/16 2014/15 +/- % Physical 140 224 -38% Discriminatory 4 3 33%+ Neglect 149 203 -27% Sexual 28 34 -18% Financial or material 99 99 0% Psychological / Emotional 76 76 0% Institutional Harm 7 7 0%

New Care Act Categories

Domestic Violence 60 N/A N/A Sexual Exploitation 2 N/A N/A Modern Day Slavery 0 N/A N/A Self-Neglect 45 N/A N/A Total 610 716 N/A

8. Concerns Progressed by the person reporting the alleged harm

28 2015/16 2014/15 +/- % Domiciliary Staff 15 35 -57% Residential Care Staff 91 84 8%+ Day Care Staff 13 21 -38% Social Worker/Care Manager 58 64 -9% Self-Directed Care Staff 1 1 0% Primary/Community Health Staff 78 137 -43% Mental Health Staff 19 31 -39% Self-Referral 43 38 13%+ Family Member 49 73 -33% Friend/neighbour 13 7 86%+ Other Service User 0 0 0% CQC 4 1 300%+ Housing 19 33 -42% Education/Training/Workplace Establishment 0 3 -100% Police 12 15 -20% Other 33 23 43%+ Total 448 566 -21%

9. Concerns Progressed by the relationship of the Adult at Risk and the person alleged to have caused the harm:-

29 2015/16 2014/15 +/- % Domiciliary Staff 53 89 -40% Residential Care Staff 90 61 48%+ Day Care Staff 6 5 20%+ Social Worker or Care Manager 2 0 100%+ Self-Directed Care Staff 2 0 100%+ Other 21 11 91%+ Partner 25 38 -34% Other Family Member 63 95 -34% Health Care Worker 37 40 -8% Volunteer or befriender 0 0 0% Other Professional 0 11 -100% Other Vulnerable Adult 42 58 -28% Neighbour or friend 24 38 -37% Stranger 24 18 33%+ Not Known 16 102 -84% Self-Neglect (New Category) 43 N/A N/A Total 448 566 -21%

10. Concerns Progressed by location of where the alleged harm occurred:-

2015/16 2014/15 +/- % Own Home 198 274 -28% Residential Home Permanent 111 113 -2% Nursing Home Permanent 4 11 -64% Residential Home Temporary 10 16 -38% Nursing Home Temporary 1 1 0% Home of the Person Alleged to have caused the harm 5 7 -29% Mental Health Inpatient Setting 1 3 -67% Acute Hospital 27 28 -4% Community Hospital 4 6 -33% Other Health Setting 2 1 100%+ Supported living 47 54 -13% Day service 10 6 66%+ Public Place 19 24 -21% Education/Training/Workplace Establishment. 1 0 100%+ Other 6 13 -54% Not Known 2 9 -78% Total 448 566 -21%

30 11. Concerns Progressed by the funding authority of the Adult at Risk:-

2015/16 2014/15 +/- % LBWF Commissioned Service 268 378 -29% Commissioned by another Local Authority 37 23 61%+ Self-funded service 35 19 84%+ Health funded 31 26 19%+ No service 77 120 -36% Total 448 566 -21%

12. Concerns Progressed by Conclusions:-

2015/16 2014/15 +/- % Unsubstantiated 155 177 -12% Partly Substantiated 28 47 -40% Substantiated 162 188 -14% Not Determined / Inconclusive 85 140 -39% Not yet concluded 18 14 29%+ Total 448 566 -21%

31 13. Concerns Progressed by Outcomes for Adults at Risk:-

2015/16 2014/15 +/- % Increased Monitoring 216 305 -29% Vulnerable Adult removed from property or service 12 8 50%+ Community Care Assessment and Services 46 68 -32% Civil Action 0 1 -100% Application to Court of Protection 9 10 -10% Application to Change Appointee-ship 2 4 -50% Referral to Advocacy Scheme 10 14 -29% Referral to Counselling/Training 10 11 -9% Moved to increase / Different Care 44 30 47%+ Management of access to finances 23 13 77%+ Guardianship / Use of Mental Health Act 2 2 0% Review of Self-Directed Support 4 1 300%+ Restriction / Manage access to alleged person causing the harm 14 14 0% Referral to MARAC 3 7 -57% Other 87 92 -5% No further action 104 76 37%+ Total 586 656 -11%

14. Concerns Progressed by Outcomes for Adults at Risk:-

32 2015/16 2014/15 +/- % Criminal Prosecution / Formal Caution 8 8 0% Police Action 30 23 30%+ Community Care Assessment 26 43 -40% Removal from Property or Service 22 13 69%+ Management of access to the Vulnerable Adult 14 17 -18% Referred to POVA / ISA 3 7 -57% Referral to Registration Body 0 12 -100% Disciplinary Action 16 9 77%+ Action by CQC 2 4 -50% Continued Monitoring 131 185 -29% Counselling/Training/Treatment 28 49 -43% Referral to Court Mandated Treatment 0 0 0% Referral to MAPPA 1 1 0% Action under Mental Health Act 3 1 200%+ Action by Contract Compliance 3 2 50%+ Exoneration 16 10 60%+ No Further Action 180 177 2%+ Not Known 10 15 -33% Total 493 576 -14%

15. Concerns received by repeat concerns

2015/16 2014/15 +/- % Total repeat concerns received 27 48 -44% Total repeat concerns progressed 20 24 -17%

Due to the four new categories of harm implemented in response to the new Care Act, 2016/17 will require the types of harm to be recorded accordingly. It is projected that ‘Domestic Violence / Harm’ will impact on original categories of ‘Physical Harm’ by a partner/family member will now be recorded under the national heading of ‘Domestic Violence’ and not ‘Physical’. For the purpose of local data information ‘Domestic Violence’ allegations will also have the type of domestic harm under this heading recorded.

It is to be noted that the process issue that reflected a 22% decrease in the number of concerns recorded, has been rectified and the first quarter data analysis of 2016/17

33 informs us of a 21% increase on 2015/16 concerns received and a 6% increase on 2014/15.

London Borough of Waltham Forest DOLS End of Year Report

April 2015 to end of March 2016

Overview of DOLS Applications in the second full-year post the Supreme Court Ruling in the Cheshire West Case

In March 2014 a Supreme Court judgment (known as “Cheshire West”) widened the definition of deprivation of liberty to a considerable extent. This meant that an individual is deprived of their liberty for the purposes of Article 5 of the European Convention on Human Rights if they:

 Lack the capacity to consent to their care/ treatment arrangements.  Are under continuous supervision and control.  Are not free to leave (even if they are not trying to leave)

The practical implications have been significant and Local Authorities all over the country have struggled to cope with the huge increase in the number of cases. In 2014/15, the first year after Cheshire West, the London Borough of Waltham Forest received a total of 658 DOLS applications. The Total number of applications received in 15/16 was 1097. This level of applications was very accurately predicted in last year’s DOLS report. However, the total number of applications processed in 15/16 was 1245. This was because, due to the huge increase in applications immediately after Cheshire West, there were still 148 Applications awaiting an outcome (either still in process or on the waiting list) at the end of 14/15. These are included in the figures below in order to properly reflect the amount of work done by the DOLS Team in 15/16:

Care Home Hospital Total Applications Received in 15/16 561 536 1097 Applications pending from 14/15 131 17 148 Authorised 337 111 448 Not Authorised 30 24 54 Deceased (Ass. Not Completed)) 36 62 98 Discharged (Ass. Not Completed) (of Care Homes 79 short-term respite) 125 328 453 Application Withdrawn (Ass. Not Completed) 17 16 33 Pending Assessment (at end of 15/16) 147 12 159 TOTAL Applications processed with 692 553 1245

There were 502 Assessments completed in 15/16 (either Authorised or Not Authorised), 100 of which were for applications that were received in 14/15.

There were 536 referrals from Hospitals in 15/16 with another 17 pending from 14/15. Of these Hospital referrals of which 111 were authorised, 24 not authorised, 390 either died

34 or were discharged before full assessment, 16 were withdrawn and 12 were pending assessment at the end of 15/16

There were 561 referrals from Care Homes in 15/16 with another 131 pending from 14/15. Of these Care Home referrals, 337 were authorised, 30 not authorised, 36 died before full assessment, 125 were discharged before full assessment, 17 were withdrawn 147 were pending assessment. Of the 125 discharged before full assessment, 79 of these were short-term respite cases where the home had submitted urgent authorisations to cover them for a couple of days. These have not been included in the recording of urgent applications received as given below.

Of the 159 pending at the end of 15/16, 92 were in-process and 67 were on the Waiting List.

The total number of referrals for the period was 1097 (51% Residential and 49% Hospital (an increase in the percentage of Hospital application which, in 14/15 made up 38% of the total applications).

543 of the 1097 applications received in 15/16 were urgent, with 536 (99%) of these coming from Hospitals.

Of the 502 assessments completed 141 of these were urgent, with 135 of these (96%) coming from Hospitals.

APPLICATIONS FROM CARE HOMES (Received 15/16 and Pending from 14/15):

APPLICATIONS (Received 15/16 and Pending from 14/15) CARE HOMES Authorised 337 30 Not Authorised 36 Deceased (Assessment not completed) 125 Discharged (Assessment not completed) 17 Withdrawn 147 Pending

APPLICATIONS FROM HOSPITALS (Received 15/16 and Pending from 14/15):

APPLICATIONS (Received 15/16 and Pending HOSPI from 14/15) TAL 111 Authorised 24 Not Authorised

35 Deceased 62 (Assessment not completed) Discharged 328 (Assessment not completed) Withdrawn 16 Pending 12

TOTAL APPLICATIONS (Received 15/16 and Pending from 14/15):

APPLICATIONS (Received 15/16 and Pending from 14/15) GRAND TOTAL 448 Authorised 54 Not Authorised 98 Deceased (Assessment not completed) 453 Discharged (Assessment not completed) 33 Withdrawn 159 Pending

36 APPLICATIONS (received in 15/16 Only – Standard/Urgent):

APPLICATIONS (received in 15/16 Only) TOTAL 554 Standard 543 Urgent

ASSESSMENTS COMPLETED (received in 15/16 Only – Standard/Urgent):

ASSESSMENTS COMPLETED In 15/16 (includes pending from 14/15) TOTAL 361 Standard 141 Urgent

37 Detailed Breakdown of Assessments Completed

Gender

52% of the total applications were for women compared to 54% in 14/15.

APPLICATIONS (received in 15/16 Only) GENDER 526 MALE

571 FEMALE

71% (778) of the total number of applications were for Older People compared to 74% in 14/15.

APPLICATIONS (received in 15/16 Only) AGE 319 18-64 129 65-74 267 75-84 382 85 Plus

38 Ethnicity

70% of the total applications received were for people from a White background (compared to over 75% in 14/15).

APPLICATIONS (received in ETHNI 15/16 Only) CITY Asian/Asian British 84 Black/Black British 158 Mixed/Multiple Ethnic Groups 10

Not Stated 42 Other Ethnic Origin 25 Undeclared/Not Known 7

White 771

39 COMPARISON OF 15/16 DOLS ETHNICITY WITH 2011 CENSUS (%):

APPLICATIONS ETHNICITY ETHNICITY (received in 15/16 DOLS 2015/16 CENSUS Only) (%) 2011 (%) Asian/Asian British 8 21 Black/Black British 14 17 Mixed/Multiple Ethnic Groups 1 5

Not Stated 4 0 Other Ethnic Origin 2 4 Undeclared/Not Known 1 0

White 70 53

The above comparison of the breakdown (in ethnicity percentages) of the number of DOLS applications received in 15/16 compared with the ethnicity percentages from shows the following:

 DOLS applications for people from a white ethnic origin are over-represented by about 1/3 in relation to the 2011 census.  DOLS applications for all other ethnic groups are relatively under-represented in relation to the 2011 census. This is particularly the case of Asian/Asian British, where the category is under-represented by nearly 2/3 in relation to the 2011 census.

Religion

40 54% of applications received were for people with a Christian religion compared to 66% in 14/15.

RELIGION APPLICATIONS (received in 15/16 Only) None 25 Christian 598 Hindu 8 Jewish 11 Muslim 57 Sikh 4 Buddhist 1 Any Other Religion 10 Not Stated 383

Sexual Orientation

55% of applications were “Not Known” with only 44% declared Heterosexual (compared to 66% in 14/15).

APPLICATIONS SEXUAL (received in ORIENTA 15/16 Only) TION

Heterosexual 482

Gay / Lesbian 1

Not Known 598

Undeclared 16

41 Disability

49% of all applications were for people with Dementia (compared to 66% in 14/15). Just over 18% of applications were for people with a Learning Disability and just over 10% were for people with other forms of Mental Health issues (eg. Acquired Brain Injury, Neurological disorders etc.). Many of the people referred for DOLs also had physical and/or sensory disabilities and these have been included in this year’s figures due to the large amount of applications received from Hospital settings where the cause of any loss of capacity might be more transient or not yet identified in terms of dementia or mental health.

DISABILITY APPLICATIONS (received in 15/16 Only) Dementia 538

Learning Disability 201

Mental Health 114

Hearing Impairment 7

Visual Impairment 9

Other Disability 80

Other 145

No Disability 3

Authorisations Not Granted

Of the 54 Authorisations not Granted, all 54 were because the Mental Capacity Requirement was not met (ie. the Assessor found them to have Mental Capacity with regard to their situation).

Ongoing DOLS

42 There were 318 DOLS ongoing at the end of March 2015 (compared to 216 at the end of March 14/15). 303 of these were in Residential Placements and 15 in a Hospital. The increase is in keeping with the general increase in applications.

DOLS GRANTED ONGOING AT END OF TOTAL MARCH 2015 Care Home 303

Hospital 15

Durations of DOLS Granted

102 (92%) of the 111 DOLS granted for up to 3 months were in a Hospital setting. 328 (97%) of the 337 DOLS granted for over 3 months were in a Residential setting.

DURATIONS OF DOLS TOTAL Less than 1 Month 20

1 to 3 months 91

3 to 6 months 34

1 year 303

43 Residential Funding

61% (341) of the Total Applications Received from residential settings were for people in placements funded by the Local Authority.

RESIDENTIA L APPLICATIO NS (15/16 FUNDING Only)

Local Authority 341

Health 77 Local Authority & Health Jointly 75 Self/Family Funded 68

Managing Authority Service Area

Of the 499 applications received from Barts Healthcare Trust 416 (83%) were from Whipps Cross Hospital (compared to 92% in 14/15).

44 APPLICATIO NS (received MA SERVICE in 15/16 AREA Only) Residential 320 (Older Adults) Residential 68 (Mental Health) 173 Residential (LD) 499 Hospital (Barts Health) 28 Hospital (Acute - NELFT) Hospital 9 (Other Trusts)

Locations (In/Out of Borough)

806 (73%) of the total number of applications were from Managing Authorities in Waltham Forest, whilst 291 (27%) of the total number of applications were from Managing Authorities based outside of the Borough. The breakdown in terms of Care Homes and Hospitals is given below:

APPLICATIO NS (received in 15/16 LOCATION Only) 345 WF Residential 461 WF Hospital

45 Out of Borough 216 Residential Out of Borough 75 Hospital

Deaths during DOLS

At the end of 2015/16 there had been 10 deaths during DOLS reported by the Managing Authorities. 3 of these were in Care Homes and 7 were in Hospital.

Unauthorised DOLS and Third Party Referrals

There were no unauthorised DOLS reported or third party referrals received.

IMCAS and Representatives

75 IMCAs were appointed in 2015/16. 52 of these were within Waltham Forest and 23 of these were for cases located out of the Borough.

A total of 88 Paid Representatives were appointed in 2015/16. 55 of these were for cases within Waltham Forest and 33 of these were for cases located out of the Borough.

The Impact of Cheshire West

Comparison with Previous Years:

APPLICATIO YEAR NS

2010/11 42

2011/12 31

2012/13 23

2013/14 38

46 2014/15 658

2015/16 1097

Comparison of Applications by Month 14/15 and 15/16:

TOTAL MONTH APPLICATIONS APRIL 14 16 MAY 14 19 JUNE 14 28 JULY 14 25 AUG 14 19 SEPT 14 59 OCT 14 96 NOV 14 61 DEC 14 57 JAN 15 100 80 FEB 15 MARCH 15 98

47 TOTAL MONTH APPLICATIONS APRIL 15 115 MAY 15 75 JUNE 15 78 JULY 15 85 AUG 15 64 SEPT 15 86 OCT 15 81 NOV 15 105 DEC 15 95 JAN 16 112 FEB 16 101 MARCH 16 100

In March 2014 a Supreme Court judgment (known as “Cheshire West”) widened the definition of deprivation of liberty to a considerable extent. The practical implications have been significant and Local Authorities all over the country have struggled to cope with the huge increase in the number of cases.

In Waltham Forest, the initial impact of the Cheshire West Ruling was felt in 14/15 with the number of applications increasing over that year to become a 1,732% (over seventeen-fold) increase on the previous year (13/14). The increase in applications from 658 in 14/15 to 1097 in 15/16, being an increase of 66%, can be seen as a consolidation of the trend from the previous year. This can be seen when we compare the monthly figures for 14/15 with those of 15/16. Whilst in 14/15 we see a sharp increase through the course of the year, in 15/16 we see a more gentle increase. This suggests that we might expect to see some kind levelling off in the numbers of applications starting to make itself felt the year ahead (16/17).This is upheld by a projection based on the number of applications received in the first four months of 16/17 which predicts a total of 1,200 DOLS applications will be received in 16/17 – only 103 more (a 9% increase) on the previous year, compared to the 66% increase from 14/15 to 15/16 identified above.

The practical implications of such large increases in DOLS applications over the last two years, however, have been significant, and Local Authorities all over the country have struggled to cope. The following key areas of impact for Waltham Forest continue to be experienced on a National Level:

48  Increase in Hospital Cases: 2015/16 saw applications from Hospitals increase from 238 in 2014/15 to 536 – a 125% increase. It should be noted that, prior to Cheshire West, case law had permitted the application of the Mental Capacity Act for most cases where a Deprivation of Liberty may actually have applied. However, the challenges of an increase in demand have been problems of co-ordination and prioritisation as people are often discharged or deceased quite quickly, but are also, in some cases, liable to be re-admitted.

 Increase in Out of Borough cases and difficulty getting MHAs: 2015/16 saw applications from out of Borough Care Homes and Hospitals increase from 152 (119 care Home / 33 Hospital) in 2014/15 to 291 (216 Care Home/75 Hospital) in 2015/16 – a 91% increase. Prior to the Cheshire West ruling Councils were usually willing to do complete assessments for other Council’s clients placed in their area for a charge of £600 under the ADASS protocol. With the huge increase in DOLS following the Supreme Court ruling this is no longer an option. This can present problems with

allocating MHAs with availability out of borough and also involves extra pressure on resources in terms of BIA’s time spent travelling, as well as additional travel costs.

Managing the increase in applications:

The London Borough of Waltham Forest DOLS Team have tried to ensure that the most vulnerable people are afforded the safeguards enshrined within the Supreme Court judgement. This has included:

 Appointment of 4 full-time BIAs  Training of 10 more Social Workers as BIAs  Appointment of 3 additional Administrative Co-ordinators overseen by the existing Senior DOLS Administrator and the DOLS Co-ordinator  Extension of MHA list to include a further 6 Section 12 DOLS Mental Health Assessors able to cover London and the surrounding areas, together with the continued development of a list of available Section 12 DOLS Mental Health Assessors who are based further away  Development of a checklist for prioritising applications from Residential and Nursing homes: - Un-befriended - Family members in disagreement with each other - Family members having restricted access, supervision or stipulated visiting regime - Person subject to Safeguarding concerns - Person being restricted to manage a medical condition / or to provide care - Person being moved or separated by others due to their behaviour - Person requiring physical intervention to minimise self-harm  Prioritisation of Applications from specialist Health units  Continued use of a “triage” system for Hospital Applications which involves an allocated BIA being based within the Local Hospital  Extension and expansion of Local IMCA Service contract