b
HEALTH AND ADULT SERVICES SCRUTINY SUB- COMMITTEE
Date and Time: Tuesday 23 October 2012 7.00 pm
Venue : Council Chamber, Lambeth Town Hall, Brixton Hill, SW2 1RW
Contact for enquiries: Website: Anne Rasmussen www.lambeth.gov.uk/committee Democratic Services Officer Tel/Voicemail: 020 7926 0028 Lambeth Council – Democracy Live Fax: 020 7926 2361 on Facebook Email: [email protected] http://www.facebook.com/
Governance and Democracy @LBLdemocracy on Twitter Lambeth Town Hall, Brixton Hill, http://twitter.com/LBLdemocracy London, SW2 1RW To tweet about Council agendas, minutes or meetings use #Lambeth Despatched: Monday 15 October 2012
COMMITTEE MEMBERS: Councillors KINGSBURY, MARCHANT (Vice-Chair), FRANCIS, DAVIE (Chair) and C. WHELAN
SUBSTITUTE MEMBERS: Councillors O'MALLEY, PATIL, DAVIES, BROWN, J.WHELAN and COSGRAVE
AGENDA
PLEASE NOTE THAT THE ORDER OF THE AGENDA MAY BE CHANGED AT THE MEETING
Page Nos. 1. Declarations of Pecuniary Interests
2. Minutes of Previous Meeting 1 - 8
To agree the minutes of the meeting held on 11 July 2012 as a correct record of the proceedings.
3. St George's Healthcare NHS Trust - Inquest into the death of 9 - 18 Kane Gorny
(Report no. 129/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Officer, 020 7926 0027, [email protected]
4. South London & Maudsley NHS Foundation Trust - Inquest into 19 - 30 the death of Sean Rigg
(Report no. 135/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Officer, 020 7926 0027, [email protected]
5. The Annual Report of Lambeth Safeguarding Adult Partnership 31 - 124 Board 2011-2012
(Report no. 130/12-13)
Contact details: Jane Gregory, Safeguarding Adult Policy and Development Coordinator, 020 7927 7707, [email protected]
6. South London & Maudsley NHS Foundation Trust - Cost 125 - 134 Improvement Programme
(Report no. 136/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Officer, 020 7926 0027, [email protected]
7. Lambeth Addictions Service, South London and Maudsley NHS 135 - 140 Foundation Trust - Proposal for Injectable Diamorphine Clinic
(Report no. 132/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Officer, 020 7926
0027, [email protected]
8. Proposa ls for Intermediate Care and Amputee Rehabilitation 141 - 182 (Lambeth Community Care Centre and Pulross Intermediate Care Centre)
(Report no. 137/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Officer, 020 7926 0027, [email protected]
9. Lambeth Local Involvement Network (LINk) 183 - 190
(Report no.133/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Officer, 020 7926 0027, [email protected]
10. 2012/2013 Budget Reductions Monitoring and Reporting 191 - 206
(Report no. 131/12-13)
Contact for details: Maria Millwood, Divisional Director of Resources, 020 7926 4842, [email protected]
11. South London Healthcare NHS Trust 207 - 212
(Report no. 138/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Officer, 020 7926 0027, [email protected]
12. Workplan 213 - 234
(Report no. 134/12-13)
Contact for details: Elaine Carter, Lead Scrutiny Office, 020 7926 0027, [email protected]
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Page 1 Agenda Item 2
H&ASSSC b
HEALTH AND ADULT SERVICES SCRUTINY SUB-COMMITTEE
Wednesday 11 July 2012 at 7.00 pm
MINUTES
PRESENT: Councillor Ann Kingsbury, Councillor Daphne Marchant (Vice- Chair), Councillor Niranjan Francis, Councillor Edward Davie (Chair) and Councillor Clare Whelan
APOLOGIES:
ALSO PRESENT: Councillor Jane Pickard
Action required by
1. DECLARATIONS OF INTE REST There were none. 2. MINUTES OF PREVIOUS MEETINGS (20.03.12 A ND 16.05.12) RESOLVED : That the minutes of the meetings held 20 March 2012 and 16 May 2012 be approved and signed by the Chair as a correct record of proceedings.
Ward Councillors Role in Visiting Residential and Nursing Care Homes
The Committee requested that further details be circulated to the Committee on the role of the requirements and responsibilities for ward Councillors visiting residential and nursing care homes.
Talking Therapies Contract
The Committee requested that further details be circulated in relation to the consultation and tender processes associated with this contract. Further clarity on the Equality Impact Assessment carried out would also be required.
3. 2011/2012 BUDGET RED UCTIONS MONITORING A ND REPORTING Page 2
(Report no. 80/12-13 – agenda item 8)
The Divisional Director of Resources, Adults’ and Community Services, explained the figures as set out in the report in relation to the savings targets. She confirmed that updates on the position of the savings targets achieved for the current financial year would be submitted outside of the meeting to the Committee given the gap between now and the next scheduled meeting in October. A full update on the position would be given at the October 2012 meeting.
RESOLVED :
(1) To note the savings achieved by Adults’ and Community Services in 2011-12.
4. CARE QUALITY COMMISS ION REVIEW OF COMPLI ANCE - ALLIED HEALTHCARE GROUP/ALLIED HEALTHCARE LONDON BRIDGE (Report no. 77/12-13 – agenda item 4)
Representatives from Allied Healthcare confirmed two key areas which had been identified as part of the Care Quality Commission’s (CQC) recent inspection, including medication and records management at the specified site. A comprehensive action plan had been developed and implemented by Allied Healthcare to address the failings. Improvements anticipated as a result of the action plan had been delayed slightly due to the recent appointment of a new branch manager. The new manager had been appointed as a result of the departure of the existing branch manager under whom the failings had been identified. The new manager had a proven track record of delivering good results within the CQC framework. Additional scrutiny reviews had been built into the process and reviews so far indicated that improvements had already been made.
In response to points raised by Members, officers and representatives from Allied Healthcare stated: • Whilst the impact resulting from the failings had been classified as ‘moderate’, no adverse impact had been reported in relation to the health and well being of service users. The four service users from Lambeth had not been affected by the failings directly. A meeting had been held with Allied Healthcare and the Council and sincere apologies had been given for the management oversights on behalf of Allied Healthcare. It was emphasised that the Council and Allied Healthcare had a long-standing strategic partnership which was valued by both parties. • The CQC had not informed the Council initially of the specified failings of Allied Healthcare and this had been unsatisfactory and had been raised with the CQC as a result. The Council had been assured that such break downs in communication would not be replicated in the future. Page 3
• It was also important to note that health and social care for adults was an area which included many risks and the key issue was that lessons were learned from failings such as those identified by the CQC. The safeguarding of adults across the borough was a top priority for the Council, both now and going forward, however, the Council did not have reason to believe that failings had been replicated elsewhere in the service provided by Allied Healthcare. • Committee Members would be provided with the specific details of the gap between the two branches, as requested. • Regular spot checks were carried out in the care provided by Allied Healthcare to ensure that the standard of the care provided was at a high level. Monthly routine checks were also carried out and a contract monitoring officer was employed to work closely with providers to ensure high quality care. • Following the identified failings by Allied Healthcare, further work was now being carried out to ensure that the overall organisational culture was such that any concerns could be raised at an early stage and be discussed openly with a view to resolve quickly. All failings were being reported to the appropriate board level in Allied Healthcare and whistle blowing procedures had also been implemented to ensure that the organisational culture was transparent and improving continually. • The issues relating to medication management related mainly to the auditing of medication charts and lack of training received by staff managing medication. Further work was being undertaken with community pharmacists to ensure more efficient medication management in the longer term as this was an issue which prevailed in the industry.
RESOLVED :
(1) To note the Care Quality Commission Review of Compliance Allied Healthcare Group Limited: Allied Healthcare – London Bridge.
(2) To agree to receive further details on issues, practices and policies in relation to medicines management in the healthcare industry at a future meeting.
5. TRANSITION TO NEW PU BLIC HEALTH ARRANGEM ENTS (Report 83/12-13 – agenda item 10 (second despatch))
The Director of Public Health, NHS Lambeth, introduced the item, noting the significant future changes to the public health function arising from the proposals from central government and stated that it was imperative to ensure that the Council and the NHS collaborate closely to develop a public health function which could deliver all of the priorities and outcomes for the borough in future. Page 4
In discussion, Members and officers noted the following: • Wider changes made by central government including those relating to welfare benefits overall, were anticipated to have a significant impact on public health, both in terms of supply and demand. • Some responsibilities previously held more centrally would be devolved to local levels and this was anticipated to create a new level of complexity both in terms of future provision and in terms of monitoring and tracking the effect of health services. • An update on the proposed merger of public health within Lambeth and Southwark would be presented to the Committee in autumn 2012. Cabinet had agreed the proposed joint appointment of a public health director with Lambeth and Southwark that previous Monday and the new director would be responsible for the statutory function across the two boroughs public health. Further meetings were to be carried out with Southwark on the level of support required to take this forward including governance structures and arrangements. The appointment of the joint director was likely to be made at the end of August 2012 although there was a risk that this could be delayed due to the Olympics. The appointments process would be supported by the South East NHS cluster and further work was being carried out with GPs to ensure that the public health services for the future were fit for purpose. • It was important to note that the proposed merger of the public health function was not an attempt by the Council to save money but a necessary response to changes made by central government and an attempt to ensure that adequate resources were in place to achieve the agreed priorities around public health. • Although there was still some uncertainty around the exact reduction to future funding, currently the figures were at a decrease of around 25 percent. • Concerns were raised at the lack of spending year on year on public health, but it was important to note that public health was not decreasing in importance by the Council. The work over decades across the borough had made a significant impact on residents and their health overall. Future resources for public health functions would be sustained by the Council and not de-prioritised. • It was confirmed that representatives from the Council and NHS Lambeth would be present at the forthcoming Health Watch to part-take in the debate on the future of public health.
Representatives from the Mosaic Club noted the significant issues affecting people living with HIV and AIDS, particularly affecting the black African community in the borough, and the need to consider in Page 5
detail the future of HIV/AIDS services in the borough.
RESOLVED :
(1) To note the progress made in this transition.
6. ORN AND HEALTH AND S OCIAL CARE: CONTINGE NCY ARRANGEMENTS DURING OLYMPICS (Report 83/12-13 – agenda item 3)
Officers confirmed that emergency vehicles were allowed to use the Olympic lanes established across London for use by Olympic vehicles and athletes. It was also confirmed that hospitals and GPs were working closely with local authorities and health authorities to ensure robust contingency plans during the Olympics.
RESOLVED :
(1) To note the report.
7. REVIEW OF CARERS' SE RVICES IN LAMBETH (Report 85/12-13 – agenda item 5)
Members of the Committee made the following comments in response to the report: • Given the significant responsibilities of many carers across the borough, it would be important to ensure that consultation was carried out such that carers could participate in consultation exercises in the future. • The shared life model referred to in the report was a kind of fostering method which offered temporary respite care. • Further review of current services was required as well as a potential adjustment of the terms of reference. • Collaborative arrangements had proven successful in other areas of the borough and should be examined further to establish whether this would be beneficial also within the carers service. Further work was to be undertaken to establish good links with carers groups across the borough to create opportunities for collaborative work in the future.
RESOLVED :
(1) To note the report.
8. LAMBETH LOCAL INVOLV EMENT NETWORK (LINK) (Report no. 76/12-13 – agenda item 6)
Page 6
Nicola Kingston, Lambeth LINk, noted that the newly established Health and Wellbeing Shadow Board had recently held its first meeting and had been well attended by members of the public.
RESOLVED :
(1) To note the report from the Lambeth LINk and the accompanying draft audit tool for citizen involvement in health and wellbeing.
9. DEVELOPING AN OLDER PEOPLE'S HOUSING STRATEGY (SHELTERED HOUSING AND EXTRA CARE HOUSING) (Report no. 76/12-13 – agenda item 7)
The Executive Director for Adults’ and Community Services addressed the Committee, noting the complexity in developing a comprehensive older people’s housing strategy but that progress had been made over recent months and a report would be presented to Cabinet later in the year. Extensive consultation had been carried out already, including questionnaires, public meetings, telephone interviews and focus groups.
Members asked that the Committee have early sight of the forthcoming Cabinet report when possible.
RESOLVED :
(1) To note the update report.
10. WORK PROGRAMME (Report no. 78/12-13 – agenda item 9)
RESOLVED :
(1) To agree the work programme subject to the following additions:
• Report on Sheltered Housing in October 2012 • Report on medication management • Update report on proposed SLaM savings • Further presentation and discussion with representatives from Kings Health Partners • To consider at a future meeting future service provision in relation to HIV and AIDS services.
The meeting ended at 9.20 pm CHAIR HEALTH AND ADULT Page 7
SERVICES SCRUTINY SUB- COMMITTEE Tuesday 23 October 2012
Date of Despatch : Thursday 19 July 2012 Contact for Enquiries : Anne Rasmussen Tel: 020 7926 0028 Fax: (020) 7926 2361 E-mail: [email protected] Web: www.lambeth.gov.uk
The action column is for officers' use only and does not form a part of the formal record.
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Health and Adult Services Scrutiny Sub-Committee 23 October 2012
St George’s Healthcare NHS Trust – Inquest into the death of Kane Gorny
All Wards
Report authorised by : Executive Director of Finance and Resources: Mike Suarez
Executive summary
This report is submitted following the tragic death of Kane Gorny at St George’s Healthcare NHS Trust in 2009 and the verdict of the recent coroner’s inquest. The attached paper from St George’s outlines the background of the case, the findings of the inquest, the response of the trust and gives a summary of the trends of serious incidents since this incident happened.
Summary of Financial Implications
None.
Recommendations 1. That the committee consider the report and hear from the trust on the actions undertaken to improve patient safety following this tragic incident and the learning from all serious incidents.
Page 10
Consultation
Name of Department or Organisation Date sent Date Comments consultee response appear in report received para:
Internal None External None
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 11.10.12 10.10.12 129/12/-3 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Background Documents
None
Page 11
St George’s Healthcare NHS Trust – Inquest into the death of Kane Gorny
1. Context
1.1 A report was requested following the tragic death of Kane Gorny at St George’s Healthcare NHS Trust in May 2009 and the coroner’s inquest which concluded on 12 th July 2012 with the verdict that “Kane Gorny died from dehydration contributed to by neglect”.
1.2 The attached paper outlines the background of the case, the findings of the inquest, the response of the trust and gives a summary of the trends of serious incidents since this incident happened.
2. Proposals and reasons
2.1 The committee wishes to discuss with St George’s NHS Healthcare Trust the issues raised by the inquest and the patient safety measures developed and implemented by the trust since the tragic incident, and to seek assurances on behalf of Lambeth residents around the quality of care and monitoring arrangements in place at the hospital.
3. Comments from Executive Director of Finance and Resources
3.1 Not sought.
4. Comments from Director of Governance and Democracy
4.1 Not sought.
5. Results of consultation
5.1 Not applicable.
6. Organisational implications
6.1 Risk management: Not applicable.
6.2 Equalities impact assessment: Not applicable.
6.3 Community safety implications: Not applicable.
Environmental implications:
Not applicable.
Page 12
6.4 Staffing and accommodation implications: Not applicable.
6.5 Any other implications: Not applicable.
7. Timetable for implementation Not applicable.
______
Page 13
Kane Gorny Report to Lambeth Overview and Scrutiny Committee (OSC)
1. Introduction Members of the Overview and Scrutiny Committee will have seen recent press and news reports of the tragic death of Kane Gorny at St Georges Healthcare NHS Trust on May 28 th 2009. The reports followed the final verdict of the coroner’s inquest which concluded on 12 th July 2012 with the verdict that “Kane Gorny died from dehydration contributed to by neglect” The purpose of this paper is to outline the background of the case, the findings of the inquest, the response of the trust and give a summary of the trends of serious incidents since this incident happened.
2. Background The experience of Kane Gorny is an example of where St George’s fell well short of the standard that all patients have a right to expect so it is important that we give the OSC some assurance of systems demonstrating good patient experience and safety within the trust. We are working very hard to improve the patient experience and had a 18% reduction in the number of formal complaints received in 2011/12 in comparison to the previous year. We have also introduced and rolled out a bespoke patient experience tracker which helps us analyse feedback from patients in a much more timely way. We have introduced privacy and dignity visits undertaken by volunteers and are in the process of piloting a new initiative ‘The 15 Step Challenge’ which is a structured approach for assessing clinical areas to identify what is working well and what can be improved using for key domains – welcoming, safe, caring and involving and well organised and calm. There are also specific examples of national data that demonstrates high standards of treatment at St George’s: • Dr Foster identifies us as having one of the lowest mortality figures in the country • We have shown a 95% reduction in MRSA over last few years to one of lowest in UK and a significantly reducing rate of C Difficille • We have been placed 7 th nationally for the effectiveness of our stroke services (4 th in London) • We have the best survival rate in London for patients being treated for their heart attacks requiring angioplasty 72.4% (compared to 63.3% - overall rate in London)
These achievements will not be of any comfort to the family of Kane. He was a 22 year old man who had come to the trust for a total hip replacement. In the past he had had successful surgery for a brain (pituitary) tumour in 2008 which had left him with a lifelong need for hormone replacement therapy. He was treated by the endocrine team at St George’s but the high dose of steroids led him to develop avascular necrosis of his hips and it was identified that he needed left hip replacement surgery. Page 14
At his pre-operative assessment the need for involvement of the endocrine teams was recognised. However, they were not informed when Kane was admitted in May 2009. As a result his care proceeded without any endocrine involvement in planning and monitoring his hormone replacement therapy. During the post operative recovery period his fluid balance became highly abnormal and he suffered a cardiac arrest from which he tragically died. The trust has accepted full civil liability for the failures involved in Kane’s care. A meeting was held with the family in 2010 in which an apology was given for these failures.
3. Inquest Findings The trust fully accepts the inquest findings where the coroner outlined a number of failures which contributed to Kane’s death: • “There was a failure to involve the endocrine team to assist in his inpatient stay, peri-operative and post operative care. • There was a failure to monitor his fluid balance adequately post operatively on 26 th and 27 th May. • There was a failure to administer essential medication on 27 th May and 28 th May. • There was a failure to consider an organic cause for his post operative confusion on 27 th May. • There was a failure of doctors to understand his complex medical condition. • There was a failure to act on an extremely abnormal sodium levels on 27 th May. • There was a failure to conduct proper observations and monitor his fluid balance post sedation on 27 th – 28 th May”.
Following the inquest the Coroner issued a Rule 43 letter requiring the Trust to strengthen policy related to observing patients who have been sedated. To address the coroner’s recommendation the Trust’s existing Observation Policy has been updated to include a section describing the minimum requirement for observations for a sedated patient. This policy is being re-launched by its lead and publicised on the Trust intranet. A letter of response has been sent to the Coroner confirming that the required action has been taken. Now that the inquest is complete, the GMC have commenced investigations into 5 doctors involved in the case.
4. Police Investigation As the inquest was preceded by a police criminal investigation the Crown Prosecution Service will be sent a update report by the police. This is routine but as no new significant evidence was heard in the coroner’s court it is unlikely to change the CPS view that there is no realistic prospect of conviction for either gross negligence or corporate manslaughter.
5. Actions to Improve Patient Safety Page 15
A comprehensive action plan had been developed as a result of the SI investigation during 2009 and an update was given to the inquest hearing. The following areas have formed part of the follow up from this tragic case and include some of the patient safety priorities developed from all serious incidents: • Handover systems have been updated and now include a brief handover about all patients for all ward nurses so that senior staff are aware of patients with complex needs. A Handover Policy is now out for consultation to support a consistent approach across the trust • The observation chart has been further developed to incorporate an early warning score based on the national system. This is designed to detect early when patients are deteriorating so that swift action can be taken. Regular audits monitor implementation and compliance with the trust observation policy • The SBAR tool which is a structured approach to communication has been widely disseminated to staff and incorporated into the observation chart and handover information • A programme of medication safety sessions have been attended by a wide number of staff across the trust • Systems to strengthen senior leadership on the wards have been developed including regular consultant review and rotation of nursing staff on the particular ward involved in Kane’s care • The process for the escalation abnormal results has been clarified in surgery and should be supported by implementation of an electronic system to order and manage test results.
6. Communications A range of proactive communications events have been undertaken regarding this incident: • 4 x staff Patient Safety Forums – reaching over 600 staff • 2 x membership meetings reaching over 100 public members • A stakeholder letter was sent to GPs, CCG leads, commissioners, MPs, councillors, outlining the measures we have taken to safeguard patients in future • Several all-staff emails have been distributed describing the incident and outlining the actions we have taken • Staff presentations have been published on the intranet and publicised through staff communications • A learning forum has been established to discuss serious incidents with staff in detail in the future and provide an opportunity to increase staff understanding of patient safety initiatives and to understand their relevance and importance.
7. Patient Safety Strategy. Since 2010 efforts have been made to identify underlying themes of serious incidents and ensure that patient safety priority projects work on these issues. Recent interest in patient safety has also provided an opportunity to review systems for patient safety Page 16
and to consider what would need to happen generally within the organisation to reduce the likelihood of patients suffering avoidable harm. A number of proposals will be included within the patient safety section of the quality improvement strategy building on learning from all serious incident trends and comments made at the staff forum and through other means. Currently, the following six areas form the basis for discussion and comments: 7.1 Developing Highly Reliable Processes. Incidents show us that when things go wrong it is often a series of small things that all happen at the same time. We will concentrate on improvement of everyday processes by: • Using internal intelligence and national priorities to identify required patient safety projects across the trust • Adopting a systems approach to action planning based on a combination of intelligence from clinical areas • Identify systems that make it difficult for staff to operate effectively (e.g. documentation, IT policies) and prioritise for improvement 7.2 Accountability for smooth patient journeys • Further develop systems in divisions to have a clinical governance lead in all care groups with clear responsibilities • Further develop systems to clarify accountability particularly where patients have complex needs • To align initiatives for improvement so that staff do not become weary of new ideas.
7.3 Meaningful feedback to teams. Detailed analysis and feedback to clinical teams about their complaints, incidents and audits so that they are better able to identify areas for improvement
7.4 A culture of zero tolerance. To encourage a culture of challenge when staff notice unsafe systems or poor practice and support them when they do this.
7.5 Listening to staff concerns • To use a regular staff forum to have feedback on staff concerns with follow up where relevant • To engage front line staff more closely in the identification of issues from incidents and the planning of actions • To encourage a “fresh pair of eyes” approach to identify systems that could be improved
7.7 Listening to patient stories. To further develop a programme to listen to patient stories to ensure that plans for patient safety translate to improved patient experience when they access services.
8. Serious Incidents Trends While implementing systems which aim to improve patient safety it is important to monitor trends which show the extent to which these systems are working in practice. The following graph shows the two year trend for serious incidents to August 2012. Page 17
Serious incidents categories are defined in the trust serious incident (SI) policy which is informed by NHS London requirements. During the period shown in the graph the numbers have been influenced by some redefinition of categories such as the inclusion of grade 3 and 4 pressure ulcers which are now the largest category of reported serious incident. Despite this, the number of serious incidents over this period shows a reducing trend. At the same time the general number of adverse (lower category) incidents has been increasing when benchmarked to other similar organisations. This data has been compiled by the National Patient Safety Agency (NPSA) which has recently moved to the NHS Commissioning Board. The NPSA reports state that high reporting of adverse incidents denotes a culture where patient safety is important and therefore staff are more likely to report incidents. Although these figures are encouraging, there is no room for complacency and other high profile serious incidents are the subject of ongoing coroner’s inquests. All of these cases are fully investigated and actions implemented so that the coroner can decide if they are sufficient to ensure patient safety is maintained. The development of a strategy for patient safety aims to create a long term and sustainable approach to reduce serious incidents and enhance patient safety.
9. Conclusion It is clear that the care provided for Kane Gorny fell well short of the treatment and care that all patients have the right to expect. The Trust has admitted liability and fully accepts the coroner’s verdict. A comprehensive action plan was devised following the initial investigation and this has been monitored to ensure implementation. Additionally systems for patient safety have been further developed based on the learning from all serious incident reports. Improving patient safety at St George’s is not a short term initiative and the strategic plans for patient safety will enable a longer term approach. By holding us to account on our responsibilities in this area, the Overview and Scrutiny Committee can play a role in helping us to achieve our longer term aims.
Alison Robertson – Chief Nurse & Director of Operations
Ros Given Wilson- Medical Director
Yvonne Connolly – Head of Patient Safety
October 2012 Page 18
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Health and Adult Services Scrutiny Sub-Committee 23 October 2012
South London & Maudsley NHS Foundation Trust – Inquest into the death of Sean Rigg
All Wards
Report authorised by : Executive Director of Finance and Resources: Mike Suarez
Executive summary
This report is submitted following the tragic death of Sean Rigg whilst in police custody and the verdict of the recent coroner’s inquest. Mr Rigg was in the care of South London and Maudsley NHS Foundation Trust (SLaM) at the time. The attached report from SLaM outlines the trust’s involvement and investigation into the care and treatment of Mr Rigg, the actions taken after the incident, and the learning from the coroner Inquest.
Summary of Financial Implications
None.
Recommendations (1) That the Health and Adult Services Scrutiny Sub Committee hear of the learning delivered and underway from this incident (2) That the Committee note the joint partnership programme of activities underway to support future progress
Page 20
Consultation
Name of Department or Organisation Date sent Date Comments consultee response appear in report received para:
Internal None External None
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 11.10.12 10.10.12 135-12/13 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Background Documents
None
Page 21
South London & Maudsley NHS Foundation Trust – Inquest into the death of Sean Rigg
1. Context
1.1 A report was requested from South London and Maudsley NHS Foundation Trust (SLaM) following the tragic death of Sean Rigg whilst in police custody and the verdict of the recent inquest outlining in detail the failure of local SLaM services, the Metropolitan Police Service and Penrose Housing Association in the care and attention of Mr Rigg. Mr Rigg was in the care of South London and Maudsley NHS Foundation Trust (SLaM) at the time of his death.
1.2 The attached report from SLaM outlines the trust’s involvement and investigation into the care and treatment of Mr Rigg, the actions taken after the incident, and the learning from the coroner Inquest.
2. Proposals and reasons
2.1 The committee wishes to discuss with SLaM the issues raised by the inquest and how the trust has responded since the incident including lessons learned and measures developed and implemented, and to seek assurances on behalf of Lambeth residents around mental health service provision and associated multi agency working.
3. Comments from Executive Director of Finance and Resources
3.1 Not sought.
4. Comments from Director of Governance and Democracy
4.1 Not sought.
5. Results of consultation
5.1 Not applicable.
6. Organisational implications
6.1 Risk management: Not applicable.
6.2 Equalities impact assessment: Not applicable.
6.3 Community safety implications:
Page 22
Not applicable.
Environmental implications:
Not applicable.
6.4 Staffing and accommodation implications: Not applicable.
6.5 Any other implications: Not applicable.
7. Timetable for implementation Not applicable.
______
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Lambeth Overview and Scrutiny Committee 23 October 2012
Inquest into the Death of Sean Rigg
Report to Lambeth Overview and Scrutiny Committee from South London and Maudsley NHS FT
Report authorised by: Chief Executive, SLaM FT : Gus Heafield
Executive summary
The seven week inquest into the death of Mr Sean Rigg concluded on Wednesday 1 August 2012 at Southwark Coroner’s Court. The Jury returned a narrative verdict outlining in detail the failure of local SLaM services, the Metropolitan Police Service and Penrose Housing Association in the care and attention of Mr Sean Rigg. The summary messages for Rule 43 learning from the Southwark Coroner, Dr Andrew Harris were received verbally on Friday 29 September. The written Rule 43 is awaited.
The note aims to summarise the findings of the Inquest and the learning to date and underway across SLaM FT in response to Mr Rigg’s death.
Summary of financial implications
None
Recommendations (1) That Overview and Scrutiny hear of the learning delivered and underway from this incident (2) That the Committee note the joint partnership programme of activities underway to support future progress
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Consultation N/A
Name of Department or Organisation Date sent Date Comm ents consultee response appear in report received para:
Internal N/A
Report history
Date report drafted: Report deadline: Date report sent: Report no.:
Report author and contact for queries: Jill Lockett, Service Director Behavioural and Developmental Psychiatry CAG, SLaM FT [email protected] [email protected] 0203 228 4004
Background documents
None
Appendices
None
2 Page 25
1. Context
1.1. Sean Rigg was a 40 year old black male who died in Police Custody in Brixton Police station on Thursday night of 21 August 2008. Mr Rigg was in the care of the South London and Maudsley NHS Foundation Trust (SLaM) Lambeth Community Forensic team at this time and resided at the Fairmount Forensic step down hostel, Brixton Hill.
1.2. During much of 2008, Mr Rigg remained ambivalent about his medication. He rejected the idea that he suffered from mental health problems and felt his episodes of illness were a result of stress and of him being misdiagnosed because of his ethnic origin.
1.3. On 11 August, Mr Rigg’s clinical team at SLaM were notified by the hostel that he was showing signs of relapse. By this time, Mr Rigg had not taken his regular medication for almost seven weeks. In the following days, the team agreed to increase their observations of Mr Rigg at Fairmount Hostel. There was also discussion about initiating a Mental Health Act Assessment, though this was not actioned.
1.4. On 21 August, staff at Fairmount contacted the police after becoming concerned about Mr Rigg’s behaviour. He left the hospital and, after behaving in a threatening manner towards members of the public, was arrested by the police and taken to Brixton Police Station. Whilst awaiting a transfer into a police cell, Mr Rigg became ill and an ambulance was called. He was pronounced dead on arrival at King’s College Hospital.
2. Action Taken After the Incident
2.1 Internal Investigation 2.1.1 SLaM’s internal investigation into the care and treatment provided to Mr Rigg (completed July 2009) concluded that there had been an over reliance on the client’s goodwill in terms of compliance with his treatment plan. It was noted that this reliance was partly due to “the respect and special therapeutic relations the clinical team had developed with him”. The report concluded that:
• The community forensic team did not act decisively when Mr Rigg showed signs of imminent breakdown on 13 August 2008; • A contributory factor to the incident on 21 August 2008 may have been a delay in assessing Mr Rigg under the Mental Health Act and admitting him for inpatient treatment;
2.1.2 SLaM’s Board Level Inquiry (completed October 2009) reviewed the action plan developed in response to the incident.
2.2 Zoning System The ‘zoning’ system used within the community forensic service was strengthened towards the end of 2008. This determines the clinical team’s
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management of individual patients. Patients placed in the red zone, where there are concerns about the possibility of relapse, are now seen face to face on a daily basis by the community forensic team. The patient’s care is also reviewed on a twice daily basis by the team.
2.3 Joint Protocol The Trust has developed a joint protocol between our community forensic team, community hostels and the police to improve the joint response to crisis calls at the hostel and other similar facilities within Lambeth.
2.4 Care Plans All patients under the care of our community forensic service have a crisis care plan which is made available to hostel staff and which includes communication with carers / family members. This is audited on a monthly basis. According to the most recent audit this summer, 96% of patients under the care of the Lambeth Community Forensic Team had a care plan in place. A recent Modern Matron audit confirmed all clients have crisis plans in place.
2.5 Custody Suite Project 2.5.1 SLaM is involved in a pilot project in Lambeth to support people with mental health problems who are taken into police custody. Co-ordinated by Lambeth Council and supported by Guy’s and St Thomas’ Charity, the scheme is a partnership between the council, Lambeth Police and SLaM. It involves a team of specialist nurses being on hand in police stations to assess the needs of people with mental health problems who are detained by police.
2.5.2 The team comprises a team leader and four Community Psychiatric Nurses. They provide support to custody suites across Lambeth and to Camberwell Magistrates Court. As well as assessing urgent mental health needs, the nurses work as part of a multidisciplinary team including social and probation officers who report to police on whether the detainee is fit to remain in a police cell, whether they need access to specialist mental health services and in the long term whether they are fit to plead their case.
2.5.3 Results from the pilot will be available by the end of 2012.
2.5.4 The Trust has reviewed the action plans arising from Mr Rigg’s death and is satisfied that new zoning protocols are well embedded in teams and that there is performance data and audit evidence to support the use of care plans and crisis plans for Forensic clients in the community.
2.5.5 Police Liaison arrangements are more developed since 2008 and a 4 borough liaison protocol now offers consistency of engagement between the trust and local Borough forces. A meeting has taken place between SLaM and the 4 (LSLC) Borough Commanders to sign of the refreshed protocol and consider the training and learning opportunities for the Metropolitan Police Service and other stakeholders.
2.6 Lambeth Safeguarding Board
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Lambeth Safeguarding Adult Partnership Board has requested a multiagency action plan be developed to address recommendations and learning from this case, including the findings and recommendations from the Coroner’s Inquest.
2.7 Lambeth Community Engagement Work has been underway for some time across all SLaM Boroughs to support wellbeing and recovery in the Community. This involves joint engagement through Church groups, voluntary agencies and service user and carer organisations.
2.8 Lambeth Police and Community Consultative Committee The Lambeth Police and Community Consultative Committee hosted a community and stakeholder discussion on death in custody at its September 2012 meeting. The panel members including local Borough and Area Police Commanders, the Chair of the IPCC, Lambeth Public Safety leads, SLaM representatives and the Rigg family. There was a very productive dialogue and much information shared.
2.9 Partnership Time Event and joint programme of activities with Black Mental Health UK SLaM have commissioned Black Mental Health UK to prepare and host a series of community conversations regarding use of restraint in mental health, death in custody and mental heath and policing. Three community events are planned by BMHUK and will conclude with a written report to SLaM to help shape a Partnership Time event, hosted by SLaM in the New Year 2013.
3. Rule 43 findings
3.1 Following an Inquest, the Coroner has provision to make recommendations to statutory and other bodies regarding the lessons learnt and action required following an incident. These are known as Rule 43 findings. The Southwark Coroner reported verbally on 29 September and his written Rule 43 is awaited. The elements of the Rule 43 pertaining to the health pathway were as follows:
3.2 Crisis planning. The Coroner was satisfied that the Trust now has systems and protocols in place. He said that he had heard good evidence regarding the new “red zone” protocol, close monitoring of care plans and community team engagement that demonstrated that there was no ongoing risk to the public.
3.3 Mental Health Act assessments. The Coroner noted that the Jury narrative verdict had concluded that the failure of SLaM to complete MHA Assessment for Mr Rigg more than minimally contributed to his death. The Corner felt that whilst he had heard that beds were not the issue, the evidence from SLaM was confused about the pace, knowledge, teamwork and threshold for MHA assessments locally and preferred the evidence from the expert witness Professor Peckitt from Norfolk, that these assessments were routine and that they could be arranged within 90 minutes.
3.4 The Coroner said he was not satisfied that there was no ongoing risk to the public and that local agencies including SLaM, the Metropolitan Police Service
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and the London Borough of Lambeth had work to do on assessment thresholds, knowledge, policy awareness and teamwork in order to improve confidence.
3.5 Other Rule 43 comments were summarised as follows:
3.6 Multi-agency engagement and escalation Communication and escalation - The Coroner said that agencies had failed to escalate and share fully the MH concerns and had not been proactive with family engagement. Whilst evidence had been heard from the MPS with regard the multiagency protocols in place for Mental Health liaison, these protocols did not include Penrose and they had not been involved. The weakness of crisis planning for both SLaM and Penrose meant that the family were not engaged when they should have been. Whilst the initiatives highlighted by Penrose for recent MPS liaison and joint engagement were good he was not satisfied that risks could be avoided in future and recommends that the MPS, LB Lambeth, Penrose, Lambeth PCT and SLaM to consider the communication protocols in place across the agencies and stakeholders involved.
3.7 Police Matters 3.7.1 Police action - The Coroner noted the Jury narrative verdict and the evidence heard of the unacceptable failure to act and the missed opportunities available to the Police Call Handling Control (CAD officers) and the MPS Borough Operational Control. He noted the evidence of new developments in central call handling and the training that had been completed and was satisfied that the new systems were in place. There must, however, be continued mental health training for CAD and Ops control officers as he cannot be assured that there is consistent understanding and attitude in CAD teams and asks that SLaM continue to work with MPS on this.
3.7.2 Police response - The Coroner noted the Jury findings and the evidence heard regarding the inability of the Police to assess the MH state and vulnerability of Mr Rigg. He noted the force and length of time of the restraint, the failure to spot the physical and mental deterioration of Mr Rigg, despite the evidence and guidelines available and the suggestion of risk of violence masking the local assessment of vulnerability. On this basis, the Coroner welcomed the two reviews announced by the IPCC. The first will review the IPCC investigation into MR Rigg’s death; the second will review all Police deaths in custody. The corner felt that it was for the IPCC to determine the lessons learnt and these would not be the subject of a Rule 43. Counsel for the family agreed with this recommendation.
3.7.3 Environment - The Coroner noted the evidence heard regarding the upgrade of CCTV facilities and refurbishment of Brixton police station and also the MH work underway to have trained MH nurses in the custody suite. On this basis he was satisfied that the risk had reduced in this area.
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4. Conclusion
4.1 The death of Sean Rigg is a tragedy for the Rigg family and all who knew him. He was a creative, able, fit young man. SLaM apologises unreservedly for being slow to act and in particular for not having carried out a MHA Assessment that would almost certainly have led to an admission to hospital. Much has been learnt since 2008 and the zoning protocol on place ensures that all forensic clients in crisis are seen on a daily basis by a doctor and reviewed by the team twice daily. The work on a 4 Borough MH Liaison protocol is now complete and enables consistency of practice across communities. New legislation now allows for Community Treatment Orders (CTOs) to recall patients back to hospital is they are declining community medication or showing signs of relapse. Our work in local Police stations and the Court allows for earlier screening and assessment of unwell clients, providing opportunities for divert to places of safety much earlier in the system. It is hoped that the SLaM sponsored Black Mental Health UK community conversations will provide a platform for neighbourhood residents, stakeholders and the voluntary sector to share the understanding and information about how to support modern and recovery focussed mental health care for our local population.
Jill Lockett Behavioural & Developmental Psychiatry CAG SLaM 10 October 2012
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This page is intentionally left blank Page 31 Agenda Item 5
Health and Adult Social Care Scrutiny Sub-Committee 23 October 2012
The Annual Report of Lambeth Safeguarding Adult Partnership Board 2011-2012
Report authorised by : Jo Cleary Executive Director Adult and Community Services Chair of the Lambeth Safeguarding Adult Partnership Board (LSAPB)
Executive summary
“No Secrets” statutory guidance issued under Section 7 of the Local Authorities Social Services Act asks that “the social services department” in each local authority coordinates a “standing committee of lead officers” to safeguard adults at risk. The guidance asks that this Committee should have a clearly defined remit and lines of accountability. In Lambeth the Safeguarding Adult Partnership Board (the committee of lead officers) is accountable to the Health and Adult Social Care Scrutiny Committee and submits an annual report on its activity to the Committee .
The Lambeth Safeguarding Adult Partnership Board (LSAPB) is co-ordinated by Adult and Community Services in the London Borough of Lambeth and is made up of representatives from agencies concerned with safeguarding adults at risk. These include the Police, Health Trusts and key third sector organisations such as the Local Implementation Network. The list of members of the LSAPB is contained in Appendix One of the full report. The Annual Report is written jointly by members of the LSAPB and details of the work undertaken by individual partner agencies to safeguard adults at risk are in the full report.
This report does not contain or have any financial or environmental implications.
Recommendations (1) That the Committee note the report on activity between September 2011 and Septembers 2012. (2) That the Committee supports the LSAPB’s proposals to develop safeguarding adult work in Lambeth over the next year. (3) That the Committee make any comments or observations they deem appropriate as part of the scrutiny process to Cabinet.
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Consultation
Name of Department or Organisation Date sent Date Comments consultee response appear in report received para:
Internal Director Jo Cleary Executive Director of Adult and 10 th 10 th Introduction to Community Services October October the report as 2012 2012 Chair of the Safeguarding Adult Board Fateha Salim Legal Services 2nd October 10th Added 2012 October recommendation 2012 3
Glenda Finlay Department Finance Officer 2nd October 2nd October No comments 2012 2012 Tony Otokito Corporate Finance 3rd October 3rd October No comments 2012 2012
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 24.09.12 10.10.12 10.10.12 130/12-13 Report author and contact for queries: Jane Gregory 020 7926 7707 [email protected]
Background documents
• No Secrets Department of Health 2000 • Safeguarding Adults Association of Directors of Adult Services 2005
Appendices
1) The full report of the LSAPB for the period 2011-2012;
This report gives a detailed account of the work of the Board and its sub groups, it contains all the information that No Secrets recommends should be in an Annual Report of a Safeguarding Adult Board.
2) A summary of the report:
This is designed to inform the wider community in Lambeth about safeguarding adult work in addition to reporting on the year’s activity.
3) An accessible version of the report;
This is designed for individuals with limited literacy particularly designed for People with Learning Disabilities
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The Annual Report of Lambeth Safeguarding Adult Partnership Board 2011-2012
1. Context
The work of the LSAPB is summarised and reported to the Health and Adult Social Care Scrutiny Committee annually as part of the governance arrangements of the LSAPB. This is the fourth annual report of the LSAPB submitted to this Committee.
Work to safeguarding adults at risk relates to council policies to be a caring, safe and secure borough. The objective of work to safeguard adults at risk matches the Department of Health’s objective of enabling people to retain their independence, control and dignity.
2. Proposals and reasons
There are no proposals contained in this report.
3. Finance Comments
3.1 There are no financial implications to this report
4. Comments from Director of Governance and Democracy
4.1 The DH 2000 statutory guidance requires that the Safeguarding Board keep Members aware of issues relating to the protection of vulnerable adults. The functions of this sub committee include making recommendations to Cabinet arising from the outcome of the scrutiny process.
5. Results of consultation
5.1 All LSAPB members are consulted on the contents of this report and it was jointly ratified at the LSAPB meeting held on 24 th September 2012. Specific contributions on the work of individual agencies to safeguard adults at risk are contained in the full report.
5.2 Organisational implications;
There are no organisational implications contained in this report
5.3 Risk management:
There are no specific organisational risk management implications contained in the report. The LSAPB maintains a risk register for its own area of responsibility and activity.
5.4 Equalities impact assessment:
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This is a retrospective report on activity not a policy. As such it does not require an Equalities Impact Assessment. The objective of work to safeguard adults at risk is to redress inequality in that it aims to enhance the ability of specific disadvantaged groups of adults both to protect themselves from harm and to gain redress when harmed. The report shows that work undertaken to safeguard adults at risk in Lambeth during the last year is proportionate to the composition of the adult at risk population that are known to adult care services.
5.5 Community safety implications:
Work to safeguard adults at risk takes place within the wider community safety agenda. The LSAPB has structured links with community safety provisions. This is detailed in the body of the main report.
5.6 Environmental implications:
None- this report will only be made available electronically
5.7 Staffing and accommodation implications:
None
5.8 Any other implications:
None
6. Timetable for implementation
6.1 Once agreed by the Scrutiny Committee, the report will be made available on the relevant London Borough of Lambeth web pages. London Borough of Lambeth communications team intends to draw attention to the publication of this report in order to raise awareness of safeguarding adults in Lambeth
The report will also be presented within the relevant internal governance arrangements of partner agencies. It will also be presented to the Clinical Commissioning Collaborative Group the Safer Lambeth Partnership Executive and the Shadow Health and Wellbeing Board.
Page 35 LSAPB annual report 2011-2012
Lambeth Safeguarding Adult Partnership Board
Annual Report
September 2011 - September 2012
Posters to raise awareness displayed in 48 bus stops
Volunteer “buddy scheme” established
Over 1,000 concerns about abuse of adults at risk raised Page 36 LSAPB annual report 2011-2012
Contents
Section 1 Introduction
Foreword 3
Context 4
Section 2 Where we are now
Summary of the Board’s current position 5
What we achieved this year 6
Safeguarding Adult Statistics for April 2011- April 2012 9
Section 3 Reports from Partner Agencies
Safeguarding Adult work within individual Partner Agencies 18
Section 4 Future Plans
The Board’s plans for next year 34
Appendix
1 Members of the Board 36
2 Terms of Reference for the Board 38
3 The Board’s Structure 42
4 Report on the work of the Sub and Associated Groups 45
5 The Serious Case Review concerning Mr A 48
6 The Board’s Action Plan in response to the findings 60 of the SCR concerning Mr A
7 Glossary of Terms 64
Page 37 LSAPB annual report 2011-2012
Foreword by the Chair of the Lambeth Multi Agency Safeguarding Adult Partnership Board.
I am pleased to present the fourth annual report of Lambeth’s Safeguarding Adult Partnership Board. This report summarises what has been achieved during this year and our plans for the year ahead
The Board is now a well established partnership of agencies and organisations in Lambeth working together with a mission to create a community where adults at risk of abuse or neglect because of their particular circumstances are safeguarded.
The Board knows that this will only be achieved when safeguarding adults at risk is “everybody’s business”. The residents of Lambeth have already made it clear that they regard protecting vulnerable people as important 1 and with support from our communities the Board is confident that a culture where adults at risk are treated with respect can be achieved in this Borough.
I would like to thank all members of the Board for their hard work over the last year and note in particular the contribution from our councillors, LINK and colleagues in the third sector. They have made sure that the voice of people at risk, their carers and the community is heard whenever we make decisions about how to improve services.
Whilst this report focuses on situations where something went wrong or could have gone wrong, but these are the exception. Most adults at risk that live in Lambeth continue to lead dignified, active and fulfilled lives. Their achievements are enabled and supported by the dedication, enthusiasm and commitment of staff, volunteers and unpaid carers combined with a culture of inclusivity within the local community and services.
This is the first annual report that includes the findings of a Serious Case Review. The review was undertaken by an independent panel on behalf of the Board. The panel looked at the circumstances that led to the death of a vulnerable man living on the streets in Lambeth. It has made recommendations so that a similar tragedy may be avoided in the future and the Board has agreed an action plan to meet these recommendations.
I hope you find that this report stimulating and thank you for your continuing support and commitment to safeguarding all adults at risk in Lambeth.
Jo Cleary Executive Director Adult and Community Services London Borough of Lambeth
1 2009 Lambeth residents’ survey
3 of 66 Page 38 LSAPB annual report 2011-2012
Context
Q What do we mean by an adult at risk?
Adults who are ill, frail or have a disability and are unable to protect themselves from significant harm.
Q Why have special arrangements to Safeguard Adults who are at risk?
Some people in these groups may need assistance and support to protect themselves from abuse and mistreatment. In some situations, adults at risk may not realise that they are being abused.
Q What is abuse?
Abuse is the violation of an individual’s human and/or civil rights by any other person or persons. Abuse includes physical harm, sexual exploitation, theft, discriminatory behaviour, bullying and neglect; it can be deliberate or the result of ignorance or omission. It can take place in health care and support settings, public places and in people’s home
Q What is the Lambeth Safeguarding Adult Partnership Board?
The Board is a group of senior representatives from agencies in Lambeth that work with adults at risk and their carers or supporters. Members of the Board ensure that there are arrangements in place to safeguard adults at risk from experiencing abuse, mistreatment and neglect and to support them to be safe or obtain justice.
Q What is the purpose of this report?
This report summarises the work of the Safeguarding Adult Partnership Board over the last year. It is designed to inform all who live, work, learn and volunteer in Lambeth of the activity undertaken by the Board during the last year and its plans for next year.
Q Why is safeguarding adults at risk in Lambeth important?
Everybody has the right to lead a life where their dignity, human and civil rights are promoted and respected. Adults who are less able to protect themselves from abuse and mistreatment need additional support to stay safe and to obtain redress when they have been abused or mistreated. Safeguarding adults at risk is a structured joint approach by statutory bodies, their commissioned services and the community to achieve this objective.
“Abuse is the violation of an individual’s human and civil rights by any other person or persons” No Secrets 2.5
4 of 66 Page 39 LSAPB annual report 2011-2012
Section 2 Where we are now
This year the Board has:
• Delivered information across a wide range of media to raise awareness of abuse of adults at risk and advise people on how to report concerns. • Provided intensive training to all staff leading investigations into abuse of adults at risk. • Kept up to date with the work undertaken with people with disabilities to learn how we can better prevent hate crime on the basis of disability. • Undertaken a Serious Case Review into the death of a vulnerable man who was living on the street. • Initiated a system through which the views and experiences of adults at risk are captured and used to improve the service offered. • Set up a sub group to support the development of community resources that will work with adults at risk to prevent abuse and help people recover from its impact.
This has resulted in:
• The establishment of a community service for adults at risk who have been abused. • A new disability hate crime action plan.
Next year the Board plans to:
• Increase and strengthen its work with community groups • Further improve the quality of data collected. • Deliver a wider range of good quality training to staff and volunteers working with adults at risk. • Implement the action plan following the Serious Case review concerning Mr A • Increase joint working with the Children’s Safeguarding Board. • Improve systems for gathering information on safeguarding activity in local health and social care provisions. • Ensure commissioning arrangements across all sectors are sufficiently robust to safeguard adults at risk.
5 of 66 Page 40 LSAPB annual report 2011-2012
2.2 What we achieved this year
No Our Aim Our Action Our Objective or Achievement
2.2.1 To raise Safeguarding Adult Greater awareness within the awareness Awareness fortnight community of the implications of adult abuse and what can be done to tackle it
2.2.2 To complete the The Executive Committee All actions will be completed by work plan 2011- has checked progress over December 2012 2013 the year
2.2.3 To ensure the A project worker has been A reference group of people customer’s appointed and will be who have been affected by voice influences working through the Local adult abuse that will advise the all our activity Improvement Network Board on all aspects of its work (LINk).
2.2.4 Learn from The Board considers the To make adults at risk in cases brought lessons learnt from Lambeth safer to the attention Management and Serious of the Board Case Reviews and monitors the implementation of the recommendations from these reports.
2.2.5 Learn from The Board receives reports To improve the multi agency National on national developments safeguarding adult Developments relevant to safeguarding arrangements in Lambeth adults at risk.
2.2.6 Work with the The Community Support This group is now recruiting and community to sub group of the Board has training volunteers to offer a form groups helped the charity “ Action buddy service so older people that can help on Elder Abuse ” set of a that have been abused will be people who are local group and will supported by trained volunteers a risk of or have continue to them until they to recover and regain been abused. are fully established. confidence. Lambeth is the first city inner area to develop this service
2.2.7 Achieve Staff that lead Quality assurance of proportionate safeguarding adult safeguarding adult casework is and effective investigations have been now underway. The evaluation responses to trained this year to lead measures used reflect these concerns raised investigations following principles that kept the these principles.. adult at risk at the centre of the concern.
Page 41 LSAPB annual report 2011-2012
Some achievements in detail
2.2.1 Raising Awareness
Safeguarding Awareness Fortnight
This took place in June 2012 and included
• Posters (see below) displayed in 48 bus stops across Lambeth • Leaflets sent to over 800 sites including faith and voluntary groups. • An article in Lambeth Talk and event at St Thomas Hospital.
2.2.4 Learning from things that went wrong locally
Serious Case Review concerning Mr A
This Serious Case Review commissioned by the Board (Appendix 5) looked at the circumstances that led up to the death of a homeless man with mental health problems. It made recommendations to the Board for actions that should be taken to prevent a similar tragedy in the future. The Board has agreed a number of actions including developing systems to prevent vulnerable people from being evicted, and a simple mental capacity assessment for staff and volunteers working with homeless people.
7 of 66 Page 42 LSAPB annual report 2011-2012
2.2.5 Improving the way we commission services
.
Closer to Home
The Equalities and Human Rights Commission undertook an investigation looking at to what extent public authorities promote and protect the human rights of older people (aged 65 and over) with regards to home based care and support. Around half of the older people, friends and family members expressed satisfaction with their home care. At the same time their evidence revealed many instances of care that raised real concerns. The Board requested a report on action undertaken in Lambeth in response to Closer to Home.
2.2.6 Learning from National Developments
“Mate Crime”
During this reporting period there have been several national Serious Case Reviews published about adults at risk with a common themes. In each case the adult at risk
1) Had borderline” cross cutting needs. 2) Were unaware of the risks presented by their lifestyle. 3) Retained abusive friendships.
In each case patterns of developing risk that should have been spotted if agencies had worked together were missed and all three adults at risk were tortured and then murdered by their “mates”.
The Board received a report on the work of the innovative multi agency Vulnerable Victims of Anti Social Behaviour panel in Lambeth which gathers and responds to similar situations.
The Board received a report on the innovative arrangements in Lambeth to respond to the needs of vulnerable victims of anti social behaviour
8 of 66 Page 43 LSAPB annual report 2011-2012
2.3 Safeguarding Adults Statistics April 2011 to April 2012
2.3.1 Background
The statistics presented below differ slightly to the period covered by the report, as April 1st to March 31 st is the national reporting timeframe. The statistics are based on information gathered from the Adult Social Care database (Framework- i). This has been combined with some information collected manually, from the South London and Maudsley Mental Health Trust which is collected using a different database
The introduction of a national data collection system in 2010-2011 allowed the Board to compare safeguarding adult work in Lambeth with other Local Authorities. The Department of Health are of the view that the quality of data collected nationally is not sufficiently robust at this stage for comparisons to be regarded as accurate. The Board were however satisfied that Lambeth’s performance matched or exceed that of comparable authorities based on information available.
The comparisons made with Lambeth’s population figures in this report are also limited. This is for several reasons:
• The population of adults at risk in the authority includes transient populations including people with mental health problems and people who misuse substances. • There is not a single source of information on the number of adults at risk, in Lambeth or indeed nationally. Figures used in this report are based on the figures for those known to social care services.
The Board has examined data on safeguarding adult activity at every meeting this year. It has requested and considered more detailed data on some aspects of safeguarding activity than that shown in this report. An example of this is information on how many cases that ended in increased monitoring were later the subject of abuse again. The Board were reassured to learn that this happened in less than 3% of cases.
The figures rely on accurate and comprehensive input of data by staff. It is feasible that efforts to continuously improve the quality of data recording will impact on figures and may in part be responsible for some of the changes to levels shown year on year.
The Board examines data on safeguarding adult activity at every meeting and requests specific data when it is concerned about a particular area of activity
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2.3.2 Referrals
The Number of Referrals
The chart shows an annual increase in the number of referrals made into the safeguarding process over the last six years. The Board are of the view that this reflects increased awareness of both adult abuse and the need to report it in Lambeth, rather than an increase in the number of incidents of abuse. Based on national research the Board is aware that the level of incidents that take place in Lambeth is probably higher than the number of incidents reported.
The Source of Referrals
The source of referral shows that the highest percentage (32%) has been made by social care staff including care home staff. 26% of referrals were raised by health from all sectors. This reflects the higher level of awareness among these groups, probably as a result of the number of staff from these sectors trained in
10 of 66 Page 45 LSAPB annual report 2011-2012
safeguarding adults. The Board has set itself the challenge of increasing the level of awareness among other staff in particular housing staff in the next year; this should be reflected in a more even distribution of referral sources in 2012-2013 figures.
The referrals from adults at risk their friends and neighbours and the community remain low. Empowering adults at risk to recognise and report any abuse they are subjected to continues to be a priority for the Board. The appointment of a project worker who will work with groups of adults at risk to help the Board achieve this objective should impact on these figures next year.
2.3.3 The Adults at Risk
Age and Service User Group
The needs and age of users of the safeguarding service show that just over half (52%) of referrals are about people with physical disabilities with most of that group over 65 years. In all other groups of service users most people are under 65 .People with learning disabilities are 22% of the referrals and mental health problems 21%.The proportion of the concerns that are about the care of older people reflects both the London and national picture of reports of abuse, and remains disproportionately higher than the percentage of the general population that is over 65.
There are more referrals relating to females than males with the difference being greatest in adults over 85. The Board specifically looked at the distribution of type of abuse across genders and learnt that they are very similar. Men were slightly more likely to make allegations about financial abuse than women. Women were more likely to make allegations of domestic violence and sexual abuse
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Ethnicity
The Board compared the ethnic group of the adult at risk against the number of ACS clients and found that the two matched. This indicates that there is no unusual level of activity with regards to a particular ethnic group.
There is no unusual level of activity with regards to a particular ethnic group.
12 of 66 Page 47 LSAPB annual report 2011-2012
2.3.4 The Alleged Abuse
An adult at risk may be subjected to more than one type of alleged abuse. So these figures represent multiple recording. The most common type of abuse cited in the 1,140 referrals is physical abuse which accounts for 26% of the total abuse allegations reported.
Physical abuse, neglect and financial abuse continue to dominate referrals in Lambeth this reflects the national picture
Discriminatory abuse accounted for 2 % of all allegations contained within the referrals. While similar to the national pattern the low level of discriminatory abuse reported is of concern to the Board. National reports such as “Hidden in Plain Sight “and in the British Journal of Medicine report indicate that nationally discriminatory abuse is under reported and incidents are often hidden Work undertaken locally with both adults at risk and specialist professionals suggests that incidents when abuse may be based on discriminatory attitudes are only reported in terms of the impact of that abuse e.g. physical abuse. The disability component of the Hate Crime action plan is to recommend dual recording by professionals when there is a belief that the abuse that took place was due to a discriminatory attitude
Physical abuse, neglect and financial abuse continue to dominate referrals in Lambeth this reflects the national picture
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The location of alleged abuse
44% of referrals reported the adult at risk’s own home as the location where the alleged abuse took place. The adult at risk’s own home has been the most common location for the last three years this matches the national picture.
The person who may have caused harm
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The largest group shown is social care staff this includes domiciliary (home care) workers, care home and day care staff. This is closely followed by family members which includes partners.
2.3.5 The Outcomes
The conclusions reached at the end of the investigation
Distribution of case conclusion, 2011-12 Not Determined/Inconclu sive 26% Substantiated 31%
Partly Substantiated 9%
Not Substantiated 34%
Partially substantiated means that in cases with allegations of multiple types of abuse, some types of abuse were substantiated and some were not substantiated or not determined
Among the completed safeguarding investigations in 2011-2012 the proportion of substantiated not substantiated and not determined remains broadly similar.
At the end of each investigation a conclusion on whether the concern was substantiated or not should be reached. It has not been possible to determine the conclusion in just over a quarter of cases this year.
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The outcomes for the adults at risk
The category Other Outcomes (14%) includes all outcomes which were less than five per cent a chart of what these included is shown below
Percentages and Rounded Numbers Outcome Percentage Adult at risk removed from property/service 2 Application to change appointee-ship 1 Referral to advocacy scheme 1 Referral to Counselling /Training 2 Management of access to finances 2 Restriction/management of access to alleged perpetrator 3 Referral to MARAC 1 Separated figures do not add up to 14 per cent due to rounding
For each completed referral there can be more than one action taken. In 2011- 12, the most common action of the safeguarding investigation was increased monitoring (53%) often combined with another outcome.
The Board has examined increased monitoring in greater depth to see how effective it has been in preventing further abuse in 3.7% ((9) cases there was further abuse following increased monitoring and the Board has asked that these 9 cases be examined in detail and the findings reported to the Board.
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Outcome for the person that may have caused harm (alleged perpetrator)
Outcome of completed referrals for perpetrator / organisation / service, 2011-12
Continued Monitoring, Police 6% Action, 7%
Other Outcomes, 19%
No Further Action, 41% Not Known, 26%
The category Other Outcomes includes all outcomes which occurred at a rate of less than five per cent, the full list is in the table below.
Percentages and Rounded Numbers Outcome Percentage Criminal Prosecution / Formal Caution 2 Community Care Assessment 1 Removal from property or Service 4 Management of access to the Vulnerable Adult 4 Referral to Registration Body 1 Disciplinary Action 2 Counselling/Training/Treatment 1 Referral to MAPPA 1 Action by Contract Compliance 1 Exoneration 1 Figures add up to 1 8% due to rounding.
The increase in investigations leading to continued monitoring as an outcome (from 10.5% to 19.9%) has been of concern to the Board. A more detailed examination of these cases was presented in June 2012.
This showed that 47% of completed referrals for which the outcome was increased monitoring had a case conclusion of substantiated and partially substantiated. 43% were for increased monitoring by social services, 22% by a carer, family or friends,), 13% by health service(s) and 22% not specified.
17 of 66 Page 52 LSAPB annual report 2011-2012 Section 3
Partner Agencies Reports
Age UK Lambeth’s mission is to support and work with older people to achieve a full and enjoyable quality of life. We provide a range of services and activities including Information and Advice, Handyperson Service, Befriending, Vida Walsh Activity Centre. Celebrating Age Festival. In October 2011 we launched the Lambeth Resolve information, advice and advocacy hub, funded by Lambeth Council and delivered by a partnership of local voluntary organisations.
Julia Shelley, Chief Executive Officer of Age UK Lambeth is a member of the Board, representing the Health and Wellbeing Voluntary and Community Sector Forum, and also feeding back to Safeguarding Adults is referenced in a range of relevant policies and documents
The Charity ensures all staff and volunteers have the understanding and skills to carry out their roles and duties. It trains staff and volunteers commensurate with their role. Staff and volunteers are expected to report concerns in accordance with the Multi Agency Procedures through the organisation’s line management structure and to cooperate with safeguarding adult investigations as appropriate . Training is supplemented by information dissemination within the organisation
Older people are enabled to keep safe through newsletters, Age UK leaflets, and the distribution of helpful hints.
What the Trust provides
The Trust provides mental health and substance misuse services for people living in the London Boroughs of Croydon, Lambeth, Lewisham and Southwark, and substance misuse services for people who live in Bexley, Bromley and Greenwich.
Our local communities have very high levels of mental health needs - up to six times the national rate of psychosis in some areas. There are also high levels of
18 of 66 Page 53 LSAPB annual report 2011-2012 social deprivation and substance misuse, and an ever-changing population, including high numbers of refugees.
How the Trust Safeguards Adults at Risk
The designated community based service areas are responsible for managing safeguarding cases that fall within their remit, including carrying out investigations. All staff have a duty to identify the possible abuse of vulnerable service users and to raise an alert where appropriate through their manager.
The Executive Board member for Safeguarding is the Medical Director who chairs the Trust wide Safeguarding Committee attended by safeguarding leads from across the Trust. There is a clear local structure for managing the Trust’s Safeguarding Adult work reporting to and governed by the Trust wide Committee through this process the Committee ensures that
• All staff and volunteers at trained at an appropriate level as part of a mandatory training programme to ensure that they have the understanding and skills to carry out their roles and duties. Information updates are also disseminated through the safeguarding adult co-ordinator. • A safe recruitment policy is in place. • Effective support and guidance is available for all staff from, and through the Safeguarding Adults Coordinator, the London Borough of Lambeth and in formal supervision . • Concerns are reported as appropriate through the Multi-Agency Framework • Relevant staff co-operate with investigations • Information and advice is available to patients and their carers and or supporters • Patients and relevant others are supported and advised through the process as appropriate • Monitoring Information is collected to advise the work of the Lambeth Safeguarding Adult Partnership Board
Developments this year
Mandatory training levels have been identified for all staff. Awareness sessions have been held in all relevant service areas. Regular monitoring meetings are in place for all community teams that have responsibility for accepting referrals and carrying out investigations.
All staff have access to the Multi-Agency Policy and Procedure and other relevant documents. Appropriate links are in place with related services such as domestic violence [MARAC], hate crime and anti-social behaviour [Vulnerable Victims Panel] and Self Directed Support Panel. Incidents are investigated under the Serious Incident policy (in accordance with the NHS guidance on safeguarding adults and clinical governance), and outcomes monitored by the SI panel in the CAG.
A cross-CAG Lambeth Interface meeting is being developed which will include a core focus on Safeguarding.
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Safeguarding Adults at Risk Annual Report 2011 - 2012
1.0 Introduction
1.1 The following annual report provides an overview of the activity which has been undertaken within the Trust around safeguarding the welfare of adults at risk during the last 12 months. It sets out details on the key developments and progress both internally and with our external partners.
2.0 Adults at Risk Activity during 2011 - 2012
2.1 Referrals from Acute Services
April 2011 – Q 1 Q 2 Q 3 Q4 Total % increase from March 2012 2010-2011
Safeguarding 92 83 112 93 380 50% Adults Referrals
2.1.1 The referrals are reviewed and audited each quarter. There has been a fifty percent increase in referrals to safeguarding over the last year. Most of the referrals were from A&E and the admission wards. There is an increase in referrals from the Guy’s site over the last year compared to the year before. There has been a safeguarding co-ordinator based at Guy’s hospital over the last year which has strengthened practice.
3.0 Training
3.1 Acute Services Training Data
Month Number trained Percentage of Total to date compliant staff Number to train Mar 2011 3617 65% 5568 Apr 2011 3750 67% 5581 May 2011 3822 68% 5588 June 2011 3792 69% 5505 July 2011 3803 69% 5520
20 of 66 Page 55 LSAPB annual report 2011-2012 August 2011 3789 68% 5548 Sept 2011 3760 67% 5591 Oct 2011 3905 68% 5708 Nov 2011 4066 72% 5675 Dec 2011 4205 74% 5703 Jan 2012 4255 75% 5689 Feb 2012 4296 75% 5695
3.1.2 Over the last year there has been a 10% increase in the numbers of people trained in safeguarding adults within the acute hospital setting.
3.2 Community Training Data
Month Number trained Percentage of Total to date compliant staff Number to train Nov 2011 167 19% 892 Dec 2011 167 19% 885 Jan 2012 187 21% 872 Feb 2012 427 48% 890
3.2.1 The community health services training data is as above. The numbers of staff trained in safeguarding adults started at 19%. This may not be a representative figure as staff have previously accessed safeguarding adults training in the community, but the data was not centrally collated and so not readily available as yet.
3.2.2 Work was undertaken to capture the training data and also to increase the numbers of staff trained. There were 12 training sessions organised for the community and these were well attended. This resulted in a 27% rise in staff trained between January and March 2012. The extra sessions will continue into the new financial year.
4.0 Safeguarding Team Structure and Governance arrangements
4.1 The safeguarding adults team has been expanded following received significant investment from the CQUIN monies, to improve and enhance the care delivered to patients who have dementia and or delirium over the next two years.
4.2 The safeguarding team together with the Dementia working group and the Dementia Trust lead will oversee the embedding of the Dementia and Delirium standards for care across the Trust.
4.3 The team now comprises the following posts:
• Safeguarding adults lead (community) • Safeguarding adults lead (acute) • Dementia and Delirium Clinical Nurse Specialist (community)
21 of 66 Page 56 LSAPB annual report 2011-2012 • Dementia and Delirium Clinical Nurse Specialist (acute) • Safeguarding Adults trainer • Safeguarding Adults administrator
All the above posts are have been recruited into.
5.0 Objectives for 2012 – 13
5.1 The key objectives for the safeguarding team are to: • embed the agreed standards of care for patients with dementia and delirium across the Trust. • Achieve the Dementia CQUIN training targets set for 2012 – 2013. • Achieve 95% compliance in staff having received the safeguarding adults training across the acute and community services.
Introduction.
This document provides an update to Lambeth Police’s approach and policing activity undertaken towards Safeguarding Adults at Risk and will be provided to the LSAPB annual report.
Lambeth Police Executive Board member for Safeguarding is Detective Superintendent Martin Huxley, Head of Lambeth Borough Criminal Investigations Department and Deputy Borough Commander.
Providing a Policing response to Safeguarding Adults requires contributions from a number of different units across the BOCU. This contribution includes Partnership, CID and Custody. The police service recognises their responsibilities within the Safeguarding Adults at Risk Policy (SARP) and the SAR Standard Operating Procedures (SOP). Corporately Safeguarding Adults at Risk is managed by the CSU delivery team.
The Department of Health document ‘No Secrets’ (Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse) defines a vulnerable adult as a person aged 18 years or over.
“who is or may be in need of community care services by reason of mental or other disability, age or illness; and Section 2 who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation”.
Recognising that at certain times throughout our lives we all may be vulnerable it is MPS policy to use the terminology 'Adults at Risk'.'
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1. Safeguarding Adults at Risk (Abuse Investigations)
Adults at Risk who experience abuse or have been subject to a crime that has been perpetrated on them by a person:
• in a position of authority • where there is an expectation of trust • who has been providing them with care either in a care setting (e.g. care home, hospital) or in their own home or • Where the crime manager has particular concerns about the risk to or vulnerability of the victim or the impact of the incident on the community are dealt with by the Community Safety Unit .
Forms of abuse recognised as falling under this policy include physical, psychological, financial, sexual or neglect. These will often constitute criminal offences.
Perpetrators deliberately targeting adults because of 'hatred' towards them will be covered within the Hate Crime SOP. Opportunistic crimes against adults at risk such as burglary artifice, offences of robbery by an unknown suspect, or unattended motor vehicle broken into to steal a 'blue' badge are not covered within this SOP and are dealt with by the appropriate specialist unit, i.e. Burglary Squad. These investigative units will make any necessary referrals to partnership agencies. I.e. raise safeguarding alerts.
Appropriate flags are to be entered on the Crime Recording Information System (CRIS) system. The AA Flag is to be applied for all Adults at Risk reports. The VA flag is applied for incidents in which the victim was targeted due to their vulnerability. Victim Codes of Practice must be used to identify all vulnerable victims and witnesses.
The following table outlines offence vs. Sanction Detection Performance for Safeguarding Adults offences.
1/4/2011 – 31/03/2012 1/4/2012 – 7/8/2012 Flag AA VA AA VA Offences 18 11 6 2 SD’s 2 0 2 0
Initial Risk Management of Safeguarding Adults (Abuse) crime reports are undertaken by the Risk Management Unit in the CSU. This small team has been strengthened this year by identifying a bespoke supervisor. They undertake RARA risk assessments in consultation with the officer in the case using their experience of strategic partners to identify support for the victim where appropriate.
23 of 66 Page 58 LSAPB annual report 2011-2012 CSU Investigations have now been added as an agenda item at the PTPM Meeting with the Borough Crown Prosecutor so attrition rates and anticipated issues can be discussed. This has provided focus for risk management and an opportunity for organisational learning for the CPS and BOCU.
2. Safeguarding Adults at Risk (Welfare & Support)
2.1. Mental Health
Policy
The Policy governing the Metropolitan Police’s approach to dealing with situations involving Mental Health is laid out in “Policing Mental Health SOP 2008”. The document is under review and the updated version is due for circulation by September 2012. Lambeth Borough also have a local agreement with Slam for dealing with detentions under section 136 of the Mental Health Act and to provide operational assistance and support where Slam wish to undertake activity where a risk to safety exists. Lambeth Police and SLaM are signatories to the over arching Crime and Disorder Partnership Information Sharing Protocol. Lambeth Police and SLaM are signatories to the Purpose Specific Information Sharing Agreement.
Meetings
Overall partnership activity and strategy is discussed at the Lambeth Borough Commander and Lambeth Chief Executive Meeting. Specific Mental Health issues are discussed at the quarterly SLaM trust wide and Police Meeting, and bi-monthly at the SLaM and Lambeth Police Meeting.
Training
Lambeth has one of the largest demands due to Mental health Incidents in Europe and a plan is in place to build on existing corporate Mental health training to improve service delivery.
There is mandatory computer based mental health training package for all Metropolitan Police Officers and this is reinforced during the compulsory Officer Safety training programme for Metropolitan Police Officers. Officer Safety Training takes place once a year. Officers are made aware and briefed on updates to Mental Health policy and procedures through email.
A Mental Health awareness input will be delivered to Lambeth Officers on the 5th and 6th of October by the Metropolitan Police Mental Health Team. Direct Q and A sessions have been built into future parades where the Police Officer attached to Kings College Hospital will be attending to answer questions from officers regarding the use of section 136 of the Mental Health Act.
24 of 66 Page 59 LSAPB annual report 2011-2012 The internal Lambeth Borough intranet site has links to numerous mental health documents and reference material.
Planed Mental Health Assessments
This is when SLaM request assistance from Lambeth Police to conduct a mental health assessment. On average SLaM make 20 requests per month.
Vulnerable Victims with mental health problems
Lambeth Police are active members of the multi agency Vulnerable Victims of ASB Panel since it began in July 2010. Lambeth Police make referrals to the panel, as well as providing information on active cases and have permanent representation at the monthly Case Conference.
Between April 1, 2011 and March 30, 2012, 11 high risk cases were referred to the panel by Lambeth Police where the victim had a mental health problem.
Effective Practice
A weekly crime reporting surgery has been set up by Lambeth Police at Landor Road Hospital to report and carry out the initial investigation of low level crime that occurs at the location. Crime reports are reviewed by a central MPS unit who make a decision on whether or not a secondary investigation takes place.
Vulnerable Victims
All identified vulnerable victims of crime and ASB are subject to risk assessment by their Safer Neighbourhood Team. All individuals graded as High risk are referred to vulnerable victims’ case conference. There have been 83 high risk cases mitigated in the last 2 years using partners and supporting agencies. Every victim of ASB receives a Police contact to ensure effective support is tendered.
2.2. Custody
The treatment of detained persons is laid out in the Police and Criminal Evidence Act 1984 specifically Code C of the Codes of practice. Specific mention is made of detainees suffering from ill health or Mental Health conditions. Where detainees present with Mental Health issues they are triaged by Custody Nurse Practitioners any health issues identified are sign posted appropriately. The custody team has an array of resource contacts to draw on for support and guidance. The Custody Officer undertakes a Risk Assessment of detainees at the point detention and at the conclusion of detection. Where a detainee is being transferred into the custody of the court (i.e. Serco etc) a handover form is completed to ensure continuity of awareness and care.
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MPS nurses are trained internally by the MPS and SLaM provides specific localised Mental Health training for Nurses working in Lambeth Custody suites.
2.3. Drug Intervention Project
Any detainee over 18 who falls within the parameters of the Drug Intervention Program is tested then interviewed by DIP workers. Anyone under 18, if they request or there is an immediate threat will be given the opportunity to speak to a drugs worker. The Drugs Worker can decide not to speak to the young person; however most do and will be given sign posting advice.
2.4. Missing Persons Unit (Op Compass)
The investigation of missing persons is controlled via the Investigation of Missing persons, Unidentified Persons and ‘Hospers’ SOP. The ACPO definition of a missing person is: "Anyone whose whereabouts are unknown whatever the circumstances of disappearance. They will be considered missing until located and their well-being or otherwise established."
There will be occasions when it is necessary to classify a missing person enquiry as a critical incident. The MPS definition of a critical incident is: "Any incident where the effectiveness of the police response is likely to have a significant impact on the confidence of the victim, their family and/or the community."
Risk Assessment
Missing Person reports are subject to a risk grading and this helps determine the allocation of resources to manage the investigation.
High Risk - The risk posed is immediate and there are substantial grounds for believing that the subject is in danger through their own vulnerability; or have been the victim of a serious crime; or the risk posed is immediate and there are substantial grounds for believing that the public is in danger.
Medium Risk - The risk posed is likely to place the subject in danger or they are a threat to themselves or others. Low Risk - There is no apparent threat of danger to either the subject or the public.
Immediate High Risk Missing Persons Investigations are carried out by the CID Main Office enabling a 24 hour response using officers with the necessary skill set to progress the enquiry at speed. Lambeth BOCU have improved the standard of missing persons reporting. This has included dedicated missing persons reporting cars deployed during each shift, training and enhanced supervision to ensure consistency of reporting and recording.
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Any Missing Person identified with risk or vulnerability issues will be considered for referral to Mental Health or Adult Services. Links are in place to support this both within the service and externally. The Missing Persons Unit work closely with local hospitals to help identify and notify next of kin, where no relative or friend has been informed (Hosper).
Each missing person is subject to a debrief once they are found or returned home. One of the purposes of this is to establish any underlying issues (e.g. sexual exploitation) whereupon the necessary referrals take place.
2.5. Jigsaw Unit
This unit manages registered sex offenders (RSO's), violent offenders and potentially dangerous offenders. Management of these individuals is achieved by direct contact with offenders and through partnership work with the Multi Agency Public Protection Panel (MAPPA/MAPPP).
The issue of 'Adults at Risk' is an integral part of MAPPA discussions, whether it be the offenders themselves, their families or victims.
Safeguarding is an agenda item at MAPPA meetings. Mental Health, Housing and Social Care are represented at these meetings consequently any se issues are always addressed and supported by the panel.
We recently tested the need for the Safeguarding Adult Social Work Manager to attend the meetings and this is being considered by him as to whether it is necessary for him to be a panel member or just be contacted with regard to any support/actions required.
We have on Lambeth a good working relationship with the Safeguarding Manager for the Southwark Diocese. Her work can include support, through an appropriate church for those adults who offend and are vulnerable, need respite in a safe environment.
2.6. Prostitution
Lambeth BOCU have a dedicated Vice Team which links in with the Violence against Women and Girls Board. Over the previous year they have undertaken a victim based strategy where sex workers are treated as victims and referred into supporting agencies. Joint performance indicators ensure girls are referred for drugs support and follow up from support agencies. 70% of those involved in street prostitution have a history of local authority care and 45% report experiencing sexual abuse during their childhoods (Home Office 2006). Many enter prostitution before the age of 18. Once in prostitution, 9 out 10 surveyed women would like to exit but feel unable to do so.
Lambeth BOCU Vice Unit maintain an enforcement capacity and undertake Intelligence led operations to target the users of prostitutes.
27 of 66 Page 62 LSAPB annual report 2011-2012 They have taken action against over 100 Kerb crawlers in the past 12 months. The allocation of resources to this unit has ensured that 2 planned vice operations per month have been able to take place to target users of SSWs and to identify and support SSWs. The unit is keyed into the Lambeth BOCU VAWaG strategy to develop a MARAC style process to women involved in prostitution, increasing the focus on tackling demand through deterrent and enforcement tactics.
3. Proposed Activity for the next twelve months.
Set in place joint training to improve the response to incidents involving mental health. Look at building on the joint operations currently being run between Lambeth Police, Southwark Police and support workers providing support and enforcement to the street population. Respond to changes necessitated by the Local Policing Model and Total Policing to Policing Public Protection through an action plan aimed at ensuring business continuity and improving service delivery.
The Trust
King’s College Hospital NHS Foundation Trust (Kings) is situated on the borders of Lambeth and Southwark. The Trust is a large teaching hospital delivering a full range of services for the local population and specialist services to patients nationally and internationally. The Trust’s client group is complex and challenging, combining an ethnically and culturally diverse local inner city population, from areas of high mobility and social deprivation, with a non-local cohort of patients with additional vulnerability due to chronic illness or severe injury/trauma. The Trust is one of the UK’s largest and busiest teaching hospitals. With approximately 7000 staff and 900 inpatient beds, who’s values are: “ our values have been created by the people of Kings-we see ourselves as a team working together for the benefit of our patients”:. Kings has a ‘zero tolerance’ towards abuse and will take positive action where abuse has been identified.
Safeguarding Adults team
King’s Safeguarding Adults Team provides a point of contact for all staff who wish to raise concerns about an adult at risk. The team structure consists of the Safeguarding Adults Coordinator a Learning Disabilities Coordinator and a Safeguarding Adults Administrator. The team provides advice, support and
28 of 66 Page 63 LSAPB annual report 2011-2012 training in relation to Safeguarding Adults. The safeguarding adults team have built a bespoke database to record and audit their referrals.
If an alert is received regarding Kings Services it will be addressed in compliance with the Kings’ Safeguarding Adults Policy, which was revised in August 2010, and is available to staff on the King’s intranet. The policy is compliant with the London Multi-Agency Safeguarding Adults Policy and Procedure Protocol (January 2010). For Lambeth based patients, the coordinator and team often liaise with a range of services in Lambeth, to ensure the smooth pathway of the patients’ journey.
Safe Recruitment
The Trust adheres to the mandatory Employment Check Standards issued by NHS Employers and Government legislation, which supports safeguarding. In December 2009 KPMG completed an independent audit of the Trusts recruitment procedures and reported a ‘substantial assurance’ to the Board of compliance with its own procedures and the Employment Check Standards. In September 2010 the Trust was awarded the highest level of achievement to reduce its litigation premium. This included an analysis of pre-employment checks. The Care Quality Commission conducted a check on pre-employment checks additionally on the 3 December 2010 and were satisfied with our compliance. All contractors (including for bank/agency/locum staff) are asked to confirm that they fully comply with the NHS Employment Check Standards and that they have appropriate governance and audit procedures in place to assure compliance with their own procedures. We have an internal departmental process to further check compliance against the Standards by way of independently checked monthly recording. The monthly checks are reported to the Senior Human Resources Management Team.
Training
Safeguarding Adults training is mandatory for all staff and two levels of training are available.
Level 1 awareness was delivered in a leaflet to all staff and currently we have 96% compliance
The Level 2 course for ‘hands on’ is delivered in a ‘face-to-face’ format, on induction, monthly education slots and bespoke training for individual areas. The training covers: • an essential overview of the Safeguarding Adults policy framework, including the relationship between the King’s and the Lambeth policy documents • key indicators of an adult at risk, and the core abuse types and types of safeguards • how to raise an alert • MCA and DoLS
30% of staff have been trained to date
29 of 66 Page 64 LSAPB annual report 2011-2012 Monitoring
All alerts are logged onto a secure database for critical analysis and share daily and weekly data with multi agencies on a need to know basis. The database has been Caldicott certified.
Identification of Adults at Risk
Staff are trained to identify adults at risk through factors of vulnerability and categories of abuse. The DH ‘No Secrets’ paper and Pan London procedures support this process and have been embedded in the safeguarding policy and guidance at Kings. There is both an electronic and paper based system of making alerts and the Emergency department is able to highlight ‘special cases’ for high risk and LD patients.
Governance The work of the King’s Safeguarding Adults Team is directed by the King’s Safeguarding Adults Steering Group, a multi-disciplinary group encompassing a wide range of key representatives. The King’s Safeguarding Adults Steering Group is represented by the coordinator at the Lambeth Safeguarding Adults Partnership Board. The team provide quarterly reports to the Quality and Governance Committee.
Achievements
• Healthy Passports on intranet and Kings internet website • Nursing Times safeguarding adults article accepted for publication • Learning disability service user featured on ‘24 hours in Accident and Emergency’ Channel 4 series • Trust wide Mental capacity relaunch • Mental Capacity Audit • Safeguarding adults database further developed and Caldicott certified • Level 1 safeguarding awareness training 100% compliance via November 2011 payslip leaflet • Reduction in paper based working aiming for paperless system • Working with Age UK Opening Doors LGBT project for older LGBT people
Lambeth Safeguarding Adults statistics (April 2011-March 2012)
16
14 14
12 12 12 11 10 10 10 10 9
8
6 6 5 4 4 4
2
0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
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Of the 107 cases of alleged abuse, 5 relate to King’s college care and 1 to SLAM care and 1 to care from both KCH and SLAM. Of these alleged abuses, there were 2 allegations of neglect, 1 of sexual and 4 of physical abuse
The sexual abuse allegation was unsubstantiated; the allegation of physical abuse by a SLAM member of staff was inconclusive as the patient declined to continue with a police investigation; the other 3 allegations of physical abuse were unsubstantiated; joint KCH / SLAM case is pending the outcome of a serious case review due in the Autumn 2012
Lambeth Safeguarding Adults statistics (April 2011-March 2012)
25
20 20
Not known Other Adult at Risk 15 Partner Professional Relative / Friend 11 10 Self 10 Service Provider 8 8 8 Social Care Worker Stranger 5 5 5 4 4 3 2 2 2 2 1 1 11 1 1 1 11
0 Financial Neglect Physical Psychological Self Neglect / Sexual Harm
Breakdown of Safeguarding adults referrals by ethnic group
Ethnic group 87 Not specified 8 White 3 Black African 8 Black Caribbean 1 South American
The London Borough of Lambeth has the lead co-ordinating role for safeguarding adults at risk from abuse, across all partner agencies, as set out in the Department of Health guidance ‘No Secrets’. This responsibility is both with regards to multi-agency strategic development and to most investigations into individual circumstances of abuse. Multi-agency investigations into abuse of
31 of 66 Page 66 LSAPB annual report 2011-2012 adults at risk who require or may require Community Care services due to their mental health are managed and coordinated by the local mental health trust (SLaM) and are led by the Community Health Teams. All other investigations are managed and coordinated by Care Management teams in Adult and Community Services of the London Borough of Lambeth.
The safeguarding adult work undertaken across the LB Lambeth is governed at strategic level by the Safeguarding Adult Internal Executive, which reports to the Adult and Community Services Departmental Leadership Team. The Internal Executive has a key responsibility to monitor the standard of safeguarding adult operational work undertaken by the Adult Care Management teams but also ensures that other divisions within the Department and other Departments of the Council are paying due regard to their responsibilities with regards to safeguard adults at risk.
The Executive Director of Adult and Community Services is the corporate lead for safeguarding adults within Lambeth Council. The Executive Director brings any matters relevant to safeguarding adult work, where the London Borough of Lambeth needs to establish a corporate response or approach, to the attention of the Strategic Leadership Board of the Council and to key elected members.
Much of London Borough of Lambeth’s work is already set out elsewhere in this report reflecting the co-ordinating role played by this organisation. This includes • its role in developing and leading the work of the Safeguarding Board; • the training facilitated; the collection and analysis of data relating to safeguarding adult activity, and • ensuring synergies in the work undertaken by the Board with that underway within partner agencies.
All these responsibilities are undertaken by the Adult and Community Services Department.
There is a specialist Adult Safeguarding Unit within Adult and Community Services. Its aim is to support a more effective and more consistent response to safeguarding issues across the Borough. It does this through:
• giving advice and support on individual cases; • informing the commissioning of safeguarding training • oversees the Mental Capacity Act work in Lambeth, including administration of the Deprivation of Liberties safeguards assessments for both London Borough of Lambeth and NHS Lambeth; • developing policy and strategy on safeguarding and on the Mental Capacity Act for Adult and Community Services and for the Safeguarding Partnership Board; • Leading on the quality assurance of work to safeguard adults at risk
Operational staff maintain links with other systems for keeping adults at risk safe and report back through the sub group system to the Board. Adult Safeguarding Unit members represent Adult and Community Services at the monthly Multi- Agency Risk Assessment Conference (MARAC) meeting and the Vulnerable Victims of Anti Social Behaviour monthly risk assessment meeting. The Head of
32 of 66 Page 67 LSAPB annual report 2011-2012 Adult Safeguarding sits on the steering groups for these. This ensures good management of the interface between these areas of community safety work and work to safeguard adults at risk.
The Adult Safeguarding Unit also participates in two joint sub-groups reporting to both the Children’s and the Adult Safeguarding Boards. One covers safe recruitment across all services and the other co-ordinates key cross cutting issues that need to be addressed jointly by the two boards. In addition, the representatives from Adult Safeguarding Unit attend the training and the policy sub-groups of the Safeguarding Children’s Board. This enables the two Boards to share resources, ensure that there is consistency in approach to safeguarding concerns across Children and Adult Services, and identify and develop areas in which joint training and development is required.
The Adult Safeguarding Unit also maintains links outside Lambeth, with other London Boroughs, the Department of Health, and the Social Care Institute of Excellence in order to ensure that Lambeth is aware of, following, and influencing best practice. Finally the Adult Safeguarding Unit maintains a list of “new and emerging developments” relevant to Safeguarding Adult work, a regular digest on developments is presented to each Board meeting.
“The primary focus of work to safeguard adults at risk is to offer the support and assistance they may need to live a life that is free from harm and abuse”
33 of 66 Page 68 LSAPB annual report 2011-2012
Section 4
Future Plans
The Board’s strategic objectives are;
1) To prevent abuse by ensuring that adults at risk receive safe and effective services, or are offered support to purchase these.
2) To empower adults at risk and those supporting them to recognise abuse and have the confidence to report concerns.
3) To offer an effective multi agency response to concerns that keeps the person that has been abused at the centre.
4) To work with the local community to make safeguarding adults everybody’s business and co produce local community services for people that are at risk of or have been abused.
5) To promote equality
6) To constantly improve services to safeguard adults at risk by learning from and contributing to national and local developments.
4.1 Working within this framework the Board’s plans for next year include:
4.1.1 Acting on the findings of National Serious Case Reviews
Winterbourne View Hospital
A BBC Panorama programme “Undercover Care the Abuse Exposed” was transmitted in May 2011. This programme showed patients with autism and learning disabilities living in Winterbourne View Hospital (a private hospital in Gloucestershire) repeatedly mistreated and assaulted by a group of staff . A Serious Case Review was commissioned by South Gloucestershire Safeguarding Adult Board and the Lambeth Safeguarding Adult Partnership Board has received a report on the findings of that review and its implications for Lambeth. .
The Board has asked relevant partner agencies in Lambeth to benchmark their arrangements against the findings of the Serious Case Review and to identify areas for improvement. The Board plans to undertake a piece of bespoke multi agency work in 2012 to address the risk of a similar institutional abuse going unnoticed in Lambeth as it did in South Gloucestershire by March 2013.
34 of 66 Page 69 LSAPB annual report 2011-2012 4.1.2 Improve the safeguards available to people who purchase their own care
The Board also plans to scrutinise the arrangements in place in Lambeth to empower people that are purchasing their own care and support to make safe arrangements over the next year
4.1.3 Increase engagement with the community.
The Board is confident that the foundation of a local Action on Elder Abuse group this year will increase knowledge and understanding within the community about elder abuse and how to report concerns. It is optimistic that once established the user experience group will be able to advise the Board on the best way to engage adults at risk and the community on the safeguarding adult agenda
4.1.4 Offer an effective multi – agency response to concerns
A Quality Assurance scheme has been implemented this year within Lambeth Care Management services. This currently looks at the quality of individual pieces of safeguarding casework undertaken by social workers and their managers. It is planned to extend this in 2013 to look at the way that safeguarding adult work was undertaken in a multi agency context. The Board also intends to focus more strongly on the outcomes for individuals in the performance information it receives
A multi agency workshop using fictional cases to develop better multi agency approaches to responding to concerns is also planned for the forthcoming year.
4.1.5 Monitor the impact of the Disability Strand of the Hate Crime Action Plan
The implementation of the disability strand of the Hate Crime Action Plan should impact on the level of disability hate crime reported over the next year. The Board will be monitoring this closely through performance data. The Board will also receive reports of the work of the Vulnerable Victims of Anti social behaviour in Lambeth with a particular interest on measures taken to prevent “mate crime” directed at adults at risk.
4.1.6 Facilitate constant improvement in the multi agency arrangements to safeguard adults at risk
The Board ensures that any legislative developments with implications for safeguarding adults at risk are effectively implemented across all services. It has a standing item at all meetings where it evaluates, reflects and learns from local and national casework. It also implements any recommendations for improvement to service delivery contained in these developments. Changes to the arrangements for vetting and barring individuals working with adults at risk have just been put in place with changes in Criminal Disclosure arrangements anticipated by the end of the year. The Board will work through the Safer Recruitment Sub Group of both Boards to ensure that all relevant providers are aware and acting on these changes.
35 of 66 Page 70 LSAPB annual report 2011-2012 .
Appendix One
Board Members 2011-2012
Name Organisation
Jo Cleary Executive Director Adults & Community Services LBL (Chair)
Ash Soni PEC Chair NHS Lambeth (Vice Chair)
Bruce Grain Group Manager, Fire Service
Mala Karasu Safeguarding Lead, Guys & St Thomas’ NHS Foundation Trust Aisling Duffy Chief Executive, Certitude
Stephanie Adams London Ambulance Service
Cllr Jim Dickson Cabinet Member for Health and Wellbeing
Cllr Daphne Marchant Liberal Democrat Spokesperson for ACS LBL
Cllr John Whelan Group Leader (Conservative) March 2012 onwards
Cllr Claire Whelan September 2011-March 2012
Cllr Jane Pickard Deputy Cabinet Member Older People
Lindsay Batty-Smith Safeguarding Lead, Kings NHS Foundation Trust
Martin Ryan Borough Crown Prosecutor Lambeth
Lucy Canning Service Director and Joint Leader, Psychosis Clinical Academic Group SLAM
George Marshman Divisional Director Adults Social Care & Community Safety
Julia Shelley Chief Executive, Age Concern
Rachel Sharpe Divisional Director, Housing LBL
Helen Charlesworth-May Divisional Director Commissioning & Strategy LBL
Martin J Huxley Detective Superintendent, London Metropolitan Police
Adam Kerr ACS London Probation Trust
Ann Corbett Asst Director Community Safety
Ade Adetosoye Assistant Director, CYPS
36 of 66 Page 71 LSAPB annual report 2011-2012 Theresa Joyce Trust MCA & Safeguarding Adults Lead, SLaM
Michael English LINK (Local Involvement Network) Lambeth representative
Deborah Parker Associate Chief Nurse, Guy's and St Thomas' NHS Foundation Trust
37 of 66 Page 72 LSAPB annual report 2011-2012
Appendix 2
Terms of Reference Lambeth Safeguarding Adults Partnership Board Agreed April 2011
1) Introduction
The purpose of this document is to outline the role structure and governance arrangements of the Lambeth Safeguarding Adults Partnership Board (LSAPB), the expectations of Board members and member organisations.
2) Role
The Lambeth Safeguarding Adult Partnership Board (LSAPB) is a multi agency strategic body with key responsibility for
i. Oversee and develop the inter-agency safeguarding adult arrangements across the borough ii. Scrutinise and develop the multi-agency arrangements to meet the statutory responsibilities contained in the Mental Capacity Act and Deprivation of Liberty Safeguards across the borough iii. Agreeing how local agencies will work together and co-operate to promote and safeguard the welfare of adults in Lambeth. iv. Ensure that statutory requirements, codes of practice and good practice guidance relating to safeguarding adults at risk and the Mental Capacity Act are correctly and effectively implemented in Lambeth with a particular focus on ensuring that principles of the Human Rights Act (date) and the principles enshrined in the Convention on Human Rights (date) are implemented for adults at risk in Lambeth
3) Governance
The LSAPB is accountable to
• Health and Adult Services Scrutiny Sub Committee • Lambeth First Safer Lambeth Partnership Executive
The annual report of the LSAPB together with any specific information requested will be presented to both annually
4) Commitment from LSAPB member organisations
In order to achieve its vision and meet its aims and objectives member organisations of the LSAPB have agreed and are committed to:
38 of 66 Page 73 LSAPB annual report 2011-2012 1. Establishing safeguarding adults as “everyone’s business” 2. Protecting and promoting the capacity for independence, improved well being and sustained quality of life as appropriate for adults at risk. 3. Providing services in a manner that ensures adults at risk can stay safe, and be treated with respect and dignity 4. Providing services in a manner that ensures that the statutory requirements of the Mental Capacity Act are followed. 5. Providing appropriate levels of training, development and support for all staff and volunteers to enable the above objectives to be achieved 6. Participate in reviews and implement learning from serious incidents 7. Participate in joint performance management of safeguarding adult activity in Lambeth 8. Delivering to joint procedures for operational safeguarding and mental capacity act activity including information sharing protocols.
5) Commitment from LSAPB members
Members of the Board have agreed to work together to
1. Maintain a strategic oversight, leadership and direction to all those concerned with safeguarding adults work in the borough. 2. Be visible advocates of good practice in safeguarding adults and use learning from current practice to improve the outcomes for those at risk of abuse and neglect.
6) The Board’s Vision
The vision of the Lambeth Safeguarding Adults Partnership Board is to
1. Prevent abuse of adults at risk who: • Live in Lambeth • Receive services in Lambeth • Receive services outside Lambeth that have been assessed as meeting their needs by Lambeth’s statutory agencies • Receive funding by statutory agencies in Lambeth to purchase and manage the support they require to meet their assessed needs
2. Create and maintain a transparent, even handed and person centred multi agency service to safeguard adults at risk who may have been abused.
3. Ensure that the rights of adults at risk contained in the Mental Capacity Act and Deprivation of Liberty Safeguards are met
7) The Board’s Role and Objectives:
1. To give strategic direction to partner agencies and organisations including those that are not represented on the LSAPB and identify strategic aims for multi agency safeguarding adult and mental capacity work in Lambeth.
39 of 66 Page 74 LSAPB annual report 2011-2012 2. To promote public confidence in systems for safeguarding adults at risk within Lambeth.
3. To engage with adults at risk and their carers in order to gain their input in the development of policy, practice and procedures for safeguarding adults at risk.
4. To promote and develop strategies that aim to prevent incidences of abuse occurring across all agencies.
5. Identify and commit shared resources to support safeguarding work.
6. Ensure relevant strategic links are made with local, national & regional organisations
7. To commission regular quality audits across the partnership to assess compliance with the safeguarding adult standards. Recommend and or advise on areas for improvement
8. Commission and undertake Serious Case Reviews in accordance with the serious case review policy and ensure that lessons are learned and acted upon across all relevant agencies.
9. Ensure an effective multi agency policy and procedural guidance that will safeguard and promote the safety and wellbeing of adults at risk in Lambeth is adopted and disseminated.
10. Develop standards for the recruitment and supervision of persons who work in a paid or unpaid capacity with adults at risk (including the recruitment of staff by service users) and to monitor compliance with these standards.
11. Ensure that comprehensive and high quality training, development and support is delivered to meet the needs of staff volunteers, adults at risk and their unpaid carers across all agencies. Enabling them to work effectively together in order to safeguard adults at risk
12. Ensure that matters of diversity and equality are addressed within all aspects of safeguarding adults work.
13. Ensure that data collection systems for safeguarding adult activity are in place across the partnership. Receive reports which monitor quality of operational work, outcomes, patterns and trends in safeguarding adult activity. Ensure action is taken to address identified concerns.
14. Inform the planning and commissioning of adult health and social care and other services for adults at risk in order to ensure that these activities take account of safeguarding adult at risk issues.
15. The Board will review and plan its work on an annual basis and produce an annual report about safeguarding arrangements and activity during the
40 of 66 Page 75 LSAPB annual report 2011-2012 year. These will be presented to the Health and Wellbeing Board for approval and subsequently made available to the public.
41 of 66 Page 76 LSAPB annual report 2011-2012 Appendix Three
The Board’s Structure
LSAPB Membership:
Full members The Lambeth Safeguarding Adults Partnership Board is a multi agency partnership comprising of nominated lead officers from a range of key statutory, independent and voluntary sector organisations from within Lambeth. Membership will be reviewed annually. All members of the Board or a nominated representative are expected to attend meetings, report on the work of their organisation in relation to safeguarding adults at risk. They are also expected to ensure that the organisations they represent are following local arrangements to safeguard adults at risk, complying with national statutory requirements and following national good practice advice in relation to adults at risk.
Associated members The Board may identify associate members who will provide support or advice to the Board either on general matters or on specific areas of practice or law; these members will be invited to join the LSAPB as and when required.
Chair The Chair will be responsible for the effective and smooth running of the board and ensuring that the board remains objective and independent in order to monitor the effectiveness of all agencies involved in safeguarding practice. The Chair of the LSAPB will be either the Executive Director of Adult Social Care or an independent person
Vice Chair The Vice Chair will be appointed from one of the constituent agencies and must be at a senior executive level. The Vice Chair will deputise for the Chair in their absence The Vice Chair will be appointed with the agreement of the board members. If both the Chair and the Vice Chair are unable to be present at any meeting of the LSAPB a substitute Chair will be appointed from among and with the agreement of Board members.
Meetings: The Board will meet on a minimum of 3 occasions annually. A record of the dates of the meetings held and of members’ attendance will be included in the Annual Report of the Board.
Quorum for LSAPB meetings Meetings of the Board require a minimum of seven full members representing a minimum of four agencies including at least two statutory agencies. A member of the LSAPB representing the Local Authority must be at all meetings.
Extraordinary meetings
Calling extraordinary meetings
42 of 66 Page 77 LSAPB annual report 2011-2012 Any Board member may contact the Chair in writing to request an extraordinary meeting. The Chair will make the decision if a meeting is required and respond in writing to the Board member. Any extraordinary meeting should normally take place within ten working days of the request being received by the Chair.
The Chair may also decide to call an ‘Extraordinary Meetings’ at any time, and will give at least ten working days notice to members of the Board of the meeting.
Quorum for extraordinary meetings Extraordinary meetings of the Board require a minimum of four full members representing a minimum of three agencies, including at least two statutory agencies. A member of the LSAPB representing the Local Authority must be at all meetings
Records of extraordinary meetings A record of all extraordinary meetings and those that attended will be reported to the next full board meeting.
Chair’s Action Where an urgent decision is required between meetings and the Chair decides an ‘Extraordinary Meeting’ is not required, the Chair will take Chair’s action. Any decision made or action taken will be ratified at the next Board meeting and recorded in the Annual Report of the Board. In the absence of the Chair, the Vice Chair should be contacted to make an urgent decision or call an extraordinary meeting.
Key Links to other Groups and Boards:
The work of the board is linked to the work of
• The Safer Lambeth Partnership • Lambeth Safeguarding Children’s Board • Safeguarding the Welfare of Adults Board Guys and St Thomas’ Trust • London Borough of Lambeth Safeguarding Adults Executive • Kings College Hospital Safeguarding Adult Board • South London and Maudsley Safeguarding Board
The Board’s sub group structure
In order to implement its strategy the Board has a sub group structure. Some sub groups report to more than one board while others report exclusively to the LSAPB All sub groups report to the Executive Committee of the Board
The Executive Committee’s role in brief is to
• Acts as a conduit between the LSAPB and its sub groups. • Act as a conduit between the LSAPB and linked associated boards and partnerships • Considers reports from sub groups distilling the information if appropriate and forwarding the information to the Board for a decision
43 of 66 Page 78 LSAPB annual report 2011-2012 • Ensures the Board’s work plan is being delivered and report to the Board accordingly.
Terms of Reference approved by the LSAPB April 2011
Terms of Reference scheduled for review by 1 st June 2012. (delayed until March 2013 to synchronise with new strategy and business plan)
The Board and its sub-groups to be serviced by :
Lambeth Safeguarding Adult Unit
44 of 66 LSAPB annual report 2011-2012
Governance of the Lambeth Safeguarding Adult Partnership Board
Reporting structure for the Board
Health and Adult Social Care Scrutiny Committee
Lambeth Safer Lambeth Clinical
Partnership Commissioning Page 79 Executive Collaborative Board
Shadow Health and Wellbeing Board Jan 2013 +
Lambeth Safeguarding Adult Partnership Board
Children and Safer Recruitment Quality Assurance Policy into Practice Community Support Adults Sub Group Sub Group and Audit Sub Sub Group Sub Group reports to reports to Group LSAPB & LSCB LSAPB & LSCB LSAPB annual report 2011-2012
Appendix Four
Work of Sub Groups of the Lambeth Safeguarding Adult Partnership Board September 2011-2012
Name of Group Role of Sub Group September 2011 - Achievements Plans for September 201 2- Date established September 2012 September 2013 Number of meetings Executive Committee Performance manages the Role strengthened to give the Lead on the implementation of implementation of the Board’s work plan Committee responsibility for the the action plan following the
through the sub groups, and any joint sub Board’s risk register and work SCR into Mr A Page 80 group with the LSCB. plan. Ensure the 2011-2013 work Chair Mala Karusa GSTT Monitor progress made on the Board’s All items on the Board’s work plan is completed and a 2013 – Risk Register plan have been met or are in 2015 strategy and work plan Number of meetings: 4 progress for the Board is developed
Quality Assurance and Monitors the quantitative and qualitative Monitored in detail the Examine the detailed quality Audit Sub Group . information on safeguarding adult activity. performance information on assurance work on safeguarding activity safeguarding adults that will be completed by April 2013 with Number of meetings: 4 Recommend new policies procedures and Collected audits of particular regard to multi practice needed to improve the quality of safeguarding arrangements in agency work safeguarding adult work locally key partner agencies Chair Theresa Joyce SLaM September 2011- Develop and monitors an agreed Supported a safeguarding March 2012 communication and publicity strategy for awareness campaign for the work of LSAPB LSAPB.
LSAPB annual report 2011-2012
Policy into Practice Sub Advise the Lambeth Safeguarding Adults Established a revised training Establish shared document Group Partnership Board on changes that are strategy sites for key practitioners required to the multi-agency policies, across all agencies. Number of meetings: 3 procedures and guidance as a result of Commenced a programme of changes to legislation, national, regional training for front line staff Upload the good practice or local guidance, or operational guidance and other key experience. Agreed contents of the documents on to the shared practitioners’ handbook that will sites Develops multi-agency policies, compliment the London Chair Lindsey Batty Smith procedures and guidance procedures to safeguard adults Implement those changes once agreed at risk.
Community S upport sub Enable local community groups to set up Supported Action on Elder Support the development of a group services designed to prevent abuse of Abuse to set up a local group Service User Experience group Page 81 adults at risk in Lambeth or support adults and begin recruiting volunteers that will advise the Established May 2012 at risk that have been abused for a “buddy” service for older Safeguarding Adult Board people that have been abused Number of meetings 4
Chair Cllr Jane Pickard Vice Chair Cllr Daphne Marchant
47 of 66 Page 82 LSAPB annual report 2011-2012
Executive Summary of the Serious Case Review Report to the Lambeth Adults Safeguarding Partnership Board
Mr A
Susan Harrison Independent Chair Page 83 LSAPB annual report 2011-2012
1 Introduction
1.1 Mr A was found dead on the morning of 8 December 2010 at his rough sleeping site in a small sheltered alleyway in West London. He had been sleeping there for some months. When he died, there had been severe cold weather for some days. On post-mortem examination Mr A was found to have died from Pulmonary Oedema and Pneumonia and Hypertensive heart and kidney disease.
1.2 From October 1997 until his death, Mr A had contact and support from mental health and third sector housing support services in Lambeth. Contact between Mr A and services was not consistent over that period.
1.3 Lambeth’s Adult Safeguarding Partnership Board commissioned a Serious Case Review [SCR] to establish whether there were lessons to be learned from how local professionals and agencies worked together to safeguard Mr A. The full Terms of Reference for the review can be found at Appendix 1.
1.4 While reviewing historical records, the panel learned that in 2007 Mr A had been the victim of an alleged fraud perpetrated by a support worker. In agreement with the Lambeth Adult Safeguarding Partnership Board, the panel also took responsibility to ensure that any safeguarding actions that could be taken now in relation to the alleged fraudster were followed through.
2 Mr A
2.1 Mr A was born in Pakistan, lived in Afghanistan and moved to the United Kingdom in the 1970s. He was employed as a bricklayer for a number of years. Other family members also lived in the UK. He had some contact with his sister and his nephew who lived not far from London. He died a month before his 64 th birthday.
2.2 Records show that Mr A was known to mental health services in Lambeth from 1997. His contact with services was not consistent over that period. It is not entirely clear from records whether he was every registered with a GP during this time. It is certain that he was not in recent years.
2.3 Mental health records confirm that Mr A had a diagnosis of schizophrenia. He exhibited both positive delusional symptoms and negative symptoms evidenced in withdrawal and self-neglect. He was known to drink alcohol and the records suggest that his alcohol use was problematic.
49 of 66 Page 84 LSAPB annual report 2011-2012 2.4 It is likely that someone with these characteristics could experience compromised cognitive functioning and mental capacity. However, there is no evidence in the integrated chronology of service involvement that Mr A’s mental capacity was ever fully evaluated in the round.
2.5 Workers who worked closely with Mr A report that his command of English was sufficient to enable them to converse freely with him. This was confirmed by the shopkeepers who provided practical support when he was rough sleeping in West London.
2.6 The integrated chronology of service involvement evidences little thought to whether over the years there might have been ways of involving his family or wider cultural community in attempts to help him.
2.7 Untreated hypertension led to his untimely death. As heart and kidney damage was identified in the post-mortem examination, he had probably suffered from hypertension for some time.
3 Summary chronology • Born in Pakistan in January 1946. • Lived in Afghanistan, moved to UK in 1970s. • October 1997 – May 2003 – known to and receiving South London & Maudsley NHS Foundation Trust (SLaM) services. • It is not entirely clear from records whether he was every registered with a GP during this time. It is certain that he was not in recent years. • May 2001 – Tenancy with Metropolitan (MHT) started. • May 2003 – discharged from SLaM due to unwillingness to engage and refusal to accept treatment. • March 2007 – Re-referred to SLaM by Supported Housing Officer StMCP/MHT. • Late 2007 – Allegation of fraud against him. Although safeguarding episode started, this is not followed through to conclusion. • November 2007 – One Housing Group begin working with him offering him housing support services. • February 2008 – detained under s2 of the Mental Health Act (1983) for a short period. • March 2008 - Goes absent without leave and detention is discharged in his absence. • March 2008 – One Housing Group housing support attempt to re-engage with Mr A. • 2008 – Regular attempts by agencies involved with Mr A to liaise with each other and make contact with Mr A. • 2008/early 2009 - Attempts made to chase up what is happening in relation to alleged fraud.
50 of 66 Page 85 LSAPB annual report 2011-2012 • Late 2008/early 2009 – Arrears building up and attempts made to engage with Mr A to resolve these. • February 2009 – Nephew contacts services concerned about his uncle’s welfare and (alleged) theft of money. • April 2009 –Agencies continuing to liaise with each other. Arrears continue to rise. Eviction begins to be discussed. • July/August 2009 – MHT refer Mr A to Foundation 66 for Tenancy Support Service. • September and October 2009 – Utility company invoke vulnerability protocol and contact Lambeth Housing about cutting off electricity supply. • September 2009 – MHT have decided to make court application for a possession order in respect of property occupied by Mr A. • October 2009 – Continued liaison between agencies. Agencies agree that One Housing to withdraw involvement and SLaM and Foundation 66 to make one more attempt at engagement. Mr A identified as being a high risk of self neglect and alcohol misuse. • November 2009 – Foundation 66 and SLaM close case. • December 2009 – MHT make an application for a discretionary possession order. • January 2010 –Courts grant discretionary possession order. Arrears £1538.45. • March 2010 – SlaM staff attempt to meet with Mr A. SLaM worker states that she has contacted a solicitor on Mr A’s behalf as “we are aware that he has no capacity”. • March 2010 – Tenancy support officer phones SLaM requesting an assessment of Mr A’s mental state. • April 2010 – MHT advised that SLaM will be closing the case as Mr A was not engaging, was not a threat to the community or himself. • May 2010 – Eviction takes place in Mr A’s absence. He returns to his flat and also to the estate office not knowing of the eviction and attempts to break in. He is arrested and later released. Police have some initial concerns about his mental state but assessing doctor says there is no indication of mental illness. • Late Spring/Summer 2010 – Mr A begins sleeping rough in West London. • June 2010 – Foundation 66 close the case having learned that SLaM have also closed the case. • There is a note in the minutes of the Lambeth Adult Safeguarding Strategy Meeting (09/02/11) that it was reported that Mr A’s nephew took him to Lambeth Council’s Homeless Person’s Unit sometime during this period. It has also been reported that a referral to Lambeth’s Supported Needs Assessment and Placement (SNAP) team was either considered or made. No records have been found of these two events. • Autumn 2010 – Thames Reach Lambeth Street Outreach Response Team (SORT) engaging with Mr A at rough sleeping site. Mr A receiving practical support from local shopkeepers.
51 of 66 Page 86 LSAPB annual report 2011-2012 • October 2010 – Thames Reach Lambeth Street Outreach Response Team refer Mr A to SLaM START (homeless mental health outreach team). Referral is in process when Mr A dies, but had been delayed due to confusion that had arisen over the spelling of Mr A’s name. • November 2010 – SORT actively engaging with Mr A as the weather deteriorates. Repeated attempts to persuade him to move indoors. Increased concern by SORT and shopkeepers about his wellbeing. • Over this period until his death very active and persistent attempts to engage him. Mr A visited by SORT, shop keepers, London Ambulance Service and police. Chronology shows consideration of using various mental health and mental capacity legal powers by various agencies. Generally it appears that decisions not to use legal powers to safeguard him are based on judgements that he was making decisions with capacity. • 3-4 December 2010 – Mr A persuaded to go to a B&B. B&B decline to offer him accommodation and Mr A insists on returning to his rough sleeping site. • 7 December 2010 – Very heightened concern by all involved with Mr A. LAS attend and assessment record shows that Mr A has mental capacity. • 8 December 2010 – Mr A is found dead.
3 Serious Case Review
In the first instance, the SCR was tasked to examine
• The assessments that were undertaken to determine Mr A’s primary mental health diagnosis and cultural and language needs; whether risk assessments were undertaken; and whether these led to appropriately targeted services to address his particular risks and needs.
• Whether when faced with difficulties in engaging with Mr A, professionals who came into contact with him explored and acted on the referral routes, and legal duties and powers available to them to safeguard his best interests and whether they recorded their decision making.
And then
• Whether the agencies involved worked together as an effective system, with appropriate information sharing and joint planning, to ensure a shared understanding on Mr A’s needs and how best they could be met.
3.1 Duties of the services who worked with Mr A
3.1.1 The integrated chronology of service involvement does not throw up any major discrepancies between agency accounts of events.
3.1.2 Mr A was a man who had survived many difficult times. The records of mental health and third sector housing support involvement with Mr A
52 of 66 Page 87 LSAPB annual report 2011-2012 are clear that he was adept at avoiding and rebuffing intrusions into his way of life. In recent years many of those who tried to support him found him difficult to engage.
3.1.3 Mr A had serious diagnosed mental illness. He was known to consume high levels of alcohol. He was known to neglect his own wellbeing and safety.
3.1.4 The primary duty of services who worked with Mr A was to make a concerted attempt to carry out a comprehensive assessment of his mental illness and the relationship with his alcohol use; and then to develop and implement appropriate treatment and housing plans.
3.1.5 It is possible that supported housing might have offered a better environment for Mr A than an ordinary tenancy. Closer observation of Mr A’s mental ill health and alcohol use by on-site workers, might have informed better strategies for engaging with him. The integrated chronology of service involvement gives little indication that a review of Mr A’s housing tenure was ever actively pursued.
3.1.6 The records of service involvement with Mr A have many implicit assumptions that he was a man who was making decisions with capacity. His concurrent substance use and mental illness mean that it was possible that he had compromised cognitive functioning and mental capacity. Had this been appreciated by those who had regular contact with him, it would have provided another way of highlighting the overriding need to address his underlying mental ill health.
3.1.7 Mr A was originally from Pakistan and Afghanistan. Workers who worked closely with Mr A report that his command of English was enough to enable them to converse freely with him. His level of literacy is not commented on. The management reviews and chronologies supplied to the SCR have only very occasional comment on Mr A’s cultural, language and communication needs. There is little evidence of thought as to whether over the years there might have been ways of involving his family or wider cultural community in attempts to help him.
3.1.8 The integrated chronology reveals that agencies involved with Mr A were in discussion for some weeks before the court hearing preceding his eviction in early 2010. There is no suggestion in the chronologies that any party actively considered options other than eviction.
3.1.9 Options should have included a re-evaluation of his housing needs in the light of his mental state. The panel are clear that ending this
53 of 66 Page 88 LSAPB annual report 2011-2012 particular tenancy might have been an appropriate outcome, but with a managed transition to accommodation with on-site support.
3.1.10 Eviction without a robust alternative plan for addressing his housing, care and support needs is a failure of duty to an unwell man.
3.1.11 This mirrors the various occasions when Mr A was discharged from statutory mental health services because of his non-engagement. The integrated chronology reveals no detailed risk assessments being carried out at any of these points and no alternative care plans being put in place.
3.1.12 In summary the individual management reviews and chronologies do not reveal that anyone was working with a clear understanding of Mr A’s underlying needs, a care plan and risk assessments informed by his basic needs for mental wellbeing and appropriate housing.
3.1.13 In reviewing the range of involvement and engagement with Mr A over the years, panel members were clear that there were lost opportunities to directly address his mental illness and substance use. What outcomes might have resulted had things been done differently are impossible to predict. It is possible that Mr A’s mental illness and substance misuse might have proved difficult to treat. Records of involvement only reveal a repeated pattern of Mr A remaining unengaged in support that could have increased his life chances.
3.1.14 Despite Mr A’s challenging non-cooperation with the expectations of others, it was notable that some people tried very hard to stick with him. There are many examples of this.
3.1.15 Of particular note is the practical caring provided by the shop keepers near his rough sleeping site and the persistence of Thames Reach street outreach workers in his final days.
3.1.16 Over the years some workers managed to engage with Mr A quite effectively. Sadly the records do not record reflections on what strategies worked. It is of note that the shopkeepers who tended to him when he was sleeping rough also maintained good engagement despite his wariness.
3.1.17 It is to be regretted that these moments of success were not used by health, social care and support services as leverage for more sustained engagement in order to address his more fundamental need for treatment for his mental illness.
54 of 66 Page 89 LSAPB annual report 2011-2012 4 Cold weather planning
The SCR was also tasked to consider
• Whether the borough-wide emergency planning which was undertaken during the early winter of 2010 addressed the particular risks and needs of local rough sleepers.
4.1 The SCR Chair and Panel reviewed details of the emergency planning that took place in the borough in preparation for the winter of 2010/11. The evidence reviewed indicated that comprehensive planning and clear protocols were in place.
4.2 During the course of the SCR the panel heard that further work had been undertaken in 2011 and 2012 to focus on the needs of rough sleepers generally and specifically in relation to cold weather protocols.
4.3 The panel were also able to consider how the protocols were put into practice in support of Mr A’s circumstances. As the weather deteriorated, Mr A had very intensive support from street outreach workers. They were able to identify temporary hostel shelter as well as the option of a Bed and Breakfast hotel. Sadly, when a B&B declined to accept Mr A, he then insisted on returning to his rough sleeping site, declining alternative options.
5 Family Involvement
Finally the SCR panel was asked to review
• Whether agencies worked with family members (as appropriate) in developing plans for Mr A.
5.1 The independent panel chair made brief contact with a family member but the family member did not follow up offers to meet.
6 Alleged fraud
• While reviewing historical records, the panel learned that in 2007 Mr A had been the victim of an alleged fraud perpetrated by a support worker. It is alleged that this support worker diverted some £8K of Mr A’s benefits into a post office account in his name. A Safeguarding Alert was raised at the time.
6.1 During the course of the SCR, Lambeth Adult Safeguarding, Metropolitan Housing Trust and the Metropolitan Police have worked together to
55 of 66 Page 90 LSAPB annual report 2011-2012 investigate the historical events. It appears that the police investigation was closed when Mr A did not cooperate with the investigation. The Adult Safeguarding Process was not followed through to a conclusion.
6.2 If the alleged fraudster had indeed been found guilty of fraud and convicted, the interests of other vulnerable people could have been safeguarded.
6.3 During the course of the SCR Lambeth Adult Safeguarding, Metropolitan and the Metropolitan Police have worked together to investigate the historical events. It appears that the police investigation was closed when Mr A characteristically did not cooperate with the investigation. The Adult Safeguarding Process was not followed through to a conclusion.
6.4 If this alleged fraud had been followed through as a safeguarding episode to potential prosecution it might also have created an opportunity to bring Mr A’s mental capacity into focus.
6.5 The name of the support worker and their then employer are known. This has made it possible for Lambeth Council to refer the individual to the Independent Safeguarding Authority (ISA).
6.6 At the conclusion of this Serious Case Review, the ISA had been supplied with all the necessary information to follow up the allegations about the conduct of this individual.
7 Conclusions
7.1 Mr A died whilst sleeping rough in severe cold weather. Whilst the circumstances are shocking, sadly Mr A had lived many years with an untreated mental illness that would have caused him constant and intrusive psychological distress.
7.2 Failure to address this meant that amongst many other lost opportunities for well-being and a fuller life, he lost the opportunity to have his hypertension diagnosed. Treatment for hypertension requires compliance with life-long daily medication. Averting the sad outcome of heart and kidney disease would have depended on treating his mental illness sufficiently for him to be able to comply with hypertension treatment.
7.3 In 2009/2010 eviction proceedings were set in train in relation to Mr A for arrears which at the time of eviction totalled some £1500. Taking this course of action for someone who has full benefit entitlements and is mentally ill without an alternative housing plan was a failure to understand
56 of 66 Page 91 LSAPB annual report 2011-2012 Mr A’s underlying condition and basic needs and to develop appropriate care and support plans.
8 Recommendations 8.1 The Lambeth Adults Safeguarding Partnership Board receives a report of the extensive work that has been developed in Lambeth to address the needs of rough sleepers and hostel dwellers, including understanding how the Mental Capacity Act (2005) can be used to safeguard people in this context.
The Board should note that Lambeth is leading on this work in London
8.2 The full SCR report is shared with the working group that is developing this work.
8.3 The working group develop and disseminate a simple mental capacity assessment tool for people who withdraw from services.
8.4 The Board requires Lambeth Housing to lead on briefing the Lambeth Housing Associations Group (LamHAG) on the findings of this SCR. LamHAG members are asked to review their arrears escalation policies to ensure scrutiny of cases when eviction is being considered for mentally ill tenants, especially those who lack mental capacity.
The SCR panel understands that there is significant national guidance on this topic already, such as the Ministry of Justice Pre-action Protocol for Possession Claims.
8.5 Health and social care commissioners review the service specifications for local primary care, community and secondary care mental health services to ensure the care pathways for people with Mr A’s characteristics are clear, well understood and implemented within the services, and promoted externally to agencies working with such people.
8.6 If this review suggests funding gaps or resourcing issues, that these are considered by the Commissioners. The appropriateness for Lambeth of a Multi-Agency Safeguarding Hub could be considered as part of this work.
8.7 The Lambeth Adults Safeguarding Partnership Board asks that local mental health services, housing services and housing support services across all sectors review their operational policies to ensure that the needs and risks of people with Mr A’s characteristics are escalated when there is a risk of actions being pursued which are not in their best interests. Agency reviews should focus in particular on discharge and
57 of 66 Page 92 LSAPB annual report 2011-2012 eviction decisions and the quality assurance mechanisms that check whether all bases have been covered before services are ended.
8.8 Commissioners consider whether there are ways of enhancing the specifications for local services, including advocacy services, which would increase the opportunities for people in Mr A’s circumstances to benefit from advocacy.
8.9 The Lambeth Adults Safeguarding Partnership Board requests agencies represented in the Adult Safeguarding governance arrangements to review the understanding of the provisions of the Mental Capacity Act (2005) in local services. Based on the findings of that review agencies should implement any further training and promotional activity that they have identified to be required.
58 of 66 Page 93 LSAPB annual report 2011-2012
Appendix 1 - Terms of Reference – Serious Case Review Mr A
From October 1997 to his death on 8 December 2010 Mr A made use of mental health and housing support services in Lambeth. His contact with services was not consistent over that period. At the time of his death he was sleeping rough in severe cold weather. Lambeth’s Adult Safeguarding Partnership Board has commissioned a Serious Case Review to establish whether there are lessons to be learned from how local professionals and agencies worked together to safeguard Mr A. To this end the Serious Case Review will examine: 1. The assessments that were undertaken to determine Mr A’s primary mental health diagnosis and cultural and language needs; whether risk assessments were undertaken; and whether these led to appropriately targeted services to address his particular risks and needs.
2. Whether when faced with difficulties in engaging with Mr A, professionals who came into contact with him explored and acted on the referral routes, and legal duties and powers available to them to safeguard his best interests and whether they recorded their decision making.
3. Whether the borough-wide emergency planning which was undertaken during the early winter of 2010 addressed the particular risks and needs of local rough sleepers.
4. Whether the agencies involved worked together as an effective system, with appropriate information sharing and joint planning, to ensure a shared understanding on Mr A’s needs and how best they could be met.
5. Whether agencies worked with family members (as appropriate) in developing plans for Mr A.
It is anticipated that the Serious Case Review will not review the whole chronology of Mr A’s involvement with local services from 1997 until 2010, but rather will focus on the periods of time when either as a result of his own actions, or the actions of professionals to discharge him, Mr A was either at greater risk or had become less engaged with services targeted to meet his mental health needs.
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Lambeth Safeguarding Adult Partnership Board Action Plan Serious Case Review Mr A
No Recommendation Lead Lead Partner Partner Agencies How will the Delivery Board Agency with responsibilities relevant agencies Date Member to support demonstrate to the (s) implementation of LSAPB that this the recommendation recommendation has been met?
1 The Lambeth Adults Safeguarding HCM LBL Adult and SLaM NHS Trust Report to LSAPB April 2013 Page 94 Partnership Board receives a report of Community Services LBL Housing the extensive work that has been Services developed in Lambeth to address the needs of rough sleepers and hostel dwellers, including understanding how the Mental Capacity Act (2005) can be used to safeguard people in this context.
2 The full SCR report is shared with the GM LBL Adult and The report has been July 2012 working group that is developing this Community Services distributed (Met) work.
3 The working group develop and HCM/GM LBL Adult and All Partner agencies Working group April 2013 disseminate a simple mental capacity Community Services that provide or develop tool and assessment tool for people who commission services scope plan of work to withdraw from services. implement this.
LSAPB annual report 2011-2012
4.1 The Board requires Lambeth Housing RS LBL Housing LBL Housing Minutes of relevant Dec. 2012 to lead on briefing the Lambeth Services Services LAMHAG meeting Housing Associations Group made available to (LamHAG) on the findings of this SCR. Board members
4.2 It is recommended that LamHAG RS LBL Housing LBL Housing Relevant documents March members review their arrears Services Commissioners to be made available 2013 escalation policies to ensure scrutiny to Board members of cases when eviction is being considered for mentally ill tenants, especially those who lack mental capacity.
5 Health and social care commissioners HCM LBL Adult and SLaM NHS Trust Relevant section of April 2013 review the service specifications for Community Services LBL Adult and Commissioning
local primary care, community and Community Services documents to be Page 95 secondary care mental health services NHS Lambeth made available to to ensure the care pathways for people Board members with Mr A’s characteristics are clear, well understood and implemented within the services, and promoted externally to agencies working with such people.
6.1 If this review suggests funding gaps or HCM LBL Adult and SLaM NHS Trust Relevant section of April 2013 resourcing issues, that these are Community Services NHS Lambeth Commissioning considered by the Commissioners. Report to be made available to Board members
61 of 66 LSAPB annual report 2011-2012
6.2 The appropriateness for Lambeth of a AC LBL Adult and LBL Adult and Executive Committee December Multi-Agency Safeguarding Hub MH Community Services Community Services updated on MASH 2012 and (MASH) could be considered as part of and Metropolitan developments on a onwards this work. Police (Lambeth) six monthly basis
7 The Lambeth Adults Safeguarding HCM SLaM SLaM NHS Trust This will be covered April 2013 Partnership Board recommends that LC LBL Adult and LBL Adult and as part of the local mental health services, housing RS Community Services Community Services response to 3 and 4 services and housing support services LBL Housing across all sectors review their operational policies to ensure that the needs and risks of people with Mr A’s
characteristics are escalated when Page 96 there is a risk of actions being pursued which are not in their best interests. Agency reviews should focus in particular on discharge and eviction decisions and the quality assurance mechanisms that check whether all bases have been covered before services are ended. NB Implementation of this recommendation will particularly focus on agencies that are not acting as landlords to the adults at risk
8 Commissioners consider whether there HCM LBL Adult and SLaM NHS Trust Relevant section of April 2013 are ways of enhancing the Community Services LBL Adult and Commissioning specifications for local services, Community Services Report to be made including advocacy services, which available to Board would increase the opportunities for members
62 of 66 LSAPB annual report 2011-2012
people in Mr A’s circumstances to benefit from advocacy
9.1 The Lambeth Adults Safeguarding GM LBL Adult and Al Partner agencies This will be covered April 2013 Partnership Board requires agencies Community Services as part of the represented in the Adult Safeguarding response to 3 and 4 governance arrangements to review the understanding of the provisions of the Mental Capacity Act (2005) in local services.
9.2 Based on the findings of that review GM LBL Adult and Al Partner agencies This will be covered April 2013 agencies should implement any further Community Services as part of the training and promotional activity that response to 3 and 4 they have identified to be required.
Page 97
Initials Organisational Acronyms Helen Charlesworth May (HCM) LBL London Borough of Lambeth Rachel Sharpe (RS) Slam South London and Maudsley Lucy Canning (LC) Ann Corbett (AC) Martin Huxley (MH
63 of 66 Page 98 LSAPB annual report 2011-2012 Appendix Six
Glossary of Terms
Adult at Risk Adults who are ill, frail or have a disability and are unable to protect themselves from significant harm
Carers Family, friends or neighbours who provide unpaid support and care to another person. This does not include those providing care and support as a paid member of staff or as a volunteer
Commissioners The representatives of statutory organisations that purchase services from voluntary and independent sector organisations, through which they provide services to adults at risk
Direct payments Financial resources given to people so that they can organise and pay for the services that they need, rather than use the services that the council offers
Multi-agency Public Protection Arrangements (MAPPA) A statutory set of arrangements operated by criminal justice and social care agencies that seek to reduce the serious re-offending behaviour of sex and violent offenders to protect the public.
Partner agency One of the organisations who is a member of the Safeguarding Adult Partnership Board
Person who may have caused harm This is the person or persons who may have abused or neglected an adult at risk
Professional Individuals who meet specific qualification requirements and are registered with the relevant national governing body for that profession
Safeguarding Adults All work which enables any adult "who is or may be eligible for community care services" to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect.
‘Safeguarding Adults’ Partnership The formal group of organisations who are working together to implement measures to ‘Safeguarding Adults’ in a local area.
Self Directed Support Allocated funds to be used by or for the person to implement an agreed support plan in order to meet eligible needs for social care and support
Service provider An organisation that delivers services such as health and social care services.
Service User A person who is a customer/consumer of a service (particularly used in relation to those using social care services). Page 99 LSAPB annual report 2011-2012
Staff People who are paid to provide care and support
Supporting People A working partnership of local government, service users and support agencies which provides high-quality and strategically planned housing-related or support services
Volunteers People who provide services to adults at risk for no payment
Further Information
Documents referred to in this report available on the safeguarding adult web pages
• The Board’s Strategy 2011-2013 • The Board’s Business Plan 2011-2013 • London multi-agency policy and procedures to safeguard adults from abuse
Safeguarding Adults:
All work which enables any adult "who is or may be eligible for community care services" to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect”.
65 of 66 Page 100 LSAPB annual report 2011-2012 IF YOU SUSPECT ABUSE,
TELL US
Lambeth Adult Care Services 020-7926-5555 Police non-emergency 101 Emergency services 999
66 of 66 Page 101
Lambeth Safeguarding Adult Partnership Board Annual Report (Summary)
September 2011–September 2012
Page 102
Contents of this report
Foreword 3
Context 4
What happens when a concern is raised? 5
Pearl 6
Adam 7
The Board’s activity this year 8
Key performance figures 10
Appendix One
A glossary of terms 17
“Everybody has the right to lead a life where their dignity, human and civil rights are promoted and respected”
LSAPB Annual Report 2011-2012 (summary) 2 Page 103
Foreword from the Chair of the Lambeth Multi Agency Safeguarding Adult Partnership Board.
I am pleased to present the fourth annual report of Lambeth’s Safeguarding Adult Partnership Board. This report summarises what has been achieved during this year and our plans for the year ahead
The Board is now a well established partnership of agencies and organisations in Lambeth working together with a mission to create a community where adults at risk of abuse or neglect because of their particular circumstances are safeguarded.
The Board knows that this will only be achieved when safeguarding adults at risk is “everybody’s business”. The residents of Lambeth have already made it clear that they regard protecting vulnerable people as important 1 and with support from the community’s the Board is confident that a culture where adults at risk are treated with respect can be achieved in this Borough.
I would like to thank all members of the Board for their hard work over the last year and note in particular the contribution from our councillors, LINK and colleagues in the third sector. They have made sure that the voice of people at risk, their carers and the community is heard whenever we make decisions about how to improve services.
This report focuses on situations where something went wrong or could have gone wrong, but these are the exception. Most adults at risk that live in Lambeth continue to lead dignified, active and fulfilled lives. Their achievements are enabled and supported by the dedication, enthusiasm and commitment of staff, volunteers and unpaid carers combined with a culture of inclusivity within the local community and services.
This is the first annual report that includes the findings of a Serious Case Review. The review was undertaken by an independent panel on behalf of the Board. The panel looked at the circumstances that led to the death of a vulnerable man living on the streets in Lambeth. It has made recommendations so that a similar tragedy can be avoided and the Board has agreed an action plan to meet these recommendations.
I hope you find that this report interesting and thank you for your continuing support and commitment to safeguarding all adults at risk in Lambeth.
Jo Cleary Executive Director Adult and Community Services London Borough of Lambeth
1 2009 Lambeth residents’ survey
LSAPB Annual Report 2011-2012 (summary) 3 Page 104
Context
Q What do we mean by an adult at risk?
Adults who are ill, frail or have a disability and are unable to protect themselves from significant harm
Q Why have special arrangements to safeguard adults who are at risk?
Some people in these groups may need assistance and support to protect themselves from abuse and mistreatment. In some situations, adults at risk may not realise that they are being abused.
Q What is abuse?
Abuse is the violation of an individual’s human and or civil rights by any other person or persons. Abuse includes physical harm, sexual exploitation, theft, discriminatory behaviour, bullying and neglect. It can be deliberate or the result of ignorance or omission. It can take place in health care and support settings, public places and in people’s homes.
Q What is the Lambeth Safeguarding Adult Partnership Board
The Board is a group of senior representatives from agencies working in Lambeth with adults at risk, their carers and supporters. Members of the Board work with these groups to ensure that there are arrangements in place to safeguard adults at risk from abuse, mistreatment and neglect, and to support them where appropriate to be safe or obtain justice.
Q What is the purpose of this report?
This report summarises the work of the Safeguarding Adult Partnership Board over the last year. This report is designed to inform all who live, work, volunteer, and learn in Lambeth of the activity, undertaken by the Board during the last year and its plans for next year.
Q Why is safeguarding adults at risk in Lambeth important
Everybody has the right to lead a life where their dignity, human and civil rights are promoted and respected. Adults who are less able to protect themselves from abuse and mistreatment need additional support to stay safe and to obtain redress when they have been abused or mistreated. Safeguarding adults at risk is a structured joint approach by statutory bodies, their commissioned services and the community to achieve this objective.
“Safeguarding Adults is everybody’s business”
LSAPB Annual Report 2011-2012 (summary) 4 Page 105
What happens when a concern is raised?
Stage 8 Stage 1
Check that Concern the about abuse situation is or neglect resolved
Stage 7 Stage 2 Take action to stop the Make sure abuse the person is safe
Stage 6 Stage 3
Agree Find out what took what the place. person wants
Stage 5 Stage 4
Find out Agree a what plan happened (strategy )
LSAPB Annual Report 2011-2012 (summary) 5 Page 106
Some typical examples
The examples below are based on real situations, but the names and some facts have been changed to protect identities. The photographs are of models
Elsie
Elsie, a widow, lived in a sheltered housing unit. Following a stroke in 2010, she needed help with bathing, preparing meals, shopping and cooking. She was visited daily by home care workers and her daughter Claire, who lived locally but worked full time.
Claire had to go abroad she left Elsie with £100 for her shopping and any emergencies. An arrangement was made whereby home care workers would do Elsie’s shopping using the £100 while Claire was away and Claire’s son Alan would be the emergency contact.
Two days after Claire went away, the envelope which was supposed to have the money for shopping was found empty by a home care worker. Elsie insisted she was alright as her grandson had brought her some food. The home care worker reported this to their manager who spoke with Elsie’s social worker. Elsie’s social worker visited Elsie that afternoon.
Elsie could not explain the missing money. She asked the social worker to ring her grandson. When the social worker spoke to Alan he admitted that he had taken the money and done some shopping for his grandmother and “borrowed” the remainder to pay for some tickets while he was waiting for his pay.
Elsie asked that Claire was not informed of what had taken place and said she would sort out the money with her grandson.
It was agreed that Elise’s views would be respected, but that the social worker would visit her in three months to check she was still alright.
LSAPB Annual Report 2011-2012 (summary) 6 Page 107
Jerome
Jerome is 25-years-old and has learning disabilities. He works for a Housing Association and lives with his mother. He has his own bank account where his wages are paid directly. Jerome withdraws £50 a week from the cash point to pay for his lunches and social activities. He pays his Mum £80 by direct debit and saves the rest for holidays with his club.
His mother checks his bank account with him and noticed that an extra £30 had been taken out of Jerome’s account every week. Alan said this was because he was helping his friend John from the club, who was behind with his rent. Jerome’s mum spoke to club leader Ken, who was very concerned as John was a volunteer at the club. Jerome was reluctant for anything to happen as he thought it would get John in trouble, but Ken explained he had a duty to report this to the police and Jerome’s social worker Geeta because of the risk to others
The police established that John had a history of volunteering for various charities and clubs. He had a pattern of borrowing money from clients then disappearing. People that he had “borrowed” money from in the past had been unwilling to give a statement as they felt foolish, so John did not have a criminal record . The references that John had supplied were checked and it was established that the people who had sent them did not exist.
The police interviewed John who admitted taking Jerome’s money and supplying false references. John was found guilty of theft at a Magistrate’s Court. This conviction will appear on John’s CRB check in future. Geeta reported John to the Independent Safeguarding Authority, which has the power to bar people from working with adults at risk. Ken changed the club’s policy on recruiting volunteers so that they would phone referees in future and it was agreed that Jerome, Geeta and Jerome’s Mum would meet in three months time to check that all was well.
LSAPB Annual Report 2011-2012 (summary) 7 Page 108
The Board’s activity this year
This year the Board has:
• Delivered information across a wide range of media to raise awareness of the issues in Lambeth and advise local people on how to report concerns. • Provided intensive training to all staff leading investigations into abuse of adults at risk • Worked with the Hate Crime Service to increase awareness to improve confidence in reporting hate crime based on disability • Undertaken a Serious Case Review into the death of a vulnerable man who was living on the street • Initiated a system through which the views and experiences of adults at risk are captured and used to improve the service offered • Set up a community support sub group to improve the resources available in the community in order to prevent abuse and help people recover from its impact.
This has resulted in
• A community service that offers volunteer “buddies” for older people who have been abused • A new disability hate crime action plan
Next year the Board plans to:
• Increase and strengthen its work with community groups • Further improve the quality of data collected. • Deliver a wider range of good quality training to staff and volunteers working with adults at risk • Implement the action plan following the Serious Case review into Mr A • Increase joint working with the Children’s Safeguarding Board • Improve the ability to gather information on local health and social care provisions • Ensure that commissioning arrangements across all sectors are sufficiently robust to safeguard adults at risk that are using them
LSAPB Annual Report 2011-2012 (summary) 8 Page 109
Three examples of the Board’s work this year
Mr A
This year the Board commissioned an independent review to establish if the death of a homeless man with mental health problems could have been prevented. The Board has agreed actions that will be put in place by next March to prevent a similar tragedy in the future.
Some of the actions that it has been agreed will be in place by March 2013 are;
• Better systems for avoiding situations where adults at risk were evicted.
• Better arrangements for following up individuals who refused services.
• Clearer guidelines for staff on how to assess if a person has capacity to make a specific decision.
Winterbourne View Hospital
A BBC Panorama programme “Undercover Care the Abuse Exposed” was transmitted in May 2011. This programme showed patients with autism and learning disabilities living in Winterbourne View Hospital (a private hospital in Gloucestershire) repeatedly mistreated and assaulted by a group of staff .
The Board has studied the report to learn why the abusive regime in this establishment was not uncovered sooner. It is currently checking arrangements in Lambeth so that it can be assured that services are adequately monitored preventing a similar regime from developing in this area.
Action on Elder Abuse group
The Board has supported the national charity Action on Elder Abuse to set up a new community group in Lambeth .
The group is recruiting and training volunteers to “buddy” an older person that has been abused
LSAPB Annual Report 2011-2012 (summary) 9 Page 110
Key Performance Figures April 2011 to April 2012
Referrals
The Number of Referrals
The chart shows an annual increase in the number of referrals made into the safeguarding process over the last six years. The Board are of the view that this reflects increased awareness of both adult abuse and the need to report it in Lambeth, rather than an increase in the number of incidents of abuse. Based on national research the Board is aware that the level of incidents in Lambeth is probably higher than the number of incidents reported.
The Source of Referrals
The source of referral shows that the highest percentage (32%) has been made by social care staff including care home, day care and staff working in the person’s home. Staff across community, acute and mental health services raised 26% of the referrals. This reflects the higher level of awareness among
LSAPB Annual Report 2011-2012 (summary) 10 Page 111
these groups, probably as a result of the number of staff from these sectors trained in safeguarding adults. The Board has set itself the challenge of increasing the level of awareness among other staff in particular housing staff in the next year.
The Adults at Risk
Age and Service User Group
The needs and age of users of the safeguarding service show that just over half (52%) of referrals are about people with physical disabilities with most of that group over 65 years. In all other groups of service users most people are under 65 .People with learning disabilities are 22% of the referrals and mental health problems 21%.The proportion of the concerns that are about the care of older people reflects both the London and national picture of reports of abuse, and remains disproportionate to the percentage of the general population.
The proportion of the concerns that are about the care of older people reflects both the London and national picture of reports of abuse, and remains disproportionate to the percentage of the general population.
LSAPB Annual Report 2011-2012 (summary) 11 Page 112
The alleged abuse
The type of abuse
The most common type of abuse cited in the 1,140 referrals is physical abuse which accounts for 26% of the total abuse allegations reported.
Physical abuse, neglect and financial abuse continue to dominate referrals in Lambeth this reflects the national picture
The location of alleged abuse
44% of referrals reported the adult at risk’s own home as the location where the alleged abuse took place. The adults at risk’s own home has been the most common location for the last three years in line with the national picture
LSAPB Annual Report 2011-2012 (summary) 12 Page 113
The person who may have caused harm
The largest group shown is social care staff; this includes domiciliary (home care) workers, care home and day care staff. This is closely followed by family members which includes partners. This is probably partially explained by the higher level of reporting in these sectors and the underreporting of familial abuse nationally as shown in national research statistics.
Lambeth reflects the national picture of abuse of adults at risk in that
• Physical abuse, neglect and financial abuse dominate referrals.
• The person’s own home has been the most common location for alleged abuse in the last three years.
LSAPB Annual Report 2011-2012 (summary) 13 Page 114
The Outcomes
The conclusions reached at the end of the investigation
Distribution of case conclusion, 2011-12 Not Determined/Inconclu sive 26% Substantiated 31%
Partly Substantiated 9%
Not Substantiated 34%
Among the completed safeguarding investigations in 2011-2012 the proportion of substantiated not substantiated and not determined remains broadly similar.
For each completed referral there can be more than one action taken. In 2011-12, the most common action of the safeguarding investigation was increased monitoring (53%)
LSAPB Annual Report 2011-2012 (summary) 14 Page 115
The Board has examined increased monitoring in greater depth to see how effective it has been in preventing further abuse. In 3.7% ((9) cases there was further abuse following increased monitoring and the Board has asked that these 9 cases be examined in detail and the findings reported to the Board.
Outcome for the person that may have caused harm
Outcome of completed referrals for perpetrator / organisation / service, 2011-12
Continued Monitoring, Police 6% Action, 7%
Other Outcomes, 19%
No Further Action, 41% Not Known, 26%
The increase in investigations leading to continued monitoring as an outcome (from 10.5% to 19.9%) has been of concern to the Board. A more detailed examination of these cases was presented in June 2012.
This showed that 47% of completed referrals for which the outcome was increased monitoring had a case conclusion of substantiated and partially substantiated. 43% were for increased monitoring by social services, 22% by a carer, family or friends,), 13% by health service(s) and 22% not specified. .
The Board has examined increased monitoring in greater depth to see how effective it has been in preventing further abuse and has been satisfied with the findings.
LSAPB Annual Report 2011-2012 (summary) 15 Page 116
Appendix One
Glossary of Terms
Carers Family, friends or neighbours who provide unpaid support and care to another person. This does not include those providing care and support as a paid member of staff or as a volunteer
Partner agency One of the organisations who is a member of the Safeguarding Adult Partnership Board
Person who may have caused harm This is the person or persons who may have abused or neglected an adult at risk
Professional Individuals who meet specific qualification requirements and are registered with the relevant national governing body for that profession
Safeguarding Adults All work which enables any adult "who is or may be eligible for community care services" to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect.
‘Safeguarding Adults’ Partnership The formal group of organisations who are working together to implement measures to ‘Safeguarding Adults in a local area.
Service provider An organisation that delivers services such as health and social care services.
Service User A person who is a customer/consumer of a service (particularly used in relation to those using social care services).
Staff People who are paid to provide care and support
Volunteers People who provide services to adults at risk for no payment
“Safeguarding Adults All work which enables any adult "who is or may be eligible for community care services" to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect.”
LSAPB Annual Report 2011-2012 (summary) 16 Page 117
Would you like more information ?
This report is a summary of the full annual report of the Lambeth Safeguarding Adult Board (LSAPB)
The full report contains
1) More detailed information on the achievements of the LSAPB over the last year
2) More detailed performance figures
3) More detailed information on the Board’s plans for the forthcoming year.
4) Details of the Board Members, the Board’s Terms of Reference and the Board and sub group meetings held
5) The Executive Summary and Action Plan following the Serious Case Review Mr A
6) Reports from the following partner agencies: • Lambeth Age UK • Guy’s and St Thomas’ NHS Foundation Trust Acute Services • Guy’s and St Thomas’ NHS Foundation Trust Community Services • The Metropolitan Police • South London and Maudsley NHS Foundation Trust • The London Borough of Lambeth • Kings College Hospital NHS Foundation Trust
LSAPB Annual Report 2011-2012 (summary) 17 Page 118 IF YOU SUSPECT ABUSE, TELL US
Adult Care Services 020-7926-5555 Police non-emergency 101
If emergency services are needed call 999
LSAPB Annual Report 2011-2012 (summary) 18 Page 119
Annual Report of the Lambeth Safeguarding Adult Board 2011-2012
This report tells you about abuse and mistreatment of people who live in Lambeth and are old, ill or have disabilities.
Abuse is when somebody hurts a person or treats them badly such as taking their money, shouting at them or touching them in a way that they don’t like .
Abuse is wrong and should not happen .
LSAPB AR Accessible 2011-2012 1 of 6 Page 120 This report tells you
How many times we have been told about abuse or bad treatment.
What was done to stop abuse and make the person safe
How all the services work together to stop abuse and bad treatment.
LSAPB AR Accessible 2011-2012 2 of 6 Page 121 What we are doing to help people avoid being abused or badly treated by others
What happened this year in Lambeth?
There were 1,140 reports of abuse made in Lambeth. This is more than last year.
More people are reporting that they are unhappy about how they are being treated.
About a quarter of the reports were about people with learning disabilities
Just over a quarter of the reports were about people living in care homes.
Over half the reports were about people living in their own home.
The mix of people was similar to the mix of people that live in Lambeth.
Everybody was offered help or given help to keep safe.
LSAPB AR Accessible 2011-2012 3 of 6 Page 122
The Good News
Posters and Leaflets were distributed to more than 800 different places and 34 bus stops had posters about abuse
Staff have been trained so they know they must find out what the person who has been abused would like to happen
We looked at the reasons why a vulnerable man died while living on the street and what can be done to stop this from happening again.
LSAPB AR Accessible 2011-2012 4 of 6 Page 123
What do we plan to do next year?
A group of people who know what it feels like to be abused will advise us on how to do things better.
We will make sure that people who buy their own care have the help they need to do this safely.
We will learn from things that have gone wrong to stop them happening again.
LSAPB AR Accessible 2011-2012 5 of 6 Page 124 Over to you
If you are worried about yourself or somebody else
TELL US AND WE CAN HELP
Adults Social Care 020-7926-7707 Police non emergency 101
If it is an emergency telephone 999
Please contact us if you want a copy of the full report, more information about protecting adults at risk or would like to make a comment on this report .
Telephone 020-7926-5555
LSAPB AR Accessible 2011-2012 6 of 6 Agenda Item 6 Page 125
b
Health and Adult Services Scrutiny Sub-Committee 23 October 2012
South London & Maudsley NHS Foundation Trust – Cost Improvement Programme
All Wards
Report authorised by : Executive Director of Finance and Resources: Mike Suarez
Executive summary
For a number of years NHS organisations have been required by Government to deliver Cost Improvement Programmes. The committee has sought information from South London and Maudsely NHS Foundation Trust (SLaM) on its CIP. The attached report from SLAM sets out a context overview of its approach to the CIP and the key components of the Lambeth CIP 2012/13.
Summary of Financial Implications
There are no financial implications arising from consideration of this report.
Recommendations (1) That the Health and Adult Services Scrutiny Sub Committee note the report provided by the South London and Maudsley NHS Foundation Trust on its Cost Improvement Programme.
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Consultation
Name of Department or Organisation Date sent Date Comments consultee response appear in report received para:
Internal None External None
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 11.10.12 10.10.12 136-12/13 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Background Documents
None
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South London & Maudsley NHS Foundation Trust – Cost Improvement Programme
1. Context
1.1 For a number of years NHS organisations have been required by Government to deliver Cost Improvement Programmes. The committee has sought information from South London and Maudsely NHS Foundation Trust (SLaM) on its CIP.
2. Proposals and reasons
2.1 The attached report from SLAM sets out a context overview of its approach to the CIP and the key components of the Lambeth CIP 2012/13.
3. Comments from Executive Director of Finance and Resources
3.1 Not sought.
4. Comments from Director of Governance and Democracy
4.1 Not sought.
5. Results of consultation
5.1 Not applicable.
6. Organisational implications
6.1 Risk management: Not applicable.
6.2 Equalities impact assessment: Not applicable.
6.3 Community safety implications: Not applicable.
Environmental implications:
Not applicable.
6.4 Staffing and accommodation implications: Not applicable.
6.5 Any other implications:
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Not applicable.
7. Timetable for implementation Not applicable.
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Cost Improvement Programme [CIP] - Lambeth
PURPOSE OF THE REPORT To provide the Lambeth Health and Adult Services Scrutiny Sub Committee with information on South London and Maudsley [SLaM] NHS Foundation Trust’s cost improvement programme [CIP].
BACKGROUND About the Trust • Most extensive portfolio of mental health and substance misuse services in the UK, serving a very diverse local population of 1.1 million in south London and offering specialist expertise nationally. - Providing in-patient care to over 5,000 people each year - Providing support to around 36,000 people, of which 7,500 are seriously mentally ill and on the CPA - Employing 4,800 staff - Operating out of more than 100 sites - With a turnover of £360m per annum
• Working in partnership with the Institute of Psychiatry, King’s College London to generate and put into practice world leading research • Largest mental health research and development portfolio in the country • Joint host with the Institute of Psychiatry of the UK’s only specialist National Institute for Health Research (NIHR) Biomedical Research Centre for mental health and a Biomedical Research Unit for Dementia. • Provider of an extensive range of learning opportunities • A leader in the field of involving service users in the provision of education and training • Provider of the most comprehensive mental health NHS library in London. • Part of an Academic Health Sciences Centre - King’s Health Partners - which promotes health in mind and body, and which is one of only five AHSCs in the UK • Provider of integrated adult mental health and social care services in partnership with local authorities
Our mission is : • To treat mental illness effectively • To work in partnership to promote mental well-being • To support others by sharing our clinical expertise and knowledge
Our strategic goals are: 1. Providing high quality, safe and innovative clinical care and treatment that meets the expectations of services users and their carers and the requirements of commissioners and regulators
2. Developing care pathways in collaboration with key stakeholders that will deliver efficient and effective services, with a focus on the interface between mental health care and physical care. Focus on the care pathway [not the component parts in isolation] and address gaps, overlaps and inconsistencies from the users’ perspective.
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3. Promoting recovery, social inclusion and mental wellbeing for the benefit of service users and the wider population.
4. Maintaining financial sustainability by increased operational efficiency and actively developing commercial skills so that the organisation is able to thrive in a more competitive and challenging environment.
5. Contributing to the delivery of King’s Health Partners vision and objectives – to identify and develop opportunities to address the inequalities and unique needs of our local population through provision of early intervention and personalised intervention to help people to maintain, improve and enhance their health.
Foundation Trusts and regulatory requirements As an NHS Foundation Trust [FT] we are an organisation for public benefit, regulated by Monitor to ensure we that are well-governed both in terms of finance and quality, that we meet healthcare targets and national standards and that we are financially viable. As an FT this assessment gives us some discretion around objectives, priorities and financing. Monitor expects NHS Foundation Trusts, in conjunction with their stakeholders, to set their own aspirations for improvement in current provision and innovation through development of new services. FTs are also required to make a surplus in line with their financial risk rating, and if not delivered FTs can face intervention from Monitor.
As part of the regulatory process Monitor requires us to submit an annual forward plan, quarterly and ad hoc reports.
Under the Under the Health and Social Care Act 2012 Monitor will continue as our regulator and will soon license us as a provider of NHS services.
COST IMPROVEMENT PROGRAMME [CIP] For many years NHS organisations have been required by Government to deliver Cost Improvement Programmes, the national targets set since 2009 are shown below. Year Target 2009/10 - 3.0% 2010/11 - 3.5% 2011/12 - 4.0% 2012/13 - 4.0% 2013/14 - 4.0% forecast 2014/15 - 4.0% forecast
Since the period of funding growth came to an end in 2011/12 there have been
In common with many areas of the public sector, the current economic situation has presented the NHS with a huge challenge which is to continue to improve the quality of services with a budget that has been held at a constant level since 2011. Whilst there has been no significant real terms increase in the resources available to the NHS there has been growth in demand for services, new technologies, the continuing need for quality improvement and the increased expectation of service users.
The introduction of the Quality, Innovation, Productivity and Prevention [QIPP] programme, which is a national Department of Health strategy, aims to improve the quality and delivery of NHS care while reducing costs to make £20bn efficiency savings by 2014/15. These savings will be reinvested to support the front line. Since its introduction the QIPP target has been locally determined by each PCT. The QIPP challenge also coincides with a period of major
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reorganisation for the NHS in England, set out initially in the NHS White Paper 1 and through the provisions of the Health and Social Care Act 2012.
Monitor, the independent regulator of NHS Foundation Trusts, has acknowledged that maintaining and improving quality whilst delivering the level of savings that has been required in recent years ‘represents a significant challenge and a potential risk for trusts’. This has also been highlighted in a recent King’s Fund quarterly monitoring report 2 that surveyed finance directors in the health service. While most were confident of making the required £5bn in savings this year, the majority think the NHS will not be able to continue to make the same level of productivity gains until 2015.
Without fundamentally transforming service delivery, the task of meeting the required annual CIP and QIPP will become increasingly more difficult. With the financial challenges that lay ahead for both commissioners and providers working collaboratively to plan and deliver the best quality services that meet the needs of the local population will be vital.
The distinction between CIP and QIPP programmes described above complicates an already challenging exercise and has the potential to distract us all, while our focus needs to be on maintaining the mental health services that best meet the needs of the local community within budget and without loss of quality.
Details of the efficiency targets for Lambeth are as follows:
2009/10 20010/11 20011/12 2012/13 2013/14 2014/15 Total £000 £000 £000 £000 £000 £000 £000
CIPs 2,336 2,891 3,271 3,115 2,818 2,704 17,135
QIPP 0 1,000 1,357 3,556 4,057 1,500 11,470
Total 2,336 3,891 4,628 6,671 6,875 4,204 28,605 From a 2008/09 baseline of £89.3m = 32% savings requirement over 6 years
Our CIP plan design is aligned to the strategic priorities of delivering: • Highest quality services – improving outcomes, safety, experience, access and building capacity and capability; and • A responsive, cost effective organisation through productivity and flexibility
Up to, and including 2013-13, many of the CIP schemes have been small scale, in most cases using a salami slice approach. In the future this approach cannot continue to deliver the scale of efficiencies that are needed and therefore we will need to implement large-scale transformation programmes.
The Trust has identified three key transformation themes that we will believe can deliver more efficient and effective use of our resources in the future. The themes are:
1. Estates Delivering community services from fewer buildings through development of a hub and spoke system. This will involve utilising buildings more intensively through extending both
1 Equity and Excellence: Liberating the NHS [June 2010] 2 How is the NHS performing? Quarterly monitoring report. King’s Fund, Sept 2012
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the number of days a week facilities are open and the working day and, where there are opportunities, through shared use of the estate and facilities.
2. Workforce This involves improved workforce management through the roll out and more effective use of e-rostering, reviewing workforce productivity and reduction in use of bank and agency staff. We are also developing more flexible ways of working including generic job descriptions, greater use of annualised hours and the development of flexible pools of staff. In addition, as we reduce the size of our estate teams we will need to offer technology to support mobile working [see below].
3. Processes and technology The further introduction of technology and streamlining of processes and systems will act as an enabler to support more efficient ways of working, including development of mobile working that will enable more efficient use of estate in the future.
To deliver on the scale of the challenge we recognise the importance of working in collaboration with key stakeholders on the development of these schemes and ensuring that the implications for quality, workforce, equality and risk are fully assessed as individual proposals are worked up.
COMPONENTS OF LAMBETH CIP 2012-13
CIP Staffing Estates £000 WTE 1 Estate cost - rationalisation and improvement in energy efficiency 436 0.0 436 0.0
Workforce 1 Corporate workforce rationalisation 332 6.9 2 Improved staff deployment and productivity 1,010 21.8 1,342 28.7
Processes/systems 1 Corporate administrative review 501 6.5 2 CAG administrative review 396 2.3 897 8.8
Other 1 Contracts savings 331 4.0 2 Income generation 109 440 4.0
3,115 41.5
Individual proposals are still being worked up and will all be subject to risk assessment including an Equality Impact Assessment screening and full EIA where identified; quality implications; workforce implications and consultation plans. We will be focusing on ensuring these are conducted systematically as plans are developed.
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The plans that have been worked up to date relate to improved use of estate and energy savings, rebalancing staffing levels to demand, deletion of long term vacant posts, improvements to systems and processes, reduction in non-pay spend, savings delivered through improved contracts and income generation.
ENGAGEMENT AND COLLABORATIVE WORKING Our planning process requires each Clinical Academic Group and Infrastructure Directorate to submit an annual local business plan for the forthcoming three years. This information in turn informs the development of the Trust’s Annual Forward Plan that is submitted to Monitor.
The Trust Board working collaboratively with, and accountable to, the Members’ Council [SLaM’s Board of Governors], are responsible for setting the strategy, deciding options and approving budgets. The Members’ Council has a specific Strategy and Planning sub-group, and this arrangement has ensured that the Members’ Council is continually involved in, and influences, the development of our plans. Throughout the development of the plan the Trust Executive, Senior Leaders and Team Leaders are also involved through various meetings and events.
In 2011 the Members Council held two Membership involvement events to engage the wider membership in discussions around the future provision of mental health care. There are plans to do this again, holding one in each borough during the autumn/winter of 2012.
We work closely with our commissioners in the development of our plans, and we seek to further expand our collaborative approach to planning through the introduction of Roundtable events to involve a range of stakeholders. As part of this process we are planning a Lambeth specific Forward Planning Roundtable Event on the 29 th October. At this event we will share with our key partners themes from SLaM’s Forward Plan and our immediate and longer term financial projections.
Our plans are at different stages of development and we are seeking early input to enable us to then move into detailed design based on stakeholder advice and guidance. The round table discussion will offer an opportunity for our key partners to help shape our plans for the benefit of all our local communities including working with us to identify areas which require further work and development.
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b
Health and Adult Services Scrutiny Sub-Committee 23 October 2012
Lambeth Addictions Service, South London and Maudsley NHS Foundation Trust – Proposal for Injectable Diamorphine Clinic
All Wards
Report authorised by : Executive Director of Finance and Resources: Mike Suarez
Executive summary
The Addictions Clinical Academic Group, South London and Maudsley NHS Foundation Trust, is proposing to run an injectable diarmorphine clinic at Lorraine Hewitt House, Brighton Terrace, Brixton. The attached paper sets out the proposal and the consultation underway with the local community.
Summary of Financial Implications
None.
Recommendations 1. That the committee consider the paper submitted by the Addictions Service, South London and Maudsley NHS Foundation Trust and submit any comments on the proposal to run an injectable diamorphine clinic at Lorraine Hewitt House, Brighton Terrace, Brixton.
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Consultation
Name of Department or Organisation Date sent Date Co mments consultee response appear in report received para:
Internal None External None
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 11.10.12 10.10.12 132-12/13 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Background Documents
None
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Lambeth Addictions Service, South London and Maudsley NHS Foundation Trust – Proposal for Injectable Diamorphine Clinic
1. Context
1.1 The Addictions Clinical Academic Group, South London and Maudsley NHS Foundation Trust, is proposing to run an injectable diarmorphine clinic at Lorraine Hewitt House, Brighton Terrace, Brixton. The proposal is set out on the attached paper submitted by the clinical lead for Lambeth Addictions, SLaM.
2. Proposals and reasons
2.1 The trust is in the consultation phase with the local community and invites the Health and Adult Services Scrutiny Sub Committee to consider the proposal and submit any comments.
3. Comments from Executive Director of Finance and Resources
3.1 Not sought.
4. Comments from Director of Governance and Democracy
4.1 Not sought.
5. Results of consultation
5.1 Not applicable.
6. Organisational implications
6.1 Risk management: Not applicable.
6.2 Equalities impact assessment: Not applicable.
6.3 Community safety implications: Not applicable.
Environmental implications:
Not applicable.
6.4 Staffing and accommodation implications: Not applicable.
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6.5 Any other implications: Not applicable.
7. Timetable for implementation Not applicable.
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Proposal by The Addictions Clinical Academic Group of The South London and Maudsley NHS Trust for an Injectable Diamorphine Clinic at Lorraine Hewitt House, 12-14 Brighton Terrace Brixton SW9 8DG.
Paper Prepared by Dr Michael Kelleher. Consultant Psychiatrist and Clinical Lead for Lambeth Addictions (SLaM).
Date: 10 October 2012
Background Supervised Injectable Opioid Treatment (IOT) is the prescription of injectable diamorphine (pharmaceutical heroin) in a supervised clinic setting for the treatment of opiate misusers who have not responded to other types of treatment. Since the mid-1990s, a new modality of closely-supervised injectable prescribing has been developed in Switzerland) and supported by research trials in Europe, Canada and, most recently, in England- where the trial of such treatment was led from Marina House in Camberwell (Strang, 2010). As a result of these studies, injectable opioid treatment (IOT) is now evidenced as a clinically effective second line treatment for a small group of people who have repeatedly failed to respond either to standard methadone treatment or to residential rehabilitation. The Department of Health have agreed further central funding to support the delivery of such clinics in local areas. One such area is Lambeth.
The Proposal The current proposal is to deliver injectable diamorphine three local settings in London (Camden, Southwark and Lambeth). Each of the sites will have at most 10 clients attending to take supervised injectable diamorphine on-site. They will attend that most twice a day. To take part in the service they will need not to be drinking to excess or abusing benzodiazepines. This will be tightly monitored through breathalysing for alcohol and Urine Drug Screens.
The hours of attendance will be between 9.00 a.m. and 5.00 p.m. Monday to Friday. At the weekend should they wish to continue injectable diamorphine this will be delivered on the Maudsley Hospital site. There will be no change to the opening hours of Lorraine Hewitt House.
If client's fail to show a response to the treatment at six months they will be returned to standard treatment.
All clients taking part this service will be existing Lambeth clients, with links to the Borough demonstrated through registered GP, benefits and registered address. For a client to be considered suitable for the service they need have engaged fully in optimised standard treatment for six months with Lambeth addiction services.
The ongoing service will be evaluated in cooperation with the commissioners to see whether it is a viable cost effective longer term option for the treatment of opioid dependence. Page 140
Timeline At present we are in the consultation phase with the local community and therefore approached local councillors and health scrutiny committee.
We will offer through local networks to hold a consultation event with local residents. This will be carried out in cooperation with local representative councillors. We aim to have this process completed by 20 November 2012.
Should we meet approval we would aim to make the minor structural changes to the clinic needed between December and January.
We aim to see the first client in this clinic on 1 March 2013.
Risk Supervised injecting clinics have run in Camberwell, Darlington and Brighton for the past 4 to 5 years. There have been no untoward events relating to the local community in any of these three clinics that we are aware of.
The diamorphine will be securely stored in line with the Home Office statute for the safe storage of controlled drugs. This is no different to the safe storage of such drugs on community pharmacies on Brixton high Street.
SLaM will ensure that full health and safety analysis is carried out in Lorraine Hewitt House so that it complies with all relevant legislation.
Agenda Item 8 Page 141
b
Health and Adult Services Scrutiny Sub-Committee 23 October 2012
Proposals for Intermediate Care and Amputee Rehabilitation (Lambeth Community Care Centre and Pulross Intermediate Care Centre)
All Wards
Report authorised by : Executive Director of Finance and Resources: Mike Suarez
Executive summary
The attached report from NHS Lambeth Clinical Commissioning Group updates the committee on discussion and engagement to date on proposed changes to inpatient intermediate care in Lambeth and an improved pathway for people who have had amputations. The two linked proposals propose changes to services offered at Lambeth Community Care Centre, Kennington and Pulross Intermediate Care Centre, Brixton.
The Friends of Lambeth Community Care Centre have submitted comments on the change proposals to the Health and Adults Services Scrutiny Sub Committee and their paper is attached as Annex 1.
Summary of Financial Implications
There are no financial implications arising from consideration of this report.
Recommendations (1) That the Health and Adult Services Scrutiny Sub Committee note the work to date and proposed next steps and provide any comments on the proposals.
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Consultation
Name of Department or Organisation Date sent Date Comments consultee response appear in report received para:
Internal None External None
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 11.10.12 10.10.12 137-12/13 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Background Documents
None
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Proposals for Intermediate Care and Amputee Rehabilitation (Lambeth Community Care Centre and Pulross Intermediate Care Centre)
1. Context
1.1 Lambeth currently has two centres managed by Guy’s & St Thomas NHS Foundation Trust Community Health Services offering inpatient intermediate care: Lambeth Community Care Centre, Kennington and Pulross Centre, Brixton. In addition to inpatient care, intermediate care for rehabilitation at home is also provided by the Supported Discharge Team (for patients being discharged from hospital) and the Enhanced Rapid Response Team service (aiming to avoid hospital admission).
1.2 Two linked proposals are being developed to fulfil commissioning intentions to move services closer to home, improve outcomes and patient experience. In summary the proposals are to consolidate the provision of bed-based intermediate care at the Pulross Centre Brixton with a higher occupancy of the ward, more intensive rehabilitation input and a higher staffing-patient ratio; and use the ward at Kennington CCC for a new form of care out of hospital for SE London, an Amputee Rehabilitation Unit.
2. Proposals and reasons
2.1 Engagement on the proposals has been undertaken during September and October and a summary of feedback is included in the attached report from the Lambeth Clinical Commissioning Group (CCG).
2.2 The Friends of Lambeth Community Care Centre have submitted comments on the change proposals to the Health and Adults Services Scrutiny Sub Committee and their commentary is attached as Annex 1.
2.3 The scrutiny committee is asked to note the work to date and proposed next steps. The paper from NHS Lambeth CCG notes that there will be a recommendations to Lambeth CCG Governing Body to extend the engagement period on the proposals to allow further input from key stakeholders.
3. Comments from Executive Director of Finance and Resources
3.1 Not sought.
4. Comments from Director of Governance and Democracy
4.1 Not sought.
5. Results of consultation
5.1 Not applicable.
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6. Organisational implications
6.1 Risk management: Not applicable.
6.2 Equalities impact assessment: Not applicable.
6.3 Community safety implications: Not applicable.
Environmental implications:
Not applicable.
6.4 Staffing and accommodation implications: Not applicable.
6.5 Any other implications: Not applicable.
7. Timetable for implementation Not applicable.
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NHS Lambeth Clinical Commissioning Group Proposed changes to provision of inpatient intermediate care services at Lambeth Community Care Centre and Pulross and the rehabilitation care pathway for people who have had amputations
1. Introduction This paper updates the Health Overview and Scrutiny Committee on discussion and engagement to date on proposed changes to inpatient intermediate care provision in Lambeth and an improved pathway for people who have had amputations. The proposals seek to improve quality of care available for patients, deliver better value for money and release resources for investment in meeting the needs of an increasing and aging population. These initiatives are part of implementation of Quality, Innovation, Productivity and Prevention (QIPP) described in the NHS Lambeth Commissioning Strategy Plan ‘Improving Health, Improving Quality’. The paper sets out the work and engagement to date including the equality impact work. Scrutiny Committee is asked to note the work to date and proposed next steps. The paper notes there will be a recommendation to Lambeth CCG to extend the engagement period on the proposals to allow further input from key stakeholders.
2. Background and developments
The NHS Lambeth Commissioning Strategy Plan (available at http://www.selondon.nhs.uk/index.php?assetId=2704&assetGroupId=2666 ) describes the health needs of people in Lambeth and how planning and commissioning of services is being developed to better meet those needs. People in Lambeth are living longer, but are living with long term conditions such as high blood pressure, diabetes, heart disease and lung disease. As quality of care has improved in conditions such as stroke and cancer we are seeing more people surviving but living with disabilities. Many people in Lambeth live with long term common or severe mental illness and we would expect around a quarter of people aged over 85 to develop dementia. Around two thirds of people in hospital are aged over 75 and a major reason for admission is care of long term conditions.
People in Lambeth tell us that they want to be supported to live at home as much as possible. We know that people tend to improve more quickly in a familiar home environment, especially people with dementia. As a health and social care system we are therefore re-focusing our resources on caring for people at home and improving our primary and community care services on supporting people to manage their long term condition.
We recognise that there is more we can do to work together with other services to better support people in need. We have therefore joined with London Borough of Lambeth, London Borough of Southwark, Kings College Hospital NHS Foundation Trust, Guy’s & St Thomas’ NHS Foundation Trust and South London & the Maudsley NHS Foundation Trust under the Kings Health Partners’ Integrated Care Programme (ICP) supported with funding from the Guy’s & St Thomas’ Charity.
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A wide range of new services are either in place, or are planned to go live over the next few months. Some examples of these changes are:
• Specialist services for people who have had a stroke at designated hospitals supported by home based rehabilitation care (London wide from 2010) • Reablement – intensive personal support to people to prevent admissions to hospital and long term care and support people on discharge from hospital. This is commissioned by London Borough of Lambeth. (Launched during 2011) • Enhanced Rapid Response – home based rehabilitation providing more intensive support and short term care support (Launched December 2011 as an addition to an existing service) • HomeWard – nursing led services to support people at home to prevent admission to or improve their discharge from hospital (this is a pilot scheme currently under evaluation with a view to rolling out across Lambeth launched Jan 2012) • Community multi-disciplinary teams – bringing together GPs, community nurses, local consultants for the care of older people, social workers and mental health teams to review care of older people (launched July 2012 as a pilot for review in 2013, starting in North Lambeth) • Holistic health assessment for older people in GP surgeries or at home for housebound people (pilot starting July 2012) • Case management by GP practices for people at risk of admission to hospital (pilot starting July 2012) • Consultant for Older People Advice line for GPs (launched July 2012) • Urgent (same day/next day) outpatient clinics to assess older people without the need (from August 2012) • Community matrons – intensive support to people at high risk of admission to hospital with complex medication requirements, a history of falls and/or previous admissions to hospitals • Community based heart failure services to support to GPs and practice nurses (launched Sept 2011) • Community based diabetes services including supporting education of GPs and Practice Nurses and people to improve self management (launched Jan 2012)
Total annual cost NHS funded Non Recurrently Funded £1,215,000 developments: Stroke, Reablement, HomeWard, Recurrently Funded £4,151,000 ERR, Community Matrons, Heart failure, Diabetes Total annual costs GST Charity Funded 2012-15 £509,750 funded schemes: CMDTs, HHAs, Case Management, consultant in older people support
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3. Engagement We have run a specific engagement process on proposed changes to services offered at Lambeth Community Care Centre and Pulross during September/October 2012. The detailed responses are set out in the appendix to this paper.
The summary of the feedback we have received is: • There is support for the principle of providing more care at home. However people would like more assurance on the quality and safety of care particularly for those living on their own; would like more information on services and how they operate; have concerns about and would want to ensure that patients and carers are involved in the development of the services. • A number of people have expressed strong concerns about the proposed changes to inpatient provision at Lambeth Community Care Centre • There is support for the proposed model of rehabilitation for people who have had amputations. People would like assurance about follow on and lifelong care and patients and carers want to be involved in the development and monitoring of the services.
4. Current service provision
Intermediate care
Lambeth currently has two centres managed by Guys & St Thomas’ NHS Foundation Trust Community Health Services (GSTT) offering inpatient intermediate care: the Pulross Centre in Brixton, and Lambeth Community Care Centre in Kennington. Both are nurse-led units offering care for adults with rehabilitation and/or nursing needs, for example to regain mobility after a fracture or an operation. Care is supported by therapists, GPs and consultants in elderly care. LCCC has 16 beds and Pulross has 20 beds and both offer 24-hour care for patients of Lambeth GPs. LCCC additionally offers care for the patients of 6 GP practices in North Southwark.
Lambeth also has well established teams also managed by GSTT which offer rehabilitation support at home - Supported Discharge for patients coming out of hospital and Rapid Response to support patients in order to avoid a hospital admission.
Intermediate care inpatient beds cost substantially more than intermediate care in the home – an inpatient stay costs 5.6 times that of an admission to the Supported Discharge team and accepts only 35% of the number of patients. In addition the average occupancy of intermediate care inpatient units is low – on average only 26 out of 36 beds were occupied throughout 2011/12.
An audit of patients based in both LCCC and Pulross in October 2011 has shown that 30% of the patients admitted could have been supported at home rather than being admitted. These unsuitable admissions mean that patients
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spend longer as an inpatient, have more moves and potentially a worse patient experience – for example, patients with cognitive impairment such as dementia do not benefit from constantly shifting environments.
Home based intermediate care
Lambeth has a range of community Intermediate Care services which aim to support people to become more independent and confident living in their own home, thereby preventing admission to hospital or the need for long term care.
In Lambeth, these services comprise of the Supported Discharge team which focuses on the needs of people being discharged from hospital and the Enhanced Rapid Response team which focuses on people at home or in A&E with urgent needs which could result in admission to hospital. Both teams aim to improve independence, limit the impact of disability and wherever possible help people remain in their own home rather than be admitted to hospital or move to a long term care home. The services are managed jointly within the GSTT Community Rehabilitation Services and referrals can be made by any health or social care professional 7 days a week.
Given the age profile of the Lambeth population it is not surprising that most people referred to these services are over 60, with 52% being over 80. The majority live alone. These teams are able to meet the needs of anyone over 18 with a physical disability or impairment, but have been specifically designed and developed to meet the wide range of needs of frail and vulnerable older people who form the majority of the caseload. Referrals are carefully reviewed to ensure that the person can be safely supported at home. If at any point the clinical team has concern that it is not safe for the person to be cared for at home, an admission to an intermediate care bed is promptly arranged. Each person receives a welcome pack with contact information of team members and their key worker. A care plan is developed with the person, and where possible their family and carers, to meet their individual needs and wishes.
As a result of new investment over the past 2 years from both health and social care, these teams are now supporting at least 120 people per month, compared to only 40 to 50 per month 3 years ago. Staffing has already increased from 19 to 47 clinical staff. Under the new proposals an additional 5 staff will join the team to meet the needs of at least a further 90 people per year.
The teams comprise of nurses, therapists, a specialist consultant in the care of older people, and rehabilitation support workers. Together they ensure immediate assessment and interventions up to three times per day, 7 days a week, within 2 hours of referral where needed. They support people to recover from a period of illness, following a fall or post surgical care; meeting physical, social and psychological needs as well as ensuring a safe home environment. A senior clinician undertakes a full health, social and
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environmental assessment on the first day and organises the delivery and installation of home equipment such as bedside commodes & perching stools on the same day. Home adaptations such as hand rails can also be arranged within one or two days. Both Supported Discharge and Rapid Response are integrated with social services staff so that a full and comprehensive service can be provided in a timely way meeting both health and social care needs without the need for another referral to Social Services. This includes assistance with home deep cleans, benefits advice, carers assessments and practical support, and provision of assistive technology such as personal care- line emergency alarms, medication reminders etc.
People stay with the teams until their needs can be met by standard ongoing community services such as homecare and district nursing. The period of care is typically 2-6 weeks. Transfer of care to standard services is carefully managed to ensure a smooth transition for the person. An important element of the team’s work is the liaison with a wide range of statutory and voluntary sector agencies that can support the person including befriending and providing support and education of family and carers.
In addition to the clinical Intermediate Care staff, Social Services have developed social worker roles and a reablement homecare service that works in an integrated way with these clinical teams. Working primarily with the Supported Discharge and Rapid Response staff, reablement homecare provides a 6 week assessment and supported recovery period for people who would otherwise have received a standard home care package on discharge from hospital or after deterioration at home. The reablement homecare service is supported with training and supervision by healthcare staff to ensure the appropriate skills and knowledge of the reablement workers.
Over the two years that Community Services and London Borough of Lambeth have been developing these services, we have regularly reviewed the opinions of service users. The most recent telephone survey (Spring/ Summer 2012) was conducted of 300 people who had received the rapid response service over a 4 month period. A total of 108 people responded. Of these, 96% said they were always treated with dignity and respect by the staff caring for them, 88% said they would definitely recommend the service to family and friends and 91% rated the care and service provided as good, very good or excellent. Areas for specific improvement included developing more written information on staying healthy and more accessible contact information. The welcome pack is being revised and contact cards have been developed with service users in response to this feedback.
An example of a patient feedback comment:
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The services are monitored and evaluated regularly including the outcomes for service users. Areas that are measured focus on improvements in outcomes and achievement of the person’s rehabilitation goals as well as whether people have remained independent and living at home. Over a 12 month period the supported discharge team have helped 85% people cared for to remain in their own home and the rapid response team have helped 80% remain in their home at the end of their period of care. In the telephone survey, out of 108 respondents, only 5 had attended A&E in the 3 months after discharge from the service.
Amputee rehabilitation
Amputations are predominantly as a result of vascular complications but will also occur in Orthopaedics, Trauma and Diabetic Medicine. Across South East London, most amputations will occur at GSTT and King’s College Hospital (KCH). A smaller number occur at Lewisham Hospital and in hospitals in Bexley, Bromley and Greenwich.
Patients undergoing an amputation in hospitals where there is limited specialist dedicated amputee therapy resource have often not received a sufficient intensity of specialist therapy during their rehabilitation phase in hospital. Given the high level of other associated health conditions in the patient group, these patients can suffer deterioration in their condition and delay to the closure of their wound. This then delays early walking aid trials and specialist prosthetic assessment (for provision of artificial limbs). Regaining the functions of daily living, which are essential for discharge home, is also delayed and length of stay increases as a consequence. The resulting level of dependency increases the need for intermediate care or re- housing in a supported environment. The limited capacity in these services means amputees are susceptible to delayed discharge.
On discharge from hospital, amputee care management is transferred to the Amputee Rehabilitation Service based at Bowley Close Rehabilitation Centre, Crystal Palace. This purpose built physical rehabilitation centre is managed through the GSTT Community Services Directorate. The service provides life long prosthetic management for all amputees across South East London.
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5. Engagement to date
Proposals for changes to Intermediate Care bedded provision: what stakeholders have told us prior to September…
We are grateful for the continued support and involvement of local user groups, in particular the Friends of Lambeth Community Care Centre who have been involved in our discussions about the future of the Centre over a number of years.
The Integrated Care Programme, together with Lambeth Age UK and independent consultants Direct Roots; produced an engagement report which collates the views and experiences of older people in respect to a range of services. The information gleaned from User Reference Group meetings, one-to-one interviews and ten ‘My Stories’ submitted by carers and patients, highlight important themes and concerns in respect to the care of older people.
Below is a brief summary of key themes and points for further consideration as part of this process and as we look to implement these proposals in the future.
• An acceptance of the need for local NHS partners to review bed-based intermediate care as part of a wider range of initiatives to bring care closer to home • Patients should have alternatives, where care provided in their home may not be suitable • Improve the consistency of follow-up in the community by GPs, nursing and other health care staff • Better and greater communication between the organisations involved in delivery of health and social care • A need to improve:- § Hospital discharge support, including the information provided to patients and carers so they know what to expect when they leave hospital § The quality of services that support patients in their homes, by:- • Supporting staff to develop the necessary skills to undertake the required tasks • Allocating sufficient time to home-visits so visits do not feel rushed • Improving the reliability of staff and service e.g. when visits are running late • Timely supply of aids and completion of adaptations that support a patient to rehabilitate and remain at home • The role of voluntary community organisations and the usefulness of signposting patients for support and as a way of reducing isolation sometimes felt particularly by those who may be vulnerable and living alone
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The following points are specific to the Lambeth Community Care Centre • The importance of the garden to Lambeth Community Care Centre, including:- • Its maintenance and upkeep by a paid gardener • Role of the garden in therapeutic rehabilitation • Refurbishment of the conservatory and balcony as a space for patients
Development of a new Amputee Rehabilitation Unit at Lambeth Community Care Centre: what stakeholders told us prior to September…
We are grateful for the support of the Bowley Close Rehabilitation Centre, Prosthetic and Orthotic User Group, which is chaired by Sam Gallop CBE, a member of the Associate Parliamentary Limb Loss Group.
In January 2011, the Associate Parliamentary Limb Loss Group (APLLG), published guidance to support the commissioning of national specialised services for people of all ages who experience limb loss. The views of the group’s broad membership (including national professional bodies, charities, user groups and individuals) informed this document, which emphasises the following (APLLG, 2011) 1:
• Patient outcomes and independence must be central to limb loss rehabilitation • A need to give greater consideration to the quality of life following limb loss – studies have shown that more intensive, specialised inpatient rehabilitation is more effective when compared to generic rehabilitation or home-based care following amputation • The importance of a patient’s access to their peer group for support, learning and improving independence • A focus on providing a patient centred service with informed patient choice in respect of their care and management • Services should be provided in specially designed and adapted facilities • Measuring the patient experience and patient outcomes are a key priority
The early proposals for the development of an Amputee Rehabilitation Unit were welcomed by the user group, as this represents a new service that will offer patients who experience limb loss a much more intensive rehabilitation, which is reflected in the aforementioned document. As this is new service further patient and public involvement is required. The views of patients and user groups will be central to the development and implementation of the final proposal and in the future, the ongoing monitoring of the quality of service, patient experience and outcome.
The Prosthetic and Orthotic User Group play an important role in the work of Bowley Close Rehabilitation Centre. This period of public engagement is a continuation of an established dialogue and relationship with this group, as
1 Associate Parliamentary Limb Loss Group, 2011. Commissioning For Patients: Guidance on National Commissioning of Specialised Services for People of All Ages with Limb Loss . London, January 2011. 8
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well as an opportunity to invite the views of other patients, their families and carers with regard to the proposals
6. Proposals for change
Intermediate care
We are proposing to consolidate the provision of bed-based intermediate care for Lambeth at the Pulross Intermediate Care Centre (Brixton), with a higher occupancy of the ward, more intensive rehabilitation input and a higher staffing ratio per patient than at present. There will also be an investment in more home-based rehabilitation as some patients currently cared for as inpatients will be looked after at home instead.
Pulross is being proposed rather than LCCC for the consolidated unit due to issues of space and capacity. LCCC has a maximum safe capacity of 16 beds, whereas Pulross can hold 20 beds. In addition Pulross is more centrally located within the borough creating equitable access whereas LCCC is at one end of the borough.
Both Lambeth and Southwark residents would continue to be able to access the facility, although the provision will be mostly for Lambeth as at present. For Southwark this would be patients registered with the 6 practices currently using LCCC.
The benefits of this proposal are:
A more intensive level of care and rehabilitation: It is anticipated that most inpatients at Pulross will require double handed care for both nursing and therapy at the point of admission, as most patients needing only one person for care and rehabilitation will be cared for at home. We would plan to transfer some of the staffing resource from one unit to the other, enabling the unit to run on a more intensive basis with up to 90% or 95% occupancy, and on the same basis each day of the week, meaning that admissions, discharges, therapy input and nursing care would all be carried out at weekends in a similar way as during the week. Staff will be able to meet the needs of the caseload more effectively than at present, provide more intensive rehabilitation, reduce length of stay and be able to refer patients on to community based services for them to complete their recovery/rehabilitation
Weekend staffing to include therapy staff: The ward will be staffed with a therapist of each discipline at weekends which will mean that • Patients can be admitted at weekends and will be fully assessed, mobility and other equipment provided and rehabilitation interventions will start immediately rather than waiting until Monday or delaying acceptance of patients for admission until Monday • Effective detailed history taking and information gathering from carers and family regarding complex social and housing environmental issues can be collected immediately upon admission by the occupational therapy staff
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and home visits planned well in advance. Discharge planning liaison and discussion with carers and relatives can also be supported more effectively. • Rehabilitation support staff can be supervised and undertake therapy/ rehab with the therapists at weekends as well as during the week to ensure patients continue to progress. • Home visits and access visits with family members who are unavailable during the week can be undertaken at weekends.
Patients will therefore receive a far higher level and consistency of care which will significantly help their recovery and rehabilitation. This will help reduce the length of stay for patients on the unit and improve outcomes. It is also likely to improve patient and carer satisfaction as they will have access to health professionals at all times
Nursing staff levels: By consolidating staff together we will be able to provide the highest and safest level of care. This will include a minimum of 2 qualified nursing staff on each shift.
Specialist Medical support: The current level of specialist medical advice to the 2 units will be combined onto one site allowing for more frequent patient reviews, advice to staff and multidisciplinary team meetings as part of the improved service.
Co-ordinated care and multidisciplinary team working: By having staff together in a single unit, we would be able to co-ordinate care better, particularly the multi disciplinary team of doctors, therapists, nurses and the aligned social workers. There would be more therapy staff and nurses working together with nursing support staff including rehabilitation support skills, meaning that patients receive a more co-ordinated level of care over the 24 hr period.
We would review the multi-disciplinary team working arrangements and clinicians’ roles and responsibilities, as well as using this opportunity to streamline processes, decision making and ensure that length of stay is minimised and care is optimised throughout the patient journey.
Improved length of stay: A co-ordinated multidisciplinary team should help reduce the currently high length of stay of around 41 days. Geriatricians have expertise in complex discharge planning in a timely manner and should have regular input into the care provided by the consolidated services. Our discussions with those involved in the service have highlighted the need to have strong, clear and dynamic multidisciplinary leadership, along with good team working, in order to bring about change in lengths of stay.
More care provided at home: feedback indicates that most patients would prefer to be cared for at home if this can be done safely and effectively rather than in an inpatient unit.
Collaboration with social care: the focus on consolidated care would provide an opportunity to streamline social care liaison and to ensure clear pathways for
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patients with enablement services, supported housing and long-term care, for example in supporting patients to return home or to residential care.
The impact on activity, cost and length of stay is set out below. The proposals will result in an increase in activity, with a total of 922 admissions to either the inpatient unit or the supported discharge team as compared to 894 admissions in 2011/12. The proposals will also result in a net saving of £469k.
Impact on activity, cost and length of stay
Actual 2011/12 Expected under new proposal Total inpatient admissions 239 188
Average bed occupancy 73% 90%
Average length of stay in inpatient 41 days 35 days (may be units able to reduce further)
Admissions to home-based supported 655 734 discharge
Average length of stay in supported 35 days 35 days discharge
Total cost of inpatient service £3,056,000 £2,446,000 (includes building costs and overheads)
Additional cost of supported £141,000 discharge service
Net financial impact -£469,000
Amputee rehabilitation
We are proposing to use the ward at the Lambeth Community Care Centre (Kennington) for a new form of care out of hospital for SE London, an Amputee Rehabilitation Unit. This will allow for specialist provision of intensive therapy post- amputation, to which patients would move shortly after amputation once they are medically stable. This is similar to the approach already adopted in South West London at the amputee rehabilitation unit at Queen Mary’s Hospital, Roehampton.
Patients undergoing amputation currently have a lengthy period in hospital post amputation. Evidence shows that specialist provision of intensive amputee rehabilitation reduces time spent in hospital, enables more rapid achievement of the functions of daily living, and improves health outcomes. There is also a reduced burden on social care. The improved rehabilitation and independence levels
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achieved reduce the need for patients to receive home care packages and admission to residential homes. The therapeutic rehabilitation package would include support and adaptations to return to work.
The new service would take the form of a 12 bed ward on the first floor of Lambeth Community Care Centre with use of the gym and other facilities on the ground floor, as well as the garden and general therapeutic environment of the Centre which will support the holistic recovery of these highly vulnerable patients. However we would aim to maintain the outpatient services currently provided on the ground floor for the benefit of the local community (foot health, heart failure, occupational therapy and speech & language therapy for older people, falls exercise, musculoskeletal physiotherapy and the acupuncture service).
The amputee rehabilitation service would be provided for all patients undergoing an amputation at GSTT or Kings College Hospital. In order to ensure that the beds are fully utilised, and make the most efficient use of the resource, we would also open access to patients from Lewisham, Bexley, Bromley, Greenwich and potentially further afield. The unit would be a highly specialist rehabilitation unit comparable with a specialist neurodisability or brain injury unit, and it is beneficial to patient outcomes and effective use of a specialist resource to bring similar activity together on one site.
The expected benefits are:
• Better health outcomes and more rapid achievement of the functions of daily living, improving patients’ quality of life and reducing the cost in social care and supported accommodation • Reduce the hospital length of stay of amputees by transferring them to a dedicated unit designed around their needs • Standardise the amputee pathway across south east London ensuring an equitable, accessible service • Allow intensive 7 day rehabilitation in a single location with a clinical service bridging acute and community services
With regard to social care, there is cogent evidence from reports by the Audit Commission 2 and the Office for Disability Issues 3 that the proposed integrated model of care for our amputee patients will realise widespread benefits across the whole health and social care system and society in addition to improved quality of life and improved health and well being outcomes for the patient and their carer.
Activity, cost and length of stay
2011/12 Amputation activity across GSTT and KCH 51
Amputation activity in Lewisham, Bromley, Bexley and 32 (estimate)
2 Audit Commission (2002): Fully Equipped. Available from www.audit-commission.gov.uk 3 HM Government (2008): Better outcomes, Lower costs. Available from odi.dwp.gov.uk 12
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Greenwich
Bed requirement for GSTT/KCH activity 7
Bed requirement for Lewisham, Bromley, Bexley and 5 Greenwich Expected length of stay in the amputee rehabilitation Average 49 unit days
Financial arrangements to pay for the amputee rehabilitation services are still being put in place but there is broad agreement with commissioners to pay for the activity with a tariff at cost plus overheads.
7. Proposed timetable for implementation
Following the end of the engagement period which we are proposing to extend to the end of December, we are proposing to put in place the changes to intermediate care arrangements first. The amputee rehabilitation unit will require some refurbishment work at LCCC as well as the recruitment of some specialist staff, so we are aiming to open this slightly later.
8. Equality Impact Under the NHS Equality Delivery Scheme, commissioners and providers of service are required to take the necessary actions to achieve:
• Elimination of unlawful discrimination. • Advancement of equality of opportunity. • Fostering of good relations between individuals and communities.
In particular we look at the protected groups: Age, Disability, Gender Reassignment, Marriage and Civil Partnership, Pregnancy and Maternity, Race, Religion and Belief, Sex, Sexual Orientation.
We have reviewed the proposals and highlight the following equality impact issues:
• Age Services are available to people of all ages and provision is based on an individualised assessment and personal rehabilitation goals. This will determine whether a patient can be supported at home or requires bed based care dependent on their holistic health and personal needs.
• Disability Both buildings are accessible for people with impaired mobility and the LCCC will be further adapted to meet the specific needs of people who have had amputations. The range of provision will be better suited for people with dementia to support them in their own home – a more familiar and comforting
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environment.
• Sex/gender/gender reassignment The Pulross centre and LCCC provide separate accommodation for men and women to ensure personal dignity can be maintained. Bathrooms and toilet facilities are separate and are used by one person at a time. This would enable people undergoing gender reassignment at whatever stage to make their own choices of which facilities to use. Both Pulross and LCCC have consistently met the national requirements to avoid mixed sex accommodation. Home based care enables people to be supported in an environment that reflects their own choices and circumstances.
• Religion and belief As more people will be supported in their own homes it will be easier to reflect the individual needs and requirements of patients and carers. The Pulross Centre and LCCC cater for the range of dietary needs of different faiths and operational policies reflect the need to respect and support religious requirements and those of no religion. Through our work on long term conditions in a community setting we are doing further work to ensure advice includes support to people of different religions e.g. diabetes and fasting.
• Race We have undertaken equality impact work on the needs of different communities represented in Lambeth and the implications for identification, advice and support for people with long term conditions. We know for example that people of African Caribbean origin are more likely to have high blood pressure and people of South Asian origin are more likely to develop Type II diabetes in later life. We are working with our GP practices to ensure we are identifying and supporting people at an early stage of these diseases to prevent complications in later life. We are monitoring all our services to review whether we are seeing the range of people from different ethnic origin we would expect based on evidence. We are also working to ensure advice is appropriate to different diets and lifestyles. Work is being undertaken to ensure that people from different ethnic minorities are represented in memory clinics for people with dementia.
• Pregnancy and Maternity The current profile of patients does not suggest there are specific issues in this area we need to take into account. GSTT have staffing policies to ensure staff are protected and supported during pregnancy and maternity.
• Sexual orientation We have not identified specific issues with regard to supporting lesbian and gay patients and their carers beyond the broader need to ensure that patients and carers wishes are respected in home based care and bed based care and in staff support. These are reflected in current
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operational and staffing policies.
Access The Pulross Centre is located in Brixton and has better public transport links across the borough for family and carers of people who receive bed based intermediate care, although conversely people who live in North Lambeth and Southwark would have further to travel. For people who have had amputations, users and carers will be travelling from across South East London. Users are normally transported via NHS transport and this would continue. As the alternative service is at Queen Mary Roehampton, the service at LCCC would be closer, in particular for Lambeth and Southwark residents. Support with costs of transport is available for those patients and carers on low incomes.
9. Timetable –
The proposal was/is being discussed at the following meetings
5 September 2012 Lambeth Clinical Commissioning To update on proposals Collaborative Meeting and seek agreement to move to final phase of engagement.
23 October 2012 London Borough of Lambeth To scrutinise the process, Health Overview and Scrutiny review proposals and Meeting engagement.
7 November 2012 Lambeth Clinical Commissioning To receive response to Group Governing Body engagement process and decide on next steps
To support the final stages of engagement, the proposal went to the following meetings where there was representation from the LCCCB & GSTT. Information was made available through the Lambeth CCG and Guy’s & St Thomas’ websites where people were invited to comment and give their views. This was supported by an online questionnaire. Paper copies of documents and questionnaire were made available through LINk and the centres and people were also invited to comment by phone or in writing if they wished.
Date Constituent Format Numbers attending group 4 Sept 2012 Older Agenda item at 11 including 4 NHS People’s regular partnership Lambeth CCG and Partnership forum GSTT staff; included Board Lambeth Council, SLaM, 3 vol orgs and 1 local authority cabinet member
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5 Sept 2012 Lambeth Meeting in public – 40 including 11 Clinical presentation of paper, members of public or Commissioni discussion by Board community/ voluntary ng members in public organisations, LINk and Collaborative and opportunity for 1 local authority Board public questions or member comments 12 Sept 2012 Bowley Close Meeting of service 5 service users RUNG user group at 5 GSTT staff meeting rehabilitation centre: presentation by NHS Lambeth CCG and GSTT, followed by discussion 13 Sept 2012 Guy’s and St Agenda item at Thomas’ regular Governors’ NHS meeting forum Foundation Trust Council of Governors Patient Experience Working Group 18 Sept 2012 Lambeth presentation by NHS 17 carers Carers’ Hub Lambeth CCG and autumn GSTT, followed by Health Focus discussion around meeting small tables, using topic guide developed with Lambeth LINk 19 Sept 2012 Lambeth presentation by NHS 26 LINk members LINK Lambeth CCG and Steering GSTT, followed by Committee discussion using topic guide developed with Lambeth LINk 25 Sept 2012 Age UK Outline of proposals 3 Age UK Lambeth Lambeth followed by open staff discussion 2 Oct 2012 Friends of Members’ meeting: 58 including 51 Lambeth outline of proposals members of the public Community followed by open and 7 NHS Care Centre discussion representatives
Other stakeholders and providers including primary care, London Borough of Lambeth, Kings College Hospital and others were informed via e-mail communication and given details on how to provide feedback and comments. We offered meetings with services or other groups if requested.
10. Responses to October 2012 The meetings undertaken and other forms of feedback are detailed in Appendix II. We have a lot of material to process and review and this has not
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been completed but some key questions are outlined below:
Why intermediate care at Pulross and not LCCC? The Pulross Centre is the more modern of the two existing intermediate care sites. While the design incorporated the successful features of the LCCC it also reflects the current requirements for a high quality, safe intermediate care environment. The central location in the borough ensures equitable access for all Lambeth residents. Being sited outside of the London congestion charging zone and having on site parking reduces the travel costs for patients and visiting carers and families.
A significant benefit of moving all care to The Pulross Centre is an issue of space and capacity. LCCC is not large enough to hold enough patients as its maximum safe capacity is 16 beds, whereas Pulross can hold 20 beds. More space is important when patients have a high level of needs.
GSTT is very keen to continue using the excellent resource of the Lambeth Community Care Centre inpatient ward. This is co-located with a number of outpatient services (physiotherapy, occupational therapy, speech and language therapy, falls exercise, foot health, acupuncture, heart failure) all of which would remain. It also has a beautiful garden which has good access from the ward and is conducive to the healing and rehabilitation process. It therefore provides an ideal environment for amputee rehabilitation which would use both the indoor and outdoor space to the full potential.
The present 16 beds would reduce to 12 to provide amputee patients with more space, offering a more comfortable environment for a typical 6 week stay. The proximity of the LCCC to St Thomas’s Hospital, where the surgical amputation activity will predominantly take place, will ensure patients have continuing access to medical and specialist input in addition to the dedicated ARU clinical team.
What other options were considered for LCCC? Other options considered included relocating other services from Guys & St Thomas' Hospital to the LCCC ward, but none of these were as appropriate for the building and its focus on rehabilitation and recovery as the proposed Amputee Rehabilitation Unit. Alternatively we considered relocating the ground floor services to other locations and releasing the whole estate, but felt that it was important to retain this valuable resource with a community services focus. The Friends of LCCC have indicated that they have some ideas about what services could be offered at the centre, but these have not been shared as yet.
Is care at home suitable for people living alone? The majority of patients cared for in NHS home based services live alone and each patient is assessed according to their needs. Referrals are carefully reviewed to ensure that the person can be safely supported at home. If at any point the clinical team has concern that it is not safe for the person to be cared for at home, an admission to an intermediate care bed is promptly arranged. Each person receives a welcome pack with contact information of
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team members and their key worker. A care plan is developed with the person, and where possible their family and carers, to meet their individual needs and wishes.
If these changes happen, will investment in alternative services actually happen? Many new and enhanced services have already been put in place prior to these proposed changes (see page 2). Some additional services are being piloted during 2011-12 and we are in the process of agreeing recurrent financial commitment between Lambeth & Southwark CCGs and Guy’s & St Thomas’. It is the provision of these services which is highlighting a reduced requirement for bed based intermediate care.
The consultation process is too short on the specific proposals put forward We believed that the work undertaken prior to September had enabled views to be gathered on the balance between bed based and home based care. We have heard that some people felt that the period of engagement on the specific proposals was too short. We will therefore be recommending to Lambeth CCG Governing Body at their November meeting that we extend the engagement period to the end of December to ensure that people in Lambeth feel able to express their views.
11. Conclusions
We have had a wide range of views expressed on the proposals and particular questions and concerns about the future of Lambeth Community Care Centre. We are keen to ensure that we give people adequate opportunity to review and comment so are recommending extending the engagement period
Health Overview and Scrutiny is asked for their comments to inform the recommendation to NHS Lambeth CCG Governing Body: • The overall proposals • The views and comments from the engagement process
Moira McGrath Director of Care Pathway Commissioning 10 October 2012
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Appendix I Case studies
Previous system Mr Smith a 78 year old man with Parkinson’s Disease who fell and fractured his hip is discharged from hospital to an intermediate care centre as he is currently unable to look after himself at a level that can be supported within his own home. He stays there for 4 weeks receiving consultant doctor review of his medical issues, nursing care and therapy sessions until he is able to do things independently enough to manage with current levels of home care and therapy support
New system Mr Smith is discharged home from hospital and receives the care he previously would have received in the intermediate care centre in his own home; in addition to his previous social services care visits he receives rehabilitative sessions from therapists and three visits a day from rehabilitation support workers to help regain his mobility, plus consultant doctor review of his medical issues,
Previous system Ms Allen an 80 year old lady fell at home and remained on the floor for 24hours before she was found by a friend. She spent 2 weeks in hospital very unwell and had a very large pressure sore from the time on the floor. The hospital discharged her to an intermediate care centre. The nurses managed her sore and she received therapist sessions alternate days as these required two therapists and large specialist equipment. To help plan for her discharge a home visit was done but had to wait until an occupational therapist was available
New system Ms Allen’s needs still require a discharge to an intermediate care centre as the therapy input cannot be provided in her own home until she only requires one therapist for a sessions and no need for large equipment. However the increased therapy staffing levels ensure she receives daily therapy. The occupational therapist is available to do the home visit as soon as Ms Allen is ready to go home so there is no delay.
Previous system A 68-year old gentleman with a history of respiratory failure and heart failure was discharged from St George’s to an intermediate care bed following a collapse. He needed 2 staff to support his movements, with input more than once a day from a physiotherapist with a therapy assistant to help him progress to a level where it was safe to support him in trying to regain his mobility. His progress would have been quicker if two staff had been available at all times to do this, including at weekends when therapy is currently not available. A home visit assessment was done with this patient on a Monday and he went home the following Wednesday.
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New system With increased staff availability at the weekends the visit could have been done the previous Saturday enabling him to go home a little earlier.
Previous system A 70 year old gentleman underwent an amputation resulting from diabetes and vascular disease. He was discharged to an inpatient intermediate care bed having only had one therapy session. The unit has no specialist amputee equipment and no amputee therapists. He then had to wait to be seen in a hospital outpatient service for rehabilitation therapy. In the meantime he could not be cast for a prosthetic limb, and without a prosthetic limb he was unable to return home. The absence of intensive rehabilitation increases the risk of losing strength in the muscles, which increases dependency and prolongs immobility, further delaying discharge home as patients can then require greater input from social services. This also has an impact on psychological well being and motivation.
New system With specialist care in an Amputee Rehabilitation Unit, this gentleman would have started post amputation therapy immediately and been cast for a limb within a week. The prosthetic limb would have been provided a week later. During this time he would have continued to receive daily therapy, supported by specialists, able to ensure the appropriate rehabilitation and support package was in place to allow him both to return home and achieve his best possible ability to function with the minimum of delay.
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Appendix II
Interim Feedback Report: local views about proposals for changes to intermediate care at Lambeth Community Care Centre and Pulross Centre and the development of a new Amputee Rehabilitation Centre 10 October 2012
1. Introduction This report gives a summary of feedback from local people to proposals for changes to the provision of intermediate care in Lambeth and rehabilitation services for people who have had amputations. The proposals were developed jointly by NHS Lambeth Clinical Commissioning Group and Guy’s and St Thomas’ NHS Foundation Trust and involve changes in the use of the Lambeth Community Care Centre in Kennington and the Pulross Intermediate Care Centre in Brixton.
2. Objectives and focus of engagement In discussions with local stakeholders we wished to focus on practical steps we might take as commissioners and providers of NHS services to ensure that our plans for intermediate care and amputee rehabilitation follow best clinical practice, tie in with national and local strategies for addressing health need and securing health improvement, achieve a good patient experience and result in improved outcomes. Feedback was invited on:
• factors that contribute to or impede the delivery of high quality effective intermediate care as an inpatient (including discharge arrangements and weekend operation) • factors that contribute to or impede the delivery of high quality effective intermediate care at home (including assessment and issues affecting confidence in the service) • factors that contribute to or impede the delivery of high quality effective amputee rehabilitation (including physical and emotional aspects of care) • comments on specific proposals • how people might be involved in implementing proposals • how people might be involved in monitoring the quality of services • equalities issues
3. Methods for engagement
People were encouraged to give their views through a range of methods and media. We list methods used and numbers of responses for each:
Method Responses/ Comments participants Survey - online 18 Survey - paper 18 Survey total 36 11 patients/carers 15 local residents/ local group, organisation or church members 1 vol org
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11 NHS staff incl 9 clinicians/therapists writing to a named individual in NHS 0 Lambeth CCG telephoning a named individual in 0 NHS Lambeth CCG emailing comments to a dedicated 1 local authority member email box at NHS Lambeth CCG attending one or more of a series of 165+ includes 16 NHS Lambeth CCG or meetings during September and GSTT NHS FT staff/representatives October 2012
We arranged a series of meeting targeting patient, carer and community groups that we could anticipate would be most affected by the proposals and who we knew would be interested: older people; carers; amputees; service-based ‘friends’ group; LINk, as well as key local stakeholders. We sought to go out and attend meetings of these groups where these were planned, rather than to arrange separate meetings, but we did set up a meeting jointly with Age UK Lambeth and attended a special meeting of the Friends of Lambeth Community Care Centre. The following meetings offered opportunities for individuals, groups and stakeholders to hear about the proposals, ask questions and give their views:
Date Constituent group Format Numbers attending 4 Sept Older People’s Agenda item at regular 11 including 4 NHS 2012 Partnership Board partnership forum Lambeth CCG and GSTT staff; included Lambeth Council, SLaM, 3 vol orgs and 1 local authority cabinet member 5 Sept Lambeth Clinical Meeting in public – 40 including 11 2012 Commissioning presentation of paper, members of public Collaborative Board discussion by Board members or community/ in public and opportunity for voluntary public questions or comments organisations, LINk and 1 local authority member 12 Sept Bowley Close RUNG Meeting of service user group 5 service users 2012 meeting at rehabilitation centre: 5 GSTT staff presentation by NHS Lambeth CCG and GSTT, followed by discussion 13 Sept Guy’s and St Agenda item at regular 2012 Thomas’ NHS Governors’ meeting forum Foundation Trust Council of Governors Patient Experience Working Group 18 Sept Lambeth Carers’ presentation by NHS Lambeth 17 carers 2012 Hub autumn Health CCG and GSTT, followed by Focus meeting discussion around small tables, using topic guide
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developed with Lambeth LINk 19 Sept Lambeth LINK presentation by NHS Lambeth 26 LINk members 2012 Steering Committee CCG and GSTT, followed by discussion using topic guide developed with Lambeth LINk 25 Sept Age UK Lambeth Outline of proposals followed 3 Age UK Lambeth 2012 by open discussion staff 2 Oct Friends of Lambeth Members’ meeting: outline of 58 including 51 2012 Community Care proposals followed by open members of the Centre discussion public and 7 NHS representatives
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4. Views expressed and feedback on proposals
Analysis of the comments made and questions asked by participants in meetings and by people responding to the survey reveals some clear themes which we are considering carefully. Below is a summary of key areas we are now looking at.
Thematic analysis of feedback during engagement meetings and in survey, October 2012
Thematic area Key issues, comments, questions raised
Intermediate care
Inpatient intermediate Page 168 care Activity and current use • Concern re potential loss of a valued local service at LCCC due to underuse of beds of intermediate care • Suggestion that current underuse of intermediate care beds is due to a lack of referrals rather than lack of need: are beds potential referrers (eg GPs and hospital clinicians) unaware of the facilities or are the services not being promoted by the local NHS? • Scepticism regarding the figure cited that 30% of people occupying beds could be cared for at home –where did this figure come from? • Question whether there is evidence that there are not patients in Lambeth who are overstaying in hospital and/or prematurely returning home because they are not being referred to an inpatient intermediate care bed Need / capacity for • There is unmet need and continuous demand for beds at present. Is there an analysis of numbers and age of elderly inpatient intermediate population to be catered for? care in the future • The proposed changes represent nearly a 50% reduction in the number of intermediate care beds. At the time of the ‘snapshot’, Pulross Centre was 88% occupied. Can we be sure given the ageing population that the remaining 20 beds would offer sufficient capacity in the future? • Will 20 beds be enough to meet demand while related intermediate care services providing home-based care are further developed? • Some people who are ill like the idea of ‘security’ – LCCC is a safe place and there is a need for inpatient intermediate care in the future • What evidence is there that enhanced care will ensure that patients recover more quickly?
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Reduction in beds • Does the reduction in beds mean a reduction in intermediate care provision overall? Reducing 36 beds to 20 seems like a cut • How will the service cope when beds are reduced and more home visits are needed? • How will GPs cope with 16 fewer beds? Location of intermediate • Beds should be reasonably accessible to allow family, friends or neighbours to visit care beds • Having intermediate care beds in the middle of the borough means more people will be able to use them • Patients north Lambeth and North Southwark will be disadvantaged by location of beds at Pulross in Brixton • Pulross has poor public transport access – LCCC is better in this regard • Brixton is not suitable because it is not local • Why not provide the service at LCCC? • Lambeth Community Care Centre used to take patients from Streatham, and farther – the service is actually for the whole of Lambeth and concerns to keep it ‘local’ are misguided • Pulross premises are unsuitable and uncomfortable • The gardens at Pulross are poor, too small; the LCCC garden is better, but it isn’t used Respite care • Respite care is not included in these proposals – where does it fit into these proposals? When LCCC opened there Page 169 were respite beds • In the future there will be more need for respite care for carers of people with dementia Joined up services and • There is potential to use Council assistive technology in the unit continuity of care across • Effective liaison and communication between the whole team is needed for optimum recovery including inpatient agencies team, GP, social services, transport services where needed, family and patient • Continuity of staff and care, joined-up pathway and flexibility of care and support between different parts of the whole system Social benefits • Inpatient units offer people social opportunities – to eat with others etc • ‘When you see other people being rehabilitated it gives you hope’ Staffing, skill -mix and • Adequate permanent staffing levels to support rehabilitation goals and give continuity of care across 7-day week multidisciplinary working • Appropriate skill-mix among staff and strong multidisciplinary ethos and practice, eg social worker on site for multidisciplinary review and involvement of physiotherapists, occupational therapists, speech and language therapists etc as appropriate • Appropriately skilled and competent staff who are pro-active in assessing and addressing needs and providing stimulation • Effective team-working extending to hospital, community, social care, GP etc • Some patients need two people to transfer and staffing levels should reflect this
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• Will weekend clinical care mean reduced availability of clinicians during the week? If so, what is the gain? • Availability of admin support to make best use of clinicians’ time • Concern that therapy staff working weekends will be a waste of resource without availability of appropriate acute staff for handover Facilities and other • Use of garden and outside space as a resource for rehabilitation resources, systems and • Availability and timely access to appropriate specialist equipment that is maintained, and speedy assessments for processes equipment use • Efficient systems that release time for patient care - eg pharmacy orders • Transport from hospital to intermediate care unit or from unit to home, including at weekends
Transfers from hospital • Admission process from hospital to ICU is lengthy and convoluted and slow; referrals should be electronic and /community and to home auditable • A good handover from hospital/community and comprehensive and seamless discharge summary and handover to Page 170 Care and discharge community teams planning • Allocated case manager from within the team to lead discharge planning • Ensure care package in place on discharge / before patient leaves • Home visits at weekend to support discharge planning • Assessment of medical stability of patient prior to discharge home • Concern that community services are not well set up to receive patients with complex needs at weekends and out of hours • Involvement of patient and carers/relatives in planning clear discharge plan and programme of care that everyone understands – clear communication • Correct medication to be issued on discharge Concerns and Care at home model is not suitable for all - intermediate care bedded units are needed because: perceptions of limitations • some homes are not suitable for care because of stairs of care at home model • care at home will not cover overnight • some people do not have any immediate family to care for them Qualit y and safety • Having staff on site makes some people feel safer • a care centre is a safer option, because less efficient staff are being monitored – this doesn’t happen with home care
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Intermediate care at home
Communication • good communication is needed between health care professionals, social care etc - not expecting the carer to act as the co-ordinator between them Needs assessment and • Discharge plans developed with patient and carers if patient transferring from hospital or intermediate care unit care planning • Rehabilitation goals to be directed by the patient • Care package in place on discharge home • Important to know who is responsible and what care is going to be provided and by whom - care plan to include a list of who to contact • Assessment must take into account support available at home from family and carers • Assessment must consider suitability of home environment and need for adaptations or assistive technology • View that people with severe dementia, shouldn’t be asked to complete questionnaires about where they want
treatment. They will say ‘home’, but this will often not be possible Page 171 • Important that people going into people’s homes are skilled up to address people’s wellbeing as well as their physical rehabilitation needs, and they need to be able to make assessment for assistive technology • What about care at night? • Patient choice a factor in weekend or bank holiday care at home – will patients want to be seen at these times? Availability of crisis • Access to a 24-hour helpline for immediate and distressing concerns will give patients and carers confidence support • Advice on where to take concerns if things aren’t working out Informal c arer s: • Importance of a good assessment of carer's needs involvement, impact of • Views of carers taken into account in care plan proposals and support • Carers would prefer home-based care wherever possible - being cared for in hospital or other in patient unit is very disorientating for the patient and does not reduce the burden on the carer; opposite view also expressed – that intermediate care at home may place additional burden on informal carers and negatively affect their health • Only rely on carers /family if they are confident and willing to provide support • when patient wishes care to be provided by carer alone carers could be supported by advice and information; training - eg to support someone with eating or drinking difficulties using correct and safe techniques; and practical support around eg, disinfection and odour removal Continuity of ca re • Concern about continuity of clinicians – need to build trust and develop a relationship – suggestions included having teams in areas (a ward), and a system of matching a patient with a nominated keyworker
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Quality and safety • A perception that hospital at home is less safe • Three home visits a day sounds a lot, but it may not feel like this if you’re the patient • Patients should have a 24-hour number to contact in an emergency • Speech and language therapists need to be included in the 7-day model – without support from SLTs discharge home for patients with swallowing difficulties at weekends could be unsafe • There needs to be regular and independent evaluation of the service and recipients should be asked for their experiences and what could be improved Social isolation / people • A concern that care at home is less suitable (or not suitable) for people who live alone or with a frail partner – they who live alone may not have support from friends or neighbours or may not wish to rely on them • Often what helps recovery is engagement with others – there is a potential for that not to be the case if people are cared for in their own home • For some people, a goal to get back to where they were before a fall, an operation etc may still leave them in a poor position – eg isolated and at risk – wellbeing should be a dimension of recovery goals; good intermediate care could Page 172 support people to reconnect with their community in a way that will support them longer term If done well, intermediate care at home can remove social isolation by linking people back into their community, or making that link for the first time; social care can support this Social aspects of • Motivation is harder if you’re on your own... being with other people in a similar situation can help – could a group be rehabilitation and local organised for people to come into the Pulross for exercise? links • Information on services, facilities and support groups available locally would be helpful for someone recovering at home Access: home • Intermediate care at home has to be linked to good home environment and a proper housing assessment, with environment - suitability housing requirements factored in, eg the need for wheelchair access, heating etc /assessment / • There should be a risk assessment of the home environment - what about stairs? adaptations • Equipment /assistive technology should be in place • Ability to order and deliver equipment promptly is important to enable person to get home as soon as planned • Some homes are not suitable for care because of stairs etc How patients are treated • more care at home is good but it needs to be the ‘right kind of care’ - carried out with dignity, involving and by staff - ‘human values’ respecting the carer, with good communication between health care professionals, social care etc - not expecting the and patient focus carer to act as the co-ordinator between them • Importance of continuity on staffing to dignity and respect: if staff have to keep going through your book and you have to repeat yourself it doesn’t make for a dignified experience’ • Conversation with the patient is important - paid carers need to spend time listening to the patient and developing a
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relationship, not just filling in forms • Health care providers need to focus on the patient and not show their own stresses and pressures, as this can make the patient feel guilty for taking up their time • Carers should not change their schedules to suit themselves • Reliability is extremely important – that carers come when they should do so, and keep patients informed of any changes to schedules Involvement and • Concern that social care and housing play their part – confidence is low among many people in care at home services adequacy of community- and poor experience of adaptations to home environment based support (local • Care at home needs to link with social care and GPs need to visit at home authority - social care • There is a lack of evidence of good home support or improvement of outpatient services -proposals for supporting and housing, primary people in the community (eg Home Ward) are new and untested care and community- • Investment in expansion of supported discharge and rapid response teams’ work will be needed but there is no detail based NHS support) on increased resources for this or timetable in proposals; • nursing care in the community requires different skills so simple transfer of location is not workable
Inefficient use of • Clinicians will have to travel a lot, which wastes time. This doesn’t happen in a bedded centre Page 173 clinicians’ time
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General issues intermediate care Proposed model of care – • Of course we’d all rather be cared for at home rather than go into hospital, but practicalities should be the deciding general comments factor • Care at home is best for the patients if the care is good • the extra attention being given to health care in the home is welcome, but there are many situations where that is not the best arrangement and temporary inpatient provision is the best solution • There are pros and cons to the proposal. We are well-looked-after at LCCC – it is a good place; BUT: it’s now 2012 – people want to be home asap. • It’s a good time for change! Cost and savings • We are told there are money problems, but also that this proposal is not about savings • The cost of the proposal must be enormous Page 174 • What will the savings be? • Will properly provided care at home be cheaper than inpatient care? • There seems to be confusion about the financial aspects of this proposal – on the one hand it is described as a cost reduction exercise and on the other that increased resources will be put into this service • The unit costs issue is important, because unit costs look better the more a place is used Engagement process • the proposal for the future use of the LCCC has been arrived at without reference to the Friends or the community • the consultation is taking place too late • It is a very short consultation period – 30 days is not enough • Things have to change, but local people could have good ideas for better use of LCCC - there should be a delay in decision-making for a few months, to give a chance for local people to contribute ideas • What other scenarios have been considered? • the questionnaire is slanted, the questions are not helpful and it is full of gobbledygook • the consultation document asks questions about people’s opinions on the details of different care services, but nothing specific or direct about the future of the LCCC facility, its current and proposed future use • people have been told about commissioners’ plans rather than consulted or asked • Will all comments be available to the Board, or just a ‘smoothed-over’ summary? • Can there be a petition?
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Alternative uses for LCCC • Things have to change, but local people could have good ideas for better use of LCCC. There should be a delay in decision-making for a few months, to give a chance for local people to contribute ideas • What other scenarios have been considered? Existing outpatient • How will proposals affect existing outpatient provision? services at LCCC • desire expressed for increased access to physiotherapy from LCCC to local residents • Is there a possibility of a falls clinic at the LCCC? Existing outpatient • Will other services at Pulross be affected or remain the same? services at Pulross Centre Local ‘ownership’ of • the Friends of LCCC have supported the centre and the intermediate care unit for many years and many are existing LCCC concerned at the proposed change of use • Local residents’ association and others worked hard to get LCCC; they don’t want to have to travel to Brixton • view that LCCC was developed for local people; it should be kept Therapy input / • The need for rehabilitation goals to be directed by the patient rehabilitation goals • Regular therapy sessions including at weekends • Recovery is also about wellbeing Page 175 • Restoring confidence • Stimulation for inpatients – not just occupational therapy Spiritual care • Spiritual care needs of patients need to be addressed both in proposals and in the questions asked of respondents Social aspect of • Social aspect to learning how to do things again – whether as inpatient or having intermediate care at home rehabilitation Equalities • Reducing inpatient care from 36 to 20 beds is a cut that will affect the elderly of north Lambeth • If care is provided at home, how will the needs of people who do not speak English and whose family work full-time be met? Outcomes, measuring • People must make complaints if they have a poor experience quality and patient • This is a brilliant idea and I hope it works! We’d need to review, say, in 6 months. We’re not so good at reviewing to experience see how well things are working. You can use carers to feed back sometimes • a care centre is a safer option, because the less efficient staff are being monitored – this doesn’t happen with home care • Monitoring of outcomes is important to ensure good patient experience • Outcomes of good/successful intermediate care experience would include: people feeling more in control of their lives after intensive intervention; people feeling more confident and ‘in touch’ – linked in and aware of ongoing sources of support
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Development of Amputee Rehabilitation Unit (ARU) Relationship to wider • Do the proposals for a new ARU to provide capacity to other parts of London, tie in with current vascular services strategy across South- strategy? east London for vascular services
Sustainable business • Is the proposed amputee rehabilitation unit sustainable long-term and is this a viable market? Is there a gap in model/case provision currently and is there sufficient demand beyond Lambeth? Will there be sufficient additional activity (besides GSTT and LCH patients) to support the new unit? • The proposals that will offer specialist rehabilitation for amputee patients are welcome – what is the proportion of beds that would be available to local patients and those which may be offered to patient from further a field? Page 176 • Would this unit be in competition with the unit in Roehampton or might learning and skills be shared? Key aspects of • Pre-operative home assessment rehabilitation service – • Stump care, wound care, pain management physical care • Availability of specialist trained staff and readily available equipment • Staff continuity • Speed of access to prosthetics, orthotics and assistive technologies and support to learn to use • Therapy/ rehab care – mobility practice and strengthening exercises • Free access to gym equipment Key aspects of • Confidence-building through physiotherapy rehabilitation service – • Ease of access for family and friends – location of service in relation to home and family emotional care • Pastoral care and social support incl peer group (incl development of peer group) • Information about what to expect post-surgery • Talking therapy input Discharge from ARU and • How will people living in hostels can be cared for and supported? follow-on support • Concern re: patients being discharged at 2.00am with no support available at home – could training be available for next of kin in how to help and support patients? Seems to be an assumption that neighbours are available to help and support patients • Agreement that people like care in the community but question re: mechanisms for those who lived on their own to
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ensure they are not forgotten or lost in the system • Reaction of family and friends to patient’s change in circumstance • Availability of equipment and specialist staff • Emotional support • Access to relevant specialist multidisciplinary teams (eg medical, diabetes, rheumatology, gerontology) • Accessibility of centre for wheelchair users Longer term concerns • Using public transport • Employment Workforce implications • How will the workforce implications be managed given the areas are sometimes difficult to recruit to? and opportunities • Concern re: possible shortage of appropriately experienced nursing staff – where will they come from? Appropriateness of LCCC • The garden and existing facilities offer an ideal environment for rehabilitative services as site for ARU • Many concerns expressed by Friends of Lambeth Community Care\Centre, including: o Amputees will want to use the garden, but at LCCC it is difficult, uphill o Amputees need a better service, but not at LCCC
o Is LCCC suitable? Is it too small? Page 177 Support from user group • Amputee user group agreed to accept and support the proposals
Re lationship of proposed • Could the relationship with existing Friends of Lambeth Community Care Centre be retained with change of use to ARU to friends of LCCC? amputee rehabilitation unit?
Rationale for ARU • Is the amputee unit proposal anything to do with the fact that after 2014 all military personnel will have to be cared for in their own home area? Accessibility for visitors • To make LCCC viable as an amputee centre, it will need to go farther afield for patients, so visitors will have to travel a long way Conflict with existing • The proposal to develop an amputee rehabilitation unit is welcome but jeopardises a valued local service for elderly service people Prevention • What is being done to prevent risk of amputations and development/progression of conditions that may lead to amputation eg diabetes, obesity?
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Intermediate care and ARU
Involving people in • Around the individual: continue to seek the views of individual patients, their carers and relatives, and other support implementing proposals groups involved with the individual while they are in receipt of care • 1:1 face-to-face interviews with clients in rehabilitation centres • Continue to ask staff, clients, carers • Build on existing interest groups and invite local groups to get involved in developing proposals • Through LINks/HealthWatch • Publicity • Public meetings in various parts of the borough Involving people in • Listening to views of existing user groups Page 178 monitoring quality of • Mystery shopping care in new services • Survey the patients • Avoid telephone or written interviews with clients • Spot check visits to inpatient units • Review various sources of feedback including complaints and compliments • Use informal carers Equalities • the provider of the service should be well trained to address these issues • the problems faced by elderly and disabled people living on their own need to be imaginatively addressed • communication disability should be considered and support put in place as appropriate. This would also be true for clients for whom English is a second language, or who are illiterate • wheelchair access; access for older , less mobile patients; shuttle bus for access? taxi service for family members? mini-bus service for peer or other support group meetings? • health is often ill equipped to deal with mental health and learning disability users
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5. Next steps
This paper has summarised the many and diverse views we have heard during the engagement period and the responses we have received to the survey. Next steps include:
analysing these views more closely to help us make recommendations to our governing bodies (Lambeth Clinical Commissioning Collaborative Board and Guy’s and St Thomas’ NHS Foundation Trust Board) compiling an equality impact assessment on the proposals continuing to engage with local groups and stakeholders regarding future developments reporting to Lambeth Health and Adult Services Scrutiny Sub- committee on our proposals, our engagement process and our plans recommending to our governing bodies the decisions they should make regarding the proposals providing feedback and responses to those who have given their views and publishing our decisions and our responses to local views on our websites
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Annex 1
LAMBETH COMMUNITY CARE CENTRE: CHANGE OF USE
1. Views of Friends of Lambeth Community Care Centre (LCCC)
At a Special Meeting at LCCC on 2 October 2012 to discuss the change of use proposals, attended by some 60 people, members of the Friends heard presentations on the proposals from Moira McGrath, Lambeth Clinical Commissioning Group (CCG) and Heather Blake, Community Services, Guy’s & St Thomas NHS Foundation Trust (GSTFT). The following two motions were passed by an overwhelming majority:
1. The Friends of Lambeth Community Care Centre, which exists to support and encourage the valued contribution the Centre makes to intermediate care in this community, is opposed to the current proposal to end the in-patient care provision at the Centre. We see this as a significant cut in our health service, a major loss to our community, and a short-sighted move against a background of such changes as the increasing numbers of elderly people, more people living on their own, and evidence of unmet demand and need. We welcome the extra attention being given to health care in the home, but there are many situations where that is not the best arrangement and temporary in-patient provision is the best solution. We recognise the importance of amputee rehabilitation provision, but that should not be at the expense of an existing valued service for other patients.
2. In order to achieve the objectives of the first motion, the meeting requests a moratorium of 12 months during which the plan for the future of the Monkton Street Centre can be developed by the NHS and the Friends of LCCC working together.
2. What does Lambeth Community Care Centre provide?
Situated in Monkton Street, North Lambeth, LCCC has, on the first floor, 16 in-patient beds (recently reduced from 20) providing care for individuals coming out of hospital in need of a period of rehabilitation or for people who are unwell but do not need acute care. Referrals can be from hospital, GP or community health and social workers. Managed by nurses, medical care is provided by a GP from the Hurley Clinic and a consultant geriatrician from St Thomas’ Hospital. The ground floor is used for a range of out-patient services, including the Gateway Clinic, offering acupuncture and traditional Chinese medical treatments on the NHS.
3. Proposal for change of use
To close in November 2012 the 16-bedded in-patient intermediate care unit on the first floor at LCCC and convert it to a 12-bedded rehabilitative unit for amputees, starting January 2013; ‘enhanced’ in-patient intermediate care for Lambeth patients to be delivered 7 days a week from the 20-bedded unit in Pulross, Brixton. Out- patient services on the ground floor of the LCCC will remain. This is an overall reduction in beds for intermediate care from 36 to 20.
4. Points raised in discussion by FLCCC members at 2 October meeting No confidence in home care: • inadequacy of existing home care services to meet current need let alone increased demand when Care Centre beds closed • failure of home care staff to turn up for appointments Page 182
• no public confidence that care at home will be better; proposals look good on paper, but not likely to be dependable; travel takes up time – this does not happen in a bedded centre. Consultation a travesty • not a genuine consultation: 30 days too short; NHS informing not sharing, ignoring considered views from Friends; a travesty • poor, slanted, confusing questionnaire circulated by Lambeth NHS CCG; ‘gobbleydegook’, ridiculous, pretentious • request for delay in decision-making for a few months to give local people a chance to contribute ideas. LCCC: ‘a safe place’ • LCCC set up by GPs; sick people like the idea of ‘security’; LCCC is a safe place and still needed; locality does matter; public transport access to Pulross can be very difficult and unfriendly. • ‘hospital at home’ is less safe: three visits a day sounds generous but may not be for the patient • Referral to LCCC always difficult; a ‘well-kept secret’ and unknown to hospital staff; newer GPs also unfamiliar with the place • Care Centre underused; bed statistics poor and misleading; do not reflect real need for in-patient care; disgraceful lack of effort in NHS to get GPs to use LCCC; building may need changes, but should not accept cut in beds. Benefits of in-patient intermediate care • staff can be better monitored in a residential unit • for frail and elderly living alone the importance of community/company in an in-patient unit providing support • early discharge puts more burden on GPs; in-patient care particularly important for single people with no family to call on; neighbours can only do a certain amount. Proposals will provide inadequate care: Pulross ‘overwhelmed’? • not a case of intermediate care either in a bed or at home - both are needed; will 20 beds at Pulross be enough for the whole community?; intermediate care is not a static problem; there are more elderly and Pulross could be overwhelmed. Statistics • in relation to bed occupancy, the estimated 30% figure of those who could have been treated at home: on whose judgement was this made? were the patients asked? was it a clinical decision by doctors or nurses? • do not consider unmet need; shamefully poor. Finance • what will savings be? • ‘efficient’ means cutting costs to NHS managers; to patients it means good care.
5. NHS responses at 2 October meeting • times have changed; home care is better; takes home circumstances into account, eg stairs, care at night; people more important than buildings; new proposal allows for best service at home, then Pulross, then hospital • Pulross service will be better: a 7-day service for the whole of Lambeth; • savings will be invested in home care • consultation one of five meetings; results go to the Clinical Commissioning Group 7 November Board meeting • for amputee services to be viable 12 beds are necessary: 8 for GSTT; 4 for other institutions in South East; garden very suited for amputee rehabilitation. Agenda Item 9 Page 183
b
Health and Adult Services Scrutiny Sub-Committee 23 October 2012
Lambeth Local Involvement Network (LINk)
All Wards
Report authorised by : Executive Director of Finance and Resources: Mike Suarez
Executive summary
The Lambeth Local Involvement Network (LINk) has a standing invitation to submit a report on its activities and any key matters arising to the Health and Adult Service Scrutiny Sub Committee. The report of the LINk is attached.
Summary of Financial Implications
None.
Recommendations 1. That the report from the LINk is noted.
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Consultation
Name of Department or Organisation Date sent Date Comments consultee response appear in report received para:
Internal None External None
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 11.10.12 10.10.12 133-12/13 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Background Documents
None
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Lambeth Local Involvement Network (LINk)
1. Context
1.1 Local Involvement Networks (LINks) are statutory organisations set up with the aim of giving local people a stronger say in the planning, design, commissioning and provision of health and social care services. LINks are independent of NHS trusts and the council and comprise networks of local people, organisations and groups from across the community. The LINk in Lambeth is led by a Steering Group comprising individual and organisation representatives and has two co- chairs.
2. Proposals and reasons
2.1 Whilst it is important that the Health and Adult Services Scrutiny Sub Committee and the LINk retain their independence there will be times when both bodies share common interests or concerns and will be in a position to inform and complement each others work. To ensure that members of the committee are kept informed about the work of the LINk it has been proposed that an update from the LINk be included as a standing item on the HASSC agenda.
3. Comments from Executive Director of Finance and Resources
3.1 Not sought.
4. Comments from Director of Governance and Democracy
4.1 Not sought.
5. Results of consultation
5.1 Not applicable.
6. Organisational implications
6.1 Risk management: Not applicable.
6.2 Equalities impact assessment: Not applicable.
6.3 Community safety implications: Not applicable.
Environmental implications:
Not applicable.
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6.4 Staffing and accommodation implications: Not applicable.
6.5 Any other implications: Not applicable.
7. Timetable for implementation Not applicable.
______
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Lambeth LINk Report to Health and Adults Services Scrutiny Sub Committee
October 23, 2012
1. Lambeth LINk provides regular reports to HASSC on the issues and activities of the Lambeth LINk. This report sets out the main issues, concerns and activities of the Lambeth LINk since July 2012.
2. Working with Lambeth Council: 2.1. There have been two Roundtable discussions with Councillor Jim Dickson covering the progress of Lambeth’s service transformation and the need to build the capacity of Lambeth residents to engage with, and make real, the goal of cooperative commissioning. Roundtable meetings will now be held regularly and will include all policies and services under Cllr Dickson’s portfolio
2.2. A major part of the LINk’s workplan for 2012/13 is to engage with the Council on service areas subject to review and consultation, supporting public involvement and challenging the Council to follow robust processes. The LINk is participating in the Carers Review Reference Group, and hosting a discussion on the End to End review at our October Steering Committee meeting.
2.3. Lambeth LINk members have continued to contribute to Lambeth Council’s Welfare Reform Reference Group.
2.4. LINk has had two meetings with the team dealing with the reassessment of Discretionary Freedom Passes. Assessment statistics have been presented to the LINk. Now only a small number of people remained qualified under the new criteria. LINk is also concerned about the 200 people who have not responded to the re-assessment invitation. We now await final data from the Council and an updated EIA.
2.5. LINk has been invited to join the Children’s Trust Board and is a member of the CYPS CVS Forum and attended their last meeting. Further engagement will take place with children and young people, especially around the production of HealthWatch Lambeth.
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3. Working with Health partners in Lambeth: 3.1. Talking Therapies LINk has reviewed EIA work carried out since 2009. Findings are that a thorough initial EIA was conducted but that there are lessons in relation to how this was carried through after 2009, with the review in 2010, further consultation in 2011 and the specification for new contract in 2012. LINk has recommended that evidence and improvement outcomes from previous EIA work are more explicitly built into contract specifications where services are re-commissioned, and has confirmed that it is ready to work with commissioners on reviewing the equalities impacts for the service. Also, that the results of EIA work is shared and made publically available. Further recommendations, applicable more widely across NHS and Lambeth commissioning are around the need for an agreed, consistent, coherent and transparent framework for conducting EIA’s and building on findings over time, with the planned involvement of diverse groups of service users and Lambeth citizens. This is being taken up through the LCCCB.
3.2. SEL Hospitals Trust – Office of the Special Administrator Rosemary Glanville, LINk Steering Committee member will be participating in the PPAG meetings on behalf of Lambeth LINk, and we anticipate joint working with Scrutiny and with our neighbouring LINks on this.
3.3. Intermediate Care Review NHS Lambeth has carried out consultation with LINk members in LINk’s September Steering Committee meeting. Notes from the meeting is being written up the NHS will be shared with LINk.
3.4. LCCCB LINk were pleased that the excellent existing Non Executive Directors have been appointed as Lay Members of the Board, but would have preferred our recommendation in line with Commissioning Board guidance, of a Lay member with specific experience of involvement had been additionally appointed .
3.5. Patient feedback to primary care services • LINk has been commissioned by the PCT to undertake a 6 months Patient Participation Group (PPG) Pilot Project with the aim of: developing and strengthen PPGs to influence quality and service development within their GP practices; and to enhance the quality and quantity of co-ordinated feedback from patients to influence clinical commissioners and the wider health and wellbeing agenda in Lambeth; • The project will also map various PPG model and identify best practice;
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• The Project development worker is now in post and has begun working with 12 GP practices/PPGs spread evenly across the 3 localities.
4. Health and Wellbeing Board The Board agreed the Principles for Citizen Involvement and we look forward to working with the Board to discuss these with other partners, and to find examples for joint working for the audit process before the end of the financial year. The Board discussed how the principles could be used in work on the JSNA and the Health and Wellbeing Strategy. The Board heard about the work of the Integrated Care Programme and asked for a report back on the governance of the programme.
5. Transition to Local HealthWatch LINk co-chairs and vice chairs are members of a Healthwatch Co-Production Steering Group, established following Cabinet decision to co-produce Healthwatch with Lambeth Citizens. Other interests represented on the Group include the Council (Community/Children and Young People), LCCCB (|Engagement Lead), and NHS Lambeth (Head of Engagement). The group is agreeing an action plan to ensure that a new social enterprise is established and that the necessary infrastructure is put in place before 1 April 2013. Public events – including the specific involvement of children and young people – are being planned for Lambeth citizens. The LINk will discuss Healthwatch at its October Steering Committee Meeting and is dedicating the whole of its November meeting to this matter.
6. LINk Dignity and Respect Sub-Group 6.1. The sub-group has conducted a survey with care homes in Lambeth but the return rate was low. The sub-group is now looking at how to develop further work with care homes in conjunction with the review of Enter & View visits.
6.2. Enter and View (E&V) LINk has conducted and produced reports on 2 E&V visits to Dulwich Care Centre and the British Home. The Sub-group is now discussing learning from these visits to review and strengthening E&V processes and tools.
6.3. Safeguarding Service User project A new two year project aiming to: • involve people who have used Lambeth safeguarding services in influencing and shaping those services;
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• recruit volunteers to be informed and active champions of safeguarding, sitting in ward level Safer Neighbourhood Panels and raise the priority of protection for vulnerable people; and • to raise public and organisational awareness of issues around vulnerable people and abuse, and how to report it.
The Project worker is now in post. She is getting to know the landscape of safeguarding services, listening to worker and client experiences of safeguarding issues, and putting together a project plan that will both engage volunteers and deliver improvements
7. LINk Steering Committee and Lambeth LINk AGM Meetings have focussed on Healthwatch, Intermediate Care, End to End review.
8. South East London LINk Chairs and Hosts meetings LINk Hosts and Chairs across South East London are still meeting regularly to share good practice and to discuss transition to Local HealthWatch. On 4 October, SEL LINks organised an event to learn and discuss work on Equalities. This event was supported by the Department of Health and the Guys & St. Thomas NHS Foundation Trust. The meeting agreed to further develop joint working on Eqalities.
Nicola Kingston/Aisling Duffy, Co- Chairs, Lambeth LINk, October, 2012.
4 Agenda Item 10 Page 191
b
HASS Scrutiny Sub-Committee 23 October 2012
2012/2013 Budget Reductions Monitoring and Reporting
All Wards
Report authorised by : Maria Millwood - Divisional Director of Resources
Executive summary
The delivery tracker was introduced last year as a mechanism to ensure that the Council was delivering to the challenging savings programme totalling £94.510m over the four years to 2014/15. During 2011/12 the target savings were £37m and for 2012/13 they are £29.152m. Delivery of these savings is paramount and focus needs to be on the implementation of proposals to ensure the council operates within its reduced budget.
The savings target for Adults & Community Services for 2012/13 is £8.276m. Of this £6.911 relates to this committee, £5.348m to Adult Social Care, £1.364m to Strategy & Commissioning and £0.199m to Resources.
The current position is that Adult Social Care is forecasting to deliver 66% of total savings, leaving a current savings gap of £1.825m.Strategy and Commissioning is forecasting to deliver 88% of total savings, leaving a current savings gap of £0.165m.Resources are forecasting to deliver 90% of total savings, leaving a current savings gap of £0.019m.
Summary of financial implications
The delivery tracker has been incorporated into the established financial monitoring cycle and governance arrangements. The delivery tracker facilitates the identification of financial implications as a result of late or non-delivery of savings and allows for the incorporation of further management actions to mitigate any savings gaps.
The Health and Social Care savings target of £6.911m is forecast to under achieve by £2.009m. Many of the shortfall areas are as a result of timing issues with implementation of major change programmes. Management actions have been developed to cover £1.006m of the deficit in 2012/13.
The remaining deficit is primarily against Social Care Contract savings targets where expected work with Capita to assist with the delivery in savings will now not occur (£945k) and Non-Residential Contributions Policy savings (£58k).
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Recommendations (1) That the sub-committee note the current savings realised, and the full year forecast.
Consultation
Name of Department or Organisation Date sent Date Commen ts consultee response appear in report received para:
Internal
Maria Millwood Adults & Community Services 1/10/12 3/10/12 Throughout Peter Hesketh Adults & Community Services 8/10/12 Gregory Carson Governance & Democracy 3/10/12 3/10/12 Nicola Droti-Andi F&R Finance 3/10/12 8/10/12
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 21.09.12 10.10.12 .10.12 131/12-13 Report author and contact for queries:
Maria Millwood Divisional Director of Resources Adults & Community Services Ext 64843
Background documents
Budget report to council – August 2012
Appendices
Delivery tracker template
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2012/2013 Budget Reductions Monitoring and Reporting
1. Context
1.1 This report is setting out the process for monitoring and reporting the implementation of savings and the resulting impact to service delivery.
The savings target for Adults & Community Services for 2012/13 is £8.276m, which reflects the proposals agreed as part of the 2010 and 2011 budget planning processes.
The August savings tracker shows a forecast of £5.268m against a target of £8.276m. The current forecast highlights a shortfall of £3.008m (36.7%).
Many of the shortfall areas are as a result of timing issues with implementations. Management actions have been developed to cover £1.006m of the deficit in 2012/13, leaving a remaining deficit on the savings target of £2.002m.
The department is continually reviewing and managing services while formulating plans to cover remaining shortfalls. These will be updated on the tracker on a monthly basis.
2. Impacts and Outcomes
2.1 Impacts and outcomes monitored as a consequence of budget reductions are identified against the corresponding budget reduction area in the attached delivery tracker.
3. Comments from Executive Director of Finance and Resources
3.1 The savings target for Adults & Community Services for 2012/13 is £8.276m (including £5.809m prior year savings bought forward). Of this £6.911m relates to this scrutiny committee.
Savings Total Forecast Savings Realised Savings Savings Gap to Date £000 £000 £000 £000 Adult Social Care 5,348 1,328 3,523 1,825 Strategy & Commissioning 1,364 1,144 1,199 165 Resources 199 160 180 19 6,911 2,632 4,902 2,009
3.2 The savings are across a range of proposals – these can individually be seen in the attached delivery tracker.
The risk matrix uses the corporate standard risk assessment. Each saving proposal is assessed by departments in relation to their likelihood of being achieved, with the options of very likely; likely; unlikely and very unlikely.
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The impact score is then automatically calculated using the value of the proposal as a parameter. Proposals with an agreed saving target of less than £100k are deemed as minor; those between £100k and £200k are deemed as significant; and those between £200k and £500k are deemed as serious. Proposals with a target greater than £500k are deemed to have a major impact.
Therefore those savings targets less than £100k, regardless of their likelihood assessment will show as ‘Green’; and those items greater than £500k will only be ‘Green’ if assessed as a guaranteed likelihood’
3.3 Management actions have been developed to cover £1.006m of the deficit in 2012/13.
The remaining shortfall in the Adult Social Care relates to two savings targets:
• Social Care Contracts (£945k – RED delivery status) is a high risk area as expected work with Capita to assist with the delivery in savings will now not occur. A review has been completed of the savings associated with the closure and reconfiguration of Effra Road daycentre (£336k) and the closure of Palace Road (£187k). The total of these savings (£523k) has been set against the contract savings.
• The Non-Residential Contributions Policy (£58k – AMBER delivery status) where the new contributions policy was fully implemented in February 2012, however significant credit memos have been raised in July / Sept which may affect future levels of income from Service Users. This is being analysed and will reported as part of the budget monitoring exercise in September.
The Resources gap is due to delays in restructures which will not be fully implemented until January onwards; therefore part year savings only can be made this year. Current year deficit will be covered by additional income.
The forecast savings as per the delivery tracker are recognised in the budget monitor full year forecast.
4. Comments from Director of Governance and Democracy
4.1 The Council has a duty to maintain a balanced budget throughout the year and, accordingly, members are required to regularly monitor the Council's financial position in accordance with section 28 of the Local Government Act 2003. In considering the implementation of the Council’s financial strategy for 2012/13, members will need to balance the proposed level of expenditure in discretionary areas of service provision against that required to ensure that the Council complies with its statutory duties. It is essential, as a matter of prudence that the financial position continues to be closely monitored. In particular, members must satisfy themselves that sufficient mechanisms are in place to ensure both that savings are delivered and that new expenditure is contained within the available resource.
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5. Organisational implications
5.1 Risk management: The delivery tracker provides assurance on the actual delivery of proposed savings. The tracker highlights the risk of late delivery and any resulting financial implications. 5.2 Equalities impact assessment: There is no direct impact of this report, however, each the impact of savings delivery will be monitored as part of the cumulative equalities impacts assessment. 5.3 Community safety implications: None 5.4 Environmental implications: None 5.5 Staffing and accommodation implications: None 5.6 Any other implications: None
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HASS Scrutiny Only August 2012
The Deliverables Financial Progress Narrative Ref Proposals Officer Agreed Savings Forecast Forecast Percentage Likelihood Delivery Current Status of Outcomes Expected Outcomes or Impact Unexpected Impact not Planned for Mitigating Actions responsible Savings Realised YTD saving by Variance Variance Status for delivery Proposal Value (£'000s) 31/03/13 11/12 (£'000s) (£'000s) ASC7 Brokerage Dominic £81 £37 £37 £44 54.3% Likely 2 GREEN BU is working on outcomes from LEAN event to Expected outcomes for service users include Comprehensive staff training for all Brokerage staff. Benchmarking with Review and Stanton release vacant post; in addition Other allowances an improved interface with Brokerage, other authorities. Developing the market Restructure cost for staff has been restricted and used to particularly for clients with personal budgets contribute towards savings delivery and those who are self funders. Impacts on commissioned/contracted bodies include less emphasis on block contracts, service change, amendment and alteration; and increased use of personalised care providers including personal assistants, preferred providers, and innovative social as well as practical care providers.
ASC9 Assistive Alex £499 £205 £499 £0 0.0% Likely 2 AMBER Work is underway to evaluate the cost and Expected outcomes for service users include: Information from the consultation will be used to ensure that any new Technology McTeare efficiency of different packages of AT equipment increased independence, well-being, and service meets the needs of all service user groups. and their impact on the cost of care packages for satisfaction with services provided (including Assessments and reviews will be used to ensure that Telecare services recipients. As this work progresses the net for carers of service users) due to increased are offered only when it meets service users individual needs. Contract savings delivered by the AT service will be use of Telecare/assistive technology solutions, monitoring and the annual statutory survey will be used to ensure that calculated from the start of the financial year, this and reduced numbers of service users in the service is delivered appropriately and that it helps service users work should be completed by the October 2012. residential care settings. Expected impacts on achieve the expected outcomes. Financial assessments will ensure An options paper was presented to DLT in July commissioned / contracted bodies are: that people do not pay more than they can afford, and that they are 2012, and it was agreed that the options to deliver externalisation of Social Work Case directed to welfare benefits advice to maximise their income. We will the service in the future through an integrated Management Service, increased quality of also set up close monitoring of the service in order to track demand provision with other services, would be explored assessment processes, reduction in and ensure that Telecare equipment provided offers the best value for further. This includes the potential to deliver assessment processes through better money. services externally and that options would be integrated services and better awareness of worked through the commissioning strategy to be and ability to prescribe telecare solutions by a developed for January 2013. range of care professionals
ASC11 Universal Offer Alex £744 £310 £744 £0 0.0% Likely 2 AMBER The Extra Care programme is being delivered Expected outcomes for service users include Monitoring of KPIs through reablement steering group of Enablement McTeare according to plan and realising savings against increased access to enablement service, Monitoring of packages of care through commissioning panels; setting Service & Extra residential care expenditure which will be reported increased levels of independence, increased target numbers of adults and older people to be pro-actively moved into Page 197 Care Housing in the following periods. Savings planned for numbers taking up personalised care options, extra care to avoid/ be discharged from residential care delivery by the enablement service are at serious increased levels of satisfaction of carers and risk following the failure of the service provider service users, and reduced admissions to resulting in notice being served on the contract. hospital and nursing and residential care Measures are being put in place to secure an homes. Expected impacts on commissioned / alternative service. Updates to follow in later contracted bodies include reduced use of periods. residential care, and increased spend on community packages of care, increased use of day services, community meals service, telecare services and community equipment service.
ASC12 End to End Simon £344 £104 £104 £240 69.8% Unlikely 3 AMBER To date savings of c.£104k have been identified Impact of service re-design is to be 1) easier Ongoing consultation with service users, local residents and other Process Froud through staff leaving the organisation (PRS), which access to adult social care for the public and 2) stakeholders will help to ensure that the end to end process meets the Maria contributes to the overall £344k target set for the more efficient and targeted use of different staff needs of residents and stakeholders. Burton year. Additional work is being undertaken to skills and better integrated working. identify posts that have been held as vacant and are not covered by agency staff. Any savings arising from either the deletion of posts or a decision to continue to hold as vacant pending the staffing restructure will contribute to the End to End savings target. Further work is underway to identify how any shortfall will be met.
ASC13 Transformation Simon £350 £350 £350 £0 0.0% Very 1 GREEN A review of services has been undertaken. The The impact on service users/customers would Delays of implementation Mitigating actions will be developed through the next stage of the of Day Centres Froud Likely next phase of work is being jointly managed include increased access to day services service planning process for Vulnerable through Commissioning and Operations. A through opening the service up to self funding People under Steering Group has been established and plans clients, more personalised service provision, auspices of the are being drawn up to engage with Service users. and increased access to training and Cooperative Vacancies are being held as per management education, leisure, culture and other day centre Council actions to cover this savings until the review and opportunities. implementation are completed. Impacts on commissioned/contracted bodies: if the day centres pursue the route of becoming social enterprise organisations, there could be an impact on the council ‘back office’ support services currently provided to the centres, as they may choose to have such support provided through more cost effective routes. HASS Scrutiny Only August 2012
The Deliverables Financial Progress Narrative Ref Proposals Officer Agreed Savings Forecast Forecast Percentage Likelihood Delivery Current Status of Outcomes Expected Outcomes or Impact Unexpected Impact not Planned for Mitigating Actions responsible Savings Realised YTD saving by Variance Variance Status for delivery Proposal Value (£'000s) 31/03/13 11/12 (£'000s) (£'000s) SC1f Floating Elizabeth £240 £100 £115 £125 52.1% Unlikely 3 AMBER Work undertaken with outgoing providers re The impact on service users/customers may May be redundancy costs not To work with the provider to assess and prioritise clients imminently Support Clowes management of cases, and discussions with HRE include higher levels of homelessness due to calculated, since TUPE does not apply threatened with homelessness. Officers from ACS and HRE will work Services for and continuing provider re priorities. Notice has eviction for reasons of anti social behaviour, with the provider to agree priorities and potential new ways of working. Vulnerable been issued on 2 contracts. The SHP notice has rent arrears etc due to reduction in capacity of The full years saving will still be achieved due to under activity in some Adults been delayed. the Floating Support Service. The impact on existing budgeted contracts. commissioned / contracted bodies could be high due to the number of clients migrating from the services potentially being decommissioned or reduced. It is highly likely that the Vietnamese Mental Health Service will experience some difficulties as a result of this change but although the overall impact is not yet known.
SC1h Reduction in Elizabeth £80 £0 £40 £40 50.0% Very 1 GREEN Notice issued for contract to end 30/09/12. Work The impact on service users/customers may None to date Officers will work with SLYMCA, a valued provider, and agree required bed space and Clowes Likely undertaken with provider re decant of building include the support needs of current tenants in actions necessary to deliver the savings, which will include a review of contract value the semi-independent flats being reviewed, and the needs of the young people in the semi-independent flats. SLYMCA at YMCA those in need of higher levels of support moved will also be a key stakeholder in the review of teenage pregnancy (Stockwell) on to other services if necessary. The aim of services, examining the pathways, support needs and models of care the project is to support young people who are for teenage parents in the borough. The full years saving will still be motivated to employment, education and achieved and offset due to under activity in a current budgeted contract training, with minimal support needs. The . potential impact on commissioned / contracted bodies will need to be assessed further, however the YMCA will continue to run the hostel King Georges House on the site so it is not expected to have a detrimental effect on the viability of the provider. Page 198
RES6 Resources Pete £199 £160 £180 £19 9.5% Very 1 GREEN The facilities management restructure has not There is no expected impact on our None required. Establishment Hesketh Likely started yet, it is anticipated that this will commence customers/service users or commissioned / and Non in October. contracted bodies. Essential Spend Reduction ACS1 Non- Pete £200 £36 £142 £58 29.0% Likely 2 AMBER Policy fully implemented in February 2012. The The council no longer charges service users None observed to date, although the impact of changes to the Welfare Residential Hesketh current number of clients assessed to contribute to based on the individual services they receive, benefits system may have an impact in the future. Contributions their care is lower than anticipated. A rather the charge is on the total package they Policy comprehensive analysis of invoices/charging is receive. The policy will also maximise welfare currently being undertaken with a view to complete benefits for individuals. Some service users as part of the budget monitoring exercise by the have seen an increase in the amount they pay end of November. and some for the first time.
ACS2 Social Care Nimesh £1,468 £218 £523 £945 64.4% Very 4 RED CAPITA have carried out their initial analysis of the There are no intended impacts on service If insufficient savings are identified as None observed, however, this will be monitored through contract Contracts Mehta Unlikely contract base across the Council as a whole and users through these processes, as reductions part of renegotiated prices, some management processes. REPROFILING no opportunities for savings in Adult Social Care in contract price are expected to be achieved services may need to be de- have been identified as feasible. Previous without affecting service delivery. However, this commissioned or re-commissioned in forecasts were based on estimated savings from will be monitored through contract monitoring a different way. the CAPITA project and therefore the forecast processes and the use of EIA's where savings has worsened considerably in August. appropriate. The department is developing an action plan which has identified some savings. However, this saving, which was brought forward into 2012/13, is very unlikely to be fully met in the current year.
ACS3 Older People’s Elizabeth £100 £68 £68 £32 32.0% Likely 2 GREEN Negotiations with one provider for reduction in Carers review is expected to improve equity of None to date Officers will continue to work with stakeholders Residential Clowes rates complete; remainder of savings expected to access Respite be delivered by review. The above figure is based on usage in 2010/11 - actual savings will vary depending on service usage. Contract is currently overspending. ACS4 Review of Simon £400 £0 £400 100.0% Unlikely 3 AMBER A piece of work has been undertaken to identify It is unclear the likely impact at this stage,> Delays of implementation Mitigating actions will be developed through management action plans Transport Day Froud how the savings can be achieved via the Transport and the next stage of the project planning process. Services Alex and Taxi contracts across all 6 day services and The business case to cover this savings in 2012/13 from Earmarked McTeare there is a risk that full saving will may not be Reserves was agreed by DLT and Corporate at year-end 2011/12. achieved this year. HASS Scrutiny Only August 2012
The Deliverables Financial Progress Narrative Ref Proposals Officer Agreed Savings Forecast Forecast Percentage Likelihood Delivery Current Status of Outcomes Expected Outcomes or Impact Unexpected Impact not Planned for Mitigating Actions responsible Savings Realised YTD saving by Variance Variance Status for delivery Proposal Value (£'000s) 31/03/13 11/12 (£'000s) (£'000s) ACS5 Social Work Simon £875 £0 £800 £75 8.6% Very 1 AMBER An agreement with Health to fund this amount from There is likely to be an impact in the Mental Dependant upon other strategic Realignment of management portfolios as part of the restructure Management Froud Likely the Health allocation of the Social Care Transfer Health service delivery of front line services considerations - cross Borough proposals. The four Borough work may have an impact on the structure and Specialist has been made for 2012/13. This has yet to be with a reduction of staff if the Sect 256 working plans are being considered so in the future. A review of placements linked to savings is underway Delivery - ratified through the Section 256 agreement. As this agreement is not reached and the funding is it is unclear how the service will be Generic funding may not be recurrent a review of the joint not mainstreamed in 2013/14. configured in the future. Reduction service with SLaM and our three neighbouring (Mental Health) boroughs is being undertaken. £75 savings is being delivered from staffing underspend within Safeguarding Business unit - B201
ACS15 Supporting Elizabeth £1,044 £1,044 £1,044 £0 0.0% Guarante 0 GREEN Savings delivered; large hostel closed, remodelling No expected impact on service users. Vulnerable people living independently will continue to be monitored. People Clowes ed of services to deliver efficiencies Reduction of units has been minimal, however reduction in costs has been significant.
ACS18 Social Welfare Elizabeth £287 £0 £256 £31 10.8% Very 1 GREEN Priorities determined, alternative income identified. Impacts on already stretched service Increasing demand due to welfare Continue to identify alternative sources of funding Advice Clowes Likely Award of new contracts still in process, which has reform Services resulted in the first 6 months being paid at the old rate. Forecast that the new contracts will be paid from 01/10/12
£0 0 £0 0
£6,911 £2,632 £4,902 £2,009 29.1%
Additional Savings outside SFP / Management Action Plan £0 0 ASC7 Other allowances cost for staff has been restricted and used to contribute towards savings delivery £44 -£44
There is a timing issue with meeting this 0 Page 199 savings target. A review of services, including the use of taxis is being ACS4 undertaken. £400 -£400 This is a timing issue. Vacancies are 0 being held to cover £75k of this savings in 2012/13 until a review of service can be ACS5 undertaken £75 -£75 There is a timing issue with meeting this 0 savings target. A review of vacant posts is being undertaken to cover the deficit in ACS12 2012/13. £240 -£240 This is a timing issue in regards to a 0 restructure. A review of expenditure has been performed to cover the deficit in RES6 2012/13 £19 -£19 There is a timing issue with notice on 2 contracts. The savings deficit will be covered in 2012/13 by reduced activity in existing contracts. ACS SC 1 £125 -£125 There is a timing issue with notice on contract. The savings deficit will be covered in 2012/13 by reduced activity in existing contracts. ACS SC 1 £40 -£40 There is a timing issue with meeting this savings. The deficit will be covered in ACS 3 2012/13 by SP funding. £32 -£32 There is a timing issue with meeting this savings. The deficit will be covered in ACS 18 2012/13 by SP funding. £31 -£31 £0 0
£0 £0 £1,006 -£1,006 #DIV/0! Savings Gap
£6,911 £2,632 £5,908 £1,003 14.5% £6,911 £4,902 £1,006 £1,003 Saving Summar y
Target by RAG Status (in £M) Profile of Savings Delivery Number of Proposals by Delivery Status £1 1 £1
£0 Value (£'000s) Value 3
3
Total Agreed
Savings Gap Number and Value of Savings proposals by Status Savings by Lever Page 200
15% 70%
15%
Savings by Lever Proposal entry sheet for Delivery tracker
The tracker focuses on 11/12 savings
Council Proposal delivery as at June 2011
The Deliverables Financial Progress Narrative Ref Project/Theme Term of Project SFP Savings Proposal Business Case SFP Savings Business Case SFP Savings over Business Case Savings over SFP Saving Remaining Business Case Actual Budget Costs Forecast Costs Forecast Costs over Forecast saving by Forecast Variance Forecast saving by Forecast Variance Revised Project/Theme Value 11/12 Savings Value Proposal Value Savings Value lifetime of lifetime of Project/Theme Realised YTD saving Saving Realised Costs (£'000s) lifetime of 31/3/12 11-12 11/12-13/14 11/12-13/14 Delivery Date Comments (£'000s) 11/12 11/12-13/14 11/12-13/14 Project/Theme (if different then 3 year) (£'000s) to deliver YTD (£'000s) Project/Theme (£'000s) (£'000s) (If appropriate) (£'000s) (if different then 3 (£'000s) (£'000s) year ) End to End Process £0 £0 £0 £0 £0
Care Pathway £0 £0 £0 £0 £0
Library Strategy £0 £0 £0 £0 £0
Reshaping CYPS 3 Years £0 £0 £0 £0 Traded Services 3 Years £0 £0 £0 £0
Schools standards and 1 Year £0 £0 £0 £0 Youthi Services t 1 Year £0 £0 £0 £0
Adventure Playgrounds 1 Year £0 £0 £0 £0
Children's Centres £0 £0 £0 £0
HRE Transform £0 £0 £0 £0
Parking £0 £0 £0 £0 £0
Waste Management £0 £0 £0 £0 £0
Housing Strategy £0 £0 £0 £0 £0 Page 201
Neighbourhood Regeneration £0 £0 £0 £0 £0
£0 £0 £0 £0 £0
Delivery tracker version 1.1 Service and Financial Planning Delivery TrackerPage Guidance 202 Service and Financial Planning Delivery Tracker Terminology
Proposals1 sheet:
-Ref: Each department can label their proposals using a code to correlate with any internal monitoring. If the department is not using any individual code, then a code will be applied by the VfM team. These codes will be unique for each proposal and will be used to track the proposal over the 3 year period.
-Proposal: A brief name of the proposal so that anyone reading the document will understand the where the savings are being delivered from. The proposal name should be descriptive but does not need to spell out what the proposal is in detail.
-Officer responsible for delivery: One person will be identified as responsible for the delivery of each proposal. This individual should be at least a Business Unit manager to Divisional Director.
-Proposed Delivery Date: The last date proposal can be delivered in 31/03/2012, however there may be some proposal that are proposed to be delivered before the end of the financial year. The proposed delivery date is by month only and can be selected from the drop down box.
-Lever: Each proposal should have been categorised into one of the 8 principles from service and financial planning (Assets, Income, Contracts, etc...) or listed as a brought forward saving if it was agreed in previous years.
-Agreed Savings Proposal Value: This is the agreed savings that will be delivered by the proposal. All savings were agreed through the service and financial planning process. Proposal value should not change as they have been politically agreed.
-Saving Realised YTD: Some proposal will involve multiple activities releasing savings over the year. As saving are made available, use this cell to track the savings that have been delivered. By the end of the financial year, 100% of the proposed savings should have been delivered.
-Remaining Saving to deliver: The remaining savings to be delivered are calculated by subtracting the Agreed Savings Proposal Value by Savings Realised YTD. This is automatically calculated.
-Forecast Saving by 31/3/2012: Each proposal should deliver the entire proposed savings by the end of the financial year, however if during the year it becomes apparent the new saving will not be delivered then a revised savings figure must be entered. This new savings figure should be accurate and the delivery staff should have high confidence they will be able to deliver the new amount in full by the end of the financial year.
-Forecast Variance: The variance is the difference between the Agreed Savings Proposal Value and the Forecast savings and show the gap between delivery and agreed savings. This will show the value that managers will need to cover with Management Action Plans to meet the savings they have agreed.
-Percentage Variance: The variance is listed here as a percentage of the Agreed Savings Proposal Value.
-Likelihood: The Likelihood is based upon your estimation of how likely the proposal will be to deliver it's agreed value. The range of responses goes from "Very Likely" which is the best rating as you are likely to deliver the full amount of savings to "Very Unlikely" which is the worst rating.
-Impact: The Impact is based upon the Agreed Savings Proposal Value as the larger savings will have a bigger impact on the council achieving it's overall savings proposals. The Impact is automatically calculated and cannot be changed. Further information on the levels of Impact are listed in a comment on the Proposal1 sheet
-Delivery status: The Likelihood and Impact will combine to produce the Delivery Status ranking. The proposal status provides a recognisable indicator as to how confident your are on the delivery of savings by the proposal. A red status indicates the proposal is unlikely to deliver the agreed savings, an amber status indicates the proposal may deliver some of its agreed savings, and a green status indicates that a proposal will deliver a great deal or all of its savings on time. The proposal status is automatically generated and cannot be changed.
-Revised Delivery Date: If the delivery of a proposal will not meet the proposed delivery date, the newest date of delivery should be listed here. These new delivery dates should be achievable and represent the date proposal delivery staff are highly confident the savings will be available.
-Comments: This is an opportunity to put across any high level risk and issue that may impact on the delivery of the proposal savings. Project Managers and service leads should also use this area to express any intended or un-intended consequences that they have seen in their areas. For proposals that have been delivered we can also list the deliverable that have been completed or delivered by the proposals. Councillors will be using this information to monitor what changes have actually been made in departments. Savings !Delivery !Tracker R! Guidance ! 1.0Recogni on !of !Savings The !delivery !tracker !must !portray !the !accurate !position !of !each !individual !saving !proposal. !If !a!figure !is !entered !into !the !Year !to !Date !(YTD) !field !there !must !be ! evidence !available !to !support !the !submission. !It !is !important !that !the !delivery !tracker !represents !the !accurate !position !of !each !department, !and !an !audit !trail !is ! available !on !request. Improvement !Recommendation :!It !is !recommended !that !departments !review !their !submissions !to !ensure !that !where !stated !that !a!saving !has !been !partly !or !fully ! achieved !there !is !an !audit !trail !that !supports !the !reported !position. !If !evidence !is !not !available !then !the !tracker !needs !to !be !amended !accordingly.
2.0Validity !of !Savings ! It !is !important !that !saving !proposals !are !true !savings !to !the !council, !and !will !benefit !the !general !fund. !Where !recharges !to !other !council !departments !are !taking ! place !this !is !not !a!saving. !It !is !only !a!saving !when !the !council !is !collecting !income !from !an !external !body, !so !this !must !be !kept !in !mind !for !the !remaining !six !months ! and !the !forthcoming !years. Improvement !Recommendation :!It !is !recommended !that !departments !review !their !submissions !to !ensure !that !all !saving !proposals !will !mean !true !savings !to !the ! council. !This !may !involve !analysis !into !specific !proposals !to !establish !if !all !or !part !of !the !proposal !will !equate !to !a!gain !to !the !general !fund. !If !established !that !none ! Page 203 or !only !some !of !the !proposal !will !be !a!gain !to !the !general !fund !then !the !tracker !needs !to !be !updated !to !reflect !this.
3.0Consistency Issues !with !consistency !have !mainly !arisen !as !a!result !of !establishment !savings. !It !has !become !clear !that !some !departments !are !reporting !the !gross !position ! whereas !others !are !reporting !the !net !position, !and !this !is !largely !in !relation !to !redundancy !and !payment !in !lieu !of !notice. !Departments !should !be !reporting !the ! gross !position !in !relation !to !establishment !savings. Improvement !Recommendation :!It !is !recommended !that !departments !review !their !establishment !savings !to !ensure !that !they !are !all !showing !the !gross !position, ! and !where !amendments !need !to !be !made !they !are !updated !expediently !on !the !departmental !delivery !tracker !submissions.
4.0Transparency It !has !been !noted !that !there !is !a!discrepancy !between !the !true !position !of !some !saving !proposals !and !what !is !being !reported. !Transparency !is !extremely !important ! and !the !data !being !submitted !on !the !delivery !tracker !must !be !accurate !for !each !individual !saving !proposal. !For !example, !it !has !been !discovered !that !for !a!specific ! saving !proposal !the !forecast !was !under !the !agreed !saving !target, !but !another !saving !proposal !was !overachieved, !which !was !used !to !offset !the !shortfall !of !the ! other !saving !proposal. !Although !this !has !no !impact !on !the !bottom !line !regarding !the !forecast !savings !“virements” !between !savings !should !be !avoided !so !that !the ! true !position !of !each !individual !saving !proposal !is !transparent. Improvement !Recommendation :!It !is !recommended !that !departments !review !their !delivery !tracker !submission !to !ensure !that !the !true !position !of !each !individual ! saving !proposal !is !being !documented, !and !no !offsetting !is !taking !place. 5.0Re ect !Changes It !is !important !that !on !a!monthly !basis !each !individual !saving !proposal !is !reviewed, !so !that !changes !to !achievement !of !the !proposal !be !it !YTD, !forecast !or !likelihood ! are !updated !regularly. !For !example, !at !the !start !of !the !year !confidence !maybe !high !that !the !agreed !saving !target !will !be !achieved, !and !therefore !the !forecast ! showed !the !full !saving. !However; !a!few !months !on !it !may !become !apparent !that !the !agreed !saving !target !will !not !be !fully !achieved. !In !this !instance !the !forecast ! must !be !updated !accordingly !to !reflect !the !true !position !of !the !proposal. !It !is !essential !that !a!thorough !review !takes !place !every !month !so !that !an !accurate ! position !is !submitted !regularly, !which !will !prevent !any !unwelcome !surprises !surfacing !at !year !end. Improvement !Recommendation :!It !is !recommended !that !departments !review !each !saving !proposal !within !their !respective !areas !on !a!monthly !basis, !and !where ! changes !have !occurred !to !the !YTD, !forecast, !variance !and !likelihood !they !are !reflected !in !the !most !recent !monthly !submission.
6.0Impacts To !help !bring !to !the !attention !of !senior !management !the !impact !of !the !reduced !budget, !SLB !and !Scrutiny !requested !that !non !financial !impacts !be !feed !into !the ! tracker. !The !intention !of !having !both !financial !information !and !performance !information !in !relation !to !the !saving !proposals !was !to !build !a!holistic !view !of !how !the ! council !was !performing !within !the !budget !constraints, !and !how !this !was !impacting !on !service !users !and !more !widely !the !citizens !of !Lambeth. !Each !month !Heads !of ! Performance !are !asked !to !update !the !tracker !with !impact !information. Page 204 Departments !need !to !ensure !that !they !have !appropriate !arrangements !in !place !to !monitor !the !impact !of !the !saving !proposals. Improvement !Recommendation :!It !is !recommended !that !departments !review !the !way !in !which !they !are !monitoring !impacts !to !ensure !that !impacts !are !being ! appropriately !captured !and !reported !on. !A!holistic !view !of !the !impacts !of !the !saving !proposals !is !needed !to !be !able !to !fully !understand !the !implications !of !the ! reduced !budget. !Consideration !needs !to !be !given !as !to !whether !the !right !performance !indicators !are !being !monitored !and !perhaps !the !scope !of !performance ! monitoring !needs !to !be !broadened !to !include, !for !example, !analysis !of !complaints !and !Member !Enquiries.
7.0Comments When !the !delivery !tracker !was !first !developed !there !was !a!single !comments !column !where !we !expected !departments !to !provide !detail !around !high !level !risks !and ! issues !that !may !impact !on !the !delivery !of !the !proposed !savings. !Due !to !feedback !received !from !scrutiny !members !additional !comment !columns !were !added. !Each ! departmental !tracker !now !has !four !comment !columns, !and !they !are !titled: !current !status !of !outcomes, !expected !outcomes !or !impact, !unexpected !impact !not ! planned !for !and !mitigating !actions. !This !now !provides !departments !with !the !opportunity !to !confirm !the !impacts !on !a!line !by !line !basis, !which !we !hoped !would ! encourage !more !detailed !and !meaningful !impact !information, !and !allows !departments !the !opportunity !to !put !forward !ways !they !plan !to !mitigate !any !shortfall.
The !usage !of !the !comment !columns !varies !by !department. !It !is !important !that !the !comment !columns !are !updated !on !a!monthly !basis !and !should !support !what !the ! financial !information !and !the !likelihood !ratings !are !indicating. !Over !the !last !six !months !we !have !seen !instances !where !the !comments !are !confirming !that !the ! saving !proposal !is !unlikely !to !be !achieved !but !then !the !likelihood !is !entered !as !‘likely’, !and !vice !versa, !so !it !really !is !important !that !when !changes !to !the !financial ! information !and !likelihood !are !made !that !the !comments !are !also !updated. !
If !the !comment !fields !are !updated !and !explain !fully !the !position !of !each !proposal !this !will !prevent !the !VfM !Team !contacting !departments !asking !for !additional ! If !the !comment !fields !are !updated !and !explain !fully !the !position !of !each !proposal !this !will !prevent !the !VfM !Team !contacting !departments !asking !for !additional ! information !each !month. !Sometimes !the !comment !columns !are !left !blank, !which !makes !it !impossible !for !us !to !gain !a!thorough !understanding !of !the !proposal !and ! prevents !us !from !being !able !to !provide !details !within !the !monthly !monitor !and !tracker !report.
It !has !also !been !noted !that !departments !are !assuming !we !know !what !each !proposal !means. !It !may !be !obvious !for !those !working !in !the !relevant !departments, !but ! quite !often !we !are !uncertain !as !to !what !the !proposals !actual !denotes, !because !all !we !have !to !work !from !is !the !title !of !the !proposal. !On !a!number !of !occasions !we ! have !referred !to !the !proposal !reports !within !the !budget !report, !but !quite !frequently !they !lack !the !level !of !detail !that !we !need. !It !would !therefore !be !useful !if !a! brief !explanation !of !each !proposal !was !provided. Improvement !Recommendation :!It !is !recommended !that !the !comment !fields !are !reviewed !and !updated !on !a!monthly !basis, !to !ensure !they !are !accurate !and !up !to ! date, !and !of !sufficient !detail !to !provide !an !understanding !of !the !progress !of !the !proposal, !and !should !provide !an !explanation !of !the !financial !information !entered ! on !the !tracker.
8.0Recovery !Ac on When !departments !are !reporting !a!savings !gap !recovery !action !must !be !proposed !on !the !delivery !tracker, !which !should !mitigate !all !or !most !of !the !savings !gap. !!! Improvement !Recommendation :!It !is !recommended !that !departments !consider !the !level !of !their !shortfall !and !devise !suitable !recovery !action !which !will !cover !
their !respective !savings !gap. ! Page 205
9.0Risk !Ra ng !/!RAG !system ! The !risk !matrix !uses !the !corporate !standard !risk !assessment. !Each !saving !proposal !is !assessed !by !departments !in !relation !to !their !likelihood !of !being !achieved, !with ! the !options !of: Very !likely; !likely; !unlikely !and !very !unlikely. ! The !impact !score !is !then !automatically !calculated !using !the !value !of !the !proposal !as !a!parameter. !
The !proposals !with !an !agreed !saving !target !of !less !than !£100k !are !deemed !as !minor. ! The !proposals !with !a!target !of !between !£100k !and !£200k !are !deemed !as !significant. The !proposals !with !a!target !of !between !£200k !and !£500k !are !deemed !as !serious. ! The !proposals !with !a!target !greater !than !£500k !are !deemed !to !have !a!major !impact.
As !per !our !findings !it !would !appear !that !on !occasions !the !risk !rating !does !not !reflect !the !position !of !the !saving !proposal. !The !lack !of !consistency !may !lead !to ! proposals !not !being !flagged !appropriately. !The !lack !of !consistent !risk !rating !may !be !due !to !interpretation. !!
Discussion !around !the !possibility !of !creating !prescriptive !rules !for !the !likelihood !score !took !place, !but !it !is !felt !this !would !be !too !restrictive !and !does !not !promote ! trust !within !the !process. !As !a!guide, !however; !we !would !like !departments !to !consider !using !the !following !rules:
Wh h % i f i l i When !the !%!variance !of !a!saving !proposal !is: Between !0R25% !the !likelihood !rating !should !be !very !likely. Between !26 R50% !the !likelihood !rating !should !be !likely. Between !51 R75% !the !likelihood !rating !should !be !unlikely. Between !76 R100% !the !likelihood !rating !should !be !very !unlikely.
The !matter !of !selecting !the !incorrect !likelihood !rating !maybe !due !to !a!misunderstanding !of !what !is !actually !being !rated !as !being !likely. !For !instance, !under !the ! terminology !tab !which !is !on !each !departmental !tracker !the !likelihood !is !described !as: ‘the !Likelihood !is !based !upon !your !estimation !of !how !likely !the !proposal !will !be !to !deliver !its !agreed !value. !The !range !of !responses !goes !from !"Very !Likely" !which !is ! the !best !rating !as !you !are !likely !to !deliver !the !full !amount !of !savings !to !"Very !Unlikely" !which !is !the !worst !rating’
The !key !words !being !the !likelihood !of !delivering !the !‘full !amount’ !and !that !is !exactly !what !the !likelihood !score !should !represent. ! Improvement !Recommendation :!It !is !recommended !that !departments !review !their !delivery !tracker !likelihood !statuses !to !ensure !that !the !rating !is !assessing !the ! likelihood !of !achieving !the !full !agreed !savings !target, !and !nothing !else. !It !is !recommended !that !departments !look !at !the !%!variance !to !assist !them !when !deciding ! Page 206 on !a!suitable !likelihood !rating, !and !if !still !unsure !the !above !rules !should !be !adopted.
10.Challenge !Process Due !to !the !limited !time !available !from !the !when !the !delivery !tracker !is !submitted !by !departments !to !when !the !VfM !Team !has !to !submit !the !final !tracker !report, !it ! was !discussed !and !agreed !at !FSB !that !when !the !VfM !Team !wants !to !challenge !an !item !that !the !relevant !department !responds !expediently. ! If !the !department !is !unable !to !respond !on !the !same !working !day !then !a!sufficient !holding !response !should !be !provided !with !confirmation !as !to !when !a!final !formal ! response !will !be !issued. !If !the !final !formal !response !is !not !received !within !the !tight !timescales !that !the !VfM !Team !are !working !to !then !the !reported !position !that ! was !submitted !by !the !department !will !be !used, !but !a!note !will !be !made !within !the !tracker !report !that !there !is !a!possibility !that !the !data !may !change !once !the ! department !has !formally !responded !to !the !challenge. Agenda Item 11 Page 207
b
Health and Adult Services Scrutiny Sub-Committee 23 October 2012
South London Healthcare NHS Trust
All Wards
Report authorised by : Executive Director of Finance and Resources: Mike Suarez
Executive summary
This report notes the appointment of a Trust Special Administrator (TSA) at South London Healthcare Trust and the timetable that the TSA is working to in reporting to the Secretary of State for Health. It proposes that a meeting of the Health and Adult Services Scrutiny Sub Committee be held with Southwark Council’s Health, Adult Social Care, Communities and Citizenship Scrutiny Sub Committee to formally consider the TSA draft report during the consultation period.
Summary of Financial Implications
There are no financial implications arising from this report. Any costs associated with the additional meeting will be contained within the Democratic Services budget.
Recommendations 1. That a meeting of the Health and Adult Services Scrutiny Sub Committee be held on 5th December. This meeting will be held with Southwark Council’s Health, Adult Social Care, Communities and Citizenship Scrutiny Sub Committee and take place at Southwark Council, Tooley Street SE1 2TZ.
Page 208
Consultation
Name of Department or Organisation Date sent Da te Comments consultee response appear in report received para:
Internal Mark Hynes Director Governance and 5.10.12 5.10.12 Democracy (for ED Finance and Resources) Salim Fateha Governance and Democracy 5.10.12 9.10.12 4 Nicola Drito-Andi Corporate Finance 5.10.12 8.10.12 3 Cllr Davie Chair HASSC 5.10.12
Report history
Date report drafted: Report deadline: Date report sent: Report no.: 4.10.12 10.10.12 10.10.12 138-12/13 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Background Documents
None
Page 209
South London Healthcare NHS Trust
1. Context
1.1 On 16 July 2012 the Secretary of State for Health placed South London Healthcare NHS Trust (SLHT) into the Regime for Unsustainable Providers (UPR). South London Healthcare Trust runs three hospitals - Queen Mary's in Sidcup, the Queen Elizabeth in Woolwich and the Princess Royal University Hospital in Bromley.
1.2 This is the first time the UPR has been enacted. A Trust Special Administrator, Matthew Kershaw, has been appointed who has assumed full control of SLHT and responsibility for discharging the Trust’s duties. The TSA is also tasked with making a recommendation to the Secretary of State on how to deliver access to safe, high quality, affordable health services and a long-term sustainable health economy for the people of south east London.
2. Proposals and reasons
2.1 The TSA will conduct a rapid and wide-ranging assessment of SLHT, make immediate changes to address issues where appropriate and then produce a report with recommendations on longer-term solutions. The timelines are constrained and the TSA is working to the following timetable for preparation of draft report, consultation and reporting to the SoS.
§ 29 October 2012 - Deadline for the TSA to produce draft report and publish that report and consultation plan.
§ 2 November 2012 - Begin consultation within 5 working days of publishing draft report.
§ 14 December 2012 - Consultation ends after 30 working days.
§ 8 January 2013 - Submit the final report to Secretary of State.
§ 4 February 2013 - Within 20 working days, the Secretary of State to decide on the action to take in relation to the trust.
2.2 Whilst the three hospitals are located in Bexley, Greenwich and Bromley, it has been made clear that this issue impacts across the health economy of the whole south east London sector. The TSA is currently undertaking a process to consider options on how the Trust and the services it provides could be made sustainable. As part of the market engagement interested parties have been invited to inform the TSA of their interest in managing or providing some or all of the services currently provided by the Trust.
2.3 Both the Lambeth and Southwark health OSCs have indicated their interest in considering the TSA draft report during the 30 working day consultation period. The Health and Adult Services Scrutiny Sub Committee is not scheduled to meet during that time however building on previous cross-borough scrutiny arrangements to consider issues of mutual interest and with potential impacts on
Page 210
borough’ residents it is proposed that a committee meeting be held with Southwark Council’s Health, Adult Social Care, Communities and Citizenship Scrutiny Sub Committee to enable formal consideration of the TSA report.
2.4 The proposed meeting of the two committees will take place on Wednesday 5 th December. It will be hosted by London Borough of Southwark and held at Southwark Council, 160 Tooley Street, SE1 2TZ.
2.5 The Trust Special Administrator has confirmed that he will attend on the evening of 5/12 to discuss the proposals and take questions from members of the committees.
2.6 It is also proposed that as a second agenda item Kings Health Partners be added to the meeting on 5/12 to follow up on the previous discussion with the two committees about plans exploring organisational merger across Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS foundation trusts.
3. Comments from Executive Director of Finance and Resources
3.1 There are no additional capital or revenue implications as a direct result of this report. Any costs associated with the additional meeting will be contained within the Democratic Services budget.
4. Comments from Director of Governance and Democracy
4.1 There are no immediate legal implications, but advice on specific issues may be provided in the future.
5. Results of consultation
5.1 This meeting of the two health OSCs will take place during the period for formal consultation on the TSA draft report on South London Healthcare Trust and provide an opportunity for discussion in public on the proposals.
6. Organisational implications
6.1 Risk management: Not applicable.
6.2 Equalities impact assessment: Not applicable.
6.3 Community safety implications: Not applicable.
Environmental implications:
Not applicable.
Page 211
6.4 Staffing and accommodation implications: Not applicable.
6.5 Any other implications: Not applicable.
7. Timetable for implementation Not applicable.
______
Page 212
This page is intentionally left blank Agenda Item 12 Page 213
b Health and Adult Services Scrutiny Sub-Committee 23 October 2012
Work Programme Report All wards
Report authorised by : Executive Director Finance & Resources, Mike Suarez
Executive summary
This report sets out the draft work programme for the Health and Adult Services Scrutiny Sub-Committee for 2012/13. The committee is asked to consider the work programme as currently drafted and also to identify and prioritise any additional matters for scrutiny.
Summary of financial implications
No implications beyond existing Scrutiny budget.
Recommendations 1) That the committee note the 2012/13 work programme as drafted and status of actions, agree any further topics for scrutiny and determine when such items be considered (Appendix 1).
2) To note the proposal (report elsewhere on this agenda) for an additional meeting held jointly with Southwark Council’s Health, Adult Social Care, Communities and Citizenship Scrutiny Sub Committee on Wednesday 5 th December at Southwark Council, 160 Tooley Street SE1 2TZ.
3) That the committee note the service change proposals notified by NHS Lambeth and decide whether these matters be subject to further scrutiny:
I. SLAM Eamon Fotrell Day Centre (Appendix 2) II. SLAM Continuing Care Beds (Appendix 3)
Page 214
Consultation
Name of consultee Directorate or Organisation Date sent Date Comments to response appear in report consultee received para: from consultee
Internal Mark Hynes Director Governance and 5.10.12 5.10.12 Democracy (for ED Finance and Resources) Salim Fateha Governance and Democracy 5.10.12 5.10.12 7.0 Nicola Drito-Andi Corporate Finance 5.10.12 8.10.12 6.0 Cllr Davie Chair HASSC 5.10.12
Report history
Date report drafted: Report Date report sent: Report no.: deadline: 4.10.12 10.10.12 134/12-13 Report author and contact for queries: Elaine Carter, Scrutiny Lead Officer 020 7926 0027 [email protected]
Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 215
Work Programme Development and Decision Monitoring
1. Context
1.1 Scrutiny committees are required to consider their work programmes for the forthcoming year at the start of each municipal year and then at each subsequent meeting. Although some flexibility needs to be retained to enable items to be added at relatively short notice, planning the committee’s work programme assists in the commissioning of reports and helps to ensure that planned work is not duplicated elsewhere.
1.2 The template at appendix 1 is updated following each meeting to reflect the timetabling of new items, recommendations arising from discussions and completion of actions. The work programme should be monitored at each meeting to ensure previous requests have been completed in full.
2 Proposals and reasons
2.1 The committee is asked to consider the workplan as drafted and propose any further items for inclusion including a timeline for new topics where appropriate.
2.2 Additional Meeting – 5th December 2012
2.3 A report elsewhere on this agenda proposes that an additional meeting of the Health and Adult Services Scrutiny Sub Committee be held jointly with Southwark Council’s Health, Adult Social Care, Communities and Citizenship Scrutiny Sub Committee to consider (i) consultation proposals put forward by the Special Trust Administrator regarding South London Healthcare Trust and (ii) Kings Health Partners update on merger proposals.
2.4 The additional meeting will be held on Wednesday 5 th December at Southwark Council, 160 Tooley Street.
3 Savings Tracker/Budget Monitoring
3.1 All scrutiny committees will continue to receive reports from the relevant departments detailing progress made in delivering the agreed reductions against the 2011/12 and 2012/13 budgets for their areas.
4 Commission Work
4.1 The New Arrangements for Health in Lambeth Scrutiny went to Cabinet in April 2012 for in principle endorsement, however the majority of recommendations are for health partners/partnership boards and the report is being submitted to those relevant bodies for formal response and the action planning process. In view of the timelines associated with external formal presentation and their responses the draft Action Plan setting out how the commission’s approved recommendations will be taken forward is still in development and will be reported to a later meeting of the committee.
4.2 It has been agreed that the Street Detox Commission – Making Lambeth’s Town Centres Healthier be established. Member nominations have just been confirmed and it is intended to start the commission imminently.
Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 216
5 NHS Service Changes (Substantial Service Variations)
5.1 The committee is asked to consider the information submitted by NHS Lambeth and South London and Maudsley NHS FT advising on two service change proposals both for older people with mental health needs. The NHS do not consider the proposals to be a substantial service change but wish to committee to be aware of the proposals. The committee is asked to consider whether either matter should be subject to further scrutiny.
Eamon Fotrell Centre (Appendix 2)
5.2 SLaM currently provides a day care service located at the Eamon Fotrell Centre in Belthorn Crescent, Balham. As a temporary measure this will move to Landor Road, Clapham. SLAM is also proposing a change in the model of care and that day service provision will be redesigned in Lambeth, and specifically for dementia patients.
Continuing Care (Appendix 3)
5.3 SLAM currently provides 57 continuing care beds in two care homes (Woodlands and Greenvale). Continuing care beds are being underutilized (there are 7 vacant beds). Additionally a formal review of patients currently residing in SLAM continuing care beds is underway. It is anticipated that the review will identify patients whose needs are now better met in alternative settings. It is proposed to decommission under utilized beds, and to re-provision care for patients in settings more appropriate to their health needs based on formal assessment.
5.4 NHS health trusts are required to consult the health Overview and Scrutiny Committee on any proposals for a substantial change in the way health services are provided or delivered locally (Substantial Variation ). Where such changes are proposed the committee should consider whether these are of significance for local residents and if so the committee must be given the opportunity to be formally consulted. It should be noted that a ‘substantial variation or development’ of health services is not defined in regulations and it is up to the health OSC and health bodies to agree what might be regarded as ‘substantial’ in a local context and require formal consultation.
5.5 Officers from the local NHS trusts and the scrutiny team work together to try and ensure that the committee is advised of any key service changes at an early stage to give the committee the opportunity to consider whether such matters might be considered substantial and ensure the consultation requirements can be built in. A ‘trigger’ template is being used whereby a trust will notify the committee when it is considering a proposed variation of service provision and provide information around a series of standard questions. The submission of the template does not necessarily mean that the trust considers the matter to be a ‘substantial’ service variation requiring consultation. Based on the information provided the committee is invited to decide whether it wishes to pursue the matter further which may be via written information/formal report, a briefing or request the matter be subject to formal consultation.
6 Comments from Executive Director of Finance and Resources
Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 217
There are no additional capital or revenue implications as a direct result of this report. The work programme should be undertaken within the existing scrutiny budget.
7 Comments from Director of Governance & Democracy
There are no legal implications, but advice on specific work programme issues may be provided in the future.
8 Results of consultation
Members of the council, executive and divisional directors have been consulted regarding suggestions for the scrutiny work programme and the council’s website enables members of the public to put forward suggestions.
9 Organisational implications
None
10 Equalities impact assessment:
An equalities impact assessment of the work has not been undertaken. Reports commissioned by the committee will be expected to address any equalities issues.
11 Risk management:
None
12 Community safety implications:
None
13 Environmental implications:
None
14 Staffing and accommodation implications:
None
15 Timetable for implementation
The work programme will be updated throughout the year to account for actions arising from meetings and new reports commissioned.
Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 218
Appendix 1
HEALTH AND ADULT SERVICES SCRUTINY SUB-COMMITTEE
2012-13 – MEETING DATES AND WORK PROGRAMME DRAFT ISSUES
Date Meeting type Items/Topics • Psychotherapy changes SLAM/NHS Lambeth
Committee • HIV – re-modelling & re-commissioning of provision – consultation Wednesday th meeting (joint outcomes 16 May with LB • 2012 Kings Health Partners – Presentation: Proposals on single Southwark) healthcare organisation • Public Health: transition update and delivering PH and PH Committee improvements in the future meeting • Support to Carers/Carers Services – Review Update • Contingency arrangements during Olympics – potential health and Wednesday social care impacts: lane closures, disruption: blue light vehicles th 11 July • Allied Healthcare: update following CQC report 2012 • Sheltered Housing Review – verbal update (and overview of the Social Care White Paper if published) Standing items - budget tracker - LINk report • SLaM Cost Improvement Plan – how achieving cost reduction Committee targets/proposals meeting • Lambeth Adult Safeguarding Board Annual Report • Injectable Opiate trial clinic • Coroner Inquest: Sean Rigg (SLaM) – response to mental health Tuesday service issues arising rd • 23 October Coroner Inquest: Kane Gorny (St Georges) - patient safety issues 2012 • Service Changes: Intermediate Care – Pulross ICC/Kennington CCC • South London Healthcare Trust • Service Changes: Mental Health Improvement Programme - SLAM Continuing Care Beds - SLAM Eamon Fotrell Day Centre Standing items - budget tracker - LINk report Committee • South London Healthcare Trust – to review proposals of the Trust meeting (joint Special Administrator Wednesday with LB • 5 December Kings Health Partners – Update on merger proposals Southwark) 2012 Venue: 160 Tooley St Committee Potential/Provisional Issues meeting • Health and Wellbeing Board – early progress and engagement/working with scrutiny Tuesday 24 th • New Arrangements for Health – Commission Action Plan January 2013 • ACS Budget – EQIA re Drinkers & Teen Preg proposals should be available • DOPH Annual Report (due to be ready autumn)
th Tuesday 20 Committee To be agreed March, 2013 meeting
COMMISSIONS
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Date Meeting type Items/Topics High Street Detox: Making our Town Centres Healthier Toxic High Streets: looking at how our high streets, particularly in poor areas, are dominated by shops that encourage poor health or financial choices which damage the lives of residents and what might be done to take action.
OTHER SUGGESTED ITEMS – For potential future scrutiny Items arising from 10/11 - to be rescheduled • Older Peoples Strategy – 1 year review (moved from Sept 11 date due to capacity and other items) • End of Life Care – project review (as above) • Personalisation (as above)
Items arising during 11/12 & 12/13 or identified for potential future scrutiny • Health checks for babies and young children – update report back • South East London NHS 111 Service – briefing offer • Ward councillors visiting care homes – report back on experiences • CQC report on Lambeth PCT – support for families with disabled children • Respite care – adults with learning disabilities (PNQ) • Under 25’s conceptions - QA from Brook London • Pharmacy and Medicine Management • How working with African communities addressing health and community messages – to be determined
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Wednesday 16 th May 2012 (Joint meeting with Southwark Council Health and Social Care Committee) PRE MEETING PLANNING POST MEETING ACTIONS Lead Report Title & Key Points Outcome & Actions Arising Responsible Officer Deadline Status Officer/Author SLaM Proposed Reconfiguration of Lambeth Secondary Psychological Therapy Services A RESOLVED 1 & 2 – SLAM response 1. To agree that SLaM management and staff meet once more to resolve differences over the delivery of different modalities and invite received 5/7/12 representatives from these professional bodies to attend: British Psychoanalytic Council and UK Council for Psychotherapy. (including stakeholder 2. To agree that SLaM be given time to adequately digest the concerns raised during the consultation event held earlier that day, via the written submissions and at the scrutiny meeting and that these concerns be reflected in the final consultation proposals. engagement report). 3. To agree that SLaM set out and agree an action strategy for ongoing consultation and evaluation of the Psychological Therapy Service with LINks, Southwark and Lambeth Clinical Commissioning Committee, and any other relevant other service user bodies and stakeholders. The 3, 4,5, 9 & 10 – SLAM evaluation framework should ensure that SLaM has a clear idea of what constitutes success and how staff and services users will feed into the updating response evaluation; particularly service users with complex needs. The evaluation should ensure that data is captured on: received 3/9/12
Clinical outcomes; Waiting time; Activity levels; Patient-Reported Outcome Measure (PROMs) Page 220
4. To agree that Psychological Therapy Service and Lambeth and Southwark council services, such as housing and social care, build effective links. 3 Evaluation framework 5. To recommend that service users awaiting treatment should be given clear information at entry stage on waiting times, support services and being finalised for use in what type of service they will be receiving. Issues of access by BME individuals, and particularly late access, should also be followed up Oct & review of new potentially as part of the monitoring framework. service 4/13. 6. The committees welcomed SLaM’s proposed round table discussions to consider proposed changes to services over the coming three years and indentify those areas which are most likely to be contentions or benefit from in-depth engagement with Scrutiny and other stakeholders. In 4 Ongoing addition to this it is recommended that SLaM regularly attend the Stakeholder Reference Group for Lambeth Southwark & Lewisham (SRG
LSL) to highlight and help identify issues of concern. 7. To agree to write to the SCCC / LCCCB asking for their views on the service reorganization and whether they are satisfied with proposed 5 Undertaking via structure and outcomes for the service. In particular the potential drop in psychodynamic psychotherapy in Southwark will be highlighted and information sub group commissioners will be asked if they have a view on if they would like to invest more of their budget on this and less in other areas. 8. To agree to write to Monitor, the regulatory body for Hospital Foundation Trusts, highlighting the issues and concerns raised over the proposed 6 – roundtable date reorganisation of Psychological Therapy Services. confirmed 29/10/12 9. To note that concerns remain about Honorariums and agree to request the following information:
§ The number of individual honorariums, their clinical specialism’s, the amount of patients seen and the level of therapeutic hours delivered over the last two years. 7 – LCCCB response § The anticipated reduction as a result of this reorganization on the modalities delivered, numbers of Honorariums, patients seen and 3/9/12 therapeutic hours delivered. § The level of qualifications of Honorarium supervisors in the new proposed structure and clarify with the UK Council of Psychotherapy on 8 – Letter to Monitor the level of accreditation required. submitted 10. Concern was raised about unequal provision between Southwark and Lambeth; details were requested on the availability of different modalities in the different boroughs and how this could be made more equal.
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Presentation: KHP To note the presentation Issue for future follow Joint Kings Health • Proposal on creating a single To receive an update briefing on any points up – Strategic Outline meeting G Partners healthcare organisation not covered at the meeting (due to time Case published 27/8 5/12/12 constraints) Update on Lambeth/Southwark/ NHS Lambeth Lewisham HIV Care and Support Noted G Review
Wednesday 11 th July 2012
Report Deadline: cleared reports (including approval by Finance & Legal) MUST be submitted to Democratic Services by 28 th June 2012 PRE MEETING PLANNING POST MEETING ACTIONS Lead Report Title & Key Points Outcome & Actions Arising Responsible Officer Deadline Status Officer/Author • Ruth Wallis/Jo Public H ealth : Update and transfer to London Health Inequalities report Page 221 Cleary the council. commissioned by Marmot to be • To include future funding of public circulated health and funding splits as known • Annual Public Health Report – be (e.g. to local authority; NHS/CCG; produced for autumn (future item for Public Health England; London Health scrutiny) Improvement Board etc) as well as • How reaching small cultural group with any further clarity that has evolved on messages around health/public health respective responsibilities and future (e.g. cancer; HIV) – future potential item A working across organisations to • Joint Lam/Southwark DoPH – potential deliver health improvements. for follow up to discuss PH issues (with • How the local authority is centring Southwark?) public health as a core activity and ensuring the wider understanding of public health in the council to secure delivery of public health improvements in the future.
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James Lee/ Support to Carers /Carers Services Report noted Helen Review – Update: Explore further idea of Carers Collaborative Charlesworth- • Follow up to saving proposals in the May 12/13 ACS budget – update on the A status of the review, future arrangements to support carers and carer/public engagement thus far. ORN and health and social care: Adrian Smith contingency arrangements during Noted ACS/ Olympic s Ian Baker • Work undertaken to assess potential HRE impacts arising from the Olympic Road Network i.e. lane closures, disruption to social services and care G services (e.g. meals on wheels deliveries, reaching vulnerable clients) as well as health services (non- emergency blue light vehicles, Page 222 patients requiring regular treatments) and work to mitigate any effects including joint work across the sectors Allied Healthcare Medicine management and pharmacy – • Follow up to the CQC inspection healthcare issues and practice: potential A report future item for scrutiny LINk Lambeth LINk Update LINK now using FOI to get responses from council – HCM to look into A Healthwatch & End to End public mtgs not publicised on council website Sheltered Housing – Verbal Update on Older Adults Housing report to Cabinet Oct – (Verbal Update consultation for HASSC pre-scrutiny (subject to timeline) Report) [Adult Social Care White Paper – [Cab 22/10; HASSC 23/10] A subject to publication]
Issues arising (minutes) 1) Dates to be arranged; listing of homes in 1) Training for councillors home visits borough to be circulated 2 – LINk A 2) IAPT 2) Further work on EQIA (with LINk) over report sent next 3 months 25/9/12
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Tuesday 23 rd October 2012
Report Deadline: cleared reports (including approval by Finance & Legal) MUST be submitted to Democratic Services by 10 th October 2012 PRE MEETING PLANNING POST MEETING ACTIONS Lead Report Title & Key Points Outcome & Actions Arising Responsible Officer Deadline Status Officer/Author Provisional Issues Coroner Inquest – Sean Rigg § To hear from SLAM on findings from the inquest & how the trust has responded & lessons learned • To also follow up on issues arising from the death of Seni Lewis • To seek assurances around MH service provision & multi agency work Coroner Inquest – Kane Gorny
• To hear from St Georges on Page 223 findings from the inquest and how the trust has responded including patient safety measures • Potential to also cover reconfiguration & capacity issues SLAM Cost Improvement Programme • How achieving cost reduction targets/proposals • Invite new CE Annual Adult Safeguarding Report § Presentation of the annual report (including serious case review) Injectable Opiate Trial • Briefing on the trial clinic to be established by the Addictions Service Intermediate Care • Proposals for Pulross Centre & Lambeth Community Care Centre
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South London He althcare Trust • Confirmation of joint meeting with LB Southwark to consider TSA draft report Standing Items • LINk Report • Budget Tracker • Service Changes: - Eammon Fotrell Centre - Continuing Care
Wednesday 5 h December 2012 Joint meeting with Southwark Council Health, Adult Social Care, Communities and Citizenship Committee Venue – Southwark Council 160 Tooley Street, SE1 2TZ
Page 224 PRE MEETING PLANNING POST MEETING ACTIONS Lead Report Title & Key Points Outcome & Actions Arising Deadline Status Officer/Author South London Healthcare Trust
• To consider the report of the Trust
Special Administrator Provisional: Kings Health Partners • Update on exploration of merger proposals
Thursday 24 th January 2013
Report Deadline: cleared reports (including approval by Finance & Legal) MUST be submitted to Democratic Services by 11 th January 2013 PRE MEETING PLANNING POST MEETING ACTIONS Lead Report Title & Key Points Outcome & Actions Arising Deadline Status Officer/Author
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To be agreed
Tues day 19 th March 2013
Report Deadline: cleared reports (including approval by Finance & Legal) MUST be submitted to Democratic Services by 6th February 2013 PRE MEETING PLANNING POST MEETING ACTIONS Lead Report Title & Key Points Outcome & Actions Arising Deadline Status Officer/Author
To Be Agreed
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Appendix 2 Trigger template for proposed variations to health services
NHS Trust & lead officer contacts: London Borough of Lambeth/NHS Lambeth Helen Charlesworth-May [email protected] South London & Maudsley NHS Foundation Trust (SLaM) David Norman [email protected] Telephone: 020 3229 1624
Trigger Please comment as applicable Reasons for the change SLaM Eamon Fotrell Day Centre What change is being proposed? SLaM currently provides a day care service located at the Eamon Fotrell Centre (EFC) in Belthorne Crescent in Balham. This is a low intensity model of care under the remit of SLaM, a specialist services provider. The current service operates two and a half days a week with sessions usually running from 10.30 am to 3.30 pm.
An interim arrangement is proposed to move the day service to the Landor Road site (Lambeth Hospital) in Clapham in late October, as this has better access, lighting and a safer environment for service users and their carers. Services to transfer are the sessions offered Monday to Wednesday at Eamon Fotrell day centre; the sessions provided at Central Hill on Thursdays and Fridays will remain in place. The interim nature of the move is dependent for individual patients on the outcome of individual assessments, which are currently being conducted, and monthly patient level progress reports .
SLaM also propose a change from a low intensity model of care to a recovery focused one with an emphasis of providing services linked to individual recovery plans.
For further context, it is intended that day service provision will be redesigned in Lambeth, and specifically for dementia patients. Potential models of delivery could include closer working with carers, voluntary sector and local BME groups to actively support and enable best quality of life for this client group via participation in day care services. This will increase the choice and options available to patients and their carers in determining the mot appropriate day services for their needs. The SLaM service will be included in the review of potential models of delivery to determine its place is future day service provision. The current service site is located on a housing estate and Why is this being proposed? users and staff have indicated poor lighting and access to the location together with security problems do not provide a good environment for the service. Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 227
Current service can offer up to 62 places a week for service users providing intensity support without focused interventions.
Attendances numbers have been dropping with a significant number of users attending other local day services. The service currently has 39 service users on its register and is operating at under capacity. Referral rates have been low with 19 current service users having been referred before 2009. 4 service users were referred in 2010, 13 in 2011 and 3 in 2012.
The proposed change to the service model to one that is recovery focussed could provide a potential improvement as it is linked to specific individual patient need and would be based on more active individual participation ie the service provided will be more focused on achieving goals for patients as agreed in their care plans. What stage is the proposal at and The proposal is currently being reviewed by Joint NHS and what is the planned timescale for the Social Care commissioners as part of the ongoing review change(s)? of how mental health services for older people in Lambeth can be developed and change in response to changes in need and the Lambeth QIPP. These proposals have previously been discussed with Are you planning to consult on this? Scrutiny at a briefing meeting in August 2012. Further engagement with service users and carers has taken place since that date, and this report provides an update.
Informal consultation has taken place and the service has discussed the proposal with stakeholders including Adult and Social Care and the voluntary sector. In addition, SLaM has also been discussing the proposals with relevant staff.
Service users and carers were informed of the proposals at a meeting on September 5 th and following this, discussions took place with all 37 individual service users and also with carers as part of an initial needs assessment to get a snapshot of the provision that needs to be put in place when the service is moved. Areas explored were: aspects of the current service they most valued; needs from an alternative service; key relationships they had developed and what might sustain them; what they felt was important to them in staying well; transport; and impact on carers. Information has been collated and will be used to inform future provision.
. Are changes proposed to the Briefly describe: accessibility to services?
Changes in opening times for a It is not envisaged that there will be any changes in the service times that groups are organised.
Withdrawal of in-patient, out-patient, These services will not cease or be withdrawn. Some of
Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 228 day patient or diagnostic facilities for the groups will be held in different locations and run by one or more speciality from the same voluntary organisations. location
Relocating an existing service The service will be relocated from Belthorne Crescent in Balham to Landor Road in Clapham. Currently patients access the current location in Belthorne Crescent using their own transport or through booked transport arranged by the service. Landor Road is more accessible for public transport. For those patients who require help with transport this will be provided as per arrangements outlined above. In addition, the plan to provide sessions through local voluntary agencies may improve accessibility for some patients.
Changing methods of accessing a Service users will still continue to access the service via service such as the appointment the community mental health teams. system etc.
Impact on health inequalities - The service provides day centre support to older people in reduced or improved access to all Lambeth with complex mental health needs. sections of the community e.g. older people; people with learning The proposal will improve access to the service with an difficulties/physical and sensory improved and safer environment for patients, carers and disabilities/mental health needs; black staff. and ethnic minority communities; lone parents. SLaM will introduce an improved and more focussed service based on individual recovery plans.
An Equality Impact Assessment is currently in progress as part of the proposed changes. What patients will be affected? Briefly describe:
Changes that affect a local or the All 37 clients are already known to Community Mental whole population, or a particular area Health Services and 27 of the 37 users are on CPA (Care in the borough. Programme Approach) so already have care plans in place. However, given the service change and the fact that most of the clients have been attending for a number of years a service that is intended to be a time limited service, the assessments will focus on what part of the care needs are being met by day care and what alternative arrangements (if any) need to be put in place as a result of the service change. Individual reviews are underway, being undertaken by an Occupational Therapist using MOHOST (Model of Human Occupation Screening Tool) which is an accredited assessment tool suitable for review of day care clients.
It is planned that by developing groups supported by voluntary agencies that there will be better accessibility than the current model provides.
Changes that affect a group of The service will continue to be provided to older people patients accessing a specialised with complex mental health needs. service Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 229
Changes that affect particular Not applicable communities or groups
Are changes proposed to the Briefly describe: methods of service delivery?
Moving a service into a community The proposal to locate more of the current groups into setting rather than being hospital alternative locations including centres run by the voluntary based or vice versa sector. SLaM believes that this will make the service more accessible.
Delivering care using new technology Not applicable
Reorganising services at a strategic Although this proposal will affect a small number of service level users, the change in the model of care from a low intensity model to a recovery focused model does support the development of enablement and recovery models in Lambeth.
What impact is foreseeable on the Briefly describe: wider community?
Impact on other services (e.g. The development of the model is intended to support children’s / adult social care) closer integrated working between SLaM and the London Borough of Lambeth.
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Appendix 3 Trigger template for proposed variations to health services
NHS Trust & lead officer contacts: London Borough of Lambeth/NHS Lambeth Helen Charlesworth-May [email protected]
South London & Maudsley NHS Foundation Trust David Norman (SLaM) [email protected] tel: 020 3228 1624
Trigger Please comment as applicable Reasons for the change SLaM continuing care beds What change is being proposed? SLaM currently provides approximately 57 continuing care beds for Lambeth registered patients in two care homes (Woodlands & Greenvale).
The National Framework for Continuing Healthcare (2009) states Commissioners have a responsibility to ensure that the ongoing assessment of eligibility for continuing care as provision is not indefinite, as needs could change.
Implementation of the National Framework has led to underutilization of continuing care beds currently provided by SLaM. Formal needs assessment of patients currently using continuing care beds is being carried out with the potential re-provision of care for patients in an environment more appropriate to their healthcare needs.
In summary the changes are:
• Decommissioning of underutlized SLaM continuing care beds; and • Reprovision of care for patients currently in continuing care beds in a more appropriate care setting for their health needs, based on formal assessment. The National Framework for Continuing Healthcare Why is this being proposed? (revised 2009) indicates that continuing care can be provided in a variety of settings and regular case reviews of patient should be carried out to determine their level of need and how this is best met.
Implementation of the National Framework for Continuing Healthcare has reduced the number of active continuing care bed provided by SLaM located at Greenvale Specialist Care Unit in Streatham and Woodlands Specialist Care Unit in Kennington. There are currently seven vacant beds out of a total of 57 beds, and this has been the position for over 12 months.
A review of patients currently in SLaM continuing care beds is being carried out to determine changing need. It is Health and Adult Service Scrutiny Sub Committee 23/10/12 Work Programme Report Page 231
anticipated that the reviews will identify patients whose needs are now better met in alternative settings, specifically that their physical healthcare needs have overtaken their mental health needs. It is anticipated that the assessments may result in at least five patients needing alternative provision. What stage is the proposal at and NHS Commissioners and SLaM determined that what is the planned timescale for the continuing care reviews should be carried out for all change(s)? patients in Greenvale and Woodlands. Reassessments have been completed since August by SLaM involving patients, carers and advocates, using continuing care criteria.
Reviews were assessed by the Lambeth Continuing Care Panel and decisions on eligibility for a SLaM placement have been taken.
Five patients have been identified as still being eligible for NHS continuing care but with needs that would be better met in a nursing home (either EMI or for physical health needs); they do not need the specialist services of a SLaM continuing care bed. Information on local nursing homes who are registered for EMI care has been given to SLaM and staff will be working with families/advocates in identifying suitable homes and ensuring robust transfer plans are in place. Homes will only be recommended that can meet the needs of the patient and where we already place clients. Some patients will have predominantly physical health needs and they too will be placed in appropriate nursing home to meet their needs. Staff are continuing to ensure families are fully involved in this process and are engaging with advocacy services when there is no family.
Residents in nursing homes are also supported by CMHTs if required and are entitled to the full range of community health services and enhanced GP cover. All NHS-funded continuing care patients are also reviewed by the Care Home Support Team.
As this change is a result of implementation of a National Are you planning to consult on this? Framework it is assumed that the impact of any changes to the number of places commissioned by NHS Lambeth will not require full public consultation.
Families/carers are informed and do participate throughout the formal review process. Are changes proposed to the Briefly describe: accessibility to services?
Changes in opening times for a Not applicable service
Withdrawal of in-patient, out-patient, Not applicable day patient or diagnostic facilities for one or more speciality from the same location
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Relocating an existing service Not applicable .
Changing methods of accessing a Not applicable service such as the appointment system etc.
Impact on health inequalities - These changes will require an adjustment to the delivery reduced or improved access to all of care for a small group of older people with mental health sections of the community e.g. older needs currently residing in SLAM provision. people; people with learning difficulties/physical and sensory It is essential that the patient’s place of care is based on disabilities/mental health needs; black need and where this can best be met. SLaM responds to and ethnic minority communities; lone a specialist mental health need whereas for some of these parents. patients, their health needs will now take precedence e.g. heart failure, chronic obstructive pulmonary disease, and require an NHS care setting such as a nursing home to provide optimal care.
An Equality Impact Assessment will be carried out as part of the proposed changes. What patients will be affected? Briefly describe:
Changes that affect a local or the The changes will not affect a local or whole population and whole population, or a particular area do not affect a particular area in the borough. in the borough.
Changes that affect a group of patients accessing a specialised The changes affect five patients currently or previously service residing in a SLaM continuing care bed.
Changes that affect particular The changes do not affect particular communities or communities or groups groups.
Are changes proposed to the Briefly describe: methods of service delivery?
Moving a service into a community The implementation of the National Continuing Care setting rather than being hospital Framework will result in the decommissioning of SLaM based or vice versa continuing care beds currently funded by NHS Lambeth and not being utlilzed.
Following formal review of patients currently residing in SLaM continuing care beds, a proportion of patients will require a shift to NHS provision of care more appropriate to their emerging health needs such as a nursing home.
Delivering care using new technology Not applicable
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Reorganising services at a strategic This is a re-alignment of the level of SLaM beds for older level people with mental health needs commissioned by NHS Lambeth based on changes in demand and clinical need as determined by the National Continuing Care Framework.
What impact is foreseeable on the Briefly describe: wider community?
Impact on other services (e.g. Impact on other service likely to be minimal and will be as children’s / adult social care) a result of patients no longer being eligible for continuing care following application of the continuing care guidance.
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