Public Document Pack
Agenda for a meeting of the Bradford and Airedale Health and Wellbeing Board to be held on Tuesday, 29 November 2016 at 10.00 am in Committee Room 1 - City Hall, Bradford
Dear Member
You are requested to attend this meeting of the Bradford and Airedale Health and Wellbeing Board.
The membership of the Board and the agenda for the meeting is set out overleaf.
Yours sincerely
P Akhtar
City Solicitor
Notes:
This agenda can be made available in Braille, large print or tape format on request by contacting the Agenda contact shown below. The taking of photographs, filming and sound recording of the meeting is allowed except if Councillors vote to exclude the public to discuss confidential matters covered by Schedule 12A of the Local Government Act 1972. Recording activity should be respectful to the conduct of the meeting and behaviour that disrupts the meeting (such as oral commentary) will not be permitted. Anyone attending the meeting who wishes to record or film the meeting's proceedings is advised to liaise with the Agenda Contact who will provide guidance and ensure that any necessary arrangements are in place. Those present who are invited to make spoken contributions to the meeting should be aware that they may be filmed or sound recorded. If any further information is required about any item on this agenda, please contact the officer named at the foot of that agenda item.
From: To: Parveen Akhtar City Solicitor Agenda Contact: Fatima Butt Phone: 01274 432227 E-Mail: [email protected] MEMBER REPRESENTING Councillor Susan Hinchcliffe Leader of Bradford Metropolitan District Council (Chair) Councillor Val Slater Portfolio Holder for Health and Wellbeing Councillor Simon Cooke Bradford Metropolitan District Council Kersten England Chief Executive of Bradford Metropolitan District Council Dr Andy Withers Bradford District Clinical Commissioning Group Helen Hirst Bradford Districts and City Clinical Commissioning Group Dr James Thomas Airedale, Wharfedale and Craven Clinical Commissioning Group Dr Akram Khan Bradford City Clinical Commissioning Group (Deputy Chair) Brian Hughes Locality Director, West Yorkshire NHS England - North (Yorkshire and Humber) Anita Parkin Director of Public Health Michael Jameson Strategic Director of Children's Services Javed Khan HealthWatch Bradford and District Sam Keighley Bradford Assembly Representing the Voluntary, Community and Faith Sector Bev Maybury Strategic Director Health and Wellbeing Board Bridget Fletcher/Clive Kay/Nicola Lees One Representative of the main NHS Provider
A. PROCEDURAL ITEMS
1. ALTERNATE MEMBERS (Standing Order 34)
The City Solicitor will report the names of alternate Members who are attending the meeting in place of appointed Members.
2. DISCLOSURES OF INTEREST
(Members Code of Conduct - Part 4A of the Constitution)
To receive disclosures of interests from members and co-opted members on matters to be considered at the meeting. The disclosure must include the nature of the interest.
An interest must also be disclosed in the meeting when it becomes apparent to the member during the meeting. Notes:
(1) Members may remain in the meeting and take part fully in discussion and voting unless the interest is a disclosable pecuniary interest or an interest which the Member feels would call into question their compliance with the wider principles set out in the Code of Conduct. Disclosable pecuniary interests relate to the Member concerned or their spouse/partner.
(2) Members in arrears of Council Tax by more than two months must not vote in decisions on, or which might affect, budget calculations, and must disclose at the meeting that this restriction applies to them. A failure to comply with these requirements is a criminal offence under section 106 of the Local Government Finance Act 1992.
(3) Members are also welcome to disclose interests which are not disclosable pecuniary interests but which they consider should be made in the interest of clarity.
(4) Officers must disclose interests in accordance with Council Standing Order 44.
3. MINUTES
Recommended –
That the minutes of the meeting held on 19 September and 19 October 2016 be signed as a correct record (previously circulated).
(Fatima Butt – 01274 432227)
4. INSPECTION OF REPORTS AND BACKGROUND PAPERS
(Access to Information Procedure Rules – Part 3B of the Constitution)
Reports and background papers for agenda items may be inspected by contacting the person shown after each agenda item. Certain reports and background papers may be restricted.
Any request to remove the restriction on a report or background paper should be made to the relevant Strategic Director or Assistant Director whose name is shown on the front page of the report.
If that request is refused, there is a right of appeal to this meeting. Please contact the officer shown below in advance of the meeting if you wish to appeal.
(Fatima Butt - 01274 432227)
B. BUSINESS ITEMS
5. WORKING BETTER TOGETHER - UPDATE ON SUSTAINABILITY AND TRANSFORMATION PLANNING
The process of developing Sustainability and Transformation Plans (STPs) as mandated in NHS Planning Guidance for 2016/17 – 2020/21 has been ongoing at a local level in Bradford District and Craven since early January 2016 and also as one of six constituent parts of a wider West Yorkshire and Harrogate STP.
The local STP process includes work between NHS Clinical Commissioning Groups, NHS providers, Local Authorities and the Voluntary and Community Sector to identify how the health and wellbeing of the population can be improved and how, care and quality standards can continue to be improved all within the financial resources available in the next 4-5 years. This work has built on and brought up to date the Five Year Forward View for the Bradford District and Craven Health and Care Economy 2014-19 and is supported by the Better Health - Better Lives priority of the new District Plan.
The Chief Officer Bradford Districts and Bradford City Clinical Commissioning Groups will submit Document “K” which provides an update on the Sustainability and Transformation Planning process for health and social care in Bradford District and Craven, the Clinical Commissioning Groups and health providers in Bradford District and Craven.
Recommended -
(1) That the update on the Bradford District and Craven and West Yorkshire and Harrogate Sustainability and Transformation Planning processes be noted.
(2) That the Board suggests ways to contribute to the operational planning process.
(3) That the board provides feedback on the published draft of the West Yorkshire Sustainability and Transformation Plan as previously circulated and provided as Appendix 1 to Document “K” or through the links.
(Rebecca Malin – 01274 237290) 6. HEALTH AND WELLBEING BOARD TERMS OF REFERENCE
The Strategic Director for Health and Wellbeing will submit Document “L” which reports that the Terms of Reference for the Health and Wellbeing Board have been reviewed, in order to reflect changes in the scope of the Board’s responsibilities and recent changes to the Council Directorships and Portfolios as currently referenced in the Terms of Reference and to ensure that Board membership remains fit for purpose.
Recommended-
(1) That the amended Terms of Reference for Bradford and Airedale Health and Wellbeing Board be agreed.
(2) That the amended Terms of Reference are submitted to Governance and Audit Committee and through Members own governance routes.
(Angela Hutton – 01274 437345)
7. CHAIRS HIGHLIGHT REPORT - COVERING BETTER CARE FUND, BRADFORD HEALTH AND CARE COMMISSIONERS AND INTEGRATION AND CHANGE BOARD, HEALTHY WEIGHT AND YOUNG CARERS
The Health and Wellbeing Chair’s highlight report (Document “M”) summarises business conducted between meetings: where for example reporting or bid deadlines fall between Board meetings or business conducted at any meetings not held in public where these are necessary to consider material that is not yet in the public domain.
Reporting through a highlight report means that any such business is discussed and formally minuted in a public Board meeting.
The report covers:
A brief outline of each schemes contained within the Better Care Fund for Bradford District and Craven to provide background information for Board members and performance against outcomes for Quarter 2 2016-17. Business conducted at the September and October meetings of the Bradford Health and Care Commissioners Group and the Integration and Change Board. A short update on establishing a whole system approach to Healthy Weight, reporting to the Health and Wellbeing Board. Update on an issue raised at Children’s Overview and Scrutiny in respect of young carers. Progress on the West Yorkshire Sustainability and Transformation Plan
Recommended-
That the update be noted.
(Angela Hutton – 01274 437345)
8. WORKING BETTER TOGETHER: MENTAL WELLBEING IN BRADFORD DISTRICT AND CRAVEN: A STRATEGY 2016-2021
Members are reminded that progress updates on developing a Mental Wellbeing Strategy were received at Board meetings in July and again in September 2016 when it was agreed that the final strategy would return in November 2016. The Board resolved: “That the Board receives the update and provides feedback to further shape the strategy and encourages wide participation in consultation on the draft strategy through its constituent organisations.” The Strategic Director of Health and Wellbeing and the Chief Officer of Bradford City, Bradford Districts and Airedale, Wharfedale and Craven Clinical Commissioning Groups will submit Document “N” which reports that the Mental Wellbeing Strategy for Bradford District and Craven 2016 - 2021 has been developed through intensive collaborative work during April – October 2016. It is presented to the Health and Wellbeing Board for approval and to request views on the proposed approach to implementation. Recommended- (1) That the Board supports the Mental Wellbeing Strategy as the vision for the development of services and community assets to improve mental wellbeing in Bradford district and Craven. (2) That the Board provides views on the initial implementation plans detailed in Section 3.1 of Document “N”. (Ali Jan Haider – 01274 237290) 9. WORKING BETTER TOGETHER ON SAFEGUARDING: ANNUAL REPORTS OF THE BRADFORD SAFEGUARDING CHILDREN BOARD (BSCB) AND THE SAFEGUARDING ADULTS BOARD (SAB)
The Strategic Director, Health and Wellbeing and the Strategic Director Children’s Services will submit Document “O” which reports progress on the Bradford Safeguarding Children Board (BSCB) and the Safeguarding Adult Board (SAB). The report outlines in brief the main areas covered by the annual reports and highlights areas of focus where joint approaches to policy and practice are in operation or are being considered for development across children’s and adults’ safeguarding arrangements.
Recommended-
That the Board receive the annual reports of the Bradford Safeguarding Boards.
(Bernard Lanigan – 01274 432900)
T
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HIS AGENDA AND ACCOMPANYING DOCUMENTS HAVE BEEN PRODUCED, WHEREVER POSSIBLE, ON RECYCLED PAPER This page is intentionally left blank Agenda Item 5/
Report of the Accountable Officer for Bradford City, Bradford Districts & Airedale, Wharfedale and Craven Clinical Commissioning Groups to the meeting of the Bradford and Airedale Health and Wellbeing Board to be held on 29th November 2016
K Subject: Working Better Together Update
Summary statement: Update on Sustainability and Transformation Planning for Bradford District and Craven, and West Yorkshire and Harrogate
Helen Hirst –Accountable Officer, Portfolio: Bradford City, Bradford Districts and Airedale, Wharfedale and Craven Health and Wellbeing Clinical Commissioning Groups.
Report Contact: Rebecca Malin Overview & Scrutiny Area: Phone: (01274) 237290 E-mail: [email protected] Health and Social Care
Page 1
1. SUMMARY
An update on the Sustainability and Transformation Planning process for health and social care in Bradford District and Craven, the Clinical Commissioning Groups and health providers in Bradford District and Craven.
2. BACKGROUND
The process of developing Sustainability and Transformation Plans (STPs) as mandated in NHS Planning Guidance for 2016/17 – 2020/21 has been ongoing at a local level in Bradford District and Craven since early January 2016 and also as one of six constituent parts of a wider West Yorkshire and Harrogate STP.
The local STP process includes work between NHS Clinical Commissioning Groups, NHS providers, Local Authorities and the Voluntary and Community Sector to identify how the health and wellbeing of the population can be improved and how care and quality standards can continue to be improved all within the financial resources available in the next 4-5 years. This work has built on and brought up to date the Five Year Forward View for the Bradford District and Craven Health and Care Economy 2014-19 and is supported by the Better Health - Better Lives priority of the new District Plan.
This process has built on what has been acknowledged at previous Health and Wellbeing Board meetings - that there will be a significant gap between the available budget for health and social care services in the years to 2020/21 and the current level of spend created by high demand for health and social care services in Bradford District and Craven.
Financial efficiencies will need to be matched by shifting the emphasis of service provision further towards improving the health and wellbeing of the population – supporting people to become and remain healthy and independent for longer to reduce demand and to delay the need for social care services as a result of ill-health.
The summary plan for Bradford District and Craven was published on 10th November as one of six local place based chapters in the West Yorkshire STP - see Section 12 for a link. A draft of the local STP had previously been made available through the papers for the 19th October Health and Wellbeing Board, minor amendments were agreed at that Board meeting in relation to indicators for mental health and wellbeing, the care market, diabetes and a review of investment in Public Health expenditure. The amended version is now linked to the Health and Wellbeing Board website.
The STP process is ongoing and the delivery now needs to be articulated. As per NHS planning guidance 2017/18 – 2018/19 a two year operational plan from each health organisation is required to be submitted in draft in November and a final version on the 23rd December. In addition to this Integration and Change Board members have committed to a single system wide two year operational plan detailing the delivery of the STP up to 2018/19.
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Local engagement will continue as our existing transformational programmes and new proposals are developed.
3. OTHER CONSIDERATIONS
The West Yorkshire and Harrogate STP details nine priorities (see below) and the associated draft proposals. These proposals also stress the importance of improving people’s health, through better coordination of services, whilst improving the quality of care received.
West Yorkshire and Harrogate STP priorities: 1. Prevention 2. Primary and community services 3. Mental health 4. Stroke 5. Cancer 6. Urgent and emergency care 7. Specialised commissioning 8. Hospitals working together 9. Standardisation of commissioning policies
For each priority the document articulates the challenge, key milestones an decisions, the anticipated impact across health and wellbeing, care and quality and finance and efficiency and the next steps.
In addition to the main West Yorkshire and Harrogate STP a report presenting the findings from all relevant engagement activity (April 2012 – October 2016) was also published on 10th November 2016. The report recognises that in order to deliver the priorities listed above it is essential that partnership networks work together to understand the view of local populations.
4. FINANCIAL & RESOURCE APPRAISAL
As part of the Bradford District and Craven and West Yorkshire STP an appraisal of system wide finances has been undertaken. The local position was presented to the Health and Wellbeing Board in September 2016. The presentation at the Board meeting will cover the financial and resource appraisal for the health and social care sector which has been agreed to return to the Board at a minimum of six monthly intervals.
5. RISK MANAGEMENT AND GOVERNANCE ISSUES
Governance and risk management for the local Sustainability and Transformation Plan is provided through the Integration and Change Board – a sub-group of the Health and Wellbeing Board and reports up to the Health and Wellbeing Board.
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Governance and risk management of the West Yorkshire Sustainability and Transformation Plan is still being established, with input from local Clinical Commissioning Groups, Council Leaders and Chairs of the West Yorkshire Health and Wellbeing Boards.
6. LEGAL APPRAISAL
Legal appraisal will be undertaken as the finance information presented at the Board meeting in September 2016 is developed through the budget processes of the Council and partner organisations for 2017-18 onwards.
7. OTHER IMPLICATIONS
7.1 EQUALITY & DIVERSITY
7.2 SUSTAINABILITY IMPLICATIONS
The Sustainability and Transformation Plans (STP) for Bradford District and Craven and for West Yorkshire plus Harrogate have been developed in accordance with 2016-17 NHS Planning Guidance to bring local health economies onto a sustainable footing by 2020-21.
7.3 GREENHOUSE GAS EMISSIONS IMPACTS
None
7.4 COMMUNITY SAFETY IMPLICATIONS
None
7.5 HUMAN RIGHTS ACT
None
7.6 TRADE UNION
At this stage it is not possible to anticipate what, if any impact on Trade Union issues the development of transformation programmes under the West Yorkshire Sustainability and Transformation Plan.
7.7 WARD IMPLICATIONS
None
8. NOT FOR PUBLICATION DOCUMENTS
None
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9. OPTIONS
None provided
10. RECOMMENDATIONS
10.1 That the Board notes the update on the Bradford District and Craven and West Yorkshire and Harrogate Sustainability and Transformation Planning processes.
10.2 That the Board suggests ways to contribute to the operational planning process.
10.3 That the board provides feedback on the published draft of the West Yorkshire Sustainability and Transformation Plan as previously circulated and provided here as Appendix 1 or through the links below.
11. APPENDICES
11.1 West Yorkshire and Harrogate Sustainability and Transformation Plan and supporting documents http://www.southwestyorkshire.nhs.uk/west-yorkshire-harrogate-sustainability-transformation-plan/ Link from Council Health and Wellbeing Board webpage https://bdp.bradford.gov.uk/about-us/health-and-wellbeing-board/
12. BACKGROUND DOCUMENTS
None
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This page is intentionally left blank West Yorkshire and Harrogate Draft Sustainability and Transformation Plan (STP) Public Summary November 2016
Page 7 Contents //
List of organisations involved ...... 3
Foreword ...... 4
Our vision ...... 5
Our approach ...... 6
What this draft plan means for you and your family...... 8
West Yorkshire and Harrogate local plans ...... 14
West Yorkshire and Harrogate shared work ...... 22
Supporting change...... 33
Our workforce ...... 36
Having your say...... 37
This is a public summary of the draft Sustainability and Transformation Plan. The draft plan submitted to NHS England on the 21 October, 2016, along with a number of other documents is available from http://bit.ly/WestYorkshireSTP You can leave a comment here too.
Simply click on a section title in the contents to go direct to the area of your choice. To return to this menu - click the page number at the foot of the page
Page 8 2 West Yorkshire and Harrogate STP //
Organisations involved include:
Clinical commissioning groups (CCG) Care providers • NHS Airedale, Wharfedale and Craven CCG • Airedale NHS Foundation Trust • NHS Bradford City CCG • Bradford District Care NHS Foundation Trust • NHS Bradford Districts CCG • Bradford Teaching Hospitals NHS Foundation Trust • NHS Calderdale CCG • Calderdale and Huddersfield NHS • NHS Greater Huddersfield CCG Foundation Trust • NHS Harrogate and Rural District CCG • Harrogate and District NHS Foundation Trust • NHS Leeds North CCG • Leeds Community Healthcare NHS Trust • NHS Leeds South and East CCG • Leeds and York Partnership NHS • NHS Leeds West CCG Foundation Trust • NHS North Kirklees CCG • Leeds Teaching Hospitals NHS Trust • NHS Wakefield CCG • Locala Community Partnerships • The Mid-Yorkshire Hospitals NHS Trust
Local authorities • South West Yorkshire Partnership NHS Foundation Trust • Bradford Metropolitan District Council • Tees Esk and Wear Valleys NHS • Calderdale Council Foundation Trust • Craven District Council • Yorkshire Ambulance Service NHS Trust • Harrogate Borough Council • Kirklees Council Other organisations involved • Leeds City Council • NHS England • North Yorkshire County Council • Public Health England • Wakefield Council • Health Education England • Healthwatch
Thanks also to the police, fire and rescue service, housing, independent, voluntary and charitable sector organisations involved in local plans and cross cutting programmes of work.
Page 9 3 Foreword //
We can be proud of how our health and care teams have made The NHS and local councils major improvements to services over the past decade. The NHS is in West Yorkshire and treating more people than ever before, providing services faster, Harrogate commission more safely and in better environments. care and treatment for Research and innovation is delivering world leading new 2.6 million people. treatments at the forefront of technology. Our integration ‘pioneers’ are joining up health and care. We are leading the Every day a network of way in developing new models of care that better meet people’s providers work across the needs in care homes, hospitals and local communities. whole social spectrum, This history of improvement and innovation in public services is engaging people from supported by a thriving third sector, excellent universities and birth to death, head to engaged businesses. toe, inside and out. Increasingly, we have been working together to ensure we can Our 113,000 staff are make the biggest changes we can to the lives of local people. We entrusted with a budget have done this with a keen eye on local variation in populations, people’s needs and service delivery. of £4.3 billion. In 2016, we face the most significant challenges for a generation. We know that we must keep innovating and improving if we are to meet the needs of our population in a tough financial climate. Demand for services is growing faster than resources. Services in some places are not designed to meet modern standards, and local people want things to be better, more joined up, and more aligned to their needs. This is clear from the continuous engagement we have with local people, as well as the changing world we live in. Over the past six months, the leadership and staff of West Yorkshire and Harrogate health and care organisations have been working together on how we respond to these challenges. We have been linking with existing plans and seeing how we deliver ambitious improvements for people in Bradford District and Craven, Calderdale, Harrogate and Rural District, Kirklees, Leeds and Wakefield. This summary is an overview of our draft plan which sets out our high level proposals. These proposals are built on the ongoing work that has taken place locally through Health and Wellbeing Boards and local partnerships. Over the next six months we will continue to work together to Rob Webster | CEO, South engage with Health and Wellbeing Boards, staff and the public, West Yorkshire Partnership to further develop our draft plans and build on engagement NHS Foundation Trust activities to date, ensuring the involvement of everyone in future On behalf of the leadership of conversations around proposals for change. West Yorkshire and Harrogate. Page 10 4 Our vision //
Our vision for West Yorkshire and Harrogate is for everyone to have the best possible outcomes for their health and wellbeing. At the heart of this are the following ambitions: Healthy places • We will improve the way services are provided with a greater focus on preventing illness, or identifying and managing this at an early stage wherever possible. • We will support people to manage their own care, where safe to do so, with peer support and technology provided in their communities to help with self-care. • Care will be person centred, simpler and easier to navigate. • There will be joined-up community services across physical and mental health as well as much closer working with social care. High quality and efficient services • Hospitals will work more closely together, providing physical and mental healthcare to a consistently high standard by organisations sharing knowledge, skills, expertise and care records, where appropriate. • The way that services are designed and paid for will change. We will move to a single commissioning arrangement between Clinical Commissioning Groups (CCG) and local councils. This will ensure a stronger focus on local places and engagement. There will also be a stronger West Yorkshire and Harrogate commissioning function for some services. • We will share our staff and buildings where it makes sense to do so; to make the best use of the resources we have between us and to help further service investment. A health and care service that works for everyone, including our staff • West Yorkshire and Harrogate will be a great place to work. • We will always work with people in how we design, plan and provide care and support. • West Yorkshire and Harrogate will be an international destination for health innovation.
Page 11 5 Our approach //
In these tough times, we want to deliver the best outcomes we can for everyone. This will mean more emphasis on the places people live and on closer working between organisations. There will be less of a focus on competition as a means of driving change. Closer partnership working is at the very core of our STP. Over the past six months the leadership and staff of the West Yorkshire and Harrogate health and care organisations have been working hard on how we respond to the challenges we face, whilst delivering quality care and working towards achieving our vision. Our STP area covers eleven Clinical Commissioning Groups (which design, specify and buy care for local people), six local council boundaries, as well as services provided by a number of health and social care organisations, GP practices, mental health trusts, community therapy, care and nursing providers, and our hospitals. Over time these organisational differences will become less important. We want to put people and communities above individual organisational boundaries. West Yorkshire and Harrogate STP area West Yorkshire and Harrogate has a diverse population, with different health and social care needs. We believe that for the majority of services, these needs are best met on a local level through closer partnership working.
Contains Ordnance Survey data © Crown copyright and databse right 2016 Page 12 6 Our approach starts with these local places and Health and Wellbeing Boards, which have existed since 2012. They have been developing local health and wellbeing strategies based on the needs of local people. They bring together Our draft STP is based the NHS, public health, adult social care and children’s on a set of principles: we services, including councillors and local Healthwatch. They are ambitious; we do the plan how best to meet the needs of local people and tackle work together; and we local inequalities in health. They provide a way of ensuring deal with issues as locally that local people have a strong voice. as possible. The West Yorkshire and Harrogate STP is built from six local area plans: Bradford District & Craven; Calderdale; Harrogate & Rural District; Kirklees; Leeds and Wakefield. This is based around the established relationships of the six Health and Wellbeing Boards and builds on their local health and wellbeing strategies. These six local plans are where the majority of the work happens. We have then supplemented the plan with work done that can only take place at a West Yorkshire and Harrogate level (see page 22). This keeps us focused on an important principle of our STP - that we deal with issues as locally as possible.
Page 13 7 What this draft plan means to you and your family //
In developing these proposals we have thought about health and care services in three ways: • What do we need to do to help you stay healthy and well? • What do we need to do to improve the quality of care and services you receive when you need them? • What do we need to do to address the finance and efficiency challenge we face? Health and wellbeing: helping you to stay well With a population of 2.6 million people living in West Yorkshire and Harrogate, we know there are pockets of deprivation and areas of affluence. Where you live can determine your life chances and we need a new approach to make sure all people have the chance to live longer, healthier lives. There are higher than average childhood obesity levels and 50% of people are overweight in West Yorkshire and Harrogate. Over 200,000 people are at risk of diabetes and we want to reduce this number by a quarter by 2021. Alcohol is also a major concern. There are around 455,000 Where you live has a heavy drinkers across the area. This has a major impact on major impact on your people’s lives and the cost of care. We want to reduce the quality and length of life, number of people admitted to hospital because of alcohol by 500 every year and also the number of ambulance call for example there is a 11 outs for related incidents. year difference for men depending on where they Mortality is higher than average for those with serious mental health concerns and we want to work together to live in Leeds and a 10 year reduce the number of people taking their own lives. To do variation for women in this will involve sharing information, awareness raising and Calderdale. This is clearly local suicide prevention strategies. something we want to West Yorkshire and Harrogate has significantly worse rates address. than other parts of England for cardiovascular diseases (CVD), which are conditions affecting the heart or blood vessels that cause damage to the brain, heart, kidneys and eyes. It is one of the main causes of death and disability in the UK, but it can often be prevented with a healthy lifestyle. We want to reduce 10% of CVD incidents across the area by 2021.
Page 14 8 People who smoke increase their probability of lung cancer, heart and respiratory disease, such as asthma and chest conditions. In the case of pregnancy this can lead to real health issues for both mum and child. 4 in 10 cancers are preventable through lifestyle choices. For example we would like to see 125,000 fewer smokers in West Yorkshire and Harrogate and increase the one-year survival rate from all cancers to 75% by 2021, with the potential to save 700 lives each year. Some good work has already been done but we need to improve the health and wellbeing of both young and old, including those with physical and learning disabilities - so that we can improve people’s quality of life and prevent them going in to hospital or care homes, unless absolutely necessary. We know that people prefer to remain at home, independent and safe, for as long as possible and we want to fully support this.
Reduce the number of smokers by 125,000 by 2021 Improving 226,000 people at risk of diabetes, we want people’s health to reduce this by a quarter by 2021 and wellbeing Reduce number of people admitted to hospital due to alcohol by 500 a year Increase the one year survival rate of people with cancer to 75% by 2021 with a potential to save 700 lives a year By 2021 we want to adopt a philosophy that all suicides are preventable, aiming to reduce the number of suicides by up to 75% as part of the five year forward view for mental health. Reduce the number of people experiencing a CVD incident by 10% across the area by 2021. This would mean 600 people in Bradford alone.
Page 15 9 Care and quality: making sure the right care is there when you need it We want to ensure that the majority of our services remain high quality and offer a good personal experience. At the same time we want to address the fact that for some people and some populations the service falls below the standards and expectations we have set. We want to make sure services work together to support you and your family. We will build on the prevention work outlined in the previous section to ensure that everyone gets the best start in life and has the opportunity to age well. This means joined up services for new mums and families that build on traditional health visiting, community services and sees education, health and care working together. This will include new “perinatal” services that give mental health support to new mums at their most vulnerable time. Over 4 million people live with diabetes in the UK and this number is increasing. Thousands and thousands of others live with long term conditions, such as asthma and mental health problems like depression. Increasingly, we will make sure that you are supported to self care, with technology and peer support networks providing better opportunities for monitoring and management of your health condition. We want to harness the power of peer supporters, expert patients and similar developments for everyone who would find this helpful. Organisations, including the NHS, local councils, voluntary organisations and other public sector services, need to work closer together to deliver more ‘joined-up’ health and care. This coordination of services will help to improve the quality and experience of care. This is particularly true for people with multiple issues and conditions. We will make sure that frail older people, children with complex needs and similar groups have a joined up team that supports them to live their lives. In doing so we will have a modern health system that looks at people’s physical, social and mental health needs. We will increase access to psychological therapies for people with common mental health conditions (25% of people to receive these services by 2020/21), co-locating these services in primary care. We will transform care standards for people with a learning disability, so that health assessments in general practices are the norm, good and safe specialist assessments for people are available and locally based residential care is there for people who need it. We also plan to better organise and simplify urgent and emergency care so you get the very best care, at the right time, in the right place. This will mean clearer coordination and better organisation of urgent care services (including primary care, such as GP and pharmacy services, mental health, ambulances A&E and urgent care centres) so they work together and you know where to get the help you need. We aim to improve on our four hour accident and emergency standard by March 2017 to ensure 95% or more of people are seen, assessed, admitted or treated and discharged within four hours, and we will continue to improve on this. The demand for planned care (when you have a booked appointment to see a specialist or have an operation) is placing ongoing pressure on services.
Page 16 10 Unfortunately as a result people are waiting longer for appointments - we aim to address this and ensure that we meet our 18 week referral to treatment standard over the next five years across the area. In addition, we will tackle hidden waits in mental health services to ensure that we meet modern standards for mental and physical health. Improving patient experiences, choice and delivering high quality, safe care across seven days of the week is also a priority. We want to reduce avoidable emergency admissions, and the reduction in time someone will stay in hospital unless absolutely necessary. Our intention is to support more people in the community so they don’t end up being admitted or readmitted to hospital – this is where hospital avoidance schemes can make a huge difference alongside better alternatives to being in hospital.
95% of people attending A&E will be seen in 4 hours, by 2017 Our targets 92% of people will be seen by a specialist within 18 weeks and we will deliver these standards in physical and for change mental health services Supported self care for all people with a long term condition, with peer support and access to technology designed for your needs A move to 25% of the appropriate population accessing psychological therapies in their community and increasing the levels of recovery Regardless of where you live, your experience of services will have improved by 2021 A new 28 days standard to cancer diagnosis will be introduced Reduce the number of people with mental health concerns going to A&E by 2021 and bring their care closer to home Increased focus on common thresholds for care and treatment to meet standards and reduce postcode variations in care.
Page 17 11 Finance and efficiency: making the money add up by 2020/21 It’s great news that people are living longer than previous generations, but the reality is that up to two thirds of people in the UK could spend their retirement years in ill health. An ageing population, people living longer with complex health and social care needs, means we have to change if we want to improve people’s quality of life and meet the challenges we face together with the money we have available. We currently have The health and social care economy in West Yorkshire and an annual budget of Harrogate has growing income in the coming years. This £4.3 billion; by 2021 it will funding for the NHS is not growing as fast as demand increase to £4.7 billion. for care and pressures on local council budgets continue, However it’s important to particularly in social care and public health. note that if we delivered The growth funding for the NHS allocated to our draft care in the way we do STP is also lower than the national average and funds for today, with no change training doctors, nurses and therapists have reduced. This and no efficiencies, the means, unless we change the pattern of demand and make services more efficient, we could face significant financial cost would be at least an pressures in excess of £1billon between now and 2021. extra £1 billion every year by 2021. We will approach this challenge together. We will develop solutions in our local areas as well as taking collective measures across West Yorkshire and Harrogate. The way we will meet this challenge falls under the following categories:
Delivering care more efficiently, £0.5billon
Providing the right care to everyone who use our services, £0.3billion
Programmes delivering savings across the area, £0.1billon
Securing our fair share of sustainability funding, £0.2billon Page 18 12 Delivering care more efficiently, £0.5 billion We will look to drive efficiencies in the way we deliver care, focusing on reducing duplication and differences in service delivery. This will include reviewing how and where services are delivered, sharing administration and releasing funding for front line care. Providing the right care to everyone who use our services, £0.3 billion This involves a different relationship and a new approach to the way we deliver services across both health and social care services. Our focus will be on early help and support, making sure the services we offer meet the needs of everyone sooner rather than later. This will include helping you to take more control in the management of your care, where safe to do so. Programmes delivering savings across the area, £0.1 billion We will look to deliver savings by acting once across West Yorkshire and Harrogate. This will focus on our organisations working in partnership to deliver efficiencies, reducing variation in service provision, and working together to deliver better services for everyone at reduced cost. Securing our fair share of sustainable funding, £0.2 billion Our draft plan assumes that additional funding, called Sustainability and Transformation Funding, will be available to us so that we can deliver our plans. Some of this funding will be used to help make the changes happen, whilst some of this money will be used to support existing services We know this isn’t an easy message – it will be a challenge and difficult decisions will need to be made.
Page 19 13 West Yorkshire and Harrogate local plans //
If we are to make the most of our resources, we need to focus on keeping people well through healthy places and joined up care in communities. By having six local plans, we can make progress on both. Since 2012, local councils have been responsible for improving the public’s health. This means a focus on health, education, housing, the environment, and the economy. For people who need support, most of the care you and your family receive is delivered in communities. Social care, community therapy and nursing visits, GP contacts and trips to your local pharmacy, can reduce the number of A&E attendances. This community and home based care needs a greater focus and investment. This is reflected in all six of our local delivery plans as they consider communities - from Luddenden to Laisterdyke, Harrogate to Honley, Wetherby to Wakefield and all points in between. Each plan is different as it reflects local people’s needs. However, each plan also contains a number of common themes too. These are covered in the next section.
Page 20 14 Prevention and early intervention We are working in every one of our six areas to improve the way services are provided with a greater focus on early help and keeping people well. This involves helping people earlier rather than later, for example supporting people to stop smoking, when we know this is the major cause of cancer and working with families who have problems sooner rather than later. Plans vary according to the needs of local people: this includes tackling obesity, smoking and heavy drinking; making sure that children get the best start in life; and that we reduce the risk of dementia through addressing lifestyle risks. Well targeted health support can help keep people in work. This in turn can improve people’s wellbeing, including their mental health, preserving their livelihoods and keeping them in employment. It is also good for the region’s economy. Having a good coordinated set of prevention activities, for example working earlier with people at risk of diabetes, should result in a reduction in admissions to accident and emergency; decrease the numbers of people living with long term conditions and fewer avoidable early deaths. We also know that early help for children, families and adults is not only better for the person but can prevent or delay the need for more costly social care services in the future. For example Kirklees are developing a new early help model for children and families, so they get support sooner rather than later.
Spotlight on children To address some of the biggest health and care challenges we face we will need to create stronger and broader partnerships within our towns and cities and across our region. We already have great examples of where this is happening, like the Child Friendly City initiative in Leeds. Over the past four years the city has made a big effort to get more people involved in making a difference on some of the most important issues relating to children and young people, things like improving school attendance, increasing youth education, employment, training and keeping the most vulnerable children safe. A positive and wide reaching campaign has led to major businesses, sports clubs, well‑known people, public and third sector partners and even the local media, working together towards some common goals and doing more to support things like fostering and ‘family and friends care’. A combination of new approaches and different attitudes have made an impact, for example by working with families and local communities, Leeds has safely and appropriately reduced the number of children and young people placed in care by around 250. This gives them better life chances and saves a significant amount of money. If we can take the support we’ve seen for children and young people and apply it to some of our other big health and care challenges we could see a real step change.
Page 21 15 Recent engagement work has shown that people want The development of clear, easy to understand information, more involvement a thriving voluntary with communities and investment in voluntary and community sector can community services. You have also told us that not being involved in care decisions about you, has a negative help greatly with our impact on your wellbeing and health professionals should focus on early help, for communicate more with you. In delivering and designing example healthy child services, we will ensure that there is significant engagement programmes, which bring in plans to address these issues. together, health visitors, school nursing, support for families, not only from health and social care, but from community organisations too. Development of community support for families, preventing illness and elderly loneliness is also important. A new alcohol liaison service at Pinderfields Hospital means we can target people with drink related illness and injury. The aim is to provide people with a seamless transfer from hospital into community support services to help them reduce the risk of alcohol- related problems in the future.
Page 22 16 Primary and community services
Primary care includes a wide range of services supporting the health and wellbeing of everyone in the community, including your local GP, pharmacies, mental health and social care. We know that people’s experience and trust of primary care services is generally very high, but we have also heard that services are not as convenient to some as they would like them to be particularly out of core daytime hours (8.30am to 6.30pm), and that some people would like to receive services on evenings and weekends.
Primary and community care has been the subject of a number of engagement activities across West Yorkshire and Harrogate. The content of conversations varies across the local area from broad engagement on primary care to specific service areas. In summary there are a number of themes that are emerging across the West Yorkshire and Harrogate area which need to be considered in future commissioning arrangements.
This includes improving access to appointments and buildings; in particular help for urgent care issues, looking at the delivery of walk-in centres and increasing the range of services available at GP practices. We believe that this will help to address the number of people who attend emergency departments when they could have seen a health professional near to where they live. There are already good examples of where this type of service is being provided during evenings and weekends, for example in Wakefield. We want to review and potentially build upon this across the whole of West Yorkshire and Harrogate to provide services that are convenient to everybody.
In the future we would like to have more care delivered in local community and primary care settings rather than needing trips to the hospital. This means many of the tests, investigations, treatments for minor injuries and minor surgery that are usually provided in hospital can be provided nearer to home. We will consider the use of our buildings and how well equipped they are. This will help us to plan where we can provide services nearer to you and your family and closer to your home. In addition, we want to take this opportunity to think about what other services could be provided under one roof. This could include physiotherapy and citizens advice services. This would mean that you would be able to receive a range of services in one location that could meet both your health and social needs.
We hope to see more GPs in training and working together more closely with community and mental health services. Our aim is for you to see the right person, in the right place at the right time. By working in teams, health and social care professionals can provide advice and treatment for you together, instead of you needing lots of appointments at different departments.
As GP practices work more closely together, they could in the future begin employing consultants who have the specialist skills to manage your health condition in the surgery. This will also provide the opportunity to develop services that include senior nurses, hospital doctors, geriatricians, paediatricians and psychiatrists to work alongside community teams. In addition to this we would also like pharmacists, psychologists, social workers, and other staff to be part of community teams as we develop our workforce. Page 23 17 Our aim is to keep people healthier for longer and enable Bradford, District them to stay at home and not in hospital. By developing and Craven is known and improving primary care services it will help you and nationally for its work your family stay healthy and independent. in digital healthcare, in We want to work with primary care to develop existing particular providing 24/7 services that address lifestyle changes. This means face to face consultations. supporting people to stop smoking, support for losing This is something we want weight and how you can do more exercise to keep fit. This to do more of across the will mean less chance of you developing the kind of serious area. illness that needs hospital treatment in the future.
Our draft plans include how we will improve in-hours and out-of-hours access to primary care so that you can get the professional advice you need, when you need it. In Harrogate and Rural District we want to reduce Advice and support should be as convenient as possible for the number of children you to get, including making the best possible use of smart phones and digital technology. We want to work with our aged 10-11 years who are practices so that you can easily book an appointment and overweight. request a repeat prescription on line and if you want to, be able to see your medical records. As part of making the most of technology we will also think about video/skype We also want to increase type of appointments, which are being used successfully in the number of people other parts of the country already. in Leeds having bowel screening by 3%.
In Wakefield we want to reduce the number of young people not in education, employment or training.
Page 24 18 Supported self-care People with long term health conditions spend most of their time looking after themselves. We want to support them to do this as they want more focus on preventing illness, so they can stay well.
To support this they felt that more information about healthy lifestyle choices should be available with professionals having the relevant skills and knowledge to advise them on any changes they may want to make.
Each of our local plans support people to take greater control and management of their long-term health conditions.
Spotlight on self-care We will support self‑care and preventing illness by Locala is a community health care provider. They use the helping you to manage term maximising independence (MI), which was originally your health safely. This informed by a listening exercise with staff, patients and carers to describe the approach they take to support people to be as will include training confident and independent as possible when managing their our workforce to work own care in Kirklees. alongside you so that Locala’s integrated community health care teams include self‑care and early support community matrons, district nurses and therapists. will be the norm. The self-care work has involved a training programme that has helped over 1000 staff to use evidence based behaviour change and health coaching techniques. The training has helped people to manage their own care.
Evidence shows if more time is invested upfront with people to address their needs holistically then less time is needed on follow up visits. Most importantly this improves the care delivered and the person’s quality of life. Locala has also successfully used technology to improve how care is delivered, for example skype consultations. Records are also shared between health and social care professionals so that people tell their story only once. An outcomes framework has been developed by Wakefield Public Health which will provide a snapshot of data across the area. Several indicators refer to understanding how people feel they are supported to manage their condition, so they understand their long term conditions better, for example those with mental health concerns. This helps to identify further areas for improvement. Page 25 19 Around 15 million people in England have one or more People with long-term long-term health condition. The number of people with conditions are the most multiple long-term conditions is predicted to rise by a third frequent users of health over the next ten years. care services, accounting 35% of people living with long-term health conditions for 50% of all GP have low knowledge, skills and confidence to self-care. This appointments and 70% of results in a rising demand in urgent and emergency care, all inpatient bed days. including A&E attendances and emergency admissions.
Most importantly we know this is not what people want – they want to lead a healthy life as much as possible and 35% of people with supporting people to self-care can help. diabetes live with diabetes plus other long‑term conditions.
Page 26 20 Joined-up services When services are provided by different health and care organisations they often feel disconnected from one another. We have also heard that people want services that consider all of their needs together rather than different services for different conditions. We are trialling new ways of providing services that bring together organisations to better meet peoples’ needs. We believe that these new models have the potential to offer a better experience of care as well as being more efficient and cost effective. We will learn from these trials, rolling them out wider if they work well. We’re learning from our Vanguard programmes on urgent care, care homes and community services. We are building on the integration pioneer work done in Leeds and a long history of joint work in Calderdale, Kirklees and Bradford. Each plan sets out opportunities to look at new models which make these joined up services a reality for everyone. Spotlight on community care We will help you to better understand how We are joining up care services for people who live in care pharmacies and on-line homes or supported living accommodation. GPs, care home staff, volunteers, a specialist doctor, nurses, pharmacists, resources can help you therapists and mental health workers are pooling their deal with coughs, colds resources in about a quarter of care homes in Wakefield. and other minor ailments The aim is to help people to have healthier lives, with a without the need for better sense of wellbeing so that they don’t need to keep a doctor appointment going in and out of hospital. or accident and emergency visit.
Page 27 21 West Yorkshire and Harrogate shared work //
Over the past six months the leadership and staff of the West Yorkshire and Harrogate health and care organisations have been working together on how we respond to the challenges we face. To support our six local places we are carrying out a range of work collectively across the STP wide area. When we work in this way it is for one or more of three reasons: • Services cut across the area and beyond the six local places. • There is benefit from doing the work once and sharing, so we make the best use of the skill and expertise we have. • Working together can deliver a greater benefit than working separately. On this basis we have identified nine priorities for which we will work across a larger area. These are: • Prevention • Primary and community services • Mental health • Stroke • Cancer • Urgent and emergency care • Specialised services • Hospitals working together • Standardisation of commissioning policies.
Page 28 22 Prevention Prevention has been identified as a priority in each of the six local plans. Given the importance of this work we are keen to share learning, skills and expertise to ensure best practice is rolled out across the area. We are doing this with a focus on the biggest causes of ill health. This work is led by Directors of Public Health from across West Yorkshire and Harrogate and its focus is on smoking, obesity, alcohol, and ensuring that our workforce is supporting health promoting behaviours as it provides care to ensure every contact counts.
In our area 379,836 smokers there are 455,000 heavy drinkers 1.3 million people overweight We want to make every health and social care contact count for you.
We are currently working Primary and community services with local GPs to explore Like prevention, our work at West Yorkshire and Harrogate new ways of working. For level is designed to help local places take forward example, some practices programmes to deliver better primary and community are working together care. This work brings together primary and community care leaders to help design what the important parts in a hub to provide of an effective system are. This includes breaking down appointments on an organisational barriers, looking outside the clinical model evening and weekends. to develop a service that meets social needs too - making This means that people sure people are always at the centre of their care. are able to see a doctor or other professional at a range of different times. In other places teams of expert patients complement doctors to deliver peer and social support. Page 29 23 Mental health We will work together locally and at a regional level, to make sure that mental health conditions are treated the same as physical health issues. Local mental health services will be integrated with physical health and care services. This will ensure we care and treat the ‘whole’ person tailoring care to the person’s need; supporting people with long-term conditions to cope with anxiety or depression, and ensuring people only go to hospital when absolutely necessary. We are developing services across the region to reduce difference in the quality of care people receive in order to improve their wellbeing and make services more effective and efficient for the future. This includes working to introduce coordinated management of mental health in-patient beds across the area with the aim of reducing people being placed outside the region and eliminating this where better for the person. We know that people receiving care near their home and support network much improves their health and wellbeing. Our aim is that hospital stays will only take place where appropriate, and where needed only for a minimum length of stay. Good progress has already been made on the development of services to improve the experience and care for people in crisis. For example ’Safer Spaces’ have been developed so that adults and children and young people in crisis have a safe alternative to go instead of emergency departments, police cells or being admitted to hospital an in-patient unit. The plan is to roll these out to other parts of the region. We are also working to ensure that there is a service that places mental health nurses in police control centres, in place across the region assisting the police with people in crisis. This will include reducing by 50% the use of police powers around Section 136 of the Mental Health Act. Alongside this a region wide multi-agency suicide prevention strategy is also being developed with awareness and understanding at the heart of this work. We will look at international best practices that have reduced the number of suicides by 50%. Professionals in this area of expertise have also identified further services where working together at a West Yorkshire and Harrogate level would be beneficial. This includes attention deficit hyperactivity disorder (ADHD), autism, eating disorders and perinatal services (from when pregnancy begins to the first year after the baby is born). We will be working with our staff and people who use our services to develop and take forward our draft plans. This will impact on all parts of the system, including a 40% reduction in unnecessary A&E attendance.
Page 30 24 Stroke In 2013 there were 3,915 stroke admissions into West Yorkshire and Harrogate hospitals. 74% of people who had a stroke were in the 65+ age group with most aged over 75 years (52% of all strokes). Nationally and locally lots of work has taken place to improve outcomes for patients who suffer stroke. Progress in improving stroke care over the past 10-15 years has also increased the demand for the provision of specialist services. This has led to some of our hyper acute stroke services experiencing difficulty in recruiting and retaining the skilled workforce needed to meet these demands. Differences may exist in outcomes and quality of services for people. In order to reduce any differences we are working with local health professionals and those who have had a stroke to make sure care across services is working to meet the needs of people, from prevention, primary care and community services to stroke and after care. Depending on where you Working differently together to transform services live, some people have offers us new opportunities to meet increasing demands better experiences and for stroke care and to make the most of our existing resources more effectively. access to services than others. By changing the There will be a consistent approach determined by way you receive care after health professionals and stakeholders across West having a stroke, we can Yorkshire and Harrogate to reduce any differences. make our services safer We’ve already worked together to detect and treat and of a higher quality atrial fibrillation. Atrial fibrillation causes a fast and whilst also reducing your erratic heartbeat which is a major factor of stroke. chances of living with a In order to ensure sustainability across the area it disability afterwards. requires that we focus on hyper-acute stroke services. We will work across the region to deliver the best possible outcome for those affected by stroke. We currently have five hyper-acute stroke units in West Yorkshire and Harrogate and we know that this may not be viable for the future.
Page 31 25 This may mean we will need to reduce the number of hyper-acute stroke units across West Yorkshire and Harrogate, so that our services are as safe as possible. In doing so, we will save more lives and ensure better care and quality of service for people, including a consistent service over 7 days. Over the coming months we will work with you to understand the options for delivering stroke services. Engagement and consultation with the public will follow in 2017 to ensure high quality sustainable hyper-acute stroke services for all.
Page 32 26 Cancer With four in ten cancers Cancer has been recognised as a particular big issue in West preventable by changing Yorkshire and Harrogate. Every week 250 people in West lifestyles and behaviours, Yorkshire are diagnosed with cancer and sadly 115 people will the risk factors like lose their fight against this every week. smoking, poor diet Cancer patients touch each and every part of the health and and physical inactivity, social care system and therefore to be effective we need obesity and alcohol in our to plan across the whole of the system and not in isolation. communities continue to What cancer patients do not want, nor recognise, are artificial cause concern. The cancer boundaries between organisations. Understandably, we all rate continues to increase want the very best for ourselves and our families irrespective of which organisation is responsible at any given time point. at a faster rate than improvements in survival. The STP process allows us to plan across boundaries and to put the person firmly centre stage. It allows us to wrap the system around people and in so doing improve the quality of care they receive. This makes it essential that all cancer health services, If we work together, we can hope to realise our three key care providers and ambitions: charities work together, 1. Prevent cancer where possible. especially in terms of 2. Make more cancer curable from 40% to 60%. This means prevention, risk reduction 3,000 more people receiving survival enhancing treatments. and people’s experience. 3. Increase the reach and impact of people’s feedback to improve services. Our aim is to make Public Health England, NHS England, and Yorkshire Cancer sure that 95% of all Research will launch a new report this autumn, aimed at all people referred for stakeholders involved in commissioning, delivering, or receiving cancer services across the area. We will work closely with this cancer investigation are partnership to take forward these important report findings. diagnosed within 28 days.
Page 33 27 Urgent and emergency care People are worried that There has been engagement or consultation on urgent care proposals to change the across specific areas of West Yorkshire and Harrogate. way emergency services are currently provided will People report high levels of satisfaction with the service they receive in A&E. They have confidence and trust in A&E lead to further problems, and believe it provides the best place for them to get care, including increased but urgent and emergency care is provided outside A&E by mortality rates, longer other health professionals. waiting times and greater Many people believe A&E provides a convenient place to demand on services. go. It can provide reassurance that an injury or condition is not serious and does not need further treatment, and it is perceived as offering the highest level of expertise, with We are working together access to diagnostic equipment, such as x-rays. However to ensure that there medicine has changed – GPs, ambulance staff and people is excellent, quality, working in a wider range of services can and do provide urgent and emergency care. integrated emergency and A&E services in and We know that this is a challenging area of work. Getting outside of hospitals, the balance of who and why people attend A&E, and putting other safe options in place, will mean that fewer providing the best care people need to be admitted to accident and emergency for people. services. Our vision for urgent and emergency care is that we should provide a highly responsive service that delivers care as close to home as possible, minimising disruption and inconvenience for patients, carers and families. For those people with more serious or life-threatening emergency care needs, we should make sure they are treated in centres with the right expertise and facilities to maximise the prospects of survival and a good recovery. We will continue to engage with our staff, and the public about these proposals and what this will mean for you.
Page 34 28 Our work is focused on: The West Yorkshire and • ‘Hear, See and Treat’ – delivery of a Clinical Advice Harrogate Urgent and Service (CAS), 111 and out of hours service, working Emergency Care Network across Yorkshire and Humber to integrate 999 with oversee the improvement 111 services, and developing the ambulance service of urgent and emergency to provide a treatment service by March 2017. So that people get the right access to the right people at the care for everyone who right time. lives here. • Primary care – building on the local development and Healthwatch delivered an delivery of new care models to manage the urgent needs engagement programme of people and the delivery of direct booking from 111 on ‘Hear, See and Treat’. and out of hours to extended and in-hours services. Overall, 147 face to face • Delivery of a Pharmacy Urgent Repeat Medication Service (PURMs) across West Yorkshire in partnership sessions were held across with chemists . the area, supported by a social media campaign • Work together to deliver seven day services across that reached over 300,000 the clinical priority areas (vascular, stroke, hospital paediatrics and cardiology). people. The majority of people who responded • Technology - improving access to a person’s care record were supportive of the with an increasing amount of information available. Remote working facility for clinicians, a care record for proposed model. They 999 staff and direct booking arrangements. felt that it would ensure that only those people A&E proposals require a lot more consideration and we that needed to attend need to raise public awareness around the difference between urgent and emergency care services. People want A&E would do so. It was to see 24/7 access to include an out of hours primary care thought that this would service / urgent care service that is co-located with A&E. lead to a reduction in Through the co-location of urgent care services on one the inappropriate use site, people can be assessed appropriately to the necessary of ambulance services emergency or urgent care service. It would relieve the and reduction in A&E pressure in the A&E. Further work is underway. admissions. This would mean people would be seen quicker, which would result in an improvement of care.
Page 35 29 Specialised commissioning We are working to ensure that specialised services are designed to ensure that they are located where they are needed and we have enough of them to meet local people’s needs, for example patient care, mental health support for young people, specialised weight loss, help for people with brain injury and HIV services. Specialised services are those provided in relatively few hospitals, accessed by small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialised Hospital Trusts that can recruit a team of staff with the appropriate expertise which helps them to develop their skills. These include a range of services from renal dialysis and secure inpatient mental health services, through to treatments for rare cancers and life threatening genetic disorders. Our approach to commissioning specialist services is two‑fold. First to manage the demand for specialist services e.g. reduce the increasing demand for the treatment of obesity surgery through preventative approaches to tackle weight management across the whole of West Yorkshire and Harrogate, which is planned and delivered by local places in line with the needs of local people. Secondly the provision of specialist services and how this is planned and delivered to make sure services are sustainable and fit for the future. This will mean services will be provided through a networked approach. To do this we must plan together at a Yorkshire and Humber level. We have a proud history of world leading research and development of ground breaking treatments in mental and physical health. We will continue to ensure that these are supported through specialist networks.
Hospitals working together Local people have been There are significant challenges across the area for our hospitals. involved in the proposals Local hospitals will work in partnership with one another to give for how hospital and you access to the very best facilities and staff. This could mean community services will care will be provided by a team of expert medical staff who work be provided in the future, together across a number of hospital sites within a single, high such as Calderdale and quality service. All hospitals within the single service will benefit Huddersfield, Wakefield from this networked approach. You would receive the very best and North Kirklees. care - at your nearest hospital wherever possible and at a centre of excellence if required. This approach has been proven to save lives. Page 36 30 We are working with our hospitals to see how they deliver care together. Our hospitals have created the West Yorkshire Association of Acute Trusts, involving Leeds, Bradford, Calderdale and Huddersfield, Airedale, Mid-Yorkshire and Harrogate Trusts. They will look at consolidating back office and support functions, for example payroll and estates. They will also review clinical services, including hyper-acute stroke, head and neck cancer, vascular, pathology and radiology services. Working together they will ensure we ‘get it right first time’, with standard procedures. They will support centres of excellence delivering world class care. These plans will mean higher standards of care, for example reducing waiting times in accident and emergency as well as the length of wait before you get to see a senior doctor. Hospitals already specialise in providing certain types of care. For example, some specialise in stroke, others in cancer care. In the future we will see single services with hospitals specialising in emergency general surgery for patients with life threatening conditions – creating these centres of excellence networked with local hospitals will help to save more lives. Working in this way ensures that doctors working within these teams are performing the same procedures day in, day out, building up excellent levels of expertise in treating these complex conditions. If you call an ambulance, paramedics will decide which hospital to take you to for the specialist care you need. If you attend hospital yourself, doctors there will assess you and, if you need to go to another hospital, they will arrange for you to be taken to the appropriate one. If you are transferred to a specialist hospital, once you are well enough, you will be transferred to your local hospital or home to recover. Extensive work will be carried out to make sure that you and your family will be able to get to any of the specialist hospitals within a reasonable time.
Page 37 31 Standardisation of policies We have started There is a big opportunity to standardise our commissioning community conversations policies and reduce difference for people receiving health via Healthwatch in some and social care across West Yorkshire and Harrogate – often of our local areas. This referred to as a ‘postcode lottery’. This helps to ensure that has included asking for what care people receive is fair and consistent no matter people’s views on: where you live. It also supports the work of hospitals and the professional support available and given. This is divided • Gluten-free foods into four key areas: • Procedures for • Health and wellbeing – making sure that people are as managing individual well as they can be before surgery. funding requests and • Clinical thresholds – which determine an appropriate restricted treatments treatment. • Branded medicines • Follow up management – making sure you are only invited for a hospital follow up appointment when • Medicines management necessary and making the most of technology to provide further consultation as needed. • ‘Stop before your OP’ – a campaign to • Prescribing treatment and medicines – making sure they are best value for money. encourage people to stop smoking to support Our proposals will take into account all of the West people prior to having a Yorkshire and Harrogate area, and will connect to the work procedure. of local Clinical Commissioning Groups. We will be having more discussions with Health and Wellbeing Boards about these proposals over the coming months. We aim to have a standardisation of commissioning policies in place across West Yorkshire and Harrogate by 2021.
Page 38 32 Supporting change //
All of our proposals are about improvement and change. To do this we must: • Create the right workforce, in the right place with the right skills, to deliver services at the right time, ensuring the wellbeing of our staff. • Engage our communities meaningfully in co-producing services and making the right choices, including on difficult decisions. • Using technology to drive change and create a NHS fit for the future. • Place innovation and best practice at the heart of what we do, making sure that our learning benefits the whole of the area. • Ensure we have the best commissioning structures in place to push through change.
Strategic commissioning This draft STP has been developed through a network of organisations working together. Over the next year, we will be working on strengthening the decision making to make sure we have the right infrastructure to invest over £4billion of public money. Within this, the commissioning arrangements, for example how services are planned, designed and paid for – will change. We will seek to retain the best of our clinical leadership and enhance the role of local government. We will make the most of our expertise and capacity to make sure decision making happens at the right level. This means we will increasingly move to: • A West Yorkshire and Harrogate wide commissioning / contractor function dealing with acute hospital and some specialist services. This will include low volume, high cost treatments in mental and physical health, hard pressed specialties and common standards to end the postcode lottery. • A place based commissioner in each of our six areas bringing together the functions of local councils, Clinical Commissioning Groups and NHS England (primary care) commissioning. This will make sure the right ambitions and outcomes for local people, with a key focus on prevention, supported self-care and joined up services in communities; as well as local hospitals. • A transfer of some local ‘commissioning’ functions will be embedded within new models of care and providers of care. This reflects the move across the region to new joined up providers who will increasingly plan service delivery together in ways currently reserved for commissioners. This will include risk management, performance and development. These changes will take time to fully develop but our intention is to ensure progress is visible from the 1 April 2017 and to ensure that we continue to meet our principle that decisions are always taken at the right level. In doing this, we believe we can reinvigorate commissioning – to be a process about engagement, need, design, innovation and delivery in service.
Page 39 33 Communities New and existing relationships Healthwatch is a key Every local place-based plan has been built up from a partner in our STP and wealth of information, where people have told us about provide leadership, their local services. assurance and challenge, acting as the voice of the Local plans have been developed and approved by local Health and Wellbeing Boards (or equivalent structures). patient. We will also establish a new relationship with our communities built around good work on the co-production of services and care. Our proposals link to building community capacity, resilience and thriving community sector organisations across West Yorkshire and Harrogate. The voluntary and community sector (VCS) has a strong presence in our communities. They have an important We will create a new role to play, especially at a local level, and in many cases way of working with they are much better placed to do this than statutory the voluntary sector and organisations. We will build on the work that has taken place, and look at how we can ensure the involvement of will ensure we work the wider VCS in future planning and delivery of services. closely for the benefit of everyone across West We want to form new relationships, support innovative ways of working, and the development of community Yorkshire and Harrogate. capacity building. This will include working more closely with third sector leaders, social enterprise organisations and community interest groups.
Page 40 34 Innovation There are a number of The STP will be successful if it can create a vehicle for overarching key themes, sharing and nurturing innovation, including the talent in including technology the region and across our communities. We see this already to support knowledge, in change labs and new programmes of delivery. education, self-care, direct We will work with the Yorkshire & Humber Academic booking, telehealth and Health Science Network (AHSN) and all partners to create telecare. an infrastructure for innovation that will make us a global destination for innovation. This will include working We are already seeing with our universities, the independent sector, our local this in the digital space authorities, health and care institutions. with the development Leeds has been working successfully for several years across of the mHealthhabitat health and social care to develop an integrated health programme for mental record which enables more seamless care for local people. health, sponsorship of the #YHDigitalcitizen This improves the experiences of people receiving services making sure information is collected from people only programme and the once. This also reduces duplication as set out in the Getting People Driven Digital It Right First Time (GIRFT) programme and Carter Review. Movement. We are talking to Connected Yorkshire (Leeds University) to see how we can use our data to understand people’s health better so that we can bring greater benefits Digital We are also developing social movement through our Digital Health & Wellbeing Ecosystem. This is a platform for health and social care, education, industry, the voluntary sector and patient organisations, to work together and increase the uptake of digital health technology.
Page 41 35 Our workforce //
We need to create a health and social care workforce that Our workforce is getting can deliver services in new ways. older and we have Our priority is to retain them and their skills, whilst difficulty recruiting and recruiting new staff for the future. keeping staff in some Our workforce are our biggest asset and our biggest professions, such as care investment. Our approach is based on: homes. Health and social care needs to become a • Being a model employer to ensure we retain our staff career of choice and will and help them deliver good care. be looking at how best • Developing skills in teams for the 21st century. This we can achieve this across includes good training and development, new roles all areas of health and like nurse associates and advanced practitioners and pharmacists in primary care. social care, including the recruitment of local GPs. • Recruiting new staff, to replace people leaving, so we fill the gaps, so reducing agency spend. • Having the capacity to deliver this in our organisation. We have a Workforce We have close working relationships with local universities Action Board, which and the Local Workforce Advisory Board, made up of NHS considers your health and other care organisations including Health Education and social care needs England. Our workforce plan means working together, whilst working towards rather than competing with each other for staff. We will do an affordable, skilled this in a number of groupings. workforce that is fully • Primary, community and public health staff. supported and fit for the • Registered staff like therapists, nurses, midwifery and future. doctors. • Non registered staff like apprentices and care support workers. • A forum for helping staff to stay well and be ambassadors for prevention. The result will be more of the right staff, with the right skills, to support great care.
Page 42 36 Having your say //
How you can get involved? Our focus now shifts You can get involved in the NHS in many ways locally, by to building on the becoming a member of your local NHS Foundation Trust, joining conversation we have a Clincial Commissioning Group, Public Patient Involvement with you over the coming Panel or becoming a member of Healthwatch. You can also months so that together contact us with any questions you may have. Our contact details we can develop more are on the back cover. detailed plans. Engaging and consulting with local people We are committed to using all the information you have already told us and have reviewed our recent engagement activity across West Yorkshire and Harrogate. This information has informed the development of our draft plans to date and will help identify where further engagement on our proposals is needed. This has included face to face conversations, and public and staff surveys produced by local health and social care services, Healthwatch, care providers, and The Patients Association and Patient Opinion. A full report is available here: http://bit.ly/WestYorkshireSTP We will use this information to inform our plans and make sure that any future proposals will build on this work rather than duplicate effort. We all know that plans are better when they are developed with people and communities; our commitment is to do that so that we can embed the changes and make them a reality We will continue to actively engage with you around any change proposals, listening to what you say, to develop our proposals further. We are starting to develop our plans around how we will involve, engage and consult with all stakeholders, including you, and how it will work across the future planning process and the role of the Health and Wellbeing Boards. We will ensure the involvement of everyone in future conversations. This will include further work with Healthwatch and our voluntary sector partners to make sure we connect with all groups and communities. We will consider views and feed these back into our plans before any further work takes place.
Page 43 37 Our vision for West Yorkshire and Harrogate is for everyone to have the best possible outcomes for their health and wellbeing. Page 44 38 If you would like more information or this document in another format, please call 01924 317659 or email [email protected]
This information was published November 2016. Page 45 This page is intentionally left blank Agenda Item 6/
Report of the Strategic Director of Health and Wellbeing to the meeting of the Bradford and Airedale Health and Wellbeing Board to be held on 29th November 2016.
L
Subject: Health and Wellbeing Board Terms of Reference
Summary statement: Review of the Terms of Reference for the Health and Wellbeing Board
Bev Maybury, Strategic Director- Portfolio: Health and Wellbeing Health and Wellbeing
Report Contact: Angela Hutton Overview & Scrutiny Area: Phone: (01274) 437345 E-mail: [email protected] Health and Social Care
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1. SUMMARY
The Terms of Reference for the Health and Wellbeing Board have been reviewed in order to reflect changes in the scope of the Board’s responsibilities and recent changes to the Council Directorships and Portfolios as currently referenced in the Terms of Reference and to ensure that Board membership remains fit for purpose.
2. BACKGROUND
The Terms of Reference for the Bradford and Airedale Health and Wellbeing Board were established in April 2013 when the Shadow Board was constituted as a full Health and Wellbeing Board and as an Executive Committee of the Council.
The Terms of Reference form Article 11A in the Constitution of the Council and Executive Arrangements –which states that ‘The Council will appoint a Health and Wellbeing Board as a Committee of Council.
Recent developments, such as the Board taking on responsibility for overseeing and monitoring the Better Care Fund and providing the overarching governance for the Bradford District and Craven Sustainability and Transformation Plan were not reflected in the current Terms of Reference.
Subsection 9 of the Health and Social Care Act 2012 mandates that the Board be consulted: “At any time after a Health and Wellbeing Board is established, a local authority must, before appointing another person to be a member of the Board under subsection (2)(g), consult the Health and Wellbeing Board”.
Proposed changes to the Terms of Reference are then submitted to Governance and Audit Committee of the Council for agreement.
3. OTHER CONSIDERATIONS
The Terms of Reference contained sections on the principal purpose, duties, membership, meetings and the quoracy requirements for Board meetings. In September, Board members were provided with a report and the current Terms of Reference. At that meeting it was decided to re-circulate and receive comments outside the Board meeting.
3.1 Name of Board – no change
3.2 Principal purpose – wording amended to highlight the Board’s role in ensuring that commissioning plans address needs and health inequalities to improve outcomes.
3.3 Board Duties - have been amended to reflect reporting from Bradford Health and Care Commissioners and the Board’s role in respect of Sustainability and Transformation Plans.
3.4 Board membership - Membership has been updated to reflect changes to Council Portfolios and Strategic Director responsibilities at the Council and a single Accountable
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Officer for the three Clinical Commissioning Groups.
There was a range of views about adding to and amending the membership, ranging from leaving as is, to adding both NHS Acute Trusts, 2 GP Federations and private sector care provider representative as either full or co-opted members.
The proposal is to invite both Acute Trusts and one of the GP Federations to join the Board as co-opted members whilst retaining the current position of a single full NHS representative. It is suggested that the representative is rotated on a 2 year basis, and that the representative must ensure that they represent views from across the NHS provider sector.
3.5 Meetings of the Board – no change
3.6 Quorum –no change
3.7 Governance arrangements
A short governance section has been added.
4. FINANCIAL & RESOURCE APPRAISAL
None
5. RISK MANAGEMENT AND GOVERNANCE ISSUES
Governance of the Health and Wellbeing Board remains as currently constituted – as an Executive Committee of the Council. Article 11A in the Constitution of the Council and Executive Arrangements states that ‘The Council will appoint a Health and Wellbeing Board as a Committee of Council.’ Any proposed changes to the Terms of Reference must be consulted on and submitted to the Governance and Audit Committee. In addition the Board forms one of four key District partnerships that report to the Bradford District Partnership on District Plan priorities.
The Board is represented as the overarching governing body for the Bradford District and Craven STP. However, this plan sits within a broader West Yorkshire Sustainability and Transformation Plan with a governance structure to be developed.
The Board does not at present operate a risk register. Board sub-groups log and escalate risks to the Board when they cannot be resolved without Board input.
6. LEGAL APPRAISAL
Legal appraisal will be undertaken in relation to any changes to the Terms of Reference that are agreed at the November Board meeting. Board members will be asked to take the updated changes through their governance structures.
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Section 194 of the Health and Social Care Act 2012 established that The Health and Wellbeing Board is to consist of— (a) subject to subsection (4), at least one councillor of the local authority, nominated in accordance with subsection (3), (b) the director of adult social services for the local authority, (c) the director of children’s services for the local authority, (d) the director of public health for the local authority, (e) a representative of the Local Healthwatch organisation for the area of the local authority, (f) a representative of each relevant clinical commissioning group, and (g) such other persons, or representatives of such other persons, as the local authority thinks appropriate. (3) A nomination for the purposes of subsection (2)(a) must be made— (a) in the case of a local authority operating executive arrangements, by the elected mayor or the executive leader of the local authority; (b) in any other case, by the local authority. (4) In the case of a local authority operating executive arrangements, the elected mayor or the executive leader of the local authority may, instead of or in addition to making a nomination under subsection (2)(a), be a member of the Board. (5) The Local Healthwatch organisation for the area of the local authority must appoint one person to represent it on the Health and Wellbeing Board. (6) A relevant clinical commissioning group must appoint a person to represent it on the Health and Wellbeing Board. (7)A person may, with the agreement of the Health and Wellbeing Board, represent more than one clinical commissioning group on the Board. (8)The Health and Wellbeing Board may appoint such additional persons to be members of the Board as it thinks appropriate. (9)At any time after a Health and Wellbeing Board is established, a local authority must, before appointing another person to be a member of the Board under subsection (2)(g), consult the Health and Wellbeing Board.
7. OTHER IMPLICATIONS
7.1 EQUALITY & DIVERSITY None
7.2 SUSTAINABILITY IMPLICATIONS
No direct implications from this report, however the Board has influence on sustainability planning through its input to the Sustainability and Transformation Plans for Bradford District and Craven and for West Yorkshire and Harrogate.
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7.3.1 GREENHOUSE GAS EMISSIONS IMPACTS None
7.4 COMMUNITY SAFETY IMPLICATIONS
The Board can raise and contribute to issues and debates on Community Safety as one of the four key partnerships that report in to the Bradford District Partnership on District Plan priorities. The Board contributes to Community Safety through its strategic leadership on health inequalities, work to improve community mental wellbeing and safe, inclusive communities for people with learning disabilities.
7.5 HUMAN RIGHTS ACT None
7.6 TRADE UNION None
7.7 WARD IMPLICATIONS None
8. NOT FOR PUBLICATION DOCUMENTS None
9. OPTIONS
None
10. RECOMMENDATIONS
10.1 That the amended Terms of Reference for Bradford and Airedale Health and Wellbeing Board are agreed.
10.2 That the amended Terms of Reference are taken to Governance and Audit Committee and through Members own governance routes.
11. APPENDICES
Appendix 1 - Bradford and Airedale Health and Wellbeing Board - Terms of Reference November 2016.
12. BACKGROUND DOCUMENTS None
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Appendix 1
Bradford and Airedale Health and Wellbeing Board Terms of Reference – November 2016
1. Name With effect from 1st April 2013 the name of the Partnership will be “Bradford and Airedale Health and Wellbeing Board”, referred to as The Board
2. Principal Purpose To create a close working partnership between the NHS and City of Bradford Metropolitan District Council and to bring a new local accountability to assessing health and care needs. To be the key partnership forum for determining local priorities and providing oversight on their delivery through enabling and driving the integration of health, social care and wellbeing to create clear and effective pathways for service users and those who may need to access services. This relationship should significantly reduce health and social inequalities and ensure accountability for local commissioning plans, creating a whole systems approach to improving health and wellbeing and maximising value for money.
3. Principal Duties 3.1 To provide local democratic accountability for the use of public resources to improve health and wellbeing and reduce health and social inequalities 3.2 To promote integration in the commissioning and provision of health and social care services across the District. 3.3 To oversee and be assured that joint commissioning arrangements are in place for health and social care through the Bradford Health and Care Commissioners, and that joint commissioning responsibilities are being effectively discharged to address needs and reduce inequalities. 3.4 To oversee the production of the Joint Strategic Needs Assessment and the Pharmaceutical Needs Assessment 3.5 To oversee the production of the Joint Health and Wellbeing Strategy 3.6 To provide system leadership and a local interface for both planning and governance through engagement with the NHS Commissioning Board, Public Health England, Local Partnerships and providers, including the Voluntary, Community and Faith Sector, and to undertake all statutory duties. 3.7 To hold health and social care system leaders to account through the Integration and Change Board to ensure the Sustainability and Transformation Plans for
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Bradford and Craven (formerly the Five Year Forward View for Bradford and Craven) and West Yorkshire (as it relates to Bradford District) are delivered.
4. Membership 4.1. The Board shall consist of:
a) The Leader of the Council b) The Chief Executive of the Council c) The Elected Member portfolio holder for Health and Social Care d) One opposition Elected Member e) The Accountable Officer for the District’s Clinical Commissioning Groups and a clinician from each CCG if the Accountable Officer is not a clinician f) The NHS Area Team Director g) The Director of Public Health h) The Strategic Director of Health and Wellbeing. i) The Strategic Director of Children’s Services. j) One member from Bradford HealthWatch k) One member from the Voluntary, Community and Faith Sector, elected through Bradford Assembly. l) One full and two co-opted representatives of the three main NHS providers. m) One co-opted representative of the local GP Federations.
Representative role to rotate between the main NHS providers and GP federation on a 2 year cycle.
4.2 The Board will be able to co-opt further members, as required, from provider organisations. 4.3 Named alternates can be provided for the members of the Health and Wellbeing Board except the representatives of the Clinical Commissioning Groups who are able to ask any clinician on the CCGs to alternate for them.
5. Meetings of the Board 5.1 The Board will have a chair who is the leader of Bradford Council 5.2 Provision will be made for a Deputy Chair who will be appointed from the NHS membership on the Board
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5.3 Meetings will be held in public 5.4 Meetings will take place bi-monthly 5.5 Each Member of The Board will have a vote though agreement on matters considered by The Board will generally be by consensus. Further persons co-opted by The Board will be non-voting unless the terms of reference are amended by Council.
6. Quorum 6.1 One third of Board members will form a quorum, with at least two Elected Member representatives from the Council, one Council Officer, and one representative from Clinical Commissioning Groups.
7. Governance 7.1 The Board shall report to the Bradford District Partnership as required. 7.2 Sub-groups that report directly to the Board shall include the Bradford Health and Care Commissioners and the Integration and Change Board, with further direct reporting Task and Finish groups to be appointed, as needed, to progress Board priorities. 7.3 Clear reporting arrangements shall be put in place for each sub-group that reports directly or indirectly to the Board.
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Agenda Item 7/
Report of the Chair to the meeting of Bradford and Airedale Health and Wellbeing Board to be held on 29th November 2016.
Subject: M
Chair’s Highlight report – covering outline of the BCF schemes, updates from Bradford Health and Care Commissioners and Integration and Change Board, Healthy Weight update, Young Carers’ update.
Summary statement:
The Health and Wellbeing Chair’s highlight report summarises business conducted between Board meetings
Councillor Susan Hinchcliffe Portfolio: Chair – Bradford and Airedale Health and Wellbeing Board Health and Wellbeing
Report Contact: Angela Hutton Overview & Scrutiny Area: Health and Wellbeing Programme Manager Health and Social Care Phone: (01274) 437345 E-mail: [email protected]
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1. SUMMARY
The Health and Wellbeing Chair’s highlight report summarises business conducted between meetings: where for example reporting or bid deadlines fall between Board meetings or business conducted at any meetings not held in public where these are necessary to consider material that is not yet in the public domain.
Reporting through a highlight report means that any such business is discussed and formally minuted in a public Board meeting.
The report also brings any updates from the Health and Wellbeing Board sub groups – the Bradford Health and Care Commissioners meeting and the Integration and Change Board unless the issues are covered by a standing business item under the approach to ‘Working Better Together – A Whole System for Health and Wellbeing’. Increasingly the business of both sub-groups will focus on work under the Sustainability and Transformation Plan (STP) for Bradford and Craven, and the broader West Yorkshire and Harrogate STP.
The September 2016 report covers:
A brief outline of each schemes contained within the Better Care Fund for Bradford District and Craven to provide background information for Board members and performance against outcomes for Quarter 2 2016-17. Business conducted at the September and October meetings of the Bradford Health and Care Commissioners Group and the Integration and Change Board. A short update on establishing a whole system approach to Healthy Weight, reporting to the Health and Wellbeing Board. Update on an issue raised at Children’s Overview and Scrutiny in respect of young carers. Progress on the West Yorkshire Sustainability and Transformation Plan
2. BACKGROUND
As this report addresses multiple issues in brief, the background to each issue is included with the main report in section 3 below.
3. OTHER CONSIDERATIONS
3.1 Better Care Fund
At the September 2016 Board meeting it was agreed that Board members would find it useful to have a short description of each scheme under the Bradford District and Craven Better Care Fund (BCF) - a partnership between health and care partners (NHS commissioners) and the Local Authority. See 3.1.1 below.
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The BCF was created nationally with the aim of achieving better integration of health and social care and improving the lives of some of the most vulnerable people in our society, by placing them at the centre of their care and support, and providing them with ‘wraparound’ fully integrated health and social care, to provide an improved experience of care when it is needed and better quality of life.
Locally, the Fund aligns resources, including budgets, across health and care services to improve services and reduce duplication. Bradford Health and Care Commissioners (BHCC) have overseen the development of the Bradford District and Craven Better Care Fund (BCF) for 2016/17. The final Plan has now been approved by NHS England.
3.1.1 Schemes in the Bradford District and Craven Better Care Fund
Scheme 1 – Capital funding including Disabled Facilities Grants (DFG) The service to be delivered includes an assessment of need, structural feasibility of proposals and the construction of and installation of disabled facilities. The service is available to all residents in permanent accommodation across the district for children as well as adults. The service supports people to continue to live in their home.
Scheme 2 – Carers support (including carers break funding) The funding will be used to improve the health and well-being of carers, either through the provision of a carers’ small grant payment, or a voluntary and community sector service which will enable the carer to take a break from caring responsibilities including taking up a training opportunity.
Scheme 3 – Expansion of intermediate care services This scheme is made up a number of initiatives. Through the use of the BCF, our intermediate care services are being expanded and mainstreamed to ensure that they have an impact on emergency admissions.
Scheme 4 – Care Act implementation The model of care and support promoted by the Care Act is governed by the overriding principle for councils to ensure the health and wellbeing of their population in carrying out any care and support functions. Contained within the Act are a number of key principles and standards through which the council will discharge its duties in respect of the needs of individuals. The ambitions in summary are to improve people’s experience of joined up systems at the point they need to access them. A cornerstone of these ambitions is the requirement to work with partners in integrated ways, for the benefit of local populations.
Scheme 5 – Protecting Adult Social Care £4.6m of the BCF will fund the costs of Bradford Council’s Adult Services activity. Adult Social Care activity is heavily driven by referrals from the health system - primary and secondary care. This scheme is a transfer of £4.6m from health to enable the Local Authority to continue to deliver the adult social care activities and the ambitions of the STP.
Scheme 6 – Mental Health and Learning Disabilities
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Learning Disabilities - currently jointly funded plans for people with learning disabilities and/or autism are within Continuing Health Care and Section 117 funding streams. Agreeing how this is proportioned across health and social care, can be a lengthy and drawn-out process. Having this funding combined in one pot will enable more collaborative funding decisions to be made in a timely way that enables the end user and their families to achieve better outcomes.
Mental Health - the Joint Mental Health Commissioning Board development will drive the development of a district wide Mental Wellbeing strategy across Bradford, Airedale and Craven that will seek to achieve consistent outcomes for people with mental health problems and for the wider population’s mental wellbeing.
Once an agreed strategy is in place, there is an expectation that commissioners will align their activities and resources to deliver the strategy including the plans to commission for all people through accountable care operating models.
3.1.2 Performance reporting
At the time of writing, Quarter 2 performance for the BCF will be available for reporting via the Chair on 23rd November against the schemes described above. The performance summary is not therefore ready for this report, but will be available as a background document on request after this will date, and will be published with the papers for the next Health and Wellbeing Board on 31st January.
3.2 Updates from the Board sub-groups
3.2.1 Bradford Health and Care Commissioners (BHCC) update
At its last meeting BHCC as the Partnership Board for Joint Commissioning of Mental Health and Learning Disability Services endorsed and recommended to the HWB for final approval the final draft of ‘Mental Wellbeing in Bradford District and Craven: A Strategy 2016-2021’ (this is covered under a separate report).
In line with its role to oversee the planning and implementation of the Better Care Fund, BHCC focused on the approval of the BCF Plan for 2016/17, and continues to monitor BCF performance through the dashboard and formal quarterly NHS England submission. To inform Better Care Fund planning for next year BHCC has undertaken a formal review of the BCF.
BHCC has also endorsed the Section 75 for 2016/17 which is the partnership agreement relating to the commissioning of health and care services between BMDC, NHS AWC CCG, NHS BCCCG and NHS BDCCG and covers all key areas where resources transfer between the CCGs and Local Authority and provides clarity on the responsibilities of each partner.
Additionally BHCC has considered progress being made on Integrated Personalised Commissioning and Joint Commissioning of Mental Health Services from Voluntary and Community Services. It has also supported the process to resubmit the Future in Mind
Page 58 transformation plan (covered under the Mental Wellbeing item under discussion at the Board) and has looked into the commissioning responsibilities related to sexual health and the governance arrangements in place to ensure the delivery of those responsibilities.
3.2.2 Integration and Change Board (ICB) update
Following the submission of the STP the ICB has agreed to align strategic and operational planning across the STP footprint. ICB has supported the revised approach for Children’s Programme Board - with a main purpose to improve health and wellbeing outcomes and reduce health inequalities for children and young people. It has also considered a draft Primary Medical Care Commissioning Strategy to support delivery of NHS England’s General Practice Forward View which is proposed to come to the 31st January Health and Wellbeing Board meeting.
ICB has also reflected on the success of a recent event for people working in, and people of the district, to celebrate innovative services which have been developed locally, and to showcase their approaches to inspire others to learn more and work better together across health and care.
3.3 Healthy Weight Programme
At time of writing, a first meeting of senior and strategic officers is scheduled for 25th November, and a verbal update will be given at the Board meeting the following week.
The approach to be taken on healthy weight has shifted significantly. Feedback on the Terms of Reference indicated little support for a senior level Delivery Board. Therefore the November meeting will be a short workshop at which senior and strategic officers are asked to shape and inform the broad scope of a whole system approach to healthy weight, and to set the direction for a task and finish group to develop and deliver a programme to embed population level approaches across communities and in council departments and partner organisations.
The Terms of Reference will be redrafted following that meeting to what is needed to support the arrangements that are agreed, for example if a high-level Task and Finish group is established and to reflect the need to report to the Health and Wellbeing Board.
The initial actions from the July Board meeting, to review spend, costs and what is currently delivered against evidence of effectiveness, have been progressed in the interim and will inform the discussion at the November 25th meeting.
3.4 Young carer recognition and referral
In July the Children’s Overview and Scrutiny Committee noted an issue of low numbers of young carers being referred by GP practices and adult social care to the District’s young carer service for support was raised. The issue was referred to the Health and Wellbeing Board.
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The issue has been progressed in relation to primary care through meetings between the HWB Programme Manager and Young Carer service, and HWB Programme manager and one of the Clinical Chairs at the Bradford CCGs. As a result GP liaison staff at the CCGs and Children’s Services have agreed to work together with the Young Carers service to explore the issue and to ensure that appropriate referrals are made. The issue will also be considered in relation to adult social care.
3.5 West Yorkshire and Harrogate Sustainability and Transformation Plan (WYSTP)
Since the additional Board meeting on 19th October the Chair and Board members have been circulated with the draft West Yorkshire and Harrogate Sustainability and Transformation Plan following its submission to NHS England on 21st October. This included the high-level summary of the Bradford District and Craven STP as one of the chapters. The WYSTP has since been published on the 10th November and will be considered through a separate agenda item.
See section 12 for links to the West Yorkshire STP webpage which hosts published plan and supporting documents and to the Health and Wellbeing Board webpage on the Council website which also carries the link.
4. FINANCIAL & RESOURCE APPRAISAL
Resources for the Better Care Fund in 2016-17 total £168 million of aligned funding. This was described in detail in a paper to the July 2016 Board meeting.
5. RISK MANAGEMENT AND GOVERNANCE ISSUES
In relation to the Bradford District Care Fund, risk is managed by Bradford Health and Care Commissioners with the Health and Wellbeing Board having overall governance responsibility. Risk issues are reported alongside quarterly performance reporting – next due to the Board in January 2017.
In relation to the Bradford and District STP, risk is managed through a risk register by the partnership-based Integration and Change Board.
Governance and risk management of the West Yorkshire Sustainability and Transformation Plan is still being established, with input from local Clinical Commissioning Groups, Council Leaders and Chairs of the West Yorkshire Health and Wellbeing Boards.
6. LEGAL APPRAISAL
The legal status of the Better Care Fund has been established through a Section 75 agreement between the Council and the Clinical Commissioning Groups.
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7. OTHER IMPLICATIONS
7.1 EQUALITY & DIVERSITY
None
7.2 SUSTAINABILITY IMPLICATIONS
The Sustainability and Transformation Plans (STP) for Bradford District and Craven and for West Yorkshire plus Harrogate have been developed in accordance with 2016-17 NHS Planning Guidance to bring local health economies onto a sustainable footing by 2020-21.
7.3 GREENHOUSE GAS EMISSIONS IMPACTS
None
7.4 COMMUNITY SAFETY IMPLICATIONS
None
7.5 HUMAN RIGHTS ACT
None
7.6 TRADE UNION
At this stage it is not possible to anticipate what, if any impact on Trade Union issues the development of transformation programmes under the West Yorkshire Sustainability and Transformation Plan.
8. NOT FOR PUBLICATION DOCUMENTS
None.
9. OPTIONS
No options are provided
10. RECOMMENDATIONS
That the update be noted.
11. APPENDICES
None
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12. BACKGROUND DOCUMENTS
12.1 Better Care Fund Quarter 2 performance 2016-17- Highlight report. Available after 23rd November when the performance has been reported.
12.2 West Yorkshire Sustainability and Transformation Plan including Bradford and Craven Summary STP and supporting documents http://www.southwestyorkshire.nhs.uk/west-yorkshire-harrogate-sustainability-transformation-plan/
Link from Council Health and Wellbeing Board webpage https://bdp.bradford.gov.uk/about-us/health-and-wellbeing-board/
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Agenda Item 8/
Report of the Strategic Director of Health and Wellbeing and the Chief Officer of Bradford City, Bradford Districts and Airedale, Wharfedale and Craven Clinical Commissioning Groups to the meeting of The Bradford and Airedale Health and Wellbeing Board to be held on 29th November 2016.
Subject: N
Working Better Together 2: Mental Wellbeing in Bradford District and Craven: A Strategy 2016 - 2021
Summary statement:
The Mental Wellbeing Strategy has been developed through intensive collaborative work during April – October 2016. It is presented to the Health and Wellbeing Board for approval and to request views on the proposed approach to implementation.
Bev Maybury Portfolio: Strategic Director - Health and Wellbeing, Bradford MDC Health and Wellbeing
Helen Hirst Chief Officer – NHS Bradford City, NHS Bradford Districts and NHS Airedale, Wharfedale and Craven CCGs
Report Contact: Ali Jan Haider Overview & Scrutiny Area: Head of Strategic Commissioning, Bradford City and District CCGs Health and Social Care Phone: (01274) 237290
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E-mail: [email protected]
1. SUMMARY The Mental Wellbeing Strategy for Bradford District and Craven 2016 - 2021 has been developed through intensive collaborative work during April – October 2016. It is presented to the Health and Wellbeing Board for approval and to request views on the proposed approach to implementation.
2. BACKGROUND The Publication draft of the Mental Wellbeing Strategy for Bradford District and Craven is brought to the Health and Wellbeing Board for consideration and approval – the full strategy forms Appendix 1 to this paper. In April 2016 the Board discussed the proposed approach to developing a strategy and gave detailed feedback to the development team to encourage a strong focus on the wellbeing end of the spectrum – encouraging good mental wellbeing at a population level, ensuring a greater emphasis on prevention and early intervention and addressing health inequalities and the wider factors that impact on people’s mental wellbeing. Progress updates were received at Board meetings in July and again in September when it was agreed that the final strategy would return in November 2016. The Board resolved: That the Board receives the update and provides feedback to further shape the strategy and encourages wide participation in consultation on the draft strategy through its constituent organisations. As outlined in previous updates the strategy is informed by the external review of Joint Mental Health Commissioning (Autumn 2015) and the Joint Mental Health Needs Assessment. All stages of its development have been informed by extensive engagement between commissioners and service users, carers, clinicians and other staff in voluntary and community sector and statutory NHS organisations. The strategy responds to the Five Year Forward View for Mental Health (report of the Mental Health Taskforce) and the requirement of the Health and Social Care Act to value mental health equally with physical health (known as parity of esteem). The strategy builds on successful and nationally recognised health and social care innovations in the Bradford district and Craven.
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3. OTHER CONSIDERATIONS The strategy has been developed through a collaborative process involving detailed stakeholder engagement. Its three strategic priorities are: Our wellbeing, Our mental and physical health Care when we need it. There is a strong focus on prevention of mental ill health, early intervention, and taking action to avoid escalation where possible.
3.1 IMPLEMENTATION Prioritisation of commitments and action planning over next 5 years. Under the leadership of the newly-formed Mental Health Partnership Board (MHPB), we are developing partnership arrangements to further the strategic objectives, identifying clear leadership and accountability to ensure that broader services and development plans promote mental wellbeing. At its November meeting the MHPB agreed an outline plan for the delivery of the strategy. It has agreed the creation of three sub-groups that will drive the delivery plans, based on work programmes delivering Our Wellbeing, Our mental and physical health and Care when we need it. The leadership of the projects under the ‘Our mental and physical health’ and ‘Care when we need it’ programmes has been agreed and groups to develop detailed plans are currently being formed. These groups will propose priorities for action across the timespan of the strategy based on already agreed commissioning priorities, 5 Year Forward View implementation targets and a consideration of how long initiatives will take to deliver outcomes.
Each group will develop a proposal for a comprehensive range of evidence based health and care metrics that will be used to measure detailed progress. Groups have been requested to deliver their initial action plans by the end of January 2017. Given the increasing evidence base of social prescribing we will work with voluntary and community-based services to develop the community asset base as well as
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provide a service offer. The five year Mental Wellbeing strategy links to the Sustainability and Transformation Plans for Bradford District and Craven and West Yorkshire and to operational plans. We will look to other strategies (and their implementation plans) to achieve better mental wellbeing outcomes across the health and care system. It should be noted that existing structures are already delivering against the strategic commitments set out in this plan. Commissioning activity to deliver the strategy is already underway. Examples include the commissioning of a ‘buddy system’ with the VCS to work with specialist providers of CAMHS to address emotional and psychological distress at the earliest opportunity and supporting children and young people who are awaiting input from specialist services as well as supporting them through interventions. This initiative has been designed with local children and youing people and is focussed on reducing current waiting lists for specialist CAMHS. Commissioning plans in preparation that set out the business case for further development of the Primary Care Wellbeing service that provides psychological support to people with Medically Unexplained Symptoms and leads to significant reduction in inappropriate use of planned and unplanned hospital care and improves the quality of care for this group of patients. Plans are underway for the reprocurement of the MH Wellbeing Navigation Service which provides services to adults with a serious and enduring mental health problem in partnership with BDCFT and a wide range of VCS and community organisations. The services provides a full assessment to identify needs followed by the development of an ‘inclusion plan’ (owned by the service user) which identifies a package/range of activities and support for the service user to access within the community over a maximum six month period.
4. FINANCIAL & RESOURCE APPRAISAL The constituent organisations of the Health and Wellbeing Board have agreed a principle that the current spend for mental health should be, as a minimum, maintained at its current level. In 2016-17 the budget has been included for the first time in the joint planning and financial arrangements of the Bradford District Better Care Fund. It has been proposed that there should be joint commissioning of mental health and wellbeing services through this aligned budget.
5. RISK MANAGEMENT AND GOVERNANCE ISSUES Mental Health governance structures have been developed in line with the agreements set out at the February 2016 meeting of the Health and Wellbeing Board and are
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providing the leadership for the development of the strategy for Mental Health and Wellbeing. No outstanding risk issues are associated with this programme at the current time.
6. LEGAL APPRAISAL There are no specific legal issues are anticipated to arise from the development and publication of the Strategy for Mental Health and Wellbeing.
7. OTHER IMPLICATIONS
7.1 EQUALITY & DIVERSITY The joint Strategy for Mental Wellbeing will address issues of equality and diversity as they apply to protected characteristics groups. In addition the Strategy will address inequalities that are not covered under the Equality Act 2010 for example relating to deprivation, as poor health outcomes, health inequalities, inequality of access and uptake of services are associated with areas of high deprivation.
7.2 SUSTAINABILITY IMPLICATIONS The Sustainability and Transformation Plans for Bradford and Craven and for West Yorkshire will address sustainability issues in relation to financial sustainability through the work to close the finance gap for the health and social care economy. Estates workstreams will address the sustainability issues set out in the Carter Review.
7.3 GREENHOUSE GAS EMISSIONS IMPACTS None
7.4 COMMUNITY SAFETY IMPLICATIONS No specific community safety issues are anticipated to arise from the development and publication of the joint Strategy for Mental Wellbeing.
7.5 HUMAN RIGHTS ACT The current position in respect of Human Rights Act implications, for example in relation to Deprivation of Liberty, is unlikely to be impacted by the publication of the Mental Wellbeing Strategy.
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7.6 TRADE UNION None
7.7 WARD IMPLICATIONS None
8. NOT FOR PUBLICATION DOCUMENTS None
9. OPTIONS
No options are provided
10. RECOMMENDATIONS 10.1 That the Board supports the Mental Wellbeing Strategy as the vision for the development of services and community assets to improve mental wellbeing in Bradford district and Craven 10.2 That the Board provides views on the initial implementation plans (section 3.1 above).
11. APPENDICES Mental Wellbeing in Bradford District and Craven: A Strategy 2016-2021(Draft)
12. BACKGROUND DOCUMENTS None
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City of Bradford MDC
Mental wellbeing in Bradford district and Craven: a strategy 2016-2021
Page 69 1. Contents
1. Introduction...... 4 4.4 What people tell us...... 28
4.5 How mental health services are organised in Bradford district and Craven now...... 29 2. In brief...... 6 4.6 Finance...... 31
4.7 National guidance...... 32 3. Our vision for mental health and wellbeing services in Bradford district and Craven.... 14 4.7.1 The Five Year Forward View for Mental Health...... 32 3.1 Strategic priorities...... 16 4.7.2 Safeguarding children and adults...... 33 3.2 Strategic outcomes...... 16 4.7.3 The Care Act 2014...... 33
4.7.4 Children and young people...... 33 4. What we already know...... 17 4.8 Relationships with other strategies and 4.1 Assets in Bradford district and Craven...... 18 developments...... 34 4.2 Mental health needs in Bradford district and Craven...... 19 5. The future of mental health services in 4.2.1 Wider determinants...... 19 Bradford district and Craven...... 35 Environment...... 20 Where do we want to be?...... 36 Person...... 21 5.1 Our wellbeing...... 37 Genetics...... 24 5.1.1 Developing mentally healthy 4.3 Epidemiology...... 25 communities and places...... 38
4.3.1 Children...... 25 5.1.2 Reducing stigma and discrimination..... 39
4.3.2 Working age adults...... 25 5.1.3 Social care, social work and mental health...... 39 Mental wellbeing...... 25 5.1.4 Integrated approaches to health Mild, moderate and severe non-psychotic and social care...... 40 disorders...... 24 5.1.5 Developing mentally healthy homes..... 40 Non-psychotic chaotic and challenging Disorders...... 26 5.1.6 Developing mentally healthy workplaces...... 41 Psychosis...... 26 Making the case...... 41 4.3.3 Older adults...... 26 Aspirations for the future...... 41 4.3.4 .Specific challenges in Bradford district and Craven...... 26 5.1.7 Suicide prevention...... 42
4.3.5 The financial crisis and mental health... 27 5.2 Our mental and physical health and care...... 43 5.2.1 Primary care...... 43
Page 70 2 Mental wellbeing in Bradford district and Craven 5.2.2 Mental and physical health...... 44 6. How we will get there...... 59
5.2.3 Psychological therapies...... 46 6.1 Co-design...... 60
5.2.4 Care pathways for victims of sexual 6.2 The evidence base...... 60 assault and domestic violence...... 47 6.3 The voluntary and community sector...... 60 5.2.5 Physical health care of people with severe mental illness...... 47 6.4 Personalisation and asset-based care planning...... 61 5.3 Mental health care when we need it...... 48 6.5 West Yorkshire vanguard...... 61 5.3.1 Children and young people...... 48 6.6 Pathways and packages...... 62 5.3.2 Perinatal mental health...... 49 6.7 Workforce development...... 62 5.3.3 Early intervention in psychosis...... 50 6.8 Partnership commissioning arrangements.... 63 5.3.4 Community mental health services...... 50 6.9 Our investment in mental health...... 63 Community mental health teams...... 50 6.10 Technology...... 64 Personality disorders...... 53 6.11 How will we know we have made Adult eating disorders...... 53 a difference?...... 65
5.4 Urgent and emergency mental healthcare.... 53 6.12 Mental wellbeing in Bradford district and Craven: metrics...... 66 5.5 The rehabilitation of people with serious and enduring mental health problems...... 54
5.6 Older people’s mental health...... 55 Appendix 1: Strategic priorities, strategic outcomes, strategic commitments and 5.7 Carers...... 56 enabling priorities...... 68 5.8 Protected characteristics...... 56 Appendix 2: Mental Health Foundation 5.9 Other areas of care...... 57 whole community prevention framework.... 73
5.9.1 Mental health and autism...... 57
5.9.2 Criminal justice and liaison diversion... 57 7. Glossary...... 74
5.9.3 Armed forces veterans...... 58
5.9.4 Dual diagnosis...... 58 References...... 75
Acknowledgements: The development of this strategy was led by Mick James, Head of Commissioning – Mental Health, but would not have been possible without the help and support of a wide range of people. Thanks is extended to all those involved in the development of the strategy including: Kashif Ahmed (NYCC), Chris Bain (Bain Associates), Simon Baker (BMDC), Sasha Bhat (CCG), Dr Sarah Exall (BMDC), Debra Gilderdale (BDCFT), Sue Jones (CCG), Dr Brendan Kennedy (CCG), Simon Long (BDCFT), Dr Angela Moulson (CCG), Kim Shutler-Jones (Cellar Trust), Anna Smith (CCG), Nick Smith (Expert by experience), Mark Trewin (BMDC), Mark Vaughan (CCG) and Clare Smart (CCG).
Thank-you to the artists who have kindly contributed their work for inclusion in this strategy.
Page 71 A strategy 2016-2021 3 1. Introduction
We are delighted to endorse our new mental focus our efforts on preventing mental ill health wellbeing strategy for Bradford district and occurring and worsening. Craven. This is the first time we have written such a comprehensive strategy, covering all age ranges, with a very clear focus on promoting Our aim for Bradford district and Craven is to create mental wellbeing and tackling the things that environments and communities that will keep people we know can cause mental ill health. It sets well across their lifetime, achieving and sustaining out our vision and strategic priorities for the good mental health and wellbeing for all. We believe people of Bradford district and Craven over that we will be successful if we remain committed the next five years. It has been developed to working together with individuals, families, collaboratively with our stakeholders; most employers, educators, communities and the public, importantly with members of the public and private and voluntary sectors to promote better those who have a lived experience of services mental health and to drive transformation. and their carers. Separate strategies exist, or are being developed, Mental wellbeing is much more than simply not that are interdependent with this mental wellbeing being mentally ill. It is about having positive self- strategy. These include dementia, autism, self-care, esteem, good coping mechanisms and feeling learning disabilities as well as broader issues such empowered and in control. This is an important as housing. These and other strategies have been element of the ambition of our strategy. We want considered during the development of the mental to actively promote mental wellbeing through wellbeing strategy to ensure all of our plans link up addressing the broader determinants and providing and complement one another. early interventions. The summary on page seven gives a flavour of our We are rightly proud of the many notable examples vision, outcomes and priorities. For those who want of excellent quality mental health care that we to explore the issues more closely, there are more are already offering in the district and we want to detailed descriptions of the district, and what we continue to build on these. This strategy will not only know about the people who live here and their health enable us to deliver the commitments and targets set and wellbeing. Following in-depth engagement out in the Five Year Forward View (5YFV) for mental with local people, we have also described what they health but also the things that local people have told have told us about their aspirations and what they us are important to them. Most importantly, it will think about services now. We have then used this to enable us to take a radical approach to prevention describe the three strategic priorities for the next five and early intervention, based on the principles of the years: Care Act (2014). • Our wellbeing: Building resilience, promoting This strategy is deliberately ambitious and we know mental wellbeing and delivering early that it will be a significant challenge to deliver our intervention. vision and priorities in the current financial climate. We recognise that the effective support of people • Our mental and physical health: Developing experiencing mental health problems is set to and delivering care through the integration of become one of the greatest challenges we face. mental and physical health and care. Without action on the increasing demand for mental health services, it will be very difficult to meet the • Care when we need it: Ensuring that when growing demand for support to people experiencing people experience mental ill health they can mental ill health in the long term. Because of this access high quality, evidence-based care. we have agreed that we need to act decisively to
Page 72 4 Mental wellbeing in Bradford district and Craven The final sections of the strategy describe the things along with five measurable outcomes that will show us that will help us to deliver these priorities and how what impact the delivery of the plans has had on the we will make plans and monitor our progress. mental health and wellbeing of the people of the district. We are proud to be able to set out such an ambitious We will use this strategy as the basis for developing strategy that seeks to tackle the determinants of poor detailed action plans for delivering the priorities set out mental health in such a comprehensive manner. We look within it. The Joint Mental Health Commissioning Board forward to being able to demonstrate the impact of this and the Health and Wellbeing Board will monitor these in the future.
Councillor Susan Hinchcliffe, Leader - Bradford Council Sam Keighley and Helen Speight, Co-chairs - Bradford District Assembly Health and Wellbeing Board Dr Akram Khan, Clinical chair – NHS Bradford City Clinical Commissioning Group Michael Luger, Chair - Airedale NHS Foundation Trust Professor Bill McCarthy, Chair - Bradford Teaching Hospitals NHS Foundation Trust Dr James Thomas, Clinical chair – NHS Airedale Wharfedale and Craven Clinical Commissioning Group Michael Smith, Chair - Bradford District Care Foundation Trust Emma Stafford, Chair - Bradford People’s Board Dr Andy Withers, Clinical chair - NHS Bradford Districts Clinical Commissioning Group
Page 73 A strategy 2016-2021 5 Page 74 6 Mental wellbeing in Bradford district and Craven In brief
Page 75 A strategy 2016-2021 7 2. In brief
Background What is the strategy about? Our ambition locally was to develop a strategy that About the area took an all age, life-course approach with a strong focus on tackling the things that can cause mental There are 531,200 people living in the Bradford health problems and intervening early. district with a further 55,600 in Craven. This strategy is for everyone. First and foremost it is We are a big economy with globally successful for people who use these services and their carers. It businesses, a skilled and enterprising workforce and is also for people who buy services on behalf of the a distinctive identity that reflects our young, diverse local population (the commissioners) and those who and growing population. provide both mental health services and physical health. We have been aspirational in terms of the However, mental health issues will affect about vision for change that is set out in the strategy, but 155,000 people in our locality at some time during a are realistic that given the financial constraints placed person’s life, with approximately 6,200 people being on both health and social care at the current time, in need of and in contact with specialist mental that these aspirations may take longer to achieve. health services at any given time. Developing the strategy The risk of having a mental health disorder is What have we done to develop the strategy? The affected by a combination of genetics (the physical development of this strategy was informed by characteristics each person is born with), personal engagement with many people: We talked to people circumstances and the environment a person lives with lived experience of services and other members in. Social issues such as the impact of poverty, living of the public, including children, young people and conditions, quality of relationships, work and other their families. We also had involvement with schools, activities are also very relevant. the local authority, local GPs, clinical colleagues from Bradford District Care NHS Foundation Trust, In Bradford, there are large numbers of people living voluntary and community sector and specialised in environments that pose a high-risk of mental commissioning colleagues. We shared the views and illness: almost 120,000 people are thought to be experiences we had heard to date, sought views income deprived, and just under 1 in 3 people were on gaps and identified areas that needed to be economically inactive in 2015/16.1 Furthermore, in a strengthened. recent survey of Bradford’s housing, 18% of housing had class 1 hazards classifying them as non-decent.2 We know that the effective support of people experiencing mental health problems is set to become one of the greatest challenges of this decade. Without action on the increasing demand for services it will not be possible to meet the rising demand for support to people experiencing mental ill health in the long term. Because of this we have agreed that we need to act decisively to work to prevent mental ill health occurring and worsening. Mental health is greater than just the absence of mental illness. It includes the notions of positive self-esteem, coping mechanisms and the importance of empowerment and control. This is an important element of the ambition of our strategy, to tackle this issue and promote mental wellbeing through addressing the broader determinants.
Page 76 8 Mental wellbeing in Bradford district and Craven We also know that when people have physical health adults experiences a mental health problem in their problems are more likely to develop mental health lifetime. For some, mental health problems are treated problems and that when they do, this makes the and never return. However, for others, mental health outcomes of their physical ill health worse. People problems last for many years, especially if not treated with a mental health problem have an increased properly. The district is seen as a leading economy chance of developing physical illness – eg increasing for its work, particularly in the fields of crisis care, the risks of the person having conditions such as dementia diagnosis and the physical/mental health coronary heart disease, type 2 diabetes or respiratory interface, and we will continue to develop services disease. Because of this we are also targeting mental to ensure that they maintain or improve the access, and physical health. quality and effectiveness of the services on offer. For this reason we have focussed some of the strategy One in 10 children between the ages of five and 16 on making sure people can access good quality care has a mental health problem and almost one in four when they need it.
Our Vision for mental wellbeing in Bradford district and Craven
The overarching vision is based on the aspirations of our Hope – Empowerment - Support stakeholders
It is supported by three strategic Our wellbeing - Our mental and priorities: physical health - Care when we need it
We have 5 strategic outcomes that we can measure progress against so we know how well we are doing to deliver the three strategic priorities
These three strategic priorities are supported by 47 strategic commitments. We will use these to develop actions plans that set out what we are going to do to deliver Our wellbeing, Our mental and physical health and Care when we need it
These are supported by a number of other general priorities that will help us make a difference – things like using technology better, giving people more control through personal budgets, developing the workforce and making sure we make good use of resources Page 77 A strategy 2016-2021 9 Our strategic priorities
Our wellbeing Our mental and physical health Care when we need it
We will build resilience, promote Mental health and wellbeing is of When people experience mental I have as much choice and control as possible in my life mental wellbeing and deliver equal importance with physical ill health we will ensure they can early intervention to enable our health. We will develop and deliver access high quality, evidence based population to increase control over care that meets these needs care that meets their needs in a their mental health and wellbeing through the integration of mental timely manner, provides seamless and improve their quality of life and physical health and care. transitions and care navigation. and mental health outcomes.
How will we know we have achieved this?
Strategic outcomes
People in Bradford district and Craven will:-
be supported to recognise and value the importance of their mental wellbeing and take early action to maintain their mental health through improved prevention, awareness and understanding;
enjoy environments at work, home and in other settings that promote good mental health and improved wellbeing;
experience seamless care and have their physical and mental health needs met through services that are integrated and easily accessible;
reach their maximum potential through services which are recovery focused, high quality and personalised and which promote independence;
expect support to be commissioned and delivered in a way which leads to increases in efficiency and enables transformation of care through reinvestment.
Page 78 10 Mental wellbeing in Bradford district and Craven Where do we want to be by 2021? We want these statements to be true for everyone who lives in Bradford district and Craven
I have as much choice and control as possible in my life
I understand my health needs and what keeps me well, and I am encouraged and supported to do more of the activities that keep me well
In situations where I am not able to be in control, I am supported to maintain my rights and dignity and to make choices that support my recovery
I am treated with warmth and compassion and I feel respected and listened to. My concerns are taken seriously
I know how and when to access advice, support and treatment
I am not judged for how I feel or what I have done
I understand my condition and have the help I need to live my life to the best of my ability without my condition taking over my life
I have choice and opportunity to access different therapies, approaches and activities and I have support to get better without medication
My fality or carer is actively supported and involved in my care
Page 79 A strategy 2016-2021 11 How will we get there?
We will seek the views of people with a lived experience, families and carers and professionals to design and deliver services to support this strategy.
We will base our commissioning decisions on the best evidence available and build on our partnerships with academic institutions to evaluate innovations delivered locally. We will use the “pathways and packages” approach to commission evidence-based care to meet people’s needs. We will significantly expand the use of personal budgets to enable people to achieve greater choice and control over their own are and support.
We will develop an integrated workforce plan to deliver the outcomes set out in this strategy.
We will work with the voluntary and community sector (VCS) to help build their capacity to respond to the priorities set out in this strategy.
We will work to support the move to a more integrated commissioning model at a place-based level, to remove barriers and deliver efficiencies.
We will commit to protecting the current level of investment in real terms in mental health services, recognising the importance of effective mental health and wellbeing interventions in reducing the overall health and care bill.
We will rigorously review the use of those protected resources to ensure their effective use.
We will support opportunities to use technology to help deliver this strategy.
How does this link to other issues? Addressing the wider determinants of poor mental health requires housing and regeneration policies to support the vision and priorities set out by the strategy.
This strategy is focussed on mental health and wellbeing and there are a number of other areas that have a significant impact on people’s mental health. As well as the broader issues like housing, environment and employment, things like drug and alcohol misuse, dementia, learning disabilities and autistic spectrum condition also play a significant part. Whilst they are mentioned in the strategy, we have not gone into detail. This is because there are separate strategies, either already agreed or in development, that tackle these issues.
Page 80 12 Mental wellbeing in Bradford district and Craven What happens next?
The money Parity of esteem is the principle by which mental health must be given equal priority to physical health across health and social care system. It was enshrined in law by the Health and Social Care Act 2012. Our plans to deliver this strategy include a commitment to protect the current level of investment in mental health services, recognising the importance of effective mental health and wellbeing interventions in reducing the overall health and care bill. The CCGs have also committed to make further investment in line with the growth money received over the next five years.
Action plans We will use the 47 strategic commitments as the basis for developing detailed action plans for delivering the priorities set out in the strategy. These will be monitored by the Joint Mental Health Commissioning Board and the Health and Wellbeing Board.
Measuring progress The strategy is supported by measurable outcomes that will show us what impact the delivery of the plans has had on the mental health and wellbeing of the people of the district. We also expect the more detailed action plans to be supported by more specific measures that tell us what impact they have had.
Page 81 A strategy 2016-2021 13 Page 82 14 Mental wellbeing in Bradford district and Craven Our vision
Page 83 A strategy 2016-2021 15 3. Our vision for mental health and wellbeing services in Bradford district and Craven
Our vision Hope - Empowerment – Support 3.1 Strategic priorities
Our wellbeing Our mental and physical health Care when we need it We will build resilience, promote Mental health and wellbeing is of When people experience mental mental wellbeing and deliver equal importance with physical ill health we will ensure they can early intervention to enable our health. We will develop and deliver access high quality, evidence-based population to increase control over care that meets these needs care that meets their needs in a their mental health and wellbeing through the integration of mental timely manner, provides seamless and improve their quality of life and physical health and care. transitions and care navigation. and mental health outcomes.
3.2 Strategic outcomes People in Bradford district and Craven will:-
be supported to recognise and value the importance of their mental wellbeing and take early action to maintain their mental health through improved prevention, awareness and understanding; enjoy environments at work, home and in other settings which promote good mental health and improved wellbeing; experience seamless care and have their physical and mental health needs met through services that are integrated and easily accessible; reach their maximum potential through services that are recovery focused, high quality and personalised and which promote independence; expect support to be commissioned and delivered in a way which leads to increases in efficiency and enables transformation of care through reinvestment expect support to be commissioned and delivered in a way which leads to increases in efficiency and enables transformation of care through reinvestment.
The overarching vision of hope – empowerment – support is based on the aspirations of our stakeholders. It is supported by three strategic priorities: our wellbeing, our mental and physical health and care when we need it.
These three priorities are used to group our strategic commitments and they will be the starting point for three programmes to deliver our wellbeing, our mental and physical health and care when we need it respectively.
Each of these programmes will agree detailed action plans, with associated outcome metrics to measure progress of their delivery and the achievement of the five strategic outcomes listed in section 3.2.
Page 84 16 Mental wellbeing in Bradford district and Craven What we already know
Page 85 A strategy 2016-2021 17 4. What we already know
4.1 Assets in Bradford district and Craven There are a number of community development projects in Bradford are commissioned by the City Over half a million people live in Bradford district with of Bradford Metropolitan District Council and the a further 55,600 in Craven. We are a big economy Clinical Commissioning Groups. For example, People with globally successful businesses, a skilled and Can (http://peoplecanbradforddistrict.org.uk/) is a enterprising workforce and a distinctive identity that campaign developed by the VCS to support local reflects our young, diverse and growing population. people who want to help make a difference for Bradford has a rich cultural heritage. Bradford Council Bradford. It has a clean, green and active approach, has committed to building on this by making Bradford and encourages people who take part to be a “leading cultural city” over the next decade, which neighbourly, take community action, volunteer, or celebrates diversity and connects communities.3 raise money. Sandale Community Development Trust Bradford District and Craven have 37 public parks, is one example of a service aimed at making people including a multi-million pound City Park, and much feel good about where they live. The trust hosts of the region is rural. Across the region there are 15 events, such as “Buttershaw by the Sea” in 2016, and leisure centres and pools, 33 libraries, and multiple runs a local café. The Warm Homes, Healthy People museums, art galleries and theatres, including Project, jointly funded by the NHS and Bradford Bradford Industrial Museum and the recently Council, aims to support a range of community-based refurbished Cartwright Hall Art Gallery.4,5 Bradford is projects that target vulnerable people living in cold UNESCO’s first City of Film, and home of the National housing through a range of activities that encourage Media Museum. The village of Saltaire is a UNESCO people to be more neighbourly. World Heritage Site.6 The University of Bradford ranks in the UK top 10 for some courses, and recently Services delivered by Girlington Community Centre it has been voted the greenest university in the UK work in partnership with statutory and community and eighth in the World.7 organisations to deliver advice, signposting, peer support, volunteering, befriending and support Within Bradford district there is a strong focus on services to people from marginalised, isolated and community, and there is a solid history of work in the seldom heard communities. The Doula Project trains region to develop safer and stronger communities. A volunteers to support vulnerable, pregnant women key part of this work is the Communities of Interest with the aim of improving the physical and emotional (COI) Partnerships. These groups are community- wellbeing of both mother and baby. led, and are brought together to address specific issues faced by defined groups where there is an Bradford district has a young population: our children existing or emerging need. Another key partnership and young people are our greatest asset. Bradford in community development is the Neighbourhood has the youngest, fastest growing population outside Engagement and Active Communities (NEAC) Group. London and is set to be the youngest population in This group works closely with a range of organisations Europe by 2020. The Bradford Youth Service provides to support and develop a strong, dynamic voluntary things to do, someone to talk to and places for young and community sector (VCS). Community safety people to go, in addition to opportunities for young delivery groups are also instrumental in safeguarding people to participate in a range of activities, celebrate the most vulnerable people in Bradford and Airedale, their achievements and become actively involved in and preventing crime, anti-social behaviour and re- their communities. offending. Bradford is a City of Sanctuary, building a culture of hospitality for people seeking refuge, with Taken together, this work appears to be successful: in Bevan House, Refugee Action and Horton Housing, 2015 over 60% of people in Bradford district thought amongst others, providing specialist support to that their local communities were living together refugees in Bradford. harmoniously: a positive feeling which appears to have increased over the past five years.8
Page 86 18 Mental wellbeing in Bradford district and Craven 4.2 Mental health needs in Bradford district and Craven
One in ten children between the ages of five and 16 has a mental health problem and almost one in four adults experiences a mental health problem in their lifetime.9 For some, mental health problems are treated and never return. However, for others, mental health problems last for many years, especially if not treated properly. Mental health is greater than just the absence of mental illness. It includes the notions of positive self-esteem, coping mechanisms and the importance of empowerment and control.
Mental health problems are the largest cause of ill health in the United Kingdom with a cost of up to £100 billion pounds to the economy as a whole. Up to three quarters of people with mental health problems receive no treatment.
There is a large range of mental health disorders, including common problems such as anxiety, depression, phobias and panic disorders, and less common, but severe, problems such as schizophrenia and bipolar affective disorder.
4.2.1 Wider determinants The risk of having a mental health disorder is affected by a combination of genetics (the physical characteics each person is born with), personal circumstances and the environment a person lives in. Social issues such as levels of poverty, living conditions, quality of relationships, work and other activities are also very relevant.
ltural and ic, cu env om iro n nm co Living and working e oe n i conditions ta c l so c l Work o a Unemployment n r environment d e mmuni i co ty t n d n i e n et o G a w Water n l s ia o and c r lifes k sanitation o al ty l s Education S u e id f a iv c d t Health o n Age, sex and
I care r
hereditary s services
Agriculture factors and food production Housing
The Determinants of Health (1992) Dahlgren and Whitehead
Page 87 A strategy 2016-2021 19 Environment Living in a deprived community, poor housing conditions, inequalities in education, unemployment or poor working conditions, a poor built environment with lack of access to green spaces, and financial insecurity can all increase the risk of both physical and mental health problems.10,11 Other factors, such as what a person believes about their health, and how much control they have, or feel they have, affects how people ask for help when they become ill.12
The map below shows differences in deprivation in the Bradford district based on national comparisons from 2015. The darkest coloured areas are some of the most deprived neighbourhoods in England.
The chart below shows the percentage of the population who live in areas at each level of deprivation. In Bradford 45.2% of people live in the 20% most deprived areas in England. This is more than double the percentage of people in England as a whole who live in the 20% most deprived areas (20.4%).13
100 90 80 70 60 50 40 % Residents 30 20 10
0 England Bradford
Page 88 20 Mental wellbeing in Bradford district and Craven In Bradford, there are large numbers of people living in environments that pose a high-risk of mental illness: almost 120,000 people are thought to be income deprived (the fourth largest figure in England), and more than one in three people of working age were out of work in 2011. Furthermore, in a recent survey of Bradford’s housing, just over 40% of housing in the private sector was classed as “non-decent”.
Poverty, poor nutrition, stress and certain infections Person before birth and in the first few years of life can There are many risk factors related to the individual have a big impact on future physical and mental for developing mental illness. High-risk groups include wellbeing.14,15 Bradford district and Craven has one Looked After Children, children who have experienced of the biggest populations of children in the country, abuse,20 carers,21 people who identify as lesbian, gay, many living in environments that increase the risk bisexual or transgender,22 Black and minority ethnic of poor wellbeing; especially linked to poverty. The individuals, those with a learning disability or physical Bradford district is ranked the 32nd most deprived disabilities, prisoners and people who are homeless.23 local authority district in the country out of 354. It The Bradford district has a higher than average also has one of the lowest proportions of working proportion of people in some of these vulnerable age residents in employment of any local authority groups. Men and women also have different risks for in the Yorkshire and Humber region. Employment or different conditions. While people at any stage of life similar constructive activities increase self-worth and may be affected by mental ill health, the likelihood of can reduce mental health issues. Staying in work experiencing certain conditions changes with age. once a person has mental health issues is important to recovery. Gender Mental health risk factors that disproportionately Craven, by contrast, has a lower than average rate affect women include gender-based violence and of children living in poverty compared with the rest abuse, and socio-economic disadvantage. Women of England and low unemployment rates for adults may experience low social status, insecure jobs and of working age, although there are pockets of low income resulting in reduced control over the deprivation within the area16. However, some of the circumstances of their own lives, while also having population in Bradford district and much of Craven is responsibility for care of a family and household. living in rural or very sparsely-populated areas, which More women than men are diagnosed with common have a higher risk of suicide compared to the rest of mental health disorders such as depression and England.17 anxiety, and self-harm is more common among women than among men. Women have been found Stigma and discrimination to have high rates of post-traumatic stress disorder Stigma is a big issue for those suffering from mental following past experiences of sexual violence or health problems. It can lead to social exclusion, with abuse. impacts on employment and relationships, so adding to the problems faced by people with mental illness. Men may be reluctant to seek help for mental distress, It can also be a barrier to asking for help.18.19 have high levels of isolation, high rates of drug and alcohol misuse, are at greater risk of homelessness, Discrimination as a result of race, disability, age, display more externalised and destructive behaviours, sexual identity, gender and faith can further and are more likely than women to be involved with disadvantage people with mental health problems the criminal justice system. There is a continuing and add to their distress. Bullying, violence, abuse cultural expectation that they will act as protectors and hate crimes can cause increased isolation for and providers for others. Men as well as women may people with mental health problems. experience violence and abuse. The rate of suicide among men far exceeds the rate among women.
Page 89 A strategy 2016-2021 21 Age Children and young people have many of the same risk factors for mental illness as adults, with some notable additions. The recent National Confidential Inquiry into Suicide and Homicide by People with Mental Illness identified ten common themes relating to suicide in people aged under 25 in England between January 2014 and April 2015.24 • family factors such as mental illness • abuse and neglect • bereavement and experience of suicide • bullying • suicide-related internet use • academic pressures, especially related to exams • social isolation or withdrawal • physical health conditions that may have social impact • alcohol and illicit drugs • mental ill health, self-harm and suicidal ideas
Older people may also have particular risk factors for poor mental health, in particular: discrimination; reduced participation in meaningful activities; relationships; physical health and poverty.25
Sexual orientation Gay men and lesbians report more psychological distress than heterosexuals despite similar levels of social support and physical health as heterosexual men and women. They are also more likely than other patients to report a negative experience of using health services and less likely to report that they have been treated with dignity and respect. Anxiety, depression, self-harm and suicidal feelings are more common among lesbian, gay and bisexual people, and rates of drug and alcohol misuse are also higher.
Gender re-assignment People who identify as transgender experience high levels of mental illness. In one study, 88% of transgender people had either currently or previously had depression, 80% had stress, and 75% experience anxiety.26
Page 90 22 Mental wellbeing in Bradford district and Craven Race There is a rich mix of ethnic groups and cultures in the region, with approximately 75% of the population estimated to be White, and 20% from Asian backgrounds. However, this diversity is not uniform across the region, but is concentrated in particular areas.
BME population by ward, 2011
Legend
CO R P D ATA .W ard s_w ith _U R I Percentage BME <10% 10% - 24% 25% - 49% 50% - 75% >75%
© Crown copyright and database rights 2014 ordanance survey 0100019304 Public Health Analysis Team, Bradford
Bradford, as an industrial textile city, attracted a large community to work in the mills and factories and more recently has attracted migrant workers and provided homes for refugees fleeing conflict areas.
The ethnic and cultural diversity of Bradford district is an asset to the region. However, it also brings challenges, as being from a Black and minority ethnic (BME) group is a risk factor for poor mental health. The effects of the migration process, resettlement and transition alongside racism, alienation, language barriers, cultural differences and limited understanding of accessing services experienced by people - and the impact this has on their mental health - cannot be underestimated. Mental wellbeing may be understood differently by different communities, and therefore approaches to improving mental wellbeing must be tailored to each group.
Page 91 A strategy 2016-2021 23 Religion and belief There is a complex relationship between physical and Bradford has a rich diversity of faiths and spiritual beliefs. mental health and social care: poor physical health Faith and spiritual belief can play an important role in may contribute to mental health problems, and people helping people maintain good mental health, build with mental health problems are at greater risk of resilience and live with - or recover from - mental health worse physical health and related social care needs. problems. Faith and spiritual beliefs can influence the The presence of co-morbid mental and physical illness decisions people make about the treatment they receive is known to worsen outcomes for patients and increase or how they want to be supported. costs for health services.27 In 2010-11, mental illness raised the cost of physical health care in the NHS by an It is important to understand the association between estimated £10 billion.28 mental health and belief and recognise where positive aspects can be tapped into and negative For people with long-term issues acknowledged. Faith can be a reason for stress, conditions, co-morbid mental discrimination and stigma. health problems are a major determinant of overall costs, Disability typically associated with a 45–75 per cent People with disabilities use health and care services increase in service costs. more often than people who do not have a disability. However, evidence suggests that they routinely struggle to access appropriate care and support; because of this People with severe mental illness live, on average, many disabled people experience less favourable health 15-20 years less than the general population. Rates of outcomes. diabetes, cardiovascular disease and respiratory disease are also higher than in the general population. This is Bradford has a higher proportion of adults and children due to a number of reasons, including lifestyle (such with learning disabilities compared to England. An as smoking, diet, etc.), side effects of medications, and estimated 25-40% of people with learning disabilities higher rates of alcohol and substance misuse.29 also have mental health problems. People with learning disabilities are more vulnerable to more of the risk factors Almost half of all tobacco associated with mental ill health, such as adverse life consumption and deaths due to events and lack of social support, and are much less smoking occur in people with likely than the general population to be able easily to mental disorders. access psychiatric services.
Carers People with mental illness may also experience barriers In the 2011 census, around 50,000 people in Bradford accessing health services. These may include difficulties identified themselves as carers. Around 16,500 of in seeking help, communicating problems, and physical these were aged 50-64 years and 8,500 were over 65 problems being overlooked due to a focus on their years of age. It is likely that there are many more than mental health diagnosis. this, as many carers do not recognise themselves as carers. The number of carers in Bradford district and Genetics Craven is thought to be rising. Carers report high levels There is strong evidence that some mental health of psychological distress which can include anxiety, disorders run in families. In particular, schizophrenia, depression, and loss of confidence and self-esteem. bipolar disorder and major depressive disorder have been linked to genetic causes.30 However, having Mental health conditions a family history of mental illness only increases a account for 23% of all disease person’s risk. Stressful life events and environmental in England (compared to 16% factors play a major role in the development of for cancer and 16% for heart mental health problems. disease) but account for just 13% of NHS spending. Page 92 24 Mental wellbeing in Bradford district and Craven 4.3 Epidemiology
4.3.1 Children The early years are very important in mental wellbeing: half of all cases of mental illness begin by age 14 and three-quarters by the mid-twenties.31,32
Research suggests that early intervention in childhood could prevent between a quarter and a half of adult mental illness, with corresponding individual, economic and social benefits.
Table 1 shows the average ages at which different mental health problems start.
Table 1: Ages of onset for mental disorders Attention deficit hyperactivity disorder (ADHD) 7-9 years Oppositional defiant disorder 7-15 years Conduct disorder 9-14 years Psychosis Late teens – early 20s Anxiety disorders 25-45 years Mood disorders 25-45 years
In Bradford district and Craven it is estimated that almost one in ten children – around 8,477 children in total - between the ages of 5 and 16 have a mental health disorder.
This means that between two and three children in every primary school class and between three and four children in every secondary school class in Bradford district and Craven is likely to have a diagnosable mental health difficulty. For many this is persistent: surveys have shown that a quarter of children with a diagnosable mental health disorder still had the same disorder three years later.33 On top of this, it is thought that a further five to 10% are likely to have less severe emotional or mental health difficulties at any one time. This means that there are an estimated 17,000 children with some level of emotional difficulty or mental health problem living in Bradford district and Craven. By 2025, this is expected to increase to around 23,600 children.
4.3.2 Working Age Adults Mental wellbeing
People in Bradford have generally reported lower levels of well-being than people in England as a whole, with around 10% of people in Bradford having a low happiness score, and 26% having high anxiety.
People who report having higher wellbeing have less illness, recover more quickly and for longer, and generally have better physical and mental health. An improvement in wellbeing is a key part of the Care Act 2014.
While most of the differences between Bradford and the rest of the country were small and could be explained by chance variation in the numbers, the difference in anxiety score was too large to be explained by chance.
Page 93 A strategy 2016-2021 25 Mild, moderate and severe non-psychotic 4.3.3 Older adults disorders Older people can have all the mental health problems In 2013/14, 5,520 people were diagnosed with faced by younger adults in addition to specific depression across the three CCGs in Bradford district challenges resulting from older age. A national survey and Craven. This amounted to around 1% of all of older people (National Centre for Social Research people living here, which is higher than the rate for and Department of Epidemiology and Public Health England as a whole. at the Royal Free and University College Medical School 2007) found that 22% of men and 28% of Around 20% of working age people in Bradford women over the age of 65 years scored highly on have experienced depression or anxiety at some test indicating possible depression. The risk of a high point in their lives. Some of these people will have score increased with advancing age, with 40% of recovered, whilst others may still experience signs men and 43% of women aged 85 and over having and symptoms of depression or anxiety. Females in a high score. Deprivation, poor physical health, and Bradford, like in the rest of the country, are more lack of social support all increased the risk of possible likely to have anxiety and depression than males. depression. Depression is not always easy to diagnose People aged 15-24 are the least likely to be recorded in elderly people, as the symptoms can be confused as having ever experienced depression or anxiety, with those of other health conditions, including whilst those aged 50-59 are most likely. dementia.34
Non-psychotic chaotic and challenging disorders Depression and dementia are closely linked: about The Adult Psychiatric Morbidity Survey estimates half of older adults with a new onset of depression that, in any single year, as many as 0.3% of adults also have some level of dementia, and 20-60% may experience anti-social personality disorder, with of those with dementia are thought to have men being more likely than women to have the depression.33 It is known that depression in older condition. Similarly, around 0.4% of adults have people often goes undiagnosed and untreated; one borderline personality disorder in any one year: this is study for example, finding that 60% of older people slightly higher in women than men. with depression were not receiving any treatment for this.36 Locally, around 25 people each month are referred into services for treatment of a chaotic and 4.3.4 Specific Challenges in Bradford district and challenging non-psychotic disorder. The average age Craven of presentation with this type of illness is 37 years Bradford has the third largest child population in the old, and 62% of the 344 people under the care of UK. As discussed above, there are risk factors which mental health services locally were female. People increase the likelihood of poor wellbeing and mental with personality disorders often have very chaotic health, in particular the high numbers of children lifestyles and despite having poor engagement with living in poverty. services will often then present in an emergency. The overall child population increased by 10.5% Psychosis between 2002 and 2012, and is expected to grow Around one in every 227 people in Bradford has a by a further 5.5% by 2025. The 10-14 age group is psychotic illness. Each year, just over 5% of people expected to grow by 10.2% in the next 10 years. This with psychosis or bipolar disorder experience an population growth is likely to be bigger in the most acute psychotic episode. The majority of people with deprived areas of the city. 37 Over the next 25 years, a new diagnosis of a psychotic illness are young, it is expected that the numbers of older people in the aged 24 and under at the time of first presentation. Bradford District will increase substantially, but at a slower rate than in England as a whole. Craven has an older population, with a higher proportion of people aged over 65 than in England as a whole.38
Page 94 26 Mental wellbeing in Bradford district and Craven The proportion of children achieving a “good level of For both schemes the NHS receives additional development” before they start school in Bradford funding for the first year of care. There is a flat increased from 55% in 2014 to 62% in 2015. fee for primary care as well as a reimbursement of However, this is still below the national average of the actual secondary care costs. However, meeting 66%.39 In Craven the high proportion of people these needs can represent a workforce challenge living in rural areas alongside the comparatively older for provider services and rising to this challenge population pose specific challenges which must be needs to be reflected in the wider workforce considered.40 strategy. The joint working between the BDCFT Homeless and New Arrivals Health Team and Bevan Locally, there are also issues related to new migration, Healthcare CIC is recognised as an excellent example asylum seekers and refugees. There are small groups of an integrated physical and mental health team, of asylum seekers and refugees who come to the delivering services closely with GPs and voluntary district who have very high levels of need, including sector partners. mental health needs. Refugees are about ten times more likely than the age-matched general 4.3.5 The financial crisis and mental health population to have post-traumatic stress disorder The financial crisis has had health implications across (PTSD): 9% of refugees in general and 11% of Europe. Research has shown an increase in suicides children and adolescents have PTSD.41 Refugee and over the past two decades, and a decrease in road asylum-seeking women have specific healthcare traffic deaths, as well as an unexpected increase needs. Asylum-seekers arrive in the district under in outbreaks of infectious disease.42 In Portugal, the dispersal policy, with a higher proportion being another country highly affected by the financial housed in Bradford than elsewhere across the district. crisis, between 2004 and 2012 significant increases There are currently two resettlement programmes in the rate of depression were seen in men aged for refugees in place: The Home Office oversees 55–64 years, women aged 45–54 years, and those the Gateway Programme and there is also a Syrian older than 75 years. Between 2011 and 2013, there Resettlement Programme (formally the VPRS), which was a large increase in children and adolescents is a joint unit between Home Office, Department attending psychiatric outpatient appointments. for International Development and Department for Communities and Local Government.
Page 95 A strategy 2016-2021 27 4.4 What people tell us
The development of the strategy has being informed by working together with a number of key stakeholders including, most importantly, the involvement of service users, people, children, young people and their families. The engagement has also included involvement from schools, the local authority, health commissioners and providers, voluntary and community sector and specialised commissioning colleagues. Engagement on the strategy commenced in April 2016. An engagement plan supporting this work was developed. The purpose of the engagement was to share the views and experiences we have heard to date, seek views on gaps and identify areas that needed to be strengthened.
Engagement consisted of: 1. Reviewing existing data held by the CCGs. Each CCG has an ongoing mechanism of engagement which informs commissioning and service development. Data was collated and analysed to form part of the engagement process and was shared with people and stakeholders. The information considered as part of this exercise included: • Ongoing ‘Grass Roots’ insight43 • Consultations and engagement (eg inpatient hospital provision), specific reviews and projects (eg IAPT, Future in Mind, day services review, outcomes commissioning framework, project reports) • Bradford District Care Foundation Trust involvement structures with patient groups (eg involvement groups). BDCFT is the main provider of mental health services in the Bradford district and Craven. • Monitoring information from commissioned contracts through the VCS (protected groups, non-user views, eg MIND, Cellar Trust, Sharing Voices, Horton Housing, Relate, Bradford counselling, Girlington Centre etc).
2. Communications campaign to support engagement. Planned media communications were developed and shared to engage and involve people in the development of the strategy. We invited people to feedback and share their views through a range of options: • Through our Grass Roots insight feedback system • Offer to host meetings, events or interviews and feedback to us • Invitation to attend their forum, meetings, events or interviews • Feedback via our website • A survey was designed which groups could adapt and use to feedback comments and suggestions • Share their experiences on social media • A series of press releases and articles were published to promote the work and encourage participation.
3. Engagement activities These consisted of: • We conducted face-to-face interviews during ‘discovery visits and invitations’ to voluntary and community sector organisations, Lynfield Mount hospital, community groups and events. • We attended the VCS health and wellbeing forum on two occasions and initiated discussion to start a specific mental health forum which will support implementation of the strategy. Organisations were encouraged to feedback to us directly. To date we have heard back from 31 organisations including organisations working with seldom heard groups such as homeless, young people, carers, BAME groups, substance misuse, young mothers, domestic abuse, refugees, LGBT and women’s groups. • We carried out focus groups and individual interviews between June and August 2016 and we attended a series of community held events to share information about the strategy and gain further views. • In total, we carried out 39 interviews, attended 21 groups and nine events.
Page 96 28 Mental wellbeing in Bradford district and Craven 4.5 How mental health services are organised in Bradford district and Craven now
Support to people with mental health needs is available through many different services, provided by a broad range of organisations.
Often people think of mental health services as those that are provided by mental health trusts and social services. However, for many people their most frequent contacts are with primary care, the voluntary and community sector and a broad range of other public services, including other council services such as housing or leisure services, the police and the Department for Work and Pensions. Many people experiencing mental distress or ill health will also be in contact with services around their physical health needs, often without their mental health needs being formally recognised.
A number of the existing services for people with mental health problems are recognised to be good practice examples and/or cutting edge in their approach to delivering good quality care and we should rightly be proud of these achievements. Here are four examples.
In partnership with Local Authority and emergency As part of the work to develop the Acute Mental services, we undertook a whole system review of our Health pathways locally we have also developed crisis mental health services to meet the ambitions of two new services with local VCS partners. The the national Crisis Care Concordat. As a result, we Sanctuary at MIND in Bradford provides an introduced an integrated acute care pathway for adult alternative to in-patient admission and the Haven mental health offering a single point of access for all at the Cellar Trust an alternative to A&E attendance referrals, including self-referral. This urgent mental for people with a mental health presentation. health response is acknowledged nationally as a good They have established a model based on a strong practice blueprint for others to learn from and is cited partnership between VCS and statutory services. within the NHSE implementation guidance for the Five Working with VCS enables a creative approach to Year Forward View for Mental Health. It has resulted workforce development and gives opportunities in no people from Bradford district and Craven being to experts by experience, as well as ensuring the placed in beds outside of the district, already meeting clinical and social needs are met with expert advice one of the targets that have recently been set for the and support when needed. Five Year Forward View for Mental Health.
The local primary care wellbeing service has been recognised as a key good practice example by The Physical Health check template for use with the King’s Fund as a way of effectively addressing people with severe and enduring mental health the mental health needs of people with medically problems was developed in Bradford. It is now unexplained symptoms. The service supports available nationally due to its success and backing people with high levels of physical health service at national level by the previous National Clinical use and possible mental health needs through Director for Mental Health, NHS Improving a primary care-based multi-disciplinary team. Its Quality, Health Education England and Academic interventions have reduced both iatrogenic harm Health Science Network. and the overall costs of care.
Page 97 A strategy 2016-2021 29 Rather than try to describe or list all of the services that are available, we have set out below the key mental health services that are currently commissioned or directly provided by local authority and/or NHS organisations. From our review of services and stakeholder engagement we have also identified a number of service gaps and areas for improvement. These are shown by dotted lines in the diagram.
Our wellbeing Our mental and physical health Care when we need it
Local specialised services: assessment of autism, ADHD
Care Act Assessments and personal Public health: identify healthcare needs budgets assess effectiveness of interventions Nursing and residential home care public awareness campaigns Dementia diagnosis Social care for children: education, Care and support for people with Early Years, Looked After Children, dementia and their carers children with disabilities, Youth Justice Psychological therapies for mild to moderate depression and anxiety Community-based care for severe mental health needs including CMHT, Early Intervention in Psychosis, children Physical health of people with Severe and young people’s mental health Mental Illness, Primary Care Wellbeing services Service, Urgent and acute mental health care Healthcare Psychology Public health: treatment for substance and alcohol misuse Specialist inpatient services including Rehabilitation Specialist services commissioned by NHS England: Social care for adults: daytime Secure and forensic services, Tier 4 activities, supported employment, mental health services for children supported housing and young people, Tier 4 services for Personality Disorders, Gender Identity, Homeless and New Arrivals Team services for those with serious perinatal problems, Eating Disorders, services for the deaf Social Care: Approved Mental Health Professionals, Mental Health Act duties, Best Interest Assessors Eating Disorders services for adults Autistic Spectrum Conditions (adults and children ADHD – assessment and treatment More peer led models, (adults and children) intergenerational work and resilience Psychological help for people with Improved Perinatal Mental Health building physical health problems services The future model for Community Mental Health services Community pathway for people with Personality Disorder
Page 98 30 Mental wellbeing in Bradford district and Craven As indicated above, however, there are many other services that play a vital role – particularly in the voluntary sector, whose services are often essential elements of the packages of care provided to those experiencing mental ill health. Voluntary organisations provide a range of essential services including: • advocacy • carers’ support • befriending • employment support services • bereavement counselling • talking therapies • self-help groups • meaningful daytime activity • vocational and educational services • supported housing • services to reach minority groups and communities • preventative and wellbeing services
We know that some voluntary sector groups have already closed or are vulnerable in terms of uncertainty about long-term funding and that users of their services, in particular, are concerned about how they remain sustainable. Many VCS groups already fill gaps created by pressures in the statutory services and we need to ensure that their contribution to the overall network of support services can be sustained.
We also know that VCS organisations funded for mental wellbeing contracts subsidise their contracts with non-recurrent funds, fundraising, income from social enterprise activity and their reserves and we need to understand better the potential impacts of this. To enable this we will work with them to help build their capacity to respond to the priorities set out in this strategy.
4.6 Finance
The table below sets out a summary of current spend on mental health services in the Bradford district and Craven.
New services can be established and existing services expanded only if there is evidence that they provide good value for public money as well as high quality care and good outcomes for service users. Financial constraints affecting any part of the health and social care system may have an impact on people’s mental health. Changes to areas such as social care and housing may result in additional mental health care needs; if so, we will need to respond to them. 2015/16 Expenditure on mental health services
CCG ** Local Authority *** Total
Total 2015/16 £75,681,062 £12,153,561 £87,834,623
** Airedale, Wharfedale & Craven CCG, Bradford City CCG and Bradford Districts CCG
*** Bradford Metropolitan District Council
Not included: 1. Primary care services: approximately 25% of GP consultations are mental health-related 2. North Yorkshire County Council contributions (currently not available) 3. Specialist and tertiary mental health care commissioned by NHS England on behalf of CCGs 4. Mental health prevention undertaken by teachers, social workers, school nurses, health visitors Page 99 A strategy 2016-2021 31 2015/16 Expenditure on Mental Health Services
CCG /000 Local Authority /000 Total 2015/16 Expenditure on Mental Health Services
Specialist & Tertiary Mental Health Care £0 £0 Secondary
Housing Related Support Housing £54,288 £54 £54,288 Individual Assessment and Support Assessment £2,195,826 £2,196 £2,195,826 Prescribing Voluntary Sector VCS £2,255,556 £2,256 £1,143,439 £1,143 £3,401,251
Primary Care Mental Health (incl. IAPT) Primary £4,654,098 £4,654 £4,658,752 Primary
Prescribing Prescribing £6,362,371 £6,362 £6,368,733 VCS
Individual Packages of Care (Purchased Care) Individual £8,677,354 £8,677 £6,139,933 £6,140 £14,825,965 Assessment Secondary Mental Health Care (Community & Inpatient)Secondary £53,731,683 £53,732 £2,620,075 £2,620 £56,405,490 Housing Total 2015/16 #REF! #REF! #REF! £0 £5,000 £10,000 £15,000 £20,000 £25,000 £30,000 £35,000 £40,000 £45,000 £50,000 £55,000 £60,000 £ (thousands) ** Airedale, Wharfedale & Craven CCG, Bradford City CCG and Bradford Districts CCG *** Bradford Metropolitan District Council CCG Local Authority
Not included: 1. Primary care services: approximately 25% of GP consulations MH related 2. Specialist and tertiary MH care commissioned by NHS England on behalf of CCGs 3. MH prevention undertaken by teachers, social workers, school nurses, health visitors 4.7 National guidance
4.7.1 The Five Year Forward View for Mental Health Published in February 2016, the Five Year Forward View for Mental Health is the report from the independent Mental Health Taskforce to the NHS in England focused on the experience of people with mental health problems. It initiated a process of transformation to achieve the recognition of equal importance between mental and physical health for people of all ages. The implementation plan published in July 2016 set out five common principles that local areas should adopt as they plan to deliver this Five Year Forward View: • co-production with people with lived experience of services, their families and carers • working in partnership with local public, private and voluntary sector organisations, recognising the contributions of each to improving mental health and wellbeing • identifying needs and intervening at the earliest appropriate opportunity to reduce the likelihood of escalation and distress and support recovery • responding to the needs of all individuals including those from BME communities and lesbian, gay, bisexual and transgender (LGBT) people • designing and delivering person-centred care, underpinned by evidence, which supports people to lead fuller, happier lives • underpinning the commitments through outcome-focused, intelligent and data-driven commissioning.
These are the principles that we adopted in developing this mental health strategy for Bradford district and Craven; they inform the options we considered, the vision we describe and the ways we will work with people and organisations to turn this strategy into a real system that will improve mental health and emotional wellbeing for everyone in the district.
Page 100 32 Mental wellbeing in Bradford district and Craven 4.7.2 Safeguarding children and adults Local authorities (and their partners in health, As well as abuse and neglect being recognised as housing, VCS, welfare and employment services) one of the antecedents of mental ill health, children must now take steps to support prevention, to and adults who have mental health needs are at reduce or delay the need for care and support for all particular risk of abuse. Consequently, many clients local people. disclose both current and historical experiences of abuse. This highlights the need for all services to The Act includes a statutory requirement for local contribute to the prevention of abuse, as well as authorities to collaborate, co-operate and integrate ensuring effective recognition and responses to with other public authorities. safeguarding concerns, which must include access to long term recovery work for survivors. Information and advocacy should be available to all. Working Together to Safeguarding Children (2015) and The Care Act (2014) set out the legal All areas should have safeguarding as a priority frameworks for safeguarding children and adults, with clear requirements on all agencies to work Everyone has the right to request an assessment collaboratively at both operational and strategic leading to a care plan and services via individual levels. This means that prevention, recognising and budgets or direct payments when possible. responding to abuse, whether current or historical, must be considered in all aspects of mental health This mental health strategy is based upon the commissioning and service delivery. integration of the Care Act 2014 with the Five Year Forward View plan to ensure that mental health 4.7.3 The Care Act 2014 services are providing the full range of support The Care Act 2014 builds on legal reforms, replaces required in an integrated way. numerous laws and provides a coherent approach to the provision of adult social care in England. It affects 4.7.4 Children and Young People the local authority and all of its partners, especially Future in Mind was published in March 2015 by the NHS, VCS and police. the government’s Children and Young People’s Task Force.44 It provides an opportunity to develop services Part one of the Act (and its statutory guidance) collaboratively and challenges localities to establish a consolidates and modernises the framework of locality transformation plan against the following five care and support law; it set out new duties for local key themes: authorities and all its partners, and new rights for • promoting resilience, prevention and early service users and carers. intervention • improving access to effective support – a system The Care Act is designed to achieve: without tiers • clearer, fairer, care and support • care of the most vulnerable • wellbeing – physical, mental and emotional – of • transparency and accountability both the person needing care and their carer • developing the workforce • prevention and delay of the need for care and support • people in control of their care.
The Care Act 2014 provides health and social care with a new emphasis on wellbeing. Underpinning the Act is the new statutory principle of individual wellbeing which should be the driving force behind any care and support.
Page 101 A strategy 2016-2021 33 4.8 Relationships with other strategies and developments Mental health and wellbeing services are part a broad network of systems that affect the way we live, how we take care of ourselves and our families, and our access to support from professionals. The diagram below shows how this strategy for mental health and wellbeing is related to other areas, some of which are complete while others still require development.
Autistic Spectrum Conditions
Prevention of Dementia ill- health Urgent and Self-care Personalised Schools Emergency Care Accountable Care System care
Housing
Employment Mental Health and Wellbeing Strategy Sustainability and Transformation Plan Transformation
Substance misuse Acute Environment services sector and transport Primary care
Out of hospital Safeguarding
Learning disabilities
Page 102 34 Mental wellbeing in Bradford district and Craven The Future
Page 103 A strategy 2016-2021 35 5. The Future of Mental Health Services in Bradford district and Craven
Where do we want to be? We will work to ensure that when this strategy is fully implemented in 2021, these statements will be true for everyone who lives in Bradford district and Craven:
I have as much choice and control as possible in my life
I understand my health needs and what keeps me well, and I am encouraged and supported to do more of the activities that keep me well
In situations where I am not able to be in control, I am supported to maintain my rights and dignity and to make choices that support my recovery
I am treated with warmth and compassion and I feel respected and listened to. My concerns are taken seriously
I know how and when to access advice, support and treatment
I am not judged for how I feel or what I have done
I understand my condition and have the help I need to live my life to the best of my ability without my condition taking over my life
I have choice and opportunity to access different therapies, approaches and activities and I have support to get better without medication
My fality or carer is actively supported and involved in my care
Page 104 36 Mental wellbeing in Bradford district and Craven 5.1 Our wellbeing The complexity and size of this task can make the prioritisation of local preventative actions Strategic, system-wide action is required to identify challenging, but the initial step is to map existing and take opportunities to improve the mental health prevention-focused services onto the local data to of our population, at all stages of life. understand the gaps and priorities for the locality. The Mental Health Foundation’s sample mapping We need to ensure that in the future, health and care tool is reproduced in Appendix 2. This would is viewed as a universal asset to be strengthened and allow a ‘universally proportionate’ approach47 to protected. In thinking about mental health in this be adopted where mental health can be protected way, managing mental ill health is still an important overall, but also ensure that people at higher risk factor but is no longer the primary focus. It will require of mental health problems are given an appropriate commissioning that is expanded beyond the current level of priority. Such an approach paves the way to focus on services that are specific to mental ill-health tackle prevention and wellbeing at three levels: to community, social relationships and place-based 1. primary prevention through improvements to the solutions, as laid out in the Care Act. social, emotional and physical environment for everyone However, we recognise that we will need to balance 2. secondary prevention targeted support for this shift of focus, ensuring that high-quality services high-risk groups and at known trigger points in are available and accessible to those who need them, people’s lives but at the same time intervening early to reduce the 3. tertiary prevention targeted at people are already need for more specialised services and to give people experiencing distress or have a known mental and communities, the resources to protect and health problem to prevent problems getting manage their own mental health. worse.
The effective support of people The Five Year Forward View experiencing mental health (5YFV) for Mental Health problems is set to become one provides an important context of the greatest public health for this approach. A key aspect challenges of this decade. Without action on is the development of a national prevention the increasing demand for public services, concordat programme to support all health it will not be possible to absorb the rising and wellbeing boards (along with CCGs) to costs of providing care and support for those put in place joint strategic needs assessment experiencing mental ill health in the long- and mental ill health prevention plans by no term. This creates an economic imperative for later than 2017. The Care Act also supports this approach, especially the emphasis on wellbeing, prevention and choice. We can only do this by working with communities to understand the influences on their mental wellbeing and, where possible, build on their existing strengths, The Five Year Forward View for Mental Health48 resources and resilience. This can be advanced identifies the following areas for action: through a ‘whole community approach’, which 1. support for new mothers and babies provides a framework to consider all of the factors 2. mental health promotion within schools and that influence mental health and allows mental workplaces health to be reviewed across a wide range of local 3. being able to self-manage mental health policies, services, systems and data that impact the 4. ensuring good overall physical and mental health mental health and wellbeing of communities.46 and wellbeing 5. getting help early to stop mental health problems from escalating
Page 105 A strategy 2016-2021 37 The publication of this strategy provides significant opportunities for the district to take action to improve and protect the public’s health. W1 We will design and deliver The mental health and prevention report from the a comprehensive mental health Mental Health Foundation provides a comprehensive improvement programme that set of evidence-based examples to inform local will target increased awareness, action.49 The following priorities are informed by capacity for self-management and this work in the context of local needs as well as the the need for early intervention and policy drivers. A number of the recommended areas self-care. for action are covered by priorities in other local strategies and plans as well as in specific sections later in this document.
The Care Act 2014 outlines the following areas for As described in chapter four, the environment action: in which people live and the circumstances in 1. wellbeing to be at the heart of our strategy which they are living have a big impact on their 2. prevention to be at the heart of our strategy wellbeing and risk of developing a mental health 3. control and individual budgets to be at the heart disorder. Improvement of wellbeing and prevention of our strategy of mental illness, therefore, can only be achieved 4. advocacy to be fully available through the co-ordinated efforts of local policy- 5. safeguarding to be core to all services and decision-makers. Organisations that are crucial 6. for all services to be linked to our self-care in supporting positive wellbeing include, but are strategy not limited to, those with impacts on community, housing, education, employment, food, the built 5.1.1 Developing mentally healthy communities environment, green space, transport, and the and places criminal justice system. Every decision made by an It is well known that stressful life events place people organisation or department with an impact on such at higher risk of mental health problems. These areas must, therefore, aim to improve the wellbeing stressors include abuse, homelessness, financial of the population. insecurity, bereavement and unemployment, to name only a few. The concept of resilience can explain the extent to which people are protected from the damaging effects of stressful life events. Resilience can be at a community or individual level (World Health Organisation Europe 2009).50 W2 We will ensure that mental Prevention of mental illness should combine both health improvement is a central universal approaches to strengthen the resilience outcome of all community and mental health awareness of communities and investment and regeneration. individuals, and targeted approaches. Targeted work would involve identifying those people at higher risk of mental Illness due to their environment or individual risk factors, or specific life events, and giving them additional support.
Page 106 38 Mental wellbeing in Bradford district and Craven 5.1.2 Reducing stigma and discrimination in hospitals, prisons and secure care and increased Public Health England has signed up to Time to responsibilities when they leave. Social care supports Change, an anti-stigma campaign run by the leading people as they get older, if they are vulnerable or lose mental health charities Mind and Rethink Mental capacity. Many mental health problems develop from Illness.51 According to the English parliament website, social issues and prevention and recovery is dependent public awareness campaigns have been the principal on social care and health providers working hand in means of tackling negative attitudes and dispelling hand in line with the Care Act 2014. The social care misconceptions about mental health.53 The largest focus on assessment, personalisation and recovery, campaign has been Time to Change, which includes supports people to make positive, self-directed change. a media advisory service. Locally we are committed to reducing the stigma and discrimination experienced The all party parliamentary group on social work by people with lived experience of mental health. We (September 2016) recognised the vital role mental are expanding our use of digital technology, especially health social work in supporting people with mental social media and web, to raise awareness amongst our health problems: wider population around the stigma and discrimination faced by those experiencing mental health issues. Social workers fulfil a vital role in protecting people’s rights when they are in crisis or where a situation has deteriorated – particularly through their work in safeguarding, as Approved Mental Health Professionals (AMHPs) and Best Interests Assessors (BIAs). Social W3 We will develop and deliver workers are also trained to take a strengths-based evidence-based stigma and approach to prevent and reduce deterioration – to discrimination reduction work holistically and collaboratively with them, programmes that focus on their family and social networks. They focus on sustained behavioural change. empowerment and a solution-focused approach. They focus on protecting human rights and promoting social justice for individuals, families and communities. These are often the things that people using services say are most important to their recovery.51
The social care model of mental health recognises the social antecedents and determinants of mental distress throughout life that this strategy seeks to address.54 This W4 We will promote mutual includes poverty, self-care, quality of housing, work, support opportunities and relationships, trauma, loss and abuse. It also means encourage the spread of mental supporting recovery and change through focusing on health champions in organisations the person as a whole – their fundamental human and business. potential and the opportunities they could access to bring about change.
5.1.3 Social care, social work and mental health Social care and the social model of mental health W5 We will continue to support a support and recovery has a major role in the provision strong social care and social work of mental health services. Social care provides most of role within mental health services, the housing support for vulnerable people and a range integrated with health and VCS of longer-term care and support through residential, service provision. nursing or specialist placements, often jointly with the NHS. Section 117 of the Mental Health Act means that social care services have a responsibility to people Page 107 A strategy 2016-2021 39 5.1.4 Integrated approaches to health and to hospital, lengths of stay can be kept to a minimum social care and the risk of re-admission reduced when they can be Mental health services in Bradford district and Craven moved into supported accommodation designed for have a substantial track record of providing integrated their needs. health and social care services as well as a strong reputation for joint working with the VCS. We are Ensuring that we have sufficient supported committed to the continued development of this accommodation to support people is essential to the approach through joint working and developing joint realisation of caring for people in the least restrictive services and strategies, including an expansion of the environment and avoiding hospital admission. Effective scope of integration through the development of support at home provides the opportunity to realise accountable care systems to include the integration of cost reductions in the provision of more specialist physical, social and mental health pathways. In addition inpatient care, residential or nursing care and service to existing commitments we will also prioritise the users have better outcomes and more independence following. in their own home. This is in line with an enablement and recovery model of care.55,56
Commissioners have already implemented a new supported living framework that has clarified the W6 We will adopt wellbeing models standards, pricing structure and support expectations and pathways that integrate for supported accommodation for all providers in physical and mental health, in our locality. This commissioning strategy supports which social care is a core part of the use of this framework to develop supported our strategy and we will support accommodation provision. social function, spirituality, self- management and peer support As in many other areas across the country the NHS, through the Care Act 2014. local authority and housing providers are committed to working in partnership to develop jointly commissioned supported housing provision.
5.1.5 Developing mentally healthy homes In addition we will support the following evidence- Housing is a basic need for everyone and developing based interventions for delivering mentally healthy mentally healthy homes is an important element of the homes in Bradford district and Craven. recommendations from the Mental Health Foundation report on developing prevention strategies. In keeping with the universally proportionate approach, as well as developing mentally healthy homes as a universal principle, we must also have a clear focus W7 We will ensure local housing on the needs of those with an existing mental health and regeneration policy and problem, as good quality housing is a key part of the planning creates public and private prevention and recovery process. To this end, a range housing which provides a safe, of appropriate housing options is essential to facilitate stable environment that promotes effective discharge from hospital. In our locality we community cohesion and mental have a history of good quality supported housing for wellbeing. people with mental health care needs.
People with a mental health problem are less likely to require urgent and hospital-based care if they live in good stable housing, especially where specialised social and health support is provided and particularly if that support can be flexible and reflect the level of need. Furthermore, where people have had to be admitted Page 108 40 Mental wellbeing in Bradford district and Craven Making the case The moral, economic and legal case for enhancing W8 We will develop a range of mental health in the workplace is abundantly social and supported housing clear for individuals, organisations and the options for people with mental wider economy. Research by the Centre Forum health care needs. Commission led by former Health Minister Paul Burstow found that mental health problems cost UK employers £26 billion each year, through lost working days, staff turnover and lower productivity, averaging £1,035 per employee.58 From a legal 5.1.6 Developing mentally healthy workplaces perspective, Management of Health and Safety at The ‘whole system approach’ to improving mental Work Regulations 1999 also require employers to health, clearly identifies the workplace as an important assess and to act to control the risk of stress -related setting to educate and raise awareness, encourage ill health arising at work. positive health behaviours and self-care, and protect the mental health of individuals. There is also a good Conversely, research shows that investment in health opportunity for early detection and prevention of and wellbeing programmes, increases employee deterioration which can lead to long periods of sickness satisfaction, leads to higher organisational profile absence, and worklessness in the longer-term. This and reputation, higher productivity, reduced sickness is incredibly important as the longer a person is off absence and reduced staff turn-over.59 Evidence sick, the more difficult it becomes for them to return from the Sunday Times’ “best companies to work for to work and the less likely it is that they will return to in the UK” has shown that companies with higher work at all. levels of employee engagement - as measured employee wellbeing, line management and team ‘Good work’ has a positive impact on both physical working - have 13% lower staff turn-over, less than and mental health. It is clearly linked to social identify half the sickness absence of the UK average and, on and status, building resilience, self-esteem and self- the stock market, have consistently out-performed efficacy, and is a setting for social contacts and support. the FTSE 100.60 It is also a means of ‘structuring and occupying time; activity and involvement; and a sense of personal Outside the workplace there are clearly numerous achievement. That as many as 90% of workless social and economic benefits to individuals, families people who use mental health services wish to work and communities. Families without a working suggests that people with mental health problems are member are more likely to suffer from persistent aware of the benefits of employment. low income and poverty. There is also evidence of a correlation between lower parental income and poor The key, though, is ‘good work’ and there are clear health in children.61 factors in the workplace which are protective and beneficial for health. Conversely, poor work conditions Aspirations for the future can have a detrimental effect on the mental health Our vision is that workplaces across Bradford district of individuals. Seventy-seven percent of more than and Craven become renowned for tackling stigma, 3,000 people who responded to a National Employee promoting positive mental health and wellbeing for Wellbeing Survey said they had experienced symptoms all, creating the conditions needed for ‘good work’ of poor mental health; 62% of these attributed and delivering supportive, reasonable adjustments their symptoms to work or said that work was a for those individuals who need additional help contributing factor.57 In addition, mental ill health to stay well and retain their work. This strategy leads to many employees leaving employment and is recommends that all of its signatories set an example the most common reason for claiming health-related in encouraging organisations from all sectors to unemployment benefits. Despite this, employer proactively champion mentally healthy and inclusive awareness of mental health issues at work in the UK is work places. This will include a proactive approach to poor and discrimination still rife. recruiting individuals with mental health problems. Page 109 A strategy 2016-2021 41 We also want to take a system-wide, proactive and person-centred approach to supporting people into We will support people to work after a period of mental ill health, or with long- W10 develop the skills and confidence term mental health conditions – recognising that needed to be work ready, engage one size does not fit all and there is a spectrum of with employers to enhance need across our district. One of the key deliverables accessible job opportunities, and of the 5YFV for Mental Health is doubling the reach provide support to both individuals of employment support individual placement and and employers to help more people support (IPS). BDCFT is a centre of excellence for IPS with mental health problems to through its Making Work, Work scheme, which saw 86 retain their employment. services users going into paid employment during an 18-month timescale. These people will have reduced or no need for services from community mental health teams (CMHTs). Evidence suggests IPS participants are twice as likely to gain employment (55% versus 28%) In Great Britain as a whole compared with traditional vocational alternatives.62 We 73.7% of people aged 16-64 will explore how this evidence-based approach can be were in employment during the embedded and sustained. period April 2015 – March 2016 compared with only 66.4% of This strategy will support and develop people at every people in Bradford.64 stage of their recovery to become ready for work and then to access employment. We will also concentrate on supporting people having difficulty in work due to 5.1.7 Suicide prevention their mental health, to retain their employment, thus The suicide rate is rising in Bradford in line with avoiding the risk of long-term worklessness. national trends, but consistently above them. A rate of 12.1 deaths by suicide per 100,000 people was Outside the workplace there recorded from 2012-2014, compared to a national rate are clearly numerous social and of 10.1 per 100,000 nationally. This means between 40 economic benefits to individuals, and 50 people a year are taking their own lives in the families and communities. district (although numbers vary considerably each year). Families without a working member are more There have been a small number of suicides in young likely to suffer from persistent low income and people aged 15-19 in the district over the last decade, poverty. There is also evidence of a correlation similar to rates seen nationally, and Public Health, the between lower parental income and poor Bradford Safeguarding Children Board Child (BSCB) health in children.63 death overview panel and the Future in Mind Strategy Group work together to monitor these trends.
Partners in the district - including the hospital and W9 As the largest local employers, mental health trust, commissioners, local authority, we will lead the way in establishing a MIND, Samaritans, WY Police and WY Fire and Rescue district-wide network of organisations - meet regularly as part of a suicide prevention group. that are passionate about, and During 2015/16 this group updated the comprehensive committed to, mentally healthy audit of deaths by suicide in Bradford from 2013 and workplaces with all health and reviewed the national and international evidence local authority services achieving a for effective prevention. This is now leading to the mental health charter mark. We will formulation of an action plan, based on the national proactively share best practice and prevention strategy, which will be completed in early facilitate small to medium enterprises 2017. Partners are also involved in work at a West to engage through accessible training Yorkshire level around suicide prevention within the and tools. urgent and emergency care vanguard. Page 110 42 Mental wellbeing in Bradford district and Craven The key areas we will focus on are: The General Practice Forward View (GPFV) focuses on five main areas: investment; workforce; • prevention through targeted approaches to workload; practice infrastructure; and care re-design. improve mental wellbeing in specific groups Against each area the GPFV outlines what NHSE • reducing the risk of suicide in high-risk groups expects in order to support delivery of the Forward (adults and children) View. One of the main areas of interest relating to mental health is that over the next five years there • providing better information and support to will be investment in an extra 3000 mental health people bereaved of affected by suicide therapists to work in primary care by 2020, to support localities to expand the improving access to • reducing access to the means psychological therapies (IAPT) programme. of suicide To deliver the GP Forward View we will develop • support in the media in delivering sensitive local plans to stabilise general practice delivery now, approaches to suicide and suicidal behaviour to be resilient and sustainable in the future and to prepare for new ways of delivering care as part of • support research, data collection and monitoring Accountable Care Systems. General Practice is the to inform local actions. cornerstone of care and the key foundation of the whole health and social care system. It is unlikely that the future model of general practice will look like the service that is here today. Over the next five to 10 years the service needs to transform, adopting new ways of working and new ways of delivering care as part of an accountable care system (ACS). W11 We will support The ACS will require all providers to work together the development and to deliver defined outcomes which meet individuals’ implementation of the local physical, psychological and social care needs. To do suicide prevention strategy. this we will learn from what we have done well and, we will be at the forefront of testing new models of care and accountable care. We will innovate and share learning acquired through involvement in national programmes such as ‘Pioneer’ and ‘Accelerate’ and look to national and international 5.2 Our mental and physical health and care examples of best practice. We will, and will establish a culture which facilitates curiosity, to enable 5.2.1 Primary care new ideas to be tested and tried. We will change In April 2016, NHS England (NHSE) in partnership cultures and mind-sets so individuals become active with The Royal College of General Practitioners participants in their own health and wellbeing and (RCGP) and Health Education England (HEE) have ready access to information and support to self- published the General Practice Forward View.65 This care and self-manage conditions. Prevention is key document is a ‘Forward View’ for primary medical and we will work with stakeholders and individuals care services, also known as ‘general practice’. It with the aim of preventing and avoiding early onset highlights the key challenges which face primary of mental and physical health conditions. medical care currently and the changes and developments which NHSE, RCGP and HEE identify Contemporary western medicine is based on a as being high priority in ensuring a high quality and tradition of treating mental health separately from sustainable primary medical care service is in place in physical health – a tendency to assume that diseases the future. occur independently of the social context. When mental health is treated as separate from physical Page 111 A strategy 2016-2021 43 health and social determinants, the healthcare experience is often stigmatised and the care process is fragmented. Depression, the most common H2 We will develop a model of mental health condition seen in general practice, integrated physical and mental often occurs with, and compromises, care of other health services whereby people can chronic illnesses; yet stigma and secrecy often have their care needs met at the cause depression to go undetected, undiagnosed, same location as part of an agreed or under-treated.66,67 We will ensure that the pathway of care. outcomes defined as part of an ACS take account of individuals’ physical, psychological and care needs and mental health is equally as important as physical 5.2.2 Mental and physical health health. The presence of co-morbid mental and physical illness is known to worsen outcomes for patients The GP Forward View has six priority themes for and increase costs for health services.68 Overall, general practice, all of which will improve the the research shows that co-morbid mental health care and treatment of people with mental health problems are a major determinant of overall costs, problems and the development of a local response to typically associated with a 45–75 per cent increase in the GPFV will have mental health at its core. The six service costs for long-term physical health conditions. themes are: In 2010-11, mental illness raised the cost of physical health care in the NHS by an estimated £10 billion.69 • improving access to primary medical care services (in-and out-of-hours) One of the two main groups in which management of co-morbidity is particularly challenging is patients • improving the quality of primary medical care with medically unexplained symptoms (MUS) and services somatisation. MUS cause considerable distress, disability and poor outcomes for patients.70 Primary • developing the primary medical care workforce care is the patient’s first and continuing point of access but GPs may lack time, specialist knowledge • promoting self-care and prevention and strategies to manage them. Repeated investigation of the causes of symptoms can lead to • collaborative working unnecessary, costly and sometimes damaging tests and treatments.71 The patient-health professional • estates, finance and contracting, better premises relationship suffers as there is no resolution, which and well-resourced practices can provide better is frustrating for the patient and the GP. It has care for patients with mental health problems been estimated that around 20% of all primary care consultations are for MUS and the annual In response to these we will: healthcare costs in the UK exceed £3.1 billion, with total costs to the UK economy estimated at over £18 billion.72,73 The Bradford and Airedale primary care wellbeing service has been recognised as a key good practice example by the King’s Fund as a way of H1 We will improve the knowledge addressing this issue.74 The service supports people and awareness of mental health with high levels of physical health service use and within the primary care workforce possible mental health needs through a primary care to enable a more holistic approach to based multi-disciplinary team. Its interventions have patient management. reduced both iatrogenic harm as well as reduced overall costs of care.
Page 112 44 Mental wellbeing in Bradford district and Craven Co-morbid physical and psychological conditions – This is an existing priority area for the district and usually described as long-term conditions (LTCs) – also further to consultation and discussion the following result in poorer health outcomes and reduced quality areas have been highlighted for action. of life.75 Multi-morbidity is particularly associated with mental illness, which delays recovery from both mental and physical symptoms.76 Co-morbidities have a further interaction with deprivation which W12 We will provide support makes a significant contribution to generating and to people with mental health maintaining health inequalities.77 The total cost to the problems and complex physical NHS each year of poorly managing these conditions is needs to navigate services estimated at between £8-13 billion, the costs to the to maximise wellbeing and UK economy as a whole being estimated to exceed independence. £100 billion.78 As part of the Five Year Forward View for Mental Health, NHS England has set out plans for the expansion of IAPT for people with LTCs. This is supported in 2017/18 through non-recurrent funding to establish IAPT LTC services, with a clear set of expectations that sustainable funding will be generated through savings within physical health care. H3 We will develop the role of VCS and Community groups to provide access to early intervention support In secondary care, 50% of outpatients fulfil criteria which improves personal resilience. for MUS with a wide range of disorders.79 At 12 months these percentages across different specialities are: gynaecology (66%), neurology (62%), gastroenterology (58%), cardiology (53%), rheumatology (45%), general medicine (40.5%).80
These two key clinical problems overlap since people with MUS often have a physical disorder which forms the basis of their complaints but which cannot explain all their symptoms, and people with poor adjustment H4 We will develop an integrated to one or more LTC will often present with an undue approach to the identification of focus on the symptoms or treatment of their physical mental ill health in secondary care disorder. pathways, to improve the outcomes of physical health treatment. There are currently a range of services provided across the spectrum of need, but they are not currently co- ordinated, consistent or equitable in meeting needs.
In designing a future model, we need to consider the evidence base to inform the prioritisation of areas for action and the skills that are required to meet those needs, whilst acknowledging that existing examples H5 We will further develop the of good practice are limited and that local services are targeted approach to patients with already viewed as best practice exemplars. This, for medically unexplained symptoms example, could build on the learning from the Airedale (MUS) in primary care to improve complex care model where 70% of referrals experience patient outcomes and efficiency. depression with the next most common presenting problems being chronic pain followed by anxiety.
Page 113 A strategy 2016-2021 45 5.2.3 Psychological therapies in diabetes, chronic obstructive pulmonary disease Psychological therapies have a significant role (COPD), cardiovascular disease and – for some to play in improving the mental health of our people – chronic pain and medically unexplained local population. Our vision is increased access to symptoms. It is expected that over the longer-term, psychological therapy, engaging people earlier to fewer complications will result in reduced demand prevent deterioration in their mental health; reducing across the pathway. the social and economic impact for individuals, their family and community.81
Since its introduction in 2008, W13 We will extend the recovery the national improving access college service model through a to psychological therapies multi-provider network to offer (IAPT) programme has online evening and weekend successfully increased the accessibility of psychological interventions. talking therapies for common mental health disorders (anxiety and depression). Across the district services aim to engage 15% of those estimated to be suffering from anxiety and depression at any given time, around 75,000 people. W14 By 2020/21, 90% of people who access psychological We are already transforming our local psychological therapies will engage through therapy services into a multi-provider network that direct self-referral. offers choice, flexibility and easy access. Historically over 90% of referrals for psychological therapy services are via GP, which can lead to delays in engagement.
Increasing access to psychological therapy is a key objective for mental health services nationally and locally, aiming to increasing from around 12,000 H6 We will increase access to to 19,500 treatments per year across the district by IAPT from 15% - 25% prevalence 2020/21.82 providing an additional 7,500 treatments per year, 5,000 of whom Delivering new LTC IAPT services is expected to will have long-term conditions. deliver substantial savings, with services quickly becoming self-sustaining. These savings are based on evidence of physical health improvements for people with long term conditions when co-morbid mental health problems are treated in an integrated way.83 Reduced healthcare utilisation in, for H7 We will ensure that services example, A&E attendances, short stay admissions provide a balanced range of effective and prescribing costs will release funds to enable therapies as well as pharmacological 84,85 continued investment in these new services. interventions that are culturally The conditions for which there will be the greatest appropriate and effective. reduction in cost are those for which depression or anxiety co-morbidity leads to a 50-100% increase in physical healthcare costs. The strongest evidence is
Page 114 46 Mental wellbeing in Bradford district and Craven 5.2.4 Care pathways for victims of sexual early intervention in psychosis to ensure the checks assault and domestic violence are undertaken routinely. BDCFT services are smoke Only 20% of victims of sexual assault will go to a free, which should lead to a reduction in smoking. sexual assault referral centre and the rest present elsewhere (eg A&E, GP and mental health services). The physical healthcheck Many of the clients in mental health services disclose template developed in Bradford a history of abuse. Even where victims of abuse is now available nationally make an initial attendance at a specialist resource, due to its success and backing many victims will require longer-term on-going at national level by the previous National support. However, victims of child sexual abuse will Clinical Director for Mental Health, NHSIQ, take an average six years to report and will often Health Education England and Academic present as adults rather than children. There is a Health Science Network. need to ensure partners and the public are fully aware of the services available to provide longer- term support and intervention Not looking after SMI patients’ physical health is known to result in an increase in accident and emergency attendances and unplanned admissions. This is significant since 81% of emergency W15 We will ensure that local admissions for SMI patients are for physical health services/pathways are skilled problems.86,87,88 to recognise and meet the longer-term needs of people who experience sexual assault or domestic violence. H8 We will reduce premature mortality associated with physical ill health in people with severe mental 5.2.5 Physical health care of people with Severe illness to below the Yorkshire and Mental Illness Humber average by 2020. People with severe mental illness (SMI) die on average 15-20 years before the general population. This is mainly due to cardiovascular problems eg heart attacks, or cancer as a result of smoking and obesity, which can be related to the medication given. The cost of smoking in SMI people was £2.46 billion in 2009/10.
In Bradford district and Craven we have developed an electronic template to make doing annual physical health checks in SMI patients much easier. It provides a structured process to ensure clinical staff undertake all the necessary checks (eg blood pressure, weight, smoking status etc.). This has resulted in the district featuring in the top 10 in the country for performing physical health checks in SMI patients, allowing doctors to pick up early warning signs of problems such as heart disease. The process is shared with inpatient and community mental health services in BDCFT although more work needs to be done in children’s mental health services and
Page 115 A strategy 2016-2021 47 5.3 Mental health care when we need it Further guidance for the transformation plans was published in August 2015 with additional 5.3.1 Children and young people recommendations for eating disorder services and Future in Mind: the children and young people’s crisis intervention. A locality transformation plan (LTP) mental health transformation plan for Bradford has been developed via a multi-agency group and the district and Craven sets the local vision for children’s participation of children and young people. 90 This is a mental health and wellbeing.89 Children and five year plan in order to build responsive and sustainable young people will have access to a comprehensive services in order to ultimately improve the mental health range of psychological interventions to meet the and wellbeing of CYP in Bradford and Airedale. needs of a diverse young population. Services will be accessible, informed and flexible to meet the The LTP has resulted in local commissioners being needs of children and young people in a variety able to access funding relative to their population size of settings. This involves partners across statutory, which amounted to £1.1m recurrently for five years in voluntary and community services that have a Bradford and Craven. This has been agreed to support shared goal supporting and safeguarding the the priorities within the Future in Mind guidance and mental health and emotional wellbeing of children commitments in the LTP locally. This investment has and young people across the district. Access to also afforded the opportunity for commissioners and psychological interventional help should be at the providers to review the existing pattern of investment earliest opportunity for all young people to reduce and re-align towards meeting the needs of priority risk of escalation and eventual need for specialist groups. intervention. The incidence of mental health and emotional wellbeing To achieve this, we will improve access to, and the problems is more prevalent in looked after and adopted quality of, services and outcomes for children up to children and they are more likely to be involved with the age of 18 years. This covers acute and urgent youth offending, substance misuse and child sexual care, community services, child and adolescent exploitation. mental health services (CAMHS), health promotion and ill health prevention. Further to this work, Locally, young people as well as other stakeholders have Future in Mind was published in March 2015 by told us that the transition to adult services isn’t always as the government’s Children and Young People’s Task good as it could be. The experience of transition is often Force. It challenged localities to establish a locality affected by the individual’s needs, but it is acknowledged transformation plan against the following five key that some young people need additional supports until themes: they are older. Many services adopt a more flexible approach to meeting needs up to the age of 25 and • promoting resilience, prevention and early the local plans for Journey to Excellence include the intervention development of an integrated service for young people aged 14-25 with complex health and/or disabilities. • improving access to effective support – a system Young people will benefit from this approach being the without tiers norm across mental health care and we will embed this aspiration into other service development plans. • care of the most vulnerable
• transparency and accountability W16 We will develop a network to deliver mental health and • developing the workforce emotional support in each school to promote mental wellbeing amongst young people.
Page 116 48 Mental wellbeing in Bradford district and Craven 5.3.2 Perinatal mental health W17 We will improve the Perinatal mental illness is a significant complication awareness and understanding of pregnancy and the postpartum period. These of mental health for all people disorders include depression, anxiety disorders, and working with children and young postpartum psychosis. Perinatal mental illnesses cost people the NHS around £1.2 billion for each annual cohort of births. In comparison, it would cost only an extra £280 million a year to bring the whole pathway of perinatal mental health care up to the level and standards recommended in national guidance.91 This is a case for investment that cannot be ignored. Perinatal mental ill health is associated with 23% of C1 We will establish mental health maternal death, 1 in 7 of which are suicides. BDCFT expertise within the entry point to children’s services to enable has used existing resources to improve perinatal, access to early help/mental health including parent-infant, mental health care. services. Taken together, perinatal depression, anxiety and psychosis carry a total long- term cost to society of about £8.1 billion for each one-year cohort of births in the UK. This is equivalent to a cost of just C2 We will develop a community- under £10,000 for every single birth. based service for young people with eating disorders to support care delivery at home in order to Within the 5YFV for mental health there is a target reduce Hospital admissions. for NHSE specialist commissioning to increase access to specialist perinatal mental health support in the community or in-patient mother and baby units by 2020/21. This will require collaborative working across the STP footprint but also requires local services to be able to respond to the needs of women during this period. Mental health teams C3 We will extend access to crisis need to be alert to and aware of perinatal mental care through the First Response health issues, including the specific characteristics of Service (FRS) by appointing severe perinatal mental illness such as post-partum CYPMH specialists within the psychosis and locally there is a referral pathway, via a team. single point of access, for perinatal illness.
C5 We will work with partners C4 We will develop a dedicated to develop a West Yorkshire looked after and adopted children specialist perinatal mental health therapy team to deliver support, team that interfaces with local consultations and supervision to evidence based pathways. those teams working with these vulnerable groups.
Page 117 A strategy 2016-2021 49 5.3.3 Early Intervention in Psychosis The Bradford and Craven early intervention in C6 We will improve access for psychosis services are integrated health and social people experiencing a first care services that have historically responded to episode of psychosis to a NICE the needs of people from 14 to 35 years of age approved care package within and provides evidence-based care for people who two weeks of referral from 50% to are experiencing the first symptoms of psychosis. 60% by 2020/21. Psychosis has far-reaching implications for the individual and their family; without support and adequate care, psychosis can place a heavy burden on carers, family and society at large. The onset of psychosis is most frequently between the ages of 14 We will develop an evidence- and 35, therefore often during a critical period in a W18 based pathway for people at risk person’s development. of psychosis to reduce the risk of transition to psychosis. In the past it has taken up to two years after the first signs of illness for an individual to begin to receive help and treatment, but early treatment is crucial because the first few years of psychosis carry the highest risk of serious physical, social and legal harm. 5.3.4 Community mental health services Community mental health teams Community mental health teams currently provide Nationally, one in ten people with services to those experiencing a range of mental psychosis commits suicide – two health problems that require expert and often thirds of these deaths occur collaborative approaches from a multi-disciplinary within the first five years of team of professionals integrated across health illness. and social care. This model has been in operation for several decades and incorporates multiple Intervening early in the course of the disease can clinical pathways and medical, nursing, social, prevent initial problems and improve long- term and psychological approaches. Often community outcomes. Some people experience things that could mental health teams have been providing a long- be ‘warning signs’ that people are vulnerable to the term and open-ended supportive approach to development of psychosis. These early experiences individuals. are called ‘prodromal’ symptoms. Psychological and social interventions can be provided to reduce the As services have developed specific evidence- risk of transition to psychosis based delivery in areas of speciality such as early intervention in psychosis and IAPT, the model and The 5YFV for Mental Health requires, by 2020/21, at client groups served by CMHTs have shifted. As least 60% of people with a first episode of psychosis a result, the current model of CMHT requires a to start treatment with a NICE-recommended comprehensive review so that they complement package of care with a specialist early intervention these developments and look to provide a in psychosis service within two weeks of referral. It recovery and prevention oriented approach within also requires services to extend the service to include clear clinical pathways that are outcome based. people aged 14-65 years. Stakeholders also want to explore the options for better integration with primary care and other community services.
Page 118 50 Mental wellbeing in Bradford district and Craven Page 119 A strategy 2016-2021 51 CMHTs have also been the key focus for the • Prevention of Crisis: Community mental integration of health and social care in mental health health services should put into place support services. Social work, community psychiatric nursing, systems that reduce mental health crisis; occupational therapy and a range of support specialisms all have a crucial role in mental health • Clinical Pathways: In line with the 5YFV, services and improving mental health outcomes care will be provided based on evidence- for citizens. Mental health nursing has formed the based pathways to ensure the delivery of a core of the CMHT workforce since their inception. co-ordinated recovery based packages of care The role of nursing within CMHTs has expanded providing expert knowledge, facilitation and over many years, including the development of treatment with a multi-professional approach; specialist nurse practitioners, nurse prescribing and the delivery of a broad range of therapeutic • Primary Care: Community mental health interventions. It has also been influenced by the services will enhance partnership working with integration with social care. Social workers bring primary care; a distinctive social and rights-based perspective to mental health services. The social care focus on • Partnership with VCS organisations: assessment, personalisation and recovery supports Community mental health services will people to make positive, self-directed change. Social strengthen and further develop collaboration workers also manage some of the most challenging and partnership with voluntary and third sector and complex risks for individuals and society, and organisations. take decisions with and on behalf of people within complicated legal frameworks, balancing and protecting the human rights and best interests of C7 We will complete a review different parties. This includes, but is not limited to, of the current model of CMHT their vital role as the core of the approved mental and re-design services to meet health professional (AMHP) workforce and as best future needs, ensuring that the interest assessors. needs of people with personality disorder and dual diagnosis, or within criminal justice services The social care model of mental health recognises are incorporated into future the social antecedents and determinants of mental pathways distress throughout life that this strategy seeks to address.92 This includes poverty, self-care, quality of housing, work, relationships, trauma, loss and abuse. It also means supporting recovery and change through focussing on the person as a whole – their fundamental human potential and the opportunities they could access to bring about change.
There are a number of key principles and aims that will be incorporated in the review of community mental health services:-
• Integration: This will include the continued integration between mental health, physical health, primary care and social care;
• Recovery: Ensuring that services work towards supporting people to be as well and independent as is personally possible;
Page 120 52 Mental wellbeing in Bradford district and Craven Personality disorders 5.4 Urgent and emergency mental healthcare As noted previously, around 25 people each month are referred into services for treatment of these In 2015/2016 we undertook a review of our crisis disorders and their frequently chaotic lifestyles and care pathway, achieving better access to urgent poor engagement with services means that people care. We worked with partners including the local often then present in an emergency. Currently, authority, health, VCS and emergency services to evidence-based services are provided by the BDCFT create a whole-system approach. Helios Centre services. However, it is recognised that within the generic community mental health services ‘When I need urgent help to there is a lack of a cohesive evidence-based response avert a crisis I, and people close to meet the needs of this group. This can result in to me, know who to contact at inappropriate inpatient admissions, risk of eviction any time, 24 hours a day, seven and rooflessness and frequent A&E attendances. The days a week. People take me seriously and development of a clear pathway of care needs to be trust my judgement when I say I am close to a key element of the review of community mental crisis, and I get fast access to people who can health services. help me get better.’
C8 We will design and A single point of access was created making self- implement a clear pathway referral available by telephone 24 hours a day, seven of care to meet the needs of days a week for those in need of urgent mental people with a personality healthcare. Roles within the service include tele- disorder in the community. coaches (psychological therapists) who are able to assess and support via telephone, nurses and social workers who are able to make in situ assessments and advanced nurse practitioners (ANP) who are able to prescribe and divert away from out-of-hours and Adult eating disorders emergency services. Police and emergency services The review that informed this strategy has highlighted have also been given access to a timely response for significant gaps in the current local provision to adults people they have identified as being in crisis. with an eating disorder. These include the care and support of young people transitioning from CAMHS Alternative spaces for people in crisis were created into adult services, support for people who require in partnership with voluntary services including The hospital care for physical complications, community Haven, which is open seven days a week, as an services and the interface with more specialist regional alternative to A&E attendance and The Sanctuary, services commissioned by NHSE. The development which is available for those needing support during of a clear evidence-based pathway that provides the evening. seamless transition as well as a skilled response from community mental health services for adults locally New roles were introduced in the inpatient setting needs to be developed. including ANPs to support with nurse-led discharges; this process supports stepping down to the care of the intensive home treatment team. A housing social worker post was created to support with delays in C9 We will design and implement a clear pathway identifying suitable accommodation which were of care to meet the needs of preventing people from being discharged home in a adults with eating disorders. timely way.
Page 121 A strategy 2016-2021 53 The intensive home treatment team undertook a We will continue to offer an A&E liaison service review of their model and pathways to enhance their within the A&E departments of our acute hospitals home support as an effective alternative to hospital and develop tools that support the acute hospitals admission. teams to assess and signpost service users to the most appropriate care pathway. This urgent mental health response is acknowledged We will continue to develop The Haven as an nationally as a good practice alternative service to attendance at A&E with the blueprint for others to learn aim of increasing community resilience, reducing from and has resulted in no-one from the area the number of individuals attending A&E in mental being placed out of district because there were distress and provide a community-based, non-clinical no acute mental health beds available locally. setting that provides a welcoming environment for people.
We will continue to provide 24 hours a day, seven These approaches will continue to ensure that days a week single point of access and crisis and required admissions to mental health wards are out of hours care for all people requiring a mental delivered locally with no out of area placements. health service. Services will continue to support and encourage a least restrictive practice model ensuring recovery is the focus and providing people with capacity the opportunity to be the lead in their care C10 We will use through the options offered. Mental Health Act stakeholder feedback assessments are always a last resort and pathways to deliver continuous will continue to be developed and demonstrate that improvement in the each practitioner works through the least restrictive operation of First options for the service users. Response.
We will continue to work with and further develop services with the Police. We currently provide expert mental health support for calls made to emergency services, in an attempt to identify speedily if the C11 We will ensure our local person is in, or requires, mental health services and acute providers have all-age respond or signpost appropriately. mental health liaison teams in place and by 2020/21 will The Sanctuary and the Haven meet the “Core 24” standards. have established a model which is based on a strong partnership between VCS and statutory 5.5 The rehabilitation of people with serious and services. Working with VCS enables a creative enduring mental health problems approach to workforce development and gives opportunities to experts by experience, as well Despite the success of local services in ensuring that as ensuring the clinical and social needs are met the level of disability experienced by people with severe with the expert advice and support when needed. and enduring mental health problems is minimised, and that their care and treatment is delivered in the least restrictive environment, at any given time there is a small cohort of people (currently 23) who require intensive treatment in inpatient settings to enable them to live independently in the future. BDCFT provides a
Page 122 54 Mental wellbeing in Bradford district and Craven 12-bed inpatient facility at Lynfield Mount Hospital up the majority of patients in acute hospitals. A stay in but others have needs that require placement in more hospital for a physical health problem can leave people specialised facilities. These specialised placements tend feeling lonely with little opportunity for social contact. to be expensive and every opportunity is taken to keep the use of such facilities to a minimum and ensure There is an existing district-wide strategy for dementia.97 that resources are used effectively. Case managers (insert link) and mental health services make an ensure that the safety and quality of placements important contribution through the diagnosis of meet required standards. Reducing the use of such dementia in memory assessment and treatment placements can place pressures on social care (eg services (MATS) and guiding people and their carers supported housing) and community support services into local post diagnostic support pathways. Mental and it is important that we work across the system to health services also provide advice and support on the ensure that the specialised needs of this small group longer-term management of people with dementia to are met in the least restrictive environment as locally care homes and physical healthcare settings. As part of as possible. To facilitate this we will ensure that the our on-going support to the delivery of the Dementia resources available are reviewed to explore how they Strategy we will ensure that the MATS and post- are used in a collaborative way that encourages a diagnostic support pathways are fit for purpose and partnership approach to the delivery of care. provide sufficient capacity to meet future need.
5.6 Older people’s mental health Although treatment for depression is as effective for older There are many different views on when older age patients as for younger adults, begins. Some people are (as a result of their life the condition is often under- experiences) more likely to develop the first signs of recognised and under-treated: locally 13.97% older age such as physical decline earlier than others, of people are over 65, but the percentage of whilst others reaching state pension age do not people over 65 being referred to IAPT services is consider themselves as ‘old’. currently only 5.26% locally (6.36% nationally)
Supporting people to age well involves reducing social and emotional isolation, preventing depression and/ or ensuring early case identification and access to treatment, providing integrated support to meeting W19 We will provide improved mental and physical health needs, supporting carers detection and access to evidence- and improving the lives of people with dementia. based treatment of depression for older people. Loneliness and isolation are linked to poor physical and mental health in older age.93
Depression affects one in five older people living in the community and two in five living in a care home.94 Depression has been linked to dementia and it is estimated that up to 40% of people with dementia may have a co-morbid depression.95 Depression can compound isolation and speed up cognitive decline. W20 We will tackle loneliness, fear Depression in later life can often go undiagnosed and isolation through supporting despite the exposure to risk factors and losses the further development of schemes including bereavement, retirement, and loneliness and that improve mental health in later life through supporting emotional deteriorating physical health.96 The most vulnerable and social connections. older people are those who live with physical health problems associated with ageing. Many older people live with one or more long-term conditions and make Page 123 A strategy 2016-2021 55 H9 We will empower older people We will ensure that carers are and their carers by improved W21 identified, their needs are assessed involvement in personalised care and a plan agreed to support their planning to reduce admissions personal wellbeing and role as a and ensure improved partnership carer. between intermediate care and
C12 We will ensure improved C13 In view of the critical role of access to addiction services for carers, we will actively seek their older people. feedback and contribution to the future design of services.
5.7 Carers 5.8 Protected characteristics
Carers are the first line of prevention. Their support The Equality Act 2010 provides scope for often stops problems from escalating to the point positive action and strengthens protection where more intensive packages of support become against discrimination, based on nine protected necessary. But carers need to be properly identified characteristics. These are: age, disability, gender, and supported. The Carers’ Strategy for the district race, religion and belief, sexual orientation, marriage needs to be reviewed.98 and civil partnership, maternity and pregnancy and gender reassignment. The potential impacts This coincides with the Department of Health (DH) of protected characteristics on the likelihood of undertaking a consultation in order to develop a experiencing mental ill-health and on access to new national Carers’ Strategy, to provide updated effective treatment are detailed in section four. guidance on improving support for carers. This will Everyone in Britain is protected by the Equality Act. help to guide and inform local developments and in recognition of the vital role played by carers we Inequalities that arise as a result of protected will ensure that the needs and views of carers who characteristics are compounded by the stigma and support people with a mental health problem is discrimination surrounding mental ill health. One of supported by the local carers strategy. the cornerstones of tackling inequalities in service provision is delivering a truly personalised approach The Carers’ Resource is the local, specialist carers’ that identifies the specific needs of each individual centre for the Bradford district and Craven and and their family and carers, maximises their control they offer a broad range of support to carers over the support they receive and ensures that they including advice, information, practical support and are not disadvantaged by discrimination. opportunities to access groups. BDCFT ‘s carers’ hub provides education and support and are committed Throughout this document we have specifically set to the triangle of care, a therapeutic alliance out our commitment to improving wellbeing and between service user, staff and carer that promotes developing services. Through our engagement safety, supports recovery and sustains wellbeing.99 work, we have identified areas of work to focus on, develop and improve. Our work with local Page 124 56 Mental wellbeing in Bradford district and Craven community groups and organisations is vital to ensuring we have the engagement and dialogue to If local services identified and develop responsive services. supported just four per cent of adults with high functioning 5.9 Other areas of care autism and Asperger syndrome, the outlay would become cost neutral over time. 5.9.1 Mental health and autism If they did the same for just eight per cent, it Mental illness can be more common for people with could save the Government £67 million per year. autism than the general population. In particular, anxiety is very common with around 40% having Although an initial cost with identification will be symptoms of at least one anxiety disorder at any placed on the NHS – estimated to be around £28 time, compared with up to 15% in the general million for an eight per cent identification rate – population. Many people on the autism spectrum the saving for local authorities would potentially may have difficulty describing the symptoms they be around £105 million. experience. Understandably, this can lead to sadness or depression – one reason why a mixture of anxiety Locally, in 2014, we commissioned the Bradford and and depression is common. 100 Airedale neuro developmental service to do this, but the service requires review to ensure that it can provide It may be especially hard for depressed people with the required care and treatment to those who need autism to seek help because they might find change it. Children’s autism services are commissioned via daunting and anxiety-provoking, feel worried that different pathways and are not covered within this they will be blamed, or feel unsure about how to strategy. describe their symptoms. Anxiety and depression can also make people more generally introverted, withdrawn and isolated. C14 We will recommission the The Autism Act 2009 did two key things: it put local diagnostic pathway for duty on the government to produce a strategy autism for adults to improve for adults with autism, together with statutory access, quality and outcomes. guidance for local councils and local health bodies on implementing the strategy.101 The most recent strategy - Think Autism102 - was published in April 2014 and statutory guidance that tells local authorities, NHS bodies and NHS foundation trusts C15 We will contribute what actions should be taken to meet the needs of to the development and adults with autism living in their area was published implementation of autism in March 2015.103 The local authority and NHS strategies for both children and locally are committed to updating the local Autism adults in Bradford district and Strategy in line with this. Craven.
The strategy is clear that there should be a ‘pathway’ for adults to diagnosis and care, and support in 5.9.2 Criminal justice and liaison diversion place in every local area. It provides detail of how People who are being discharged from prison or forensic health and social care should collaborate in the psychiatric care with ongoing mental health issues have delivery of this. very specialist needs to ensure a successful transition to community services. In addition people who find themselves in police custody due to their mental health issues or are found to have mental health problems by officers need to be diverted into support services.
Page 125 A strategy 2016-2021 57 We commission a local liaison and diversion scheme, mental health, including eye movement desensitization based in the police cells, that works alongside our and reprocessing (EMDR) therapy for those suffering from police hub and first response and 24 hour approved post-traumatic stress disorder (PTSD).108 mental health professional service. These services divert vulnerable people from police custody if this is C17 We commit to the inappropriate. The delivery model ensures that there is identification and prioritisation a social care element to this diversion and that all staff of access to services by armed entering the police cells have an integrated approach. forces veterans in line with the Bradford Community Covenant The local authorities and NHS commissioners will Pledge. continue to work with all local criminal justice settings (prisons, YOIs, forensic mental health hospitals) to improve the discharge of prisoners with mental 5.9.4 Dual diagnosis health issues, learning disabilities and autism. This is Drug, alcohol and mental health services all report compliant with duties and the principle of equivalence that the level of complexity of co-morbidities such as under the Care Act 2014, and recognises the high physical and mental health, poverty and reduced social prevalence of mental health problems and the risks to capital show a marked and continuing rise. People with mental health posed by being in custody. a dual diagnosis have needs that cross organisational boundaries and will include drug, alcohol and community mental health services as well as physical C16 We will develop housing, health and the existing dual diagnosis services. However, education, employment people often find it difficult to access more than one and social care and support service at a time. Often, the chaotic behaviours displayed systems for people leaving by people with a dual diagnosis are not accommodated prison, forensic care or other by mental health and physical care services and people forms of custody. are discharged back to the sole care of alcohol and substance misuse services. It is generally perceived 5.9.3 Armed forces veterans that there is poor communication and that this lead NHS and LA partners are committed to supporting the to confusion and co-ordination of care between the local armed forces community, having signed an Armed existing services. The result is poor overall quality of Forces Community Covenant Pledge (Bradford) on 30 care to the vulnerable individuals who require these January 2012.104 pathways of care who are then likely to disengage.
Local NHS mental health providers apply the duties of Other agreed priorities within the strategy provide the Armed Forces Covenant to our local armed forces potential solutions to many of the issues identified community, in particular veterans as defined within the by local stakeholders. This includes opportunities to covenant.105 develop electronic solutions to provide shared access to care records, as well as ensure that the future model Mental health assessments undertaken by GPs and for the delivery of community mental health teams has specialist mental health assessments by BDCFT identify elements that enable the development of co-located record and prioritise veterans where it relates to a practitioners that can deliver joint packages of care that condition which results from their service in the Armed meet needs more efficiently. Commissioners for mental Forces, subject to clinical need. health, substance misuse and alcohol need to work collaboratively to deliver this. BDCFT has established links with the regional Veterans’ Outreach Service (VOS) to ensure that staff have access C18 We will ensure the needs of to training and agreed clinical pathways are in place.106 people with dual diagnosis are BDCFT also works closely with the local branch of embedded within agreed multi- the Soldiers, Sailors, Airmen and Families Association agency pathways of care. (SSAFA)107, which has agreed referral routes into specialist
Page 126 58 Mental wellbeing in Bradford district and Craven How we will get there
Page 127 A strategy 2016-2021 59 6. How we will get there
The following section outlines enabling structures, and social care economy, we commit to accelerating processes and systems. the quicker adoption of the best available research evidence, best clinical practice, new technology and 6.1 Co-design innovation.
Mental health services contribute to the wellbeing We also aim to build strong partnerships with other of the people of Bradford district and Craven. We agencies working in the research field to better believe that services that have been co-designed with articulate our research evidence needs, thereby the help of people with lived experience of services ensuring better alignment of effort. Research and their families or carers, will be more likely evidence tells us that patients have improved to encourage people to seek help early, improve outcomes from participating in research and clinicians peoples’ experience of care and improve their expand their skill base and motivation. Both are outcomes. We will make our decisions about the powerful reasons for individuals and organisations future design of services after seeking the views of to get involved with research. The Academic Health service users of all ages, carers, and health and social Science Networks have been created with the role of care professionals. We will work together to design helping to produce significant improvements in the and deliver person-centred care, underpinned by the health of the population by reducing service variability evidence, which helps and supports people to lead and improving patient experience in the health care fuller, happier lives. system. We will ensure that local commissioners are linked to these developments. We will also seek to build on our partnerships with academic institutions, P1 We will seek the views of people working in partnership to evaluate innovations with a lived experience, families delivered locally. and carers and professionals to design and deliver services to support this strategy. P2 We will base our commissioning decisions, service design and delivery models on the best 6.2 The evidence base evidence available and build on our partnerships with Research and its evidence translated into practice academic institutions to evaluate are vital in transforming services to improve patient innovations delivered locally. outcomes and thereby addressing challenges faced by health and social care. Our ambition is to routinely consult the evidence and design- 6.3 The voluntary and community sector in evaluation. Pursuing the use of evidence and evaluation will improve how we measure the impact The broader contribution to the mental wellbeing of for patients and will enable us to learn from what the population works well, and what does not. Locally, we are committed to providing the best care to achieve The VCS often works with our most marginalised the best outcome and therefore we will ensure that and vulnerable community members and operates at opportunities to base our commissioning decisions, a level which is embedded in local neighbourhoods service design and delivery models on the best and communities. Bradford district and Craven has available evidence are taken. over 2000 VCS autonomous organisations. Many of these organisations or groups are not funded The average time it takes to translate a research to deliver specific mental health interventions but discovery into clinical practice is widely recognised most, if not all, will impact on the mental wellbeing as more often than not being too slow. So, as well of individuals and communities, including working as a commitment to being a research active health in a preventative manner to stop mild mental health Page 128 60 Mental wellbeing in Bradford district and Craven issues from deteriorating through tackling social service users. These care plans will be asset-based isolation, as well as addressing wider social issues and strengths-based with the principle of positive risk such as welfare and housing advice, and substance assessment at its core. This will require the integration misuse. Most receive funding from different sources and modernisation of the current care planning including from grants, foundations and trusts, some systems we use to deliver the Care Act 2014 and the have contracts or service level agreements from mental health Care Programme Approach system. statutory bodies; but many are small community groups that operate on a purely voluntary basis.
Few of these are strategically linked to the P3 We will significantly expand the use of personal budgets to enable interventions offered by projects funded by local people to achieve greater choice commissioners. There is no step up or step down and control over their own are and pathway and therefore referral pathways occur by support. chance through VCS networks. So, although we know that such organisations are delivering valuable work in the heart of the communities they serve, it is 6.5 West Yorkshire vanguard not possible to realise the true potential of such work for Bradford district and Craven. NHS England has assigned West Yorkshire as an urgent and emergency care (UEC) vanguard site. We also know that VCS organisations funded for Vanguard sites are expected develop new care mental wellbeing contracts are subsidising their models that act as future blueprints for the rest of statutory contracts with non-recurrent funds, the NHS and enable the delivery of the Five Year fundraising, income from social enterprise activity Forward Review. The aim of the West Yorkshire UEC and their reserves and we need to better understand vanguard is to develop a shared outcomes model the potential impacts of this. Similarly, many have for mental health services across West Yorkshire that issues with service capacity being out-stripped by aligns the work of the urgent care network and the demand. West Yorkshire STP.
The vanguard is being delivered through collaborative P6 We will work with the VCS working between leadership groups and ‘task and sector to help build their capacity finish’ groups which have representatives from the to respond to the priorities set out three mental health providers (BDCFT, Leeds & York in this strategy. Partnership NHS Foundation Trust and South West Yorkshire Partnership Foundation Trust), the Healthy Future Collaborative Forum’s eleven CCGs, West Yorkshire Police, West Yorkshire Fire and Rescue Service, Yorkshire Ambulance Service and six local 6.4 Personalisation and asset-based care authorities. planning It is focusing on five outcomes to support future Mental health service users can use individual social development of shared standards and expectations care budgets and personal health budgets to achieve for mental health care across West Yorkshire: greater choice and control over their own care and elimination of out of area placements, reduction support. In Bradford district and Craven we want to of unnecessary mental health A&E attendance, see a major expansion of the use of these personal reduction of Section 136 place of safety episodes, budgets. To achieve this we will create an integrated avoidance of unnecessary emergency responses and system that identifies how health and social care reduction of suicides. personal budgets can be used as part of an integrated care plan created across services and jointly with Page 129 A strategy 2016-2021 61 6.6 Pathways and packages of health and care, voluntary and education partners. This provides an overarching, system-wide strategy The pathways and packages approach was initially that has been shaped, tested and refined over time. launched across Yorkshire and the North-East as a way of ensuring that people with similar groups of The IWP is an overarching and enabling programme need had their health and social care needs met which aims to work collaboratively to identify and using packages of care that were based on the work towards developing a system-wide integrated best evidence and could thus be used to promote health and social care workforce that is fit for the consistent, high quality services across economies future. At its heart is the principle of putting service and providers. The use of these evidence-based users and their carers at the centre of everything pathways became a nationally mandated approach we do; creating and developing a workforce that to commissioning and providing services in 2014/15. works in a system-wide way to deliver seamless and Local commissioners and BDCFT are recognised as integrated care. a leading economy in developing this approach, providing support to NHS Improvement nationally to The IWP recognises that individual and tailored help other providers and commissioners implement workforce plans will need to be developed and this approach. implemented for each of the delivery programmes/ patient pathways. The mental health workforce The recent publication of the guidance - plan will ensure that recruitment reflects the Implementing the Five Year Forward View for diversity of local populations. Staff will be equipped Mental Health - has provided additional direction on with knowledge and understanding to promote the use of pathways and packages and reinforces wellbeing, empowerment and recovery. the requirement to move towards accountable payment approaches linked to quality and outcomes The vision of the IWP is: in 2017/18.109 It re-states the expectation that “The best people, providing seamless care, the the pathways and packages approach is used for Bradford district and Craven Way” adult and older people’s mental health services as previously set out by NHS England and NHS The delivery of this mental wellbeing strategy will Improvement. We are committed to using this present many workforce challenges, some of which approach as the central mechanism for the will be addressed by the IWP. However, there are commissioning and contracting of core mental health already significant risks such as national shortages of services. qualified staff (particularly nursing and medical staff), the over-reliance on these groups and the challenges that such shortages and an ageing workforce P4 We will use the “pathways and present. The current organisation of the workforce in packages” approach to commission professional silos does not support the ambition of evidence-based care to meet this strategy to provide holistic integrated care and people’s needs. there will need to be a radical review of skill-mix, new ways of working supported by technology and new roles and/or reshaping of existing roles in order to move forwards with our vision.
6.7 Workforce development It is recognised that, once implementation plans have been agreed, partners will need a specific There is a district wide workforce strategy called the programme of workforce development to deliver the Integrated Workforce Programme (IWP). It has been outcomes set out in this strategy. This will include co-created and co-designed by partners within and working closely with Health Education England across the health and care system. The IWP brings and local education providers to ensure that their together the challenges, key priorities, good practice programmes will deliver the workforce needed to and potential workforce solutions from a wide range deliver this strategy.
Page 130 62 Mental wellbeing in Bradford district and Craven P8 The Joint Mental Health Commissioning Board will become We will develop a mental health P5 the programme board for the workforce plan to deliver the implementation of this strategy, outcomes set out in this strategy. informing the future integration of services.
6.8 Partnership commissioning arrangements 6.9 Our Investment in mental health
Investment in the promotion of mental wellbeing, At a purely conceptual level, a solid case can be prevention of mental disorder and early treatment made for investing in mental health, whether on of mental disorder results in significant economic the grounds of enhancing individual and population savings even in the short-term. Due to the broad health and wellbeing, reducing social inequalities, impact of mental disorder and wellbeing, these protecting human rights, or improving economic savings occur in health, social care, criminal justice efficiency. Mental health and wellbeing are and other public sectors. fundamental to our collective and individual ability as humans to think, emote, interact with each other, As we move to more integrated commissioning earn a living and enjoy life. They directly underpin at the West Yorkshire level, we will also move the core human and social values of independence to a place-based level for Bradford district and of thought and action, happiness, friendship and Craven. Integrated commissioning can offer solidarity. On this basis, the promotion, protection greater effectiveness, efficiency and accelerate and restoration of mental health can be regarded transformation and innovation. The benefits and as a vital concern of individuals, communities and impact of this have been demonstrated, especially in societies. “Investing in mental health” relates both the last three years, and we continue to take shared to the promotion and protection of mental health commissioning decisions. Commissioning efficiently and to the prevention and treatment of mental will reduce costs that can be re-invested into illness or disorders. population health and patient and client care.
This lifespan of this five-year strategy runs through P9 We will commit to protecting the likely changes in the health and care commissioning current level of investment in real landscape. We are committed to the principle that terms in mental health services, our strategic ambition will stand regardless of the recognising the importance future footprint of commissioning organisations – of effective mental health and be that at local or regional levels. The forum that wellbeing interventions in reducing has driven the development of this strategy will, the overall health and care bill. in future, become the programme board for the implementation of the Bradford district and Craven Mental Health and Wellbeing Five Year Plan leading The magnitude of the current and projected burden of the further integration of strategic commissioning. mental disorders might be considered a sufficient reason alone for investment, but only if that investment can be channelled towards effective and affordable solutions. We will work to support P7 A number of interventions are self-financing over time, the move to a more integrated even from the narrow perspective of the NHS alone. commissioning model at a place- However, the scope for ‘quick wins’, in the sense of very based level, to remove barriers and deliver efficiencies. short payback periods for the NHS, is relatively limited. Many interventions have a broad range of payoffs, both within the public sector and more widely; such as through better educational performance, improved employment/earnings and reduced crime. Page 131 A strategy 2016-2021 63 In some cases the payoffs are spread over many years. Most obviously this is the case for programmes dealing with childhood mental health P11 We will articulate the case problems, which in the absence of intervention have for additional investment through a strong tendency to persist throughout childhood the appropriate QIPP and business and adolescence into adult life. However, the overall planning processes. scale of economic payoffs from these interventions is generally such that their costs are fully recovered 6.10 Technology within a relatively short period of time. From a societal perspective, the pay-off for certain interventions – The local digital roadmap for Bradford district and including early intervention for psychosis, suicide Craven, currently awaiting review by NHS England, prevention, and learning programmes for conduct sets out the vision for developments in the use of disorder – exceeds a ratio of 10 (ie for every £1 spent, technology and data as a way to improve access to there is more than £10 of benefit). Many interventions care, make services safer, transform services to reduce are very low cost and a small shift in the balance of variability and ensure services are value for money. expenditure from treatment to prevention/promotion The journey to a local electronic health record that all should generate efficiency gains.110 services can access and use is at the heart of the plan and we have already made considerable progress via our Integrated digital care record programme and optimisation of SystmOne. P10 We will rigorously review the use of those protected resources to We have been recognised nationally as a result of the ensure their effective use. enhanced health in care homes vanguard, providing a single point of access to all aspects of specialist health and care advice through technology and an extended use of telemedicine. Disturbances to a person’s mental wellbeing can adversely compromise this capacity and the choices We are also using risk stratification to identify high-risk made, leading not only to diminished functioning at and/or complex individuals early so that we can put in the individual level but also to broader welfare losses place co-ordinated care that is personalised to reduce for the household and society. The onset or presence avoidable admissions, high cost interventions and help of a mental disorder also increases the risk of disability people remain independent and in their home for and premature mortality from other diseases due to longer. This work requires us to do more to recognise neglect of the person’s physical health. In terms of and treat the mental wellbeing issues that also exist the impact on the economy, mental disorders are within this group of patients and which add to the associated with high rates of unemployment and also costs and difficulty in giving these patients the right under-performance while at work. treatment.
As part of our overall strategy which incorporates Our local authorities continue to be key partners mental health, the CCGs have made a commitment in the development of new models of care and the to maintain current funding levels in mental health collective drive to close the gap between health and and make further investment in line with the growth social care continues with particular strides being received over the coming years and to work along made in the areas of safeguarding. our providers to develop new ways of working to improve services moving forward. Bradford Council Our local digital roadmap will continue to develop is committed to ensuring the mental health needs of alongside the sustainability and transformation plan our residents are properly cared for and will continue to take account of developments in accountable to provide the services that are needed under the care system thinking and will remain integral to how guidance of the Care Act 2014. the ACS will form and prioritise in 2016/17 and 2017/18. Page 132 64 Mental wellbeing in Bradford district and Craven We are currently using and continuing to expand our 6.11 How will we know we have made a use of digital technology, including social media and difference? web, to help raise awareness of crisis services and to facilitate self-care. This includes links to national Across health and social care there are already and localised resources which are accessible all of the a great number of measures that are routinely time. We appreciate how social media and website reported and performance managed. Many of these resources can be used to support individuals and are process measures, although some are measures professionals in the management of care and are of outcome. Fewer still are measures of health continuing to develop this offering in line with our and care outcomes, where changes can be directly local digital roadmap. attributed to interventions and treatments provided to people. From a mental health perspective we will work with the Digital Bradford programme to deliver progress Over 400 metrics from public health, social care and in the following areas: the NHS were considered in seeking to measure the outcomes from the implementation of this strategy. Below are listed the key measures for the programme as a whole.
P12 We will support the development of integrated records, which will facilitate the delivery of this strategy..
P13 We will support the use of collaboration tools which will improve the quality and efficiency of the management of crisis.
P14 We will support the implementation of digital applications to facilitate self-care and therapeutic interventions.
Page 133 A strategy 2016-2021 65 6.12 Mental wellbeing in Bradford district and Craven: metrics
1. The people of Bradford district and Craven will be supported to recognise and value the importance of their mental wellbeing and take early action to maintain their mental health through improved prevention, awareness and understanding 1.a Self-reported wellbeing 1.b Suicide rate **(NHSOF 1.5iii) 2. Enjoy environments at work, home and in other settings which promote good mental health and improved wellbeing 2.a Social isolation † (ASCOF 1.18) 2.a.i Percentage of adult social care users who have as much social contact as they would like 2.a.ii Percentage of adult carers who have as much social contact as they would like 2.b Employment 2.b.i Employment rates for district 2.b.ii Employment of people with long-term conditions (ASCOF) 2.b.iii Employment of people with mental illness (ASCOF 1F** & PHOF 1.8**) 2.c Housing 2.c.i Proportion of adults in contact with secondary mental health services living independently with or without support 2.c.ii Households in temporary accommodation (ASCOF 1.15ii) 2.c.iii Fuel poverty (ASCOF 1.17) 2.d Index of multiple deprivation: proportion of lower layer super output areas (LSOAs) in most deprived 10% nationally 3. Experience seamless care and have their physical and mental health needs met through services that are integrated and easily accessible 3.a People with long-term condition (LTC) feeling supported to manage their condition(s) (IAF) (CCGOF) 3.b Improving outcomes from planned treatments: Total health gain as assessed by patients for elective procedures (i Physical health-related procedures; ii Psychological therapies; iii Recovery in quality of life for patients with mental illness) 3.c Enhancing quality of life for people with mental illness: Health-related quality of life for people with mental illness (ASCOF 1A** & PHOF 1.6**) 3.di People with SMI receiving a full annual health check 3.dii Excess under 75 mortality rate in adults with serious mental illness (PHOF) 4. Reach their maximum potential through services which are recovery focussed, high quality and personalised and which promote independence 4.a Proportion of people who use services who have control over their daily lives (ASCOF) 4.b Improving Access to Psychological therapies (IAPT) - recovery rate 4.c People with first episode of psychosis starting treatment with a NICE-recommended package of care within 2 weeks of referral 4.d Percentage of CYP with a diagnosable mental health condition receive treatment from an NHS funded community mental health service 4.e Percentage of people with common mental health problems accessing psychological therapies 4.f Enhancing quality of life for carers: Health-related quality of life for carers (ASCOF 1D**) 4.g Proportion of community mental health service users feeling that overall they had a good experience (NHS Community Mental Health Survey) 5. Expect support to be commissioned and delivered in a way that leads to increases in efficiency and enables transformation of care through reinvestment. 5.a Spend and outcome tool (SPOT) (www.yhpho.org.uk/default.aspx?RID=49488) Page 134 66 Mental wellbeing in Bradford district and Craven Appendices
Page 135 A strategy 2016-2021 67 Appendix 1: Strategic priorities, strategic outcomes, strategic commitments and enabling priorities
Our strategic priorities
Our wellbeing Our mental and physical health Care when we need it
We will build resilience, promote Mental health and wellbeing is of When people experience mental mental wellbeing and deliver equal importance with physical ill health we will ensure they can early intervention to enable our health. We will develop and deliver access high quality, evidence based population to increase control over care that meets these needs care that meets their needs in a their mental health and wellbeing through the integration of mental timely manner, provides seamless and improve their quality of life and physical health and care. transitions and care navigation. and mental health outcomes.
Strategic outcomes People in Bradford district and Craven will
be supported to recognise and value the importance of their mental wellbeing and take early action to maintain their mental health through improved prevention, awareness and understanding;
enjoy environments at work, home and in other settings which promote good mental health and improved wellbeing;
experience seamless care and have their physical and mental health needs met through services that are integrated and easily accessible;
Reach their maximum potential through services which are recovery focussed high quality and personalised and which promote independence;
expect support to be commissioned and delivered in a way which leads to increases in efficiency and enables transformation of care through reinvestment.
Page 136 68 Mental wellbeing in Bradford district and Craven Strategic commitments
Our wellbeing Our mental and physical health Care when we need it W1 We will design and deliver H1 We will improve the a comprehensive mental health C1 We will establish mental knowledge and awareness of improvement programme that health expertise within the entry mental health within the primary will target increased awareness, point to children’s services to care workforce to enable a more capacity for self-management and enable access to early help/mental holistic approach to patient the need for early intervention health services. management. and self-care. H2 We will develop a model of C2 We will develop a community- W2 We will ensure that mental integrated physical and mental based service for yo3ung people health improvement is a central health services whereby people with eating disorders to support outcome of all community can have their care needs met at care delivery at home in order to investment and regeneration. the same location as part of an reduce hospital admissions. agreed pathway of care. C3 We will extend access to crisis W3 We will develop and H3 We will develop the role of care through the First Response deliver evidence-based stigma VCS and community groups to Service (FRS) by appointing and discrimination reduction provide access to early intervention children and young people’s programmes that focus on support which improves personal mental health specialists within sustained behavioural change. resilience. the team. H4 We will develop an integrated C4 We will develop a dedicated W4 We will promote mutual approach to the identification looked after and adopted children support opportunities and of mental ill health in secondary therapy team to deliver support, encourage the spread of mental care pathways, to improve the consultations and supervision to health champions in organisations outcomes of physical health those teams working with these and business. treatment. vulnerable groups. W5 We will continue to support a H5 We will further develop the C5 We will work with partners strong social care and social work targeted approach to patients with to develop a West Yorkshire role within mental health services, medically unexplained symptoms specialist perinatal mental health integrated with health and VCS (MUS) in primary care to improve team that interfaces with local service provision. patient outcomes and efficiency. evidence-based pathways. W6 We will adopt wellbeing models and pathways that H6 We will increase access to C6 We will improve access integrate physical and mental IAPT from 15% - 25% prevalence for people experiencing a first health, in which social care is providing an additional 7,500 episode of psychosis to a NICE a core part of our strategy and treatments per year, 5,000 approved care package within 2 we will support social function, of whom will have long-term weeks of referral from 50% to spirituality, self-management and conditions. 60% by 2020/21. peer support through the Care Act 2014. C7 We will complete a review W7 of the current model of CMHT We will ensure local housing and H7 We will ensure that services and redesign services to meet regeneration policy and planning provide a balanced range of future needs, ensuring that the creates public and private housing effective therapies as well as needs of people with personality that provides a safe, stable pharmacological interventions disorder and dual diagnosis, or environment that promotes that are culturally appropriate and within criminal justice services community cohesion and mental effective. are incorporated into future wellbeing. pathways Page 137 A strategy 2016-2021 69 Our wellbeing Our mental and physical health Care when we need it H8 We will reduce premature C8 We will design and implement W8 We will develop a range of mortality associated with physical a clear pathway of care to social and supported housing ill health in people with severe meet the needs of people with options for people with mental mental illness to below the a personality disorder in the health care needs. Yorkshire and Humber average by community. 2020. W9 As the largest local employers, we will lead the way in establishing a district-wide network of organisations that are H9 We will empower older people passionate about, and committed and their carers by improved C9 We will design and implement to, mentally healthy workplaces involvement in personalised care a clear pathway of care to meet with all health and local authority planning to reduce admissions the needs of adults with eating services achieving a mental health and ensure improved partnership disorders. charter mark. We will proactively between intermediate care and share best practice and facilitate mental health. small to medium enterprises to engage through accessible training and tools. W10 We will support people to develop the skills and confidence needed to be work ready, engage with employers to enhance C10 We will use stakeholder accessible job opportunities, feedback to deliver continuous and provide support to both improvement in the operation of individuals and employers to First Response. help more people with mental health problems to retain their employment. C11 We will ensure our local W11 We will support the acute providers have all-age development and implementation mental health liaison teams in of the local suicide prevention place and by 2020/21 will meet strategy. the “core 24” standards. W12 We will provide support to people with mental health C12 We will ensure improved problems and complex physical access for older people to needs to navigate services addiction services. to maximise wellbeing and independence. W13 We will extend the recovery C13 In view of the critical role of college service model through a carers, we will actively seek their multi-provider network to offer feedback and contribution to the online evening and weekend future design of services. psychological interventions.
Page 138 70 Mental wellbeing in Bradford district and Craven Our wellbeing Care when we need it W14 By 2020/21, 90% of C14 We will recommission the people who access psychological local diagnostic pathway for therapies will engage through autism for adults to improve direct self-referral. access, quality and outcomes. W15 We will ensure that local C15 We will contribute to the services/pathways are skilled to development and implementation recognise and meet the longer- of autism strategies for both term needs of people who children and adults in Bradford experience sexual assault or district and Craven. domestic violence. W16 We will develop a network C16 We will develop housing, to deliver mental health and education, employment and emotional support in each school social care and support systems to promote mental wellbeing for people leaving prison, forensic amongst young people. care or other forms of custody. W17 We will improve the C17 We commit to the awareness and understanding identification and prioritisation of of mental health for all people access to services by armed forces working with children and young veterans in line with the Bradford people. Community Covenant Pledge. W18 We will develop an C18 We will ensure the needs of evidence-based pathway for people with dual diagnosis are people at risk of psychosis to embedded within agreed multi reduce the risk of transition to agency pathways of care. psychosis. W19 We will provide improved detection and access to evidence- based treatment of depression for older people. W20 We will tackle loneliness, fear and isolation through supporting the further development of schemes that improve mental health in later life through supporting emotional and social connections. W21 We will ensure that carers are identified, their needs are assessed and a plan agreed to support their personal wellbeing and role as a carer.
Page 139 A strategy 2016-2021 71 Enabling priorities
P1 We will seek the views of people with a lived experience, families and carers and professionals to design and deliver services to support this strategy.
P2 We will base our commissioning decisions, service design and delivery models on the best evidence available and build on our partnerships with academic institutions to evaluate innovations delivered locally.
P3 We will significantly expand the use of personal budgets to enable people to achieve greater choice and control over their own are and support.
P4 We will use the “pathways and packages” approach to commission evidence-based care to meet people’s needs.
P5 We will develop a mental health workforce plan to deliver the outcomes set out in this strategy.
P6 We will work with the VCS to help build their capacity to respond to the priorities set out in this strategy.
P7 We will work to support the move to a more integrated commissioning model at a place-based level, to remove barriers and deliver efficiencies.
P8 The Joint Mental Health Commissioning Board will become the programme board for the implementation of this strategy, informing the future integration of services.
P9 We will commit to protecting the current level of investment in real terms in mental health services, recognising the importance of effective mental health and wellbeing interventions in reducing the overall health and care bill.
P10 We will rigorously review the use of those protected resources to ensure their effective use.
P11 We will articulate the case for additional investment through the appropriate QIPP and business planning processes.
P12 We will support the development of integrated records, which will facilitate the delivery of this strategy.
P13 We will support the use of collaboration tools which will improve the quality and efficiency of the management of crisis.
P14 We will support the implementation of digital applications to facilitate self-care and therapeutic interventions.
Page 140 72 Mental wellbeing in Bradford district and Craven Appendix 2: Mental Health Foundation Whole community prevention framework
Individual Family Community – Systems structural
Early years Perinatal pathways Support for Peer support groups Maternal health and family of support for attachment for young mums (or formation mothers young fathers) Health visiting
General mental Primary care health support
Assessment for risk and early intervention
Specialist support
Children and Self-management Parenting Whole school Education adolescents approaches programmes approaches (including digital) Further education Family therapy Bullying programmes Psychological Primary care interventions Behaviour interventions
Adults Workplace support Parenting support Stigma and Workplace – line management discrimination interventions Carers’ support programmes Housing
Psychological Mentally healthy NHS - general interventions – workplace cognitive behavioural approaches therapy (CBT), solution-focussed Trauma-informed services
Later life Self-management for Family-based Volunteering Primary care long-term conditions dementia support opportunities Home help Pre-retirement Socially connected Peer mentoring/ preparation care homes befriending NHS – general
Psychologically- Care home sector informed physical health settings
©Mental Health Foundation 2016 110 Page 141 A strategy 2016-2021 73 7. Glossary
Accountable care system Perinatal mental health An accountable care system is a group of healthcare Mental health during pregnancy and in the year after providers working together to take responsibility for birth. Perinatal mental health issues include problems quality and cost of care for a defined population within that arise at this time and those that were present before an agreed budget. the pregnancy.
Advocacy Primary care Advocacy means getting support from another person Day-to-day healthcare for first contacts and ongoing care to help you express your views and wishes, and to help including GPs, nurse practitioners and pharmacists. make sure your voice is heard. Psychosis BDCFT Psychosis is a severe mental disorder in which thought Bradford District Care NHS Foundation Trust – a provider and emotions are so impaired that contact is lost with of mental health, learning disabilities and community external reality. health services across Bradford, Airedale and Craven. QIPP Commissioning QIPP stands for quality, innovation, productivity and Commissioning is the process through which the prevention. It is a national, regional and local level health and social care needs of the local population are programme designed to support clinical teams and NHS identified and the services purchased and reviewed to organisations to improve the quality of care they deliver meet those needs. while making efficiency savings that can be re-invested into the NHS. Co-morbid A person has co-morbid illness when they have more Resilience than one illness at the same time. Emotional resilience is the ability to adapt and bounce back when something difficult happens in your life. Dual diagnosis Dual diagnosis is the term used to describe the condition Stakeholder of people with both mental illness and problematic drug The stakeholders in this strategy are everyone with an and/or alcohol use. interest or concern in mental wellbeing in Bradford district and Craven including members of the public, Epidemiology people who use services, carers and people who work in Epidemiology is the study of how often illnesses occur in health and social care. different groups of people and why. Sustainability and Transformation Plan Iatrogenic A local plan produced by every health and care system in Iatrogenic harm is harm caused by medical examination England to show how services will evolve and become or treatment. sustainable during the period 2016 – 2021 to provide better health, better patient care and improved NHS efficiency. Looked after children Children who are in the care of the local authority. Transgender Transgender is a term used to describe people who feel Non-psychotic that their gender is different from the gender the doctor Non-psychotic disorders include depressive disorders marked on their birth certificate. and anxiety disorders like phobias, panic attacks, and obsessive-compulsive disorder (OCD). Voluntary and community sector The voluntary and community sector or voluntary sector Parity of esteem consists of organisations that are not-for-profit and non- Valuing mental health equally with physical health. governmental. This sector is also called the third sector, in contrast to the public sector and the private sector. Page 142 74 Mental wellbeing in Bradford district and Craven References 1. https://www.nomisweb.co.uk/reports/lmp/la/1946157124/report.aspx#tabeinact 2. https://ubd.bradford.gov.uk/media/1235/intel-bulletin-housing-20160118.pdf 3. City of Bradford MDC (2014). Cultural Strategy: A Leading Cultural City 2014-2024 [online]. 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Page 147 A strategy 2016-2021 79 1in4 art exhibition In a bid to tackle the stigma surrounding mental health illness, Bradford District Care NHS Foundation Trust held a major art exhibition between 6 and 10 October 2016 to coincide with World Mental Health Day. The 1in4 art exhibition, which was named to reflect the high proportion of people who experience mental ill health, was held at Salts Mill, Saltaire, well known for its association with David Hockney. The exhibition showcased innovative and thought-provoking artwork created by people who have experience of mental health issues - and promoted the benefit of art in supporting good mental health.
Further information: Joint Mental Health Commissioner Douglas Mill Bowling Old Lane City of Bradford MDC Bradford Page 148BD5 7JR Tel: 01274 237290 Agenda Item 9/
Report of the Director of Health and Wellbeing and the Director of Children’s Services to the meeting of Bradford and Airedale Health and Wellbeing Board to be held on 29th November 2016.
Subject: O
Working Better Together on Safeguarding: Annual Reports of the Bradford Safeguarding Children Board (BSCB) and the Safeguarding Adults Board (SAB)
Summary statement:
This report for the Health and Wellbeing Board brings progress updates from the Bradford Safeguarding Children Board and the Safeguarding Adult Board – Bradford and Airedale for feedback and discussion. The report outlines in brief the main areas covered by the annual reports and highlights where joint approaches to policy and practice are in operation and a number of areas where further development across children’s and adults’ safeguarding arrangements could be beneficial.
Bev Maybury Portfolio: Director of Health and Wellbeing Health and Wellbeing Michael Jameson Director of Children’s Services Overview & Scrutiny Area: Report Contact: Bernard Lanigan (SAB), Jenny Cryer (BSCB) Health and Social Care Phone: (01274) 432900 E-mail: [email protected] [email protected]
Page 149
1. SUMMARY
This report for the Health and Wellbeing Board brings progress reports from the Bradford Safeguarding Children Board (BSCB) and the Safeguarding Adult Board (SAB) – Bradford and Airedale for feedback and discussion. The report outlines in brief the main areas covered by the annual reports and highlights areas of focus where joint approaches to policy and practice are in operation or are being considered for development across children’s and adults’ safeguarding arrangements.
The report introduces the annual reports which outline the progress that has been made on the delivery plans for the Children’s and Adult Safeguarding Boards. A copy of the Safeguarding Adult Board Annual Report 2015 – 16 is attached as Appendix 1. A final draft of the Bradford Safeguarding Children Board report is provided as an appendix. This will be signed off by BSCB on the 1st December and will then be published on the BSCB website. Links to the Safeguarding Board websites are provided in section 12 – Background documents.
2. BACKGROUND
The Bradford Safeguarding Adults Board is a multi-agency partnership that leads on the development of safeguarding adults work in the Bradford District. The main focus of the Board is to safeguard adults with care and support needs from abuse and neglect. Membership to the Board includes representation from the main statutory agencies Bradford Council, NHS organisations, Police, Probation and Fire Service, the housing sector and from independent and voluntary sector organisations.
The Health and Wellbeing Board resolved in November 2015;
(1) That the Board receive the annual reports of the Bradford Safeguarding Children and Safeguarding Adults Boards.
(2) That the Board support the development of a new integrated Early Help Offer for the District . (3) That the Board task the Bradford Health and Care Commissioners to support the development of a Joint Commissioning Strategy for Special Educational Need and Disability based on the recent update of the SEND Needs Assessment.
(4) That a further report be provided to the Board at its meeting in February 2016 which includes the progress made with:
(a) communication issues with the Health Service and the CSE Hub in relation to the system to flag up children/adults at risk of exploitation
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(b) service provision in terms of therapeutic support for victims of exploitation and appropriate support for frontline staff.
In February 2016 the Health and Wellbeing Board received an update in relation to communication and the raising of safeguarding concerns for children and adults at risk of exploitation and the Board was assured that sufficiency of therapeutic support would be addressed through the review of the CSE Hub during 2016.
3. OTHER CONSIDERATIONS
3.1 Bradford Safeguarding Children Board
The Safeguarding Children Board in Bradford has undergone a change of leadership over the period of this report. The Vice Chair of the Board Julie Jenkins, stepped up to chair the Board in March 2015 while a new chair was recruited. A new Independent Chair, David Niven, was welcomed in place in September 2015. The new chair’s history included being chair of the British Association of Social Workers and of being nine months into a contract as Independent Chair of Tameside Safeguarding Children Board, and he was looking forward to taking on the role for Bradford.
The Bradford Safeguarding Children Board has produced an annual report covering the period April 2015 – March 2016, reporting on the work carried out on the Board’s business plan which set out 4 Key Priority areas:
1-Performance 2-Engagement and Participation 3- Challenge and Change 4-Responding to existing and emerging safeguarding issues
Each priority area identified outcomes to be achieved that could be measured and evaluated for impact on the difference the activity made to children and their families.
3.1.1 Priority 1 has seen a significant input of resources into the performance framework by Children’s Services, West Yorkshire Police, the Police and Crime Commissioner, the CCG and Bradford Teaching Hospital Foundation Trust. This has led to a significant move forward in the quality of data being recorded around safeguarding areas of activity across the partnership, in particular the input into the Section 11 reports, and is enabling the Board to evaluate services effectively and hold partners to account where required.
3.1.2 Priority 2 has seen a qualitative improvement and an embedding of the work being carried out with faith settings across the district. Joint working with the fire service and the transport department of the Council has seen safeguarding improvements made across the District aimed at keeping children safe as they access and leave faith settings. Faith teaching providers have been more open to their safeguarding responsibilities for the volunteers they engage and there has been a marked improvement in the take up of safeguarding policies and procedures.
3.1.3 Priority 3 has seen the establishment of multi-agency challenge panels by the
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Board enabling a deep dive focus on areas of safeguarding activity identified in the business plan or through the serious case review sub group. In this period, the panel has carried out two deep dives on children with disability and children suffering sexual exploitation. The outcome of these activities has identified action plans for agencies across the partnership to address issues raised as part of the process, celebrate good practice where identified and deliver targeted multi-agency learning events to ensure the findings from the panels is shared as widely as possible. In addition, a training needs analysis has been carried out across the partnership, and has enabled the training plan for 2016-2017 to be drafted to meet the Board’s responsibilities that staff and volunteers are skilled and equipped to carry out their roles and responsibilities.
3.1.4 Priority 4 has identified that there are newer and more challenging forms of abuse that have required agencies to look inwards at their safeguarding cultures and beliefs and challenge themselves on how well they are able to meet practice expectations in these areas.
Children’s Services are taking forward the ‘Journey to Excellence’ approach in order to co- ordinate effectively the current early help provision in the Bradford District and this is being monitored by the Proactive and Responsive sub group. There is currently underway the review of the Child Sexual Exploitation Hub to evaluate the effectiveness of the multi- agency CSE service in Bradford and this is being monitored and scrutinised by the CSE sub group. The Chair of the Child Death Overview Panel continues to report directly to BSCB. The panel has responded to the high level of child deaths in Bradford by developing work around consanguinity, and the learning from this has been delivered across safeguarding week alongside learning around online safety, female genital mutilation, counter radicalism and neglect.
Over the last year several serious case reviews have either concluded or are in process. The learning from these has been helpful and there has been a good response to the learning. In particular, it has brought to the forefront the challenges facing practice of how organised criminal activity is impacting on child sexual exploitation and the risks facing children both directly and online. These challenges are being addressed within the review of the CSE Hub.
Regular meetings are now held with senior staff from all agencies looking at best practice in several areas as well as readiness for inspection. The focus on domestic abuse has continued and this work, along with substance abuse and the mental health of vulnerable parents, make for a strong overlap with the work of the Adult Safeguarding Board and the Health and Wellbeing Board. These shared areas that have such impact on a child’s experience at home are subject to continued efforts for the Boards to work together. Finding ways to engage the voices of children and young people is regularly reviewed.
3.2 Safeguarding Adults Board – Bradford and Airedale
2015/16 was the first year of the Safeguarding Adult Board (SAB) operating under the legislative framework of The Care Act 2014. The Act put the Safeguarding Adults Board on a statutory basis and required the SAB to produce a strategic plan, our first covers the period 2015 – 2018.
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The Safeguarding Adults Board Annual Report 2015 - 2016 provides an update on the priorities of the SAB during the year and the progress made against them. The report also signals those areas the board will continue to prioritise in 2016/17.
3.2.1 Making Safeguarding Personal (MSP) was and continues to be a key priority for the SAB, the approach is about putting the person at the centre of our involvement in making people safe. That where possible the wishes of the person are paramount in directing any actions without negating our duties to act where the circumstances dictate (criminal behaviour or issues of capacity are in question). The SAB has made some progress in this arena and is evidenced in some of the case examples in the annual report; there is however a way to go to ensure the practice is fully embedded across all partner services.
3.2.2 Mental Capacity - The Mental Capacity Act 2005 and ‘tenfold’ increase in requests for assessments under the act continue to put significant pressure on the Local Authority to respond, the Council has continued to invest in training more suitably qualified staff to undertake the specialist assessments required but continue to struggle to meet the level demand. In 2016 -17 the service has engaged in the use of independent assessors to assist with this task.
The annual report allows the SAB Partner agencies to report on individual progress made last year. The annual report provides some performance information offering some analysis of what the data is indicating at this point.
3.2.3 Forms and types of Safeguarding concern - Performance data indicates a significant increase in the incidence of abuse categorised as neglect over the previous year with reductions across all other categories. The increase may be reflective of the introduction by the Care Act 2014 of ‘Self-Neglect’ as falling within the remit of adult safeguarding.
In the case of Domestic Violence there has also been an increase in activity again possibly attributable to the work undertaken across agencies in preparation for the introduction of the Care Act.
The data in respect of where abuse is happening shows a marked increase in Care Settings, residential and nursing homes in the main as opposed to people’s own homes. This picture is not reflective of the wider national data which report increased levels of abuse taking place in people’s own homes. Possible explanation of this difference may be reflective of the introduction of the new CQC Inspection regime which saw a high level of services being deemed to be ‘inadequate’ and a consequent increase in the number of providers embargoed from new referrals pending their successful implementation of improvement plans and re-inspection. In 2015 -16 Members agreed to defer consultation on the closure of one of its residential care homes in order to respond to the reduction in availability of this type of care in the market.
3.2.4 Outcomes - The outcomes for people who have been through the safeguarding process in the main has resulted in the risks to their wellbeing reducing or being eliminated
Page 153 in the main. Fewer people than in the previous year remain at risk despite the intervention of services within the safeguarding framework. This will always be the case for some few people who continue to knowing put themselves in risky situations, a reflection of the rights of people to make informed choices about the lives they lead.
3.2.5 Emerging issues - In recent years there has been much media reporting of Modern Day Slavery and Human Trafficking. In 2015 -16 there were no instances recorded within Adult Safeguarding. The service is however aware of some initiatives across West Yorkshire where trafficking was identified and the department was alerted to the potential for referrals arising out of Police activity. This is an area of concern for the SAB and will be an area of focus in 2016 – 17 along with strengthening links to the Children’s Safeguarding Board and the Safer and Stronger Board in the District.
The priority areas for the SAB continue to be:
In partnership with communities and local organisations the SAB will
work towards ‘Making Safeguarding Personal’ (MSP) and the embedding of MSP into the work of all partner agencies in line with the Care Act 2014.
The SAB will ensure the deployment of independent advocacy to support adults at risk. It will also ensure that service users and carers’ views are taken into account, acted upon, and implemented into service delivery.
There is a need for the awareness of safeguarding to be promoted in order to mitigate the risk of people suffering abuse or neglect. The profile of SAB activities will be raised and the SAB will work collaboratively with communities and partners to prioritise and strengthen local arrangements to identify and monitor the incidence of abuse.
Effective arrangements to share good practice and lessons learnt from Safeguarding Adults Reviews (SARs) and inter-agency working and the sharing of information will be strengthened through collaboration between the Children’s Safeguarding Board, Health and Wellbeing Board, the Domestic Abuse partnership and other key partner organisations.
4. FINANCIAL & RESOURCE APPRAISAL
Financial and Resource appraisal is ongoing through the 2017-18 budget process of the Council.
5. RISK MANAGEMENT AND GOVERNANCE ISSUES
Risk and governance relating to safeguarding is managed through the two Safeguarding Boards’ and through each Board’s sub-groups. The approach to both risk and governance is explained through the annual reports. See Appendix 1 and Section 12 Background Documents.
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6. LEGAL APPRAISAL
The annual reports of the Bradford Safeguarding Children Board, and the Safeguarding Adults Board – Bradford and Airedale (to be published), describe how the Boards coordinate and govern the work of the Council and partners to fulfil the statutory duties in respect of safeguarding children and adults.
Legal appraisal of the 2015-16 annual reports of the BSCB and the Safeguarding Adults Board – Bradford and Airedale will be undertaken.
7. OTHER IMPLICATIONS
7.1 EQUALITY & DIVERSITY
Safeguarding vulnerable people whether children or adults cuts across all categories of communities with protected characteristics. Improvements in how our collective resources work together will increase our ability to prevent and intervene earlier when people are being abused or are at risk of abuse or neglect.
7.2 SUSTAINABILITY IMPLICATIONS
None
7.3 GREENHOUSE GAS EMISSIONS IMPACTS
None
7.4 COMMUNITY SAFETY IMPLICATIONS
The Children’s and Adults’ Safeguarding Boards for the District have representatives from the uniformed organisations as Board members and make a key contribution to community safety by leading co-ordinated, partnership action to safeguard children, young people and adults, particularly vulnerable adults, in the District.
7.5 HUMAN RIGHTS ACT
None
7.6 TRADE UNION
None
8. NOT FOR PUBLICATION DOCUMENTS
None
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9. OPTIONS
None
10. RECOMMENDATIONS
10.1 That the Board receive the annual reports of the Bradford Safeguarding Boards.
11. APPENDICES
Appendix 1 - Bradford Safeguarding Children Board (BSCB) Annual Report 2015-16 Appendix 2 Safeguarding Adults Board – Bradford and Airedale 2015-16
12. BACKGROUND DOCUMENTS
Bradford Safeguarding Children Board (BSCB) Annual Report 2015-16 – Final version to be published early December 2016 – see Appendix 1 to this report for a draft version. http://www.bradford-scb.org.uk/documents.htm
Safeguarding Adults Board (SAB) – Bradford and Airedale https://www.bradford.gov.uk/media/3321/sab-annual-report-2015-16.pdf
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Bradford Safeguarding Children Board Annual Report – 2015/2016
Annual Report 2015 - 2016
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Bradford Safeguarding Children Board Annual Report – 2015/2016
Contents Page No. Forward and Introduction 3 Background to the Report 4 Chapter 1 - The Safeguarding Context in Bradford 5 - Local Demographics 5 - Vulnerable Groups of Children 6 1 – Maintaining effective standards of Safeguarding Practice 6 - Children Subject to the Child Protection Process 6 - Children subject to the Looked-After Process 6 2 – Appraising the effectiveness of Early Help 7 - Family Centres 7 - Edge of Care services 8 - Intensive Family Support 10 Chapter 2 - Governance and accountability 13 1 - The Bradford Safeguarding Children Board 13 2 - How we are organised 14 3 - Structure of the Board 14 4 – Roles and Responsibilities 16 5 – Key Relationships 16 6 – Financial Arrangements 17 7 – Effective Performance Management – Scrutiny and Challenge 18 8 – Continuous Learning and Improvement 18 9 – Allegations Management 19 Chapter 3 - 2015/2016 – progress and Improvement on the Board’s priority Areas 21 Priority 1: Performance 21 Priority 2: Engagement and Participation 24 Priority 3: Challenge and Change 27 Priority 4: Responding to Existing and Emerging Safeguarding Issues 30 - CDOP storyboard 35 Chapter 4 – Partner Agency’s ‘Improving Safeguarding Outcomes’ storyboards 38 1 - Children’s Social Care 38 2 - Bradford Teaching Hospital NHS Foundation Trust 43 3 - NPS Bradford and Calderdale (B/C) 45 4 - Bradford District Care NHS Foundation Trust 46 5 – AWC, BC and BD CCG 48 6 – Education (CSC) – Children Missing Education 49 7 – West Yorkshire Police ‘Night Time Economy’ 51 8 – Voluntary and Community Sector Organisations (VS) ‘Young Lives Bradford’ 52 9. Family Action Hope Service 54 Chapter 5 - Ensuring the workforce is skilled and equipped to carry out their Safeguarding Roles and Duties 57 - Learning and Improvement – Dissemination of Key Messages 57 - Learning and Improvement Report 59 - Training Needs Analysis Report 61 Page 158 2
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Chapter 6 - Responding to Serious Incidents and child deaths 65 1 – CDOP 65 2 – Case Reviews 65 Chapter 7 – The Board’s overall Performance and Future Priorities for 2016 – 2018 67 - BSCB statement on overall performance 67 - Priorities for 2016 – 2018 68 Appendix 1 – Safeguarding Children Performance Report 70 Appendix 2 – Bradford Teaching Hospitals NHS Foundation Trust Audit Strategy 75 Appendix 3 – Membership of the BSCB 82 Appendix 4 – Attendance Report for the Board 84 Appendix 5 – CDOP Annual Report 85
Introduction from the Independent Chair of the Board - David Niven
In some ways, introducing the Children’s Safeguarding Board’s Annual Report is easy. So much hard work and effort has been put in over the last year by the staff of the Board, individual members and the constituent agencies. In other ways, the kind of challenges faced separately and together; by all of us who are charged with keeping Bradford’s children as safe as possible, are formidable. All face increasing pressure from the austerity measures that continue to be demanded by central Government.
Over the last year several serious case reviews have either concluded or are in process. The learning from these has been helpful and well responded to. Excellent work is being carried out in combatting child sexual exploitation, in improving intelligence and practice around children missing from home and education. The success of the CSE Hub where all new cases are received and worked on by a multi-agency team has shown clear improvement and progress in tackling one of the most challenging areas of child protection.
Regular meetings are now held with senior staff from all agencies looking at best practice in several areas as well as readiness for inspection. The focus on domestic abuse has continued and this work, along with substance abuse and the mental health of vulnerable parents , make up a strong overlap with the Adult Safeguarding Board and the Health and Wellbeing Board. These shared areas that have such impact on a child’s experience at home are subject to continued efforts for the Boards to work together. Finding ways to engage the voices of children and young people is regularly reviewed.
Bradford is, as we all know, a varied and diverse community and the Safeguarding Board has worked to reflect this. In addition we have initiated a sub group, with its Chair becoming a member of the Board, to reflect the wide range of cultural and interest groups and advise the Board accordingly.
The Wood Review of local safeguarding boards initiated by the last government has yet to be taken forward by the new administration but the response in Bradford has been to consider how to best look to the future and continue to improve the safeguarding of our children.
The Board recognises that the way people communicate is rapidly changing and so is looking to improve how the people of Bradford see and understand our work. Our annual ‘safeguarding week’ in October is a valued showcase and opportunity to debate, educate and explain the challenges involved. Our website is marked for an overhaul to make it more contemporary and accessible.
I would like to conclude by saying that this report, contains information on the vast range of work undertaken by members of the Board and the agencies, organisations or individuals they represent . We often read or hear about Page 159 3
Bradford Safeguarding Children Board Annual Report – 2015/2016 challenging cases or situations and, quite rightly, have to answer to them. However, so much good work is being carried out by those charged to protect the children of Bradford that rarely gets talked about, for all sorts of reasons. I would like to pay tribute to their dedication and look to find ways of better reflecting the success stories. We hear a lot about good news and initiatives, many of which you can read about in this annual report.
I truly believe that the Board’s duty is not just to solve problems and confront challenges but to celebrate achievement and, in doing so, constantly look to improving trust between those working in safeguarding and the wider community.
David Niven September 2016
Background to the Report
The Children Act 2004, section 14a requires the Independent Chair of the Bradford Safeguarding Children Board to publish an Annual Report that explains and evaluates the effectiveness of the local safeguarding arrangements in protecting and promoting of children in the district of Bradford, and how the Board has been influential in achieving these improvements and thereby reducing harm.
This report reviews the previous year’s safeguarding activity within and across the partnership, and the sufficiency of the budget available to support the Board’s responsibilities. The annual report is published in line with other agencies planning and reporting cycles. Following acceptance by the main Board, the report will be submitted to the Chief Executive, Leader of the Council and Portfolio holder, the local police and crime commissioner, the Chair of the Health and Well-being Board and is presented to the Overview and Scrutiny Committee of the council by the independent Chair David Niven.
The report has been constructed to enable partners to review how effectively the Board has delivered on the 2015 – 2016 priorities as set out in the Board’s Business plan. The report then sets out to explain how the Board is active within the local context, how it is governed and holds the partnership accountable for the safeguarding activity taking place and how the Board fulfils its responsibilities under its key functions.
The Report closes with a statement from the Chair on the Board’s overall performance throughout 2015 - 2016, and with a summary of the Board’s priorities for the period 2016 – 2018 resulting from the safeguarding activity across 2015 – 2016 and agreed by the partnership.
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Chapter 1: The Safeguarding Context in Bradford:
1. Local Demographics
• Bradford District - Summary
• It is currently estimated that there are:
o 528,200 people living in the Bradford District
o 8,361 births p.a.
o 140,484 children 0-17 yrs
o 33,180 children 0-3 yrs
o 64% White British people
o 20% South Asian (Pakistani)
o 15,305 children with lone parent
o 30,745 children 0-16 yrs living in low income family
o Numbers of Children on role in the Bradford District
Free LA Year Academy School Maintained Total 2015/2016 28,224 3,168 68,418 99,810
The latest population figures produced by the Office for National Statistics (ONS) on 25 June 2015 show that an estimated 528,200 people live in Bradford District.
Bradford District is the fourth largest metropolitan district (in terms of population) in England, after Birmingham, Sheffield and Leeds although the District’s population growth is lower than other major cities. In the last three years Bradford’s population has grown at 0.3% which is slower than the regional average of 0.8% and the national average of 1.5%.
Bradford is a youthful district with the third highest number of 0 -15 year olds (124,650) in England; only Birmingham and Leeds have higher numbers. Nearly one-quarter (23.6%) of the District’s population is aged under 16.
The population of Bradford is ethnically diverse. The largest proportion of the district’s population (63.9%) identifies themselves as White British. The district has the largest proportion of people of Pakistani ethnic origin (20.3%) in England.
The largest religious group in Bradford is Christian (45.9% of the population). Nearly one quarter of the population (24.7%) are Muslim. Just over one fifth of the district’s population (20.7%) stated that they had no religion.
There are 199, 296 households in the Bradford district. Most households own their own home (29.3% outright and 35.7% with a mortgage). The percentage of privately rented households is 18.1%. 29.6% of households were single person households.
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Information from the Annual Population Survey in December 2014 found that Bradford has 214,800 people aged 16- 64 in employment. At 65.3% this is significantly lower than the national rate (72.4%). 114,300 (around 1 in 3 people) aged 16-64, are not in work. The claimant count rate is 3.3% which is higher than the regional and national averages.
Skill levels are improving with 25.3% of 16 to 74 year olds educated to degree level. 16.5% of the district’s employed residents work in retail/wholesale. The percentage of people working in manufacturing has continued to decrease from 13.2% in 2012 to 12.5% in 2013. This is still higher than the average for Great Britain (8.5%).
The IMD 2015 places Bradford as the 19th most deprived district nationally (where 1 is the most deprived authority and 326 is the least deprived). Bradford’s position relative to other English districts has worsened by seven places since IMD 2010.
The pattern of deprivation remains unchanged from previous indices. Bradford has four LSOAs which are consistently within the most deprived 1% of areas nationally based on the IMD updates for 2015, 2010, 2007 and 2004. The most deprived areas are concentrated in and around central Bradford, in outlying Bradford housing estates such as Holme Wood, Ravenscliffe, Buttershaw and Allerton and in Keighley. The least deprived areas are found mainly to the north of the district in Ilkley, Burley in Wharfedale and Menston, but also Bingley and rural villages to the west of the district.
2. Vulnerable Groups of Children:
1. Maintaining efficient Standards of Safeguarding Practice : Children subject to child protection processes: o (Full data report – Performance management Appendix 1)
In 2015-16 there were 5549 referrals made to Bradford Council’s Children’s Social Care Services. The number of referrals in the year was about 11% higher than in 2014-15; this is a fairly steady increase across all age groups with the overall proportions by age band very similar to previous years. The “re-referral rate” for Children’s Social Care Services in 2015-16, at 14.7%, was a reduction on 16.7% in the previous year.
There has been an increase in children subject to Section 47 Enquiries in 2015-16 (2351 compared to 1938 in the year before). Children will only progress to a child protection conference if the threshold of, or likelihood of significant harm is met and it is assessed that a multi-agency, child protection approach is needed to reduce the harm.
ICPCs were held in respect of 540 children in the year. Timeliness of ICPCs has much improved over the last 3 years; 93.4% were held with within 15 days of the S47 Enquiry compared to 15% in 2013-14. This is higher than the national average of 74.7%.
511 children were subject to a CP Plan as at 31st March 2016, with more males than females. This compares to 513 as at 31st March 2015; the numbers of children on CP Plans remained stable this year after a fall in the previous year. The number of children who newly became subject to a CP plan during the year was 524. Of these, 83 children became subject to a CP plan for a second time compared to 12.2% the year before. In the year, there were 522 children whose CP plans ended of which the proportion that lasted over 2 years was 4.2%.
Children Looked After: Before a decision is taken that a child should become looked after, a full assessment of need is carried out, and all preventative/protection work has to be undertaken to enable the child to remain in their family. Children can only enter the care system if there is parental consent, a court order authorising this or the child is of an age and understanding to request the service in their own right. Page 162 6
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848 children in Bradford were looked after at 31 March 2016, a 3.7% reduction on the previous year of 880. 86% of children were looked after due to abuse and neglect reasons, a slight increase on last year’s figure of 85%. The national figure at 31 March 2015 was 61%.
The proportion of young people looked after by age groups has remained very similar to last year. There has been a slight decrease in the percentage of 0-4 and 5-9 year olds and a slight rise in the percentage of 10-15 and 16+ year olds. 561 children looked after at 31 March 2016 were of White British origin compared to 582 last year. The number of BME children looked after has increased slightly, 271 compared to 266 last year.
In terms of legal status, 573 children were looked after under a Full Care Order, this is an increase on last year of 528. 114 were subject to Interim Care Orders, compared to 124 last year, and 52 under a Placement Order, the same proportion as in 2014-2015. 93 children were placed under Section 20 placements, a 2% drop on last year.
167 children were placed Out of District at 31 March 2016; a decrease on last year’s figure of 186. 61% are placed with foster carers or friends and family carers, whilst 22% are in residential placements. The majority of children placed out of district are in the 10-15 age group.
2. Appraising the effectiveness of Early Help:
While the Journey to excellence process drives forward the Early Help strategy in Bradford, Early Help is currently delivered across a range of targeted services within the Bradford district that include : Early Help pathfinder gateways Children Centres Family Centres. Edge of Care Youth service Families First Community problem solver
Two new Early Help pathfinder Gateways located in areas BD 3.4.5.and Keighley have been established. Through the assessment process at the front door, the Children’s Initial Contact Point (CICP) route non-MASH contacts through to the Early Help Gateways which triage the incoming contacts. The contacts are then either routed to the multi-agency panel for a review and consideration of an offer of targeted early intervention, signposted to universal services or sent to the Duty Suite at the MASH for review and a decision on whether the contact should become a referral to CSS.
When making the new birth home visits, health visitors seek consent from the parent to inform the children centre local to the family, of the new birth. This has resulted in an increase to 95.2% of families being registered with children’s centres in the district. Children’s centres then make an offer of a home visit and this has resulted in 42% of families engaging with the children centre services. The ambition of the centres is to raise this number to a target of 65% in the coming year.
Family Centres
There are four Family Centres in the Bradford District based in Keighley, Shipley, West Bowling and Farcliffe. Each Family Centre offers a service in the local area.
Low Fold offers a service to BD13, BD15, BD20, BD21, BD22, BD23 and BD15 Farcliffe offers a service primarily to BD7, BD8, BD9 and BD14 Owlet offers a service primarily to BD16, BD17, BD18, LS29, BD1, BD2, BD3 and BD10 Burnett Fields offer a service primarily to BD4, BD4, BD6 and BD12 Page 163 7
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The Family Centre service currently only take work from CSC. All cases have had a SW assessment.
LAC - Assessment of parenting capacity for LAC cases in care proceedings - A Community Resource Worker will supervise contact, model good parenting and provide guidance and feedback about changes required to improve parenting skills. Children normally attend contact between 7.5 hours and 10 hours per week. Historically courts have ordered contact to be 5 x 1.5 hour sessions, however recently courts are requesting 3 x 2 hours session. In November 2015, the Family Centre Service had 169 LAC cases open. CIN cases - The FC service holds CIN cases. These cases have had a Social Care assessment and A Community Resource Worker is the case holder and works with partner agencies to effect change and improve outcomes for children. In November 2015 the Family Centre service had 157 CIN cases open. CP cases - The Family Centre works alongside a social worker in CP cases - They work in the family home carrying out a detailed parenting assessment and monitor any safeguarding issues from the CP plan. In November 2015 the Family Centre Service had 235 CP cases open. Joint work on CIN cases - The Family Centre Worker works alongside the Social Worker in CIN cases – In these instances, the case holder is a SW. The Family Centre Worker may be required to undertake a specific piece of work based on specialist skills. These cases are often stepped down to the Family Centre once initial concerns have reduced but still require statutory monitoring and review. In November 2015 the Family Centre Service had 157 CIN cases open. This reflects the importance of early intervention and prevention in work with children and young people to reduce the incidence of abuse and neglect, family breakdown and social exclusion. In November 2015 the Family Centre Service had 718 cases open in total.
Range of Services offered are:
• Family Group Conferencing, Family Meetings and Family Mediation all help families to understand and take control of their own destinies after being made aware of the risks and concerns of the professionals. • Special dedicated courses for parents for those children and young people who need a little extra support, Training for families whose children have Autism, Anger management, Courses for dads and other significant males in a family home, behaviour courses – ESCAPE, Short Breaks for children with disabilities. • Behavioural specialist support for those children and young people with extreme challenging behaviour. A range of parenting interventions that deliver universal support through to one to one parenting in the home. • Intensive Family Support within a family’s home, who work on Signs of Safety and getting families alongside the children, using the outcome star, to show what a difference they are making or need to make. • Support for placements whereby risk taking behaviour for teenagers has moved too far beyond the management of their parents or carers, whether this be substance misuse, risk of sexual exploitation, violence and conflict. • Multi – agency Family Support Panel for any professional to attend with consent from the parent/carers
Edge of Care Services
Specialist Behaviour Team
Manage all violent and aggressive young people within the Bradford district to prevent exclusion from home, work on behaviour modification, self-injurious behaviour, destructive, sexualised behaviour, sensory led behaviours. Deliver behavioural tested behaviour programmes, use Applied behavioural analysis (ABA) ESCAPE, support AIMS assessments, Assess Foetal Alcohol Syndrome Disorder.
Deliver on Cygnet training, Behaviour training, Sleep Clinic – regional centre. All staff are Team Teach tutors, Triple P, BILD, Fostering Changes, Page 164 8
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Measure work through Goal Attainment Scaling (GAS), HONOSCA – just developing tool for measuring outcomes for High Functioning Autism.
Specialist Inclusion Project
Deliver short breaks agenda for children with disabilities tier 2 – not for children in CSC – unless part of a direct payment paid package. Support universal settings to become more inclusive Deliver training packages Run clubs and activities, workshops, ministry of food, Minecraft etc. 100 young people a week – 150 during school holidays Co-ordinate activities, link work around 40 cases Step down for leisure and recreation packages for children’s social care around 45 cases Residential holiday care pilot - have to move to social enterprise to be able to income generate. Outward bounds placements at Nell Bank, Ingleborough and Buckdon for families, children and young people, support groups subsidised and non-subsidised packages, moving towards fully sustainable support. Monitor and review all children in commissioned placements around 70 places. Commission out small grants of up to £5,000 for inclusion agenda audit provision. Work with partner agencies who draw down money for more diffcult young people i.e. mind the gap – Duke of Edinburgh Award.
Placement Support Services
Placement Support Service priorities have altered over the last year to meet changing CSC priorities. PSS stopped working with child in need cases and targeted our intervention into 4 main areas
Return Home from Care (22% of PSS work) Supporting foster carers when placement breakdown is imminent (16% of PSS work) High risk child sexual exploitation crisis – when the risk of becoming accommodated in informed by CSE (28% of PSS work) Disruptions – when crisis comes in out of hours, children enter care in emergency provision overnight. We offer intervention and support to return children to their families. (12% of PSS work) 22% of our work in 2015 were the CIN cases we carried over at the start of the year, as well as any other cases referred through family support panel as needing our intervention.
Return Home Statistics
16 children returned to their families from foster care 8 children returned to their families from out of local authority placements 8 children returned to their families from in house Bradford residential placements. Total: 32 children returned to their families.
Foster Families
28 foster families and their foster children have received intervention in 2015 with a further cohort of carers receiving group training. Foster care intervention is often longer term as if notice has already been given then the worker will support the transition and induction into the new placements to secure permanency. Delivering fostering changes in the home as well as in groups; working on outward bounds self-esteem and confidence, attachment work with the child and adult also being trialled.
CSE – Edge of care at risk of being accommodated only
Over the last 7 years PSS have developed a resilience based approach to CSE, working with the whole family to build resilience within family and community networks. Page 165 9
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Work with children and families utilising various evidence based practice models, including Zoe Loddricks Trauma Bonds to aid parent and carers understanding of their children’s behaviour whilst also offering CSE education to move them through the cycle of change so they are able to take action to safeguard their children. As we offer a whole family approach we also work with children and wider family and friends, to identify with them their vulnerabilities and resilience and support them to build further resilience which in turn reduces their risk to CSE.
CSE work is often longer term and more intensive. We work closely with the CSE hub but much of our work is out of hours and at weekends. We form part of the social work plan and work intensively with children and families. Unsurprisingly our referrals have increased dramatically for families facing CSE, increasing from 35 referrals in 2014 to 52 referrals in 2015.
Disruptions
This is a relatively new area of work for PSS, hence the low figures. PSS used to pick up referrals via placement co- ordination but have recently alligned our duty system to EDTs work and hence we pick up referrals directly as they come in out of hours. In the main these are placements with family that have been disrupted in the short term, We provide intervention and support straight away and pick up the next day with the aim of returning the child to family wherever it is safe to do so.
We provide duty support from 3pm – 10pm every weekday and from 9am – 10pm at weekends and bank holidays with a 24 hour telephone support line for open cases outside of those hours. We have very recently supported the work of EDT within these hours and are trained to act as appropriate adults, mediate home, support children in safe places away from police stations whilst decisions are made re their placements, carry out welfare visits when needed or any other practical response in a crisis. Quite often crisis occur out of hours for our open cases so we can respond promptly to these.
Other 22%
PSS evidence based practice methods:
Trusted adult model. Resilience based approach – pull/ push / pull Motivational interviewing and the cycle of change assessments. Family meetings based on FGC philosophies Mediation. Various parenting programmes, time out for teen, nurturing parenting programme and tools learnt through level 4 in parenting. Family Star Outcome model Solution focused approaches These were all used previously in CIN cases – this number will account for some of this 22% of cases – however we also pick up cases that require intervention from Family Support Panel.
Intensive Family Support
Currently supporting families in c/p, PLO and court process o Referrals come from C/P plans, PLO/Gateway meetings and court directives o Work with all ages
Intensive support offering daily visits particularly around routine times i.e. Bedtimes, mornings and mealtimes, work times 7am -9pm including some weekend and BH work.
Key elements of our intense work-
. Having clear bottom lines at c/p and PLO stage can be a motivating factor if supported effectively Page 166 10
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. Intervention builds on strengths whilst addressing vulnerabilities . Incorporates modelling, practice, feedback/reflection and praise on an intensive level . Intensive parenting input adapted to the family home/environment to enable hands on support at times of potential stress in the families own surroundings rather than false environments. . Repetition is key and breaking down information into manageable aspects for parents who are compromised through substance misuse, learning disability and mental health . Intensity of contact promotes building up of trusting working relationships . Practical hands on support on a daily basis, someone who will do the “dirty work”- de-cluttering, cleaning, moving house . Research tells us for something to become a routine it must be done consecutively 21 times to become a habit. Needs every day repetition cannot be achieved by weekly visits. . Average number of visits per family over a 12 week period 34
IFST provides comprehensive up to date information on parenting capacity for court proceedings/parenting assessments, intensive change work using strengths based practice incorporating
Outcome star - To identify risky behaviours, facilitates useful conversations using motivational interviewing - measures motivation (cycle of change), Solution focussed practice, Measures outcomes.
Signs of safety - Individual work with children re their wishes and feelings using three houses and wizard/Fairy tools
Evidence based parenting programmes - Offered on a one to one basis – support provided at key times, bedtimes and mornings
o Family Links – Nurturing, looking at attachment o Time out for teens o Change - A parenting programme for parents with learning difficulties, where information is broken down into pictorial resources- underpinning element being Demonstration- practice-reflection – repetition. Often requested via court
FASD – Foetal alcohol spectrum disorder - Support to LAC –Fostering and adoption/SGO support plans re caring for children with FASD/Early trauma and neglect. - Education and awareness via workforce development to foster carers, adopters and partner professionals i.e. schools/YOT - Individual work with children and young people re FASD what is it and what does that mean to me? Framework of assessment - ICS recordings completed using framework of assessment to support s/w assessment Sleep clinic-sleep Scotland - Staff trained in sleep therapy to support work with bedtime routines for mainstream children The parenting programmes the team use to support families are: Family Links Nurturing Programme Family Links Nurturing Programme (Special Needs) Triple P (0 – 12) Triple P Teens Time Out for Teens Time Out For Dads
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Parenting Programmes Monitoring Data for Last Quarter
Parenting Programme Family Time Out Triple P Total Links for Teens
Parents who start the 531 65 42 638 course
Parents who complete the 395 45 28 468 course
Amount of Groups 59 7 7 73
Individual Work 37 0 5 42
Children in Age Groups Nurturing Time Out Triple P Programme for Teens
Under 1 32 3 3
1-3 243 23 11
4-11 429 29 23
12-16 154 40 31
17-20+ 68 14 7
Total per programme 926 109 75
Total Children Potentially Reached = 1111
Children who had a child protection plan in place 50
Children who had poor attendance at school 56
Children who were known to YOT / ASB Teams 55
Parents who were receiving support with substance 32 misuse
Parents who were experiencing domestic abuse 42
Parents who were experiencing mental health 63 difficulties
Family Links is run across Schools, Children’s centres and some VCS organisations, whereas Time Out for Teens and Triple P is mainly run by Educational Psychologists, YOT, and Secondary schools. Page 168 12
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Chapter 2 – Governance and Accountability.
1. The Bradford Safeguarding Children Board The Bradford Safeguarding Children Board (BSCB) is a statutory body convened under the Children Act 2004, and its activity is driven by Working Together 2014 – section 13 and 2015 chapters 3-5. The BSCB comes together to agree how the safeguarding arrangements will work in the Bradford District, how priorities for the Board’s business are defined and how partner agency’s work activity is evaluated for effectiveness and where necessary hold each other to account where services standards raise some concerns
The Safeguarding Children Board in Bradford has undergone a change of leadership over the period of this report. The Vice Chair of the Board Julie Jenkins, stepped up to chair the Board in March 2015 while a new chair was recruited. A new Independent Chair, David Niven, was welcomed in place in September 2015. The new chair’s history includes being chairman of the British Association of Social Workers and of being nine months into a contract as Independent Chair of Tameside Safeguarding Children Board, and he was looking forward to taking on the role for Bradford. The Chair reports directly to the Chief Executive Officer of Bradford District Municipal Council who is ultimately accountable for the safeguarding arrangements for the district.
Vision Statement . The Bradford Safeguarding Children Board is committed to improving the safety of all children and young people in the Bradford District. When children are safe, they can be healthy, happy, achieve and reach their future potential. We recognise and promote the concept that keeping children safe is everybody’s responsibility.
2. How we are Organised The Board meets 6 times a year in 3 hourly sessions, supported by the business unit which covers the administration of the meeting. The Business manager ensures that the agenda is agreed prior to the meeting and that all required reports are provided prior to the meetings taking place. The Board also meets for an annual development day and holds extra-ordinary meetings as required. The Board is also sits above a business Planning Group which drives the work activity of the Board, and a sub-group structure which takes forward the work of the Business plan, and these groups also meet 6 times a year.
The membership of the Board is listed in appendix 3, and currently is well attended across the full range of statutory partners, lay members and schools (appendix 4). Communication and safeguarding activity between the Board and schools has shown a significant improvement with the establishment of the Safeguarding in Education sub group (SiE), chaired by the Head of an Independent School. An Education Hub has been established to focus directly on children missing education, and the hub reports into the SiE sub group.. There is a focus on increasing participation from children, faith groups and community leaders from BME groups, and there are plans to establish a community advisory group.
Communication across the partnership is currently achieved through the website, and work is taking place to upgrade the site to improve usability. A review of the communication strategy is to take place to take advantage of the breadth of media opportunities now available to transmit messages and briefings to professionals and the public.
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3. Structure of the Board
Independent Adult Safeguarding
Health and Board Chair – Children Board David Niven Wellbeing Board Community Safety Vice Chair – Nancy O’Neill Partnership
Children’s Trust Bradford Safeguarding
Children Board
VCS Safeguard Steering Group Business Planning Group Chair - Dave Benn Chair – David Niven Safeguarding in Health Group Chair – Sue Thompson/Ruth Skelton
Child Sexual Performance Universal Pro-active Serious Case Learning and Review Exploitation Developmen Management Safeguarding and Sub-group and Missing t Sub-group Audit and Sub-group Responsive Chair – Sub-Group Chair – Evaluation Sub- Chair – Sub-group Kate Ward Chair –Supt. Sue group Chair – Jenny Cryer Chair – Sharda Vince Firth Thompson Gani Martins Parthasarthi
Child Death Safeguarding in Overview Panel Education Chair – Sub- group Shirley Brierley Chair –
Jez Stockill
4. Roles and Responsibilities
Independent Chair The period covered by this report was a challenging one for the partnership in terms of unplanned changes to the leadership of the Board resulting in several changes across the year. The Board was chaired for 6 months by Julie Jenkins, vice chair and Assistant Director for Children’s Specialist Services, while a new Chair was recruited and Page 170 14
Bradford Safeguarding Children Board Annual Report – 2015/2016 appointed. The BSCB has been led by David Niven since September 2015. The Chair is directly accountable to the CEO of BDMC and they meet bi-monthly. The Chair also meets regularly with the Director of Children’s Services.
The Local Authority BMDC has a designated lead member for Children’s Services who regularly attends the Board meetings and development day as an observer. The Lead member also works closely with the Leader of the Council and the CEO to ensure that the council exercises their responsibility for the safeguarding of children in the district. Regular briefings are provided directly to the Lead member on safeguarding issues, cases and concerns, and to the council through the Children’s Services Overview and Scrutiny committee by the Director of Children’s Services.
Designated Professionals and Advisors
Advisors to the Board:- Board Support and Administration:-
Board Manager Deputy Board Manager
BSCB
Social Services Law Team Performance and Legal and Democratic information officer
Services City of Bradford MDC BSCB advisor for Faith Settings Designated Nurse
Learning and NHS Airedale Bradford and Leeds Development Coordinator
2 Designated Doctors Board Administrator NHS Airedale Training Administrator Bradford and Leeds
The Board is supported by two designated doctors, each located at a teaching hospital in the district, and a designated safeguarding nurse who reports to the three CCG areas. The designated health professionals work across the Board’s structure providing advice on commissioning processes, safeguarding in health issues, policies and procedures and input into the learning Improvement Framework. They also chair the Safeguarding in Health group, which monitors and supports the safeguarding agenda across the health landscape. Child protection advice is provided by the Board’s business manager, who also ensures that all changes to guidance, law and practice are made available to the partnership with a summary of Implications for the Board. The Board has access to legal advice through the Council’s Legal Department, but is always mindful of potential conflicts of interest and is able to seek independent advice if the case arises.
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Partner Agencies Effective safeguarding arrangements depend on the partnership’s commitment to the Board and sub groups. While representation on the Board is defined by the Children Act 2004 Section 13, the partnership in the Bradford District is fully engaged with the Board, and provides representatives appropriate to the level of authority required at each level of the structure in order to commit their agencies to agreed policies or practice developments. They are also of sufficient authority to hold each other to account for issues of concern or non-compliance, and challenges have been issued where attendance or concerns have not been resolved.
5. Key Relationships
The Chair of the Board has established close working links with the Adult Safeguarding Children Board and the Community Safety Partnership, and the vice Chair of the Board has close working links with the Health and Wellbeing Board and the Children’s Trust.
Health and Wellbeing Board There is an effective working protocol between the BSCB and the Health and wellbeing Board (H&WB) with excellent communication being achieved in both directions through the Vice Chair of the BSCB and the Strategic Director of children’s Services who attend both Boards. The Chair of the Board also presents the BSCB’s annual report to the H&WB and agrees shared priorities for the safeguarding of children in the Bradford District.
Children’s Trust Board The Children’s Trust Board (CTB) is part of the Bradford District Partnership Board (BDP), which also includes the H&WB is chaired by the Leader of the Council and provides an overview and scrutiny of the work being carried out by the partnership. The CTB is chaired by the Strategic Director of Children’s Services, who is in the position of communicating safeguarding priorities across all three of the Board’s attended. The CTB is focusing on a range of safeguarding strategies that include:
Developing our integrated Early Help offer across all key agencies Refocusing children's placement provision within the Bradford District Provide a better response to young people in crisis Develop an integrated service across children's, adult's and health services for young people with aged 14- 25 years with complex health and/or disabilities:
Bradford Adult Safeguarding Board
The Chair of the Board has regular meetings with the Chair of the Adult Safeguarding Board to identify joint safeguarding priorities that cut across both areas of responsibility. This includes a joint focus on vulnerable adults experiencing domestic abuse, mental health challenges and substance misuse who are also parents and or carers. This is resulting in BSAB representation being invited into sub groups and challenge panels where practice expectations and protocols are being discussed.
Community Safety Partnership Board
The Board also has developed close links with the Community Safety Partnership Board through the police and national probation service both of which have members attending both Boards. The Chair of the BSCB also maintains close links through the work on substance misuse and domestic abuse.
6. Financial Arrangements The Bradford Safeguarding Children Board functions, activities and business unit is funded through a pooled budget contributed too by a range of statutory partners, and begun the 2015 – 2016 year with a budget of £552,440.00 Page 172 16
Bradford Safeguarding Children Board Annual Report – 2015/2016 made up of a base budget of £376,340.00 and a carried forward underspend of ££176,100.00. The budget contributions and activity is as follows: LOCAL SAFEGUARDING CHILDREN BOARD
Financial Statement 2015-16
- Balance b/fwd from 2014-15 176,100
2015-16 Actual as at Outturn Heading 31st Budget Variance 2014-15 March 2016 £ £ Employees (including agency) 407,572 311,328 288,000 23,328 NHS based CDOP 51,520 51,000 51,000 Admin worker based with the Police 0 Staff travel 4,343 5,385 8,350 -2,965 Staff Advertising 1,705 0 Training(Incl Room Hire and Catering) 45,348 16,822 43,500 -26,678 Materials 62 12 12 Equipment 164 434 500 -66 Printing/Publicity 2,637 5,329 5,329 Independent Consultants for SCRs and other case reviews 5,660 40,914 8,100 32,814 Independent Chair of Board 12,300 24,189 26,800 -2,611 Expenses 4,826 9,726 1,000 8,726 IT & Telecoms 22,455 935 935 Total Expenditure 558,590 466,074 376,250 89,824 0
Contributions 347,225 376,340 376,250 -90 Base Budget 27,300 0 0 0 Admin Budget 72,100 0 0 0 Misc Income 19,850 1,000 0 -1,000 Total Income 466,475 377,340 376,250 -1,090 2015-16 Total Surplus -85,186
NOTES
CONTRIBUTIONS 2015/16 Bradford Council Childrens Services 205,200 social care 137,767 Bfd Educ 34,467 Early Years 16,483 Youth Service 16,483 Health 148,350 Police 17,550 National Probation Service 2,345 West Yorkshire Community Rehabilitation 2,345 Page 173 17
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Cafcass 550
Total Contributions 376,340
7. Effective Performance Management -Scrutiny and Challenge
The Board fulfils its responsibilities to ensure that performance across the partnership is effectively managed through a range of strategies. Through the Performance Management Audit and Evaluation sub group (PMAE), multi- agency data, both quantative and qualitative, pertaining to safeguarding activity, is recorded and analysed on a quarterly basis through the data scorecard and presented to the business planning group and full board for scrutiny. This activity had identified some previous issues with attendance at case conferences which resulted in a challenge being made to agencies and this has resulted in a protocol for police attendance which is fully implemented and complied with. There was a further issue around the timeliness of case conferences and a target was set for improvement which has been exceeded.
The PMAE also oversee the audit and challenge panel agenda, organise the panels and draft an outcome report and action plan that the subgroup over sees to completion. The sub group also reviews the outcome of individual agency audits to identify areas of good practice and issues for improvement. These two activities form two parts of the evaluation of practice triangle with training evaluation forming the third side. The work has resulted in improvements taking place across a range of multi-agency and individual agency safeguarding activity. A review of the CSE hub has begun, which includes a review of the risk assessment tool and a drafting of a CSE framework. A task and finish group has been established to review the risks of CSE for disabled children, and the services and tools available to identify and reduce the risk of harm.
The PMAE also monitors and scrutinises the Section 11 process for the Board. The process runs continually in Bradford through the Virtual College input and assessment tool. Agencies across the partnership are able to update their information, evidence and analysis on a quarterly basis. The PMAE sub group drafts an action plan from the information on the system and monitors each agency’s progress on this. Currently, there is a high level of compliance, but where there has been delay in updating reports, challenges have been sent out to agencies with timescales to re-establish compliance with the agreed process. Feedback from some of the agencies identified that the tool was difficult to use, and this has been addressed with the College who put improvements in place and this issue is now resolved. The Performance Framework works alongside the Learning and Improvement Framework to assure the Board that all levels of improvement, resulting in the reduction of risks to children in the district, are being addressed.
8. Continuous Learning and Improvement
In accordance with Working Together 2015:
"Local Safeguarding Children Boards (LSCBs) should maintain a local learning and improvement framework which is shared across local organisations who work with children and families. This framework should enable organisations to be clear about their responsibilities, to learn from experience and improve services as a result." (WT 2015: p.72) The BSCB reviewed its Learning and Improvement Framework (L&IF) in April 2015 and it is available on the Board’s website for public and professional access. The development of the local framework has enabled BSCB, partner agencies and local partnership bodies to be clear about how the learning and improvement cycle can be achieved through various methods. The framework offers guidance, as well as the way in which learning can be shared in order to improve practice.
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It is important that agencies are clear about their safeguarding responsibilities and respond to the Board’s learning and improvement activity, in particular the recommendations for their agency, providing evidence of their agency’s progress on implementing the actions and using this as a basis for developing their safeguarding practice. In relation to the learning and improvement work undertaken, it is important that this is not seen as an end in itself but as a progression of improvement across the safeguarding partnership.
This is evident through the safeguarding activity arising from the different levels of reviews, audits and challenge panels carried out by the Board. Learning arising from local and national serious case reviews have resulted in a series of briefings and face to face learning events around CSE, the impact of incontinence, neglect and bruising in non-mobile babies.
9. Allegations Management The Local Authority Designated Officer Service: A well-established LADO service is in place that facilitates safer working practices in the Bradford District. It comprises of a Senior Manager as the designated LADO Officer in the Safeguarding Unit under Children’s Services and is supported by a rota of experienced child protection LADO investigators, a police contact in the MSASH and a single point of contact (SPOC) for education by a senior officer in the access and inclusion unit. The SPOC is available to schools and education providers for advice and guidance on the ‘Allegations Against Professionals’ (AAP) procedure, and whether the threshold is met for an investigation. Where the threshold is met, the SPOC refers the case to the LADO and Police officer who implement the process. The SPOC continues to support the school/education provider throughout the process where required. This has resulted in schools and education providers experiencing the process as supportive and them being more actively involved in the process overall. The police officer reviews the referral and makes a judgement on whether the case will become a criminal investigation and the outcome is recorded on the file. The LADO service has implemented 2 key initiatives which continue to demonstrate rigour and objectivity in the process around allegations made against residential unit staff and foster carers. Where an allegation is made against staff in a residential provision, an independent manager from another provider is commissioned to carry out the investigation and provide a report to the investigation team. Likewise, where an allegation is made against a foster carer, an advanced practitioner is commissioned from a different fostering team to carry out the same responsibility.
The designated officer is fully engaged with the West Yorkshire LADO network which ensures a level of consistency and application over the wider West Yorkshire partnership, and attends the National LADO conference to ensure that changes or improvements to guidelines in respect of safe working practices are disseminated across the Safeguarding partnership and that this supports the development of safe organisational cultures within organisations. This is achieved by the LADO making an annual report to the BSCB, leading on the Allegations Management and safer recruitment training events and by their presence on the Proactive and Responsive and Universal sub groups where emerging issues are considered and action identified for improvements.
Over the 2015 – 2016 period the total number of LADO referrals received was 236, this was an increase of 27 cases on the previous year. The duty to refer to the Disclosure and Barring Service was a highlighted event in the 2015 safeguarding week in Bradford. It is noted that the number of referrals being received from health services and independent nurseries has increased and evaluation is taking place as to why these increases are being noticed.
The total number of referrals successfully closed was 263, compared with a figure of 239 in 2014-2015. Ninety Eight of these closures (37%) were recorded as substantiated.
Overall Outcome: Total: Malicious 3 Substantiated 98 Unfounded 17 Page 175 19
Bradford Safeguarding Children Board Annual Report – 2015/2016
Unsubstantiated 141 Other 4 Grand Total 263
A total of 80 cases were recorded on the system for information only, which demonstrates that partners are using the service effectively for advice and guidance on whether a case reaches the threshold for an AAP or whether different action needs to be taken.
Child Protection Complaints:
Complaints, made by parents or children of sufficient understanding, about the child protection process are managed through the West Yorkshire consortium’s inter-agency safeguarding child protection procedures. The process is organised over three levels of response, culminating in an appeal to the Board if the complainant remains dissatisfied with responses at the first and second level. Every effort is made to resolve the complaint at the earliest opportunity to enable the work with the family to progress constructively. During the period covered by the report, 2 complaints were received by the safeguarding team, and one was resolved at stage one of the process and the second is on-going.
Professional partners who wish to challenge the child protection process follow the conflict resolution process under the safeguarding procedures. To date, there have been no formal challenges under this process, and the reasons for this are being reviewed through the challenge panels. Learning from each of the processes is kept under review and is included as a key priority in multi-agency safeguarding training and action plans. A further improvement is being introduced under the Signs of Safety approach to each area of child protection activity. It is anticipated that the approach will enhance parent participation and lead to reduced risks to children.
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Chapter 3 - 2015/2016 – progress and Improvement on the Board’s priority Areas The Bradford safeguarding partnership that makes up the membership of the Main Board approved the 2015 – 2016 Business plan. Through the planning process 4 key priorities were identified for further development and improvement throughout the course of year. This chapter will analyse and evaluate the progress of the activity within each priority area, what improvement was made and how this impacted on the safeguarding of children and what is next to do.
As activity progressed under the Board’s Business action plan, further areas of development or improvement became apparent and resulted in additional actions being added to the work plan, targeted multi agency, focused learning events being organised, a deep dive review of high profile issues and the establishment of a rigorous challenge panel approach to holding partners to account.
Priority 1: Performance Priority Outcome: A Performance information system that gives an overview of the effectiveness of the safeguarding system.
An LSCB that is good provides robust and rigorous evaluation and analysis of local performance that identifies areas for improvement and influences the planning and delivery of high quality services.
The BSCB has a statutory responsibility to ensure that partner agencies are effectively protecting children and promoting their welfare within the Bradford District. In order to carry out this responsibility the Board requires a sound performance management framework that enables the partnership to monitor and scrutinise safeguarding services, front line practice and triangulate evidence to identify where improvement is needed. Through this process the partners are able to hold each other to account and make constructive challenges where needed to facilitate improvement and reduce harm.
Activity identified under priority 1:
A Performance framework to be developed 1. The data set will be analysed to identify areas of declining effectiveness
2. Provision of more comprehensive performance information and analysis about priority vulnerable groups 3. The BSCB to have an overview of performance 4. Section 11 (Children Act 2004) Audit review 5. Impact evaluation of safeguarding training and the quality of front line practice on outcomes for children Early Help offer to be agreed and published Achievements to date: 1. The Performance Management, Audit and Evaluation sub group (PMAE) has worked together with the safeguarding partnership to evaluate the current performance management framework and data scorecard, to identify gaps and areas of improvement. Research has taken place over a range of models being delivered by other safeguarding boards to facilitate the development of a model that will meet the local needs of the Bradford Safeguarding children partnership.
2. A performance management framework and data scorecard model has been drafted and agreed by the sub group and is being tested across the partnership for rigour and robustness, local relevance and effectiveness in meeting the priority outcome 1.
3. The progress of the work is now routinely monitored by the Business planning group and scrutinised by the Main Board to assure the Board that progress is forward movingPage and 177 meeting the responsibilities of the Board. 21
Bradford Safeguarding Children Board Annual Report – 2015/2016
4. The Board, in conjunction with the Virtual College has achieved a design update in the toolkit for the on-line Section 11 report making the tool easier to use when updating progress and activity. The PMAE is continuing to monitor the self-reporting of partner agencies on their progress and is challenging non-compliance with their action plans, where timescales or activity has not been achieved. The outcome of this activity is reported to the Board on a half yearly basis and partners are being held to account for the progress being made and where improvements are required.
5. The Learning and Development (L&D) sub group continues to evaluate the impact of safeguarding training through a range of strategies. All courses are evaluated at source through feedback from the attendees, this is then routinely followed up with front line managers to establish the impact of the learning on the attendees practice. Partner agencies are carrying out internal audits to evaluate practice by their front line practitioners and the results of these are considered by the L&D group to evaluate impact. A further dimension to the evaluation has been introduced through multi-agency challenge panels, which spotlight a number of cases under a focused theme and the resulting report is highlighting areas of good practice and areas in need of improvement.
* The threshold of need guidance has been placed under review to ensure that it meets the changing landscape in local front line services. This work is being carried out in conjunction with the development of the early help offer. The multi-agency Early Help Board (EHB) has established two pilot areas in Bradford to model two Early Help Gateways, and an evaluation of the effectiveness of the projects is being monitored by the PMAE sub group and reported to the Main Board.
Priority 1: - work achieved by Safeguarding Partners: West Yorkshire Police – have invested considerable personnel resources into the Multi-agency Safeguarding Hub (MASH), the child sexual exploitation hub (CSE hub), CSE historical cases and children missing and missing from education. The collaborative front line activity has ensured that data from these vulnerable groups is now being robustly recorded. The Police and Crime Commissioner – has funded a data analyst post within the MASH. This has resulted in a rigorous review of the recorded data and scorecard and has produced a racetrack of CSE and Missing activity which enables the Board the effectively evaluate partner services activity in these areas. The scorecard is routinely monitored by the child sexual exploitation and missing (CSE&M) subgroup which oversees the action plans for CSE and missing children and is scrutinised by the PMAE subgroup for compliance with the plans. BLAST – Routinely participates in the CSE hub discussions on boys at risk of CSE and contributes to the collection of data in this area of safeguarding activity. Barnados – ‘NightWatch’ programme has received further funding from the community safety partnership to continue their work in the district offering advice, guidance, support and training to businesses, services and the general public in raising awareness of CSE, thus generating further intelligence that supports resource planning. Bradford Teaching Hospital Foundation Trust (BTHFT) and Airedale Hospital Foundation Trust (AHFT) – are in the process of upgrading their record and information systems to enable their contributions to the data scorecard to fully meet the new wider range of score card information required by the Board. All Partner Agencies – are contributing to the continuous process of updating the Section 11 on-line tool. Children’s Services (CSC) – Continue to drive improvements in the electronic record and case management system (LCS) to facilitate and improve the quality, range and rigor of data being produced on children and their families. Clinical Commissioning Group (CCG) and Bradford District Care Foundation Trust (BDCFT) – have worked to improve the interface between record systems within the health partnerships thus ensuring that their contributions to the data scorecard meet the new wider requirements. NSPCC – Has reviewed and produced a draft multi-agency Neglect Strategy for the Board in conjunction with the review of the Threshold guidance and the Early HelpPage offer 178– Journey to Excellence. 22
Bradford Safeguarding Children Board Annual Report – 2015/2016
Children’s Services – Journey to Excellence – is driving forward the early help offer in conjunction with the early help board, and further pilot EH gateways are being planned for implementation in the coming year.
How have these achievements made a difference to children and their family’s: The improved data scorecard and CSE racetrack has enabled intelligence led, resource planning and safeguarding action to take place within agencies across the partnership:- 1. The CSE hub now has dedicated police officer’s and social workers who daily assess the risk to children who are referred to them and ensure that an appropriate level of response is made to protect them from abuse and reduce harm. Children are kept safer throughout the process and a multi-agency approach is taken to the provision of services to address the child’s vulnerabilities and build resilience to reduce the risk of further harm. 2. The risk to boys, of CSE, is now better understood across the partnership and they are therefore better protected. The awareness raising events that have taken place now routinely ensure that boys receive the same level of scrutiny and analysis as those completed on girls. 3. Children who are recorded as missing receive a welfare visit from the police and a follow up return home interview from two dedicated services, one for looked after children and one for those missing from home. Preventative services are put in quickly to work with the child and family to analyse the driver for the behaviour and address the root cause. This has resulted in several new cases of CSE being identified and addressed through the criminal process. 4. Children are now safer because all taxi drivers registered to the Bradford Municipal District Council will undertake a training event on CSE to ensure that they are able to recognise the signs and respond effectively in referring the child to the appropriate agency. 5. Children are now safer because night time economy workers are in place and active on the ground working with hotels food outlet businesses that attract children and bring them into contact with abusive situation from groomers and paedophiles. Management and staff in these areas are provided with training on how to recognise the signs of children being exploited and abused and what action they need to take. 6. As to be expected - the wider awareness raising of CSE and missing has resulted in a significant rise in the number of children being identified at risk, and this is evaluated as an important success in the current CSE and missing strategy 7. Children are now safer within the district as non-compliance with safeguarding practice expectations, insufficiency in agency resources or failure to complete work in action plans is now identified within the performance framework, and the risk raised within the challenge and risk log at the business planning group and action taken to address the risk is provided to the main board for ratification and/or approval. Currently, the work sent to the two Early Help Gateways is filtered through the CSC front door and monitored by the MASH team manager. The Gateways have a multi-agency panel in place which considers the needs of the child and agrees the services to be offered. This has enabled children and their families, within the two areas involved, to receive targeted local services efficiently and with the minimum of delay thereby effectively promoting their welfare and preventing harm.
What needs to happen next: The performance management framework needs to be formally agreed and fully implemented across the partnership. All partners need to routinely provide an analysis of their own performance across the framework through the data provided to the scorecard, the training needs analysis process and the continuous section 11 audit process. This will enable the Board to fully understand the effectiveness of the safeguarding arrangements in place across the partnership and be assured that insufficiency and risk are identified quickly and formally addressed. That the Early Help Offer is formally agreed and implemented across the district, and that the review of the threshold guidance and the neglect strategy are also formally agreed and adopted. That the impact and implementation of the Early Help offer is evaluated through the performance management framework and scorecard to assess how partner agencies understand the contribution Early Help makes to safeguarding children; how effectively it is operating across the district in terms of multi- agency usage and what difference has made toPage children. 179 23
Bradford Safeguarding Children Board Annual Report – 2015/2016
Priority 2: Engagement and Participation Priority Outcomes: Engagement with the wider community, schools and participation from young people.
An LSCB that is outstanding is highly influential in improving the care and protection of children.
In order for the BSCB to be highly influential in improving the care and protection of the children within the district the partnership must be able to demonstrate how effectively it is able to engage with all sectors of the community through the activities that take place under the umbrella of the safeguarding arrangements. In order for the engagement process to be fully effective it must also reach out to the children and their families within the communities.
A further dimension in this process is the engagement with faith settings and the wider educational landscape that also influence the care and protection of children.
Activity identified under priority 2:
1. Build on the work done in engaging with mosques and madrassahs 2. Improve the awareness of safeguarding issues with new communities and facilitate their access to universal services 3. Further strengthen engagement with schools and FE colleges across the changing education landscape in the district 4. Increased participation of children in the safeguarding process
Achievements to date:
1. Building on the work carried out with mosques and madrassahs, a wider view of safeguarding across all faith settings has been taken by the Board. The BSCB now has a deeper understanding of the provision of unregulated Islamic/faith education within the Madrassahs sited in the Bradford District. The list of Massajids/ Madrassa continues to grow, there are approximately 125 places where teaching takes place, as well as 6 Gudwaraas, 75 churches, 1 synagogue and 4 Mandirs within Bradford District. The management and organisation of the units varies depending on the status of the provision which ranges from teaching provided in schools and faith settings, to those being carried out within private homes. An average sized madrassa teaches approximately 150 children with the biggest madrassa catering up to 500children.
Through the work carried out by the safeguarding advisor for faith settings (SAFS), the number of children being schooled is estimated to be between 12 to 16000 children attending religious studies from Monday to Saturday and as the population growth increase there will be additional demands put upon on madrassas to provide a service. As a result Bradford has a growing numbers of house madrassas where there are perceived additional risks to the children.
In partnership with faith settings, evening Road safety sessions have taken place in madrassas. Most madrassas have now taken the matter more seriously and are adhering to advice. There are encouraging signs that parents are escorting children to and from madrassa. Children wearing high visibility vests provided by the safeguarding Board and financed by partner agencies. Parents are encouraged to park elsewhere away from the main buildings thus not creating a hazard for the children or blocking an escape route.
Some of the more established madrassa are now providing on site, college education for both their staff members, the community, and are engaging with statutory agencies. Facilitated by the BSCB, the following courses are currently on offer to staff and volunteers in faith Pagesettings: 180- 24
Bradford Safeguarding Children Board Annual Report – 2015/2016
Autism- Road Safety -Alcohol and drugs -First Aid -Governance -Workshop to Raise Awareness of Prevent Safeguarding (WRAPS) Crime Prevention & Awareness Programme -Complex Health and Disability -Safeguarding Adults -Smile with the Prophet /Brush up your smile -Cyber bullying.
New Muslims are now settling in Bradford, they have come from Europe, Africa, Middle and Far East, bringing with them their own religious beliefs, tradition and cultural identity 2. Having recognised the difficulties being faced by the new Central and East European communities in Bradford in accessing universal services and housing, the Board facilitated the drafting of a fast track referral process for both the front door and the housing service. All referrals through this pathway are considered by a multi-agency assessment team consisting of professionals from children’s specialist services (CSS), West Yorkshire police, Education and health services. The referral is risk assessed and processed through CSS or signposted to targeted early help or universal services. To ensure the pathway was effectively implemented, the BSCB organised a multi-agency conference in May 2015 - Safeguarding Children from Central and Eastern European Families - that focused on the safeguarding issues specific to children from the new communities. The conference included a mix of presentations, workshops and table top activity. It was attended by a range of practitioners and managers from the BSCB partner organisations. There were 105 delegates and 45 staff involved in presenting, delivering workshops and providing information and advice. Members from the local Central and Eastern European community assisted with the delivery of a session about cultural and community issues. This was led by the Access Lead BMDC Education Service for New Communities and Travellers. 3. In order for the BSCB to be assured that the responsibilities under ‘Working Together to Safeguard Children in Education – 2015; and to strengthen the engagement and communication between the BSCB and the schools and further education providers in the district, the Board approved the setting up of a Safeguarding in Education sub group. The group first met in January 2016 and has been operating as a sub group since March 2016. The sub group is to play a key role in strategically supporting the safeguarding of children under the age of 18 years in the full range of education settings, and through the appropriate provision of education support services. This will be achieved through promoting, supporting, coordinating and monitoring the effectiveness of safeguarding practice delivered in education settings and by education support services in the District. Particular emphasis is being placed on the changing demands arising from changes to the law and Government guidance – in particular Ofsted expectations on safeguarding reporting, the prevent agenda, child sexual exploitation, domestic abuse and female genital mutilation. The Board has carried out a survey in the schools to identify what level of safeguarding training is being accessed by the schools, and whether the training being accessed meets expectations in terms of content and quality. 4. The BSCB has support a range of initiatives across the year to increase the participation of young people in the safeguarding process. A Senior Manager in Children’s Services at Bradford Council leads on Youth Voice, supported by youth service staff and youth organisations across the District. Bradford has a Youth Voice Working Group formed with the Council and Partner organisations supporting the development of District wide youth voice events. Over 500 young people have been involved in a number of recent youth voice events across the District including engagement with some high profile strategic groups. This has included engagement with the Children’s Trust Board in December 2015, consultation around the District Priorities in February 2016 and participating in a youth voice event held by Bradford College in February 2016. In addition Bradford has worked with external organisations to help us to listen to the voice of children and young people, and to raise the profile of Bradford’s children nationally. The two key opportunities for this were the Home Office Select Committee visit and the two day visit of the Children’s Commissioner.
Bradford makes good use of the Viewpoint programme with children in the care system giving a rich source of feedback data. It is anticipated that this will be further offered to children in the child protection system and children’s voices will be fed back to the Board through emerging themes arising from the feedback from both areas.
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In the Autumn of 2015, the BSCB completed a survey of children, schools and partner agencies on bullying. One hundred and eleven primary and 21 secondary schools were surveyed. Ninety Four children responded to the survey, and the data indicated that the numbers of children being bullied in Bradford was in line with national figures. The survey result indicated that the highest number of children being bullied was in the younger age range and this number significantly decreased in the older age group. Children overwhelmingly felt that adults could do better. The West Yorkshire safeguarding procedures were updated in November 2015 to strengthen the entry on cyber bullying, and there is to be a revision of the multi-agency Bullying Strategy for the Bradford District.
Priority 2: - work achieved by Safeguarding Partners:
Bradford College - In conjunction with BSCB, are currently developing an accredited basic teacher training course for faith teachers. It is envisaged this course will be rolled out in the coming year. - As part of the 2015 Safeguarding Week, a performance company the Further Education Performing Arts students from Bradford College created a piece of devised theatre called “Breaking the Silence“. This was in two parts. The students were supported by college staff to participate in workshops delivered by BSCB and Bradford Council’s trainers. The students learned about the challenging world of safeguarding children, adults and domestic abuse. These workshops then sparked the student’s creativity to develop and shape an original performance to launch Safeguarding week 2015, which was performed in two parts. Education Bradford – Community Cohesion Team - In partnership with BSCB provide a number of one day courses for faith settings such as: - DBS, Child Protection, Behaviour Management, Fire Marshall , First Aid, Work Shop to Raise Awareness Of Prevent, Drugs Awareness including an annual Interfaith celebration. BMDC - Road safety team have carried out road safety risk assessments in some of the Bradford madrassas. - An educational drama tour was commissioned by the BSCB and funded by local authority for the District’s secondary schools highlighting the risks of CSE to year 10 students. - The MASH is being extended to include a Safeguarding Education Hub which will offer operational support to all educational setting in terms of safeguarding issues, monitor children missing from education under both known and unknown categories and develop effective links with other government agencies to enable vulnerable children to be tracked and action taken to reduce the vulnerability. NSPCC School’s Service – visited half the schools in Bradford – primary, non-mainstream educational provision and private schools to present the service to head teachers and demonstrate what the service has to offer to children to make them aware of how to keep themselves safe. The awareness is raised through video and work sessions with the children who then get a ‘My Buddy Kit’ to keep if they need to report abuse at a later date. This work has resulted in a successful conviction in Bradford. BLAST School Development work - participation of Bradford schools in the development work for a CSE resource has been limited, but this work is now complete. The launch is of “Alright Charlie” is planned for the end of March 2016 – it is a CSE resource aimed at educating years 5-6 on awareness of grooming.
How have these achievements made a difference to children and their family’s: 1. The risk of harm to children in faith settings is being reduced from a range of risks. o Road safety assessments and practical support strategies included wearing high visibility safety vests, a madrassa road safety custodian oversees the safe arrival of all children. Parents have to bring and collect their children from inside of the madrassa, and giving advice to the providers on setting expectations for children’s safety have reduced the number of incidents involving children. o Fire risk assessments have been offered to providers – in particular to those being delivered in private settings. o The quality of care, teaching and child protection has been improved through the delivery of a wide range of safeguarding training through the Board and the Bradford College resulting in children having a safer experience while learning about their faith. 2. Children from the Central and East European communities are having their welfare and safety promoted through the receipt of effective and timely safeguarding services across the partnership. This is being achieved through the delivery of a fast trackPage referral 182 system for children in need and in need of protection, 26
Bradford Safeguarding Children Board Annual Report – 2015/2016
and more widely through the provision to families and professionals, of a comprehensive guide to universal and targeted services. 3. The risk of harm to children attending educational settings is being reduced through the following activity: o Schools have engaged in the delivery of the CSE programmes for year 10 and children are now aware of the risks from CSE and how to keep themselves safe. o Schools have been trained to spot signs of radical behaviour emerging and know how to protect children in these situations. o That the bullying that children experience within the educational settings is under review and action is to be taken to revise the current strategy and work with children and schools to take action to reduce this form of abuse. o The risk of radicalisation of children is now being routinely monitored by the Challenge panel and reported to the Board to assure partners that prevent activity is effective in safeguarding children. o The relationships between educational settings and the Board are being strengthened through the implementation of the sub group and the hub. This will reinforce the expectations of safeguarding activity on both sides of the relationship which will improve communication and safeguarding practice. 4. Children’s voices are now being heard across a range safeguarding, service delivery and planning and commissioning activities: o This is resulting in safeguarding themes being recognised from the feedback they are providing through Viewpoint. These themes will be considered in the PMAE sub group for on-going safeguarding scrutiny and challenge where appropriate. o Children’s voices have been heard through the bullying survey, and have raised issues over the current bullying strategy and this will be revised as a result of their feedback.
What needs to happen next: Safeguarding work in faith settings needs to be widened to cover all providers across all faith groups. Home madrassas tend to cater between 10 and 60 children and some have developed shifts patterns to accommodate local demands. Often teaching takes place in one or more rooms such as cellars, lofts; front and back rooms or garages. The risks to children were identified as a failure to implement fire safety, road safety, health and safety assessments and first aid. Of the tutors who were interviewed, with the one exception, none of the rest had Disclosure and Barring Service (DBS) checks. Therefore, targeted work on safety/risk issues needs to focused on individual providers who are delivering teaching in their own buildings or homes. The basic teacher training accreditation course for faith tutors/teachers needs to implemented and taken up by the faith settings for their volunteers and in house tutors. An agreed LADO/DBS approach needs to be implemented for unregulated settings provided by individuals. To develop a contact list of faith settings to use Emails and the website for cascading relevant information in relation to free training and events. Furthermore highlighting and promoting the good work that is taking place in some of the faith settings and in the community to encourage places of worship to look at wider issues both internally and externally so that they can play a major role in shaping the local community. A review of the fast track system for referrals around new communities to test for effectiveness and outcomes. To review the activity in the safeguarding education hub for effectiveness around children missing education. The strategy and policy on Bullying in schools be reviewed and updated.
That the Board discuss the options available to strengthen children’s participation in the Board’s activities, and the Commissioner for Children works with the Board manager to identify resource and to put the preferred option into operation. That the Board requests a regular paper on the results of viewpoint activity undertaken with children in the child protection process and in care.
Priority 3: Challenge and Change Priority Outcomes: Effective Challenge, learning, communication, information exchange and embracing change Page 183 27
Bradford Safeguarding Children Board Annual Report – 2015/2016
An outstanding LSCB can demonstrate that their evaluation of performance is exceptional and helps the local authority and its partners to understand the difference that services make and where they need to improve. The LSCB creates and fosters and effective learning culture.
In order for the Bradford Safeguarding Children Board to meet its statutory responsibilities it must be able to demonstrate through the Board’s accountability framework that the activity taking place under the sub groups will be overseen at both the strategic and operational level. The framework will ensure that partners hold one another to account effectively, drive the improvements through the workflow of the Board and ensure that its core functions are met in the safeguarding of children in the Bradford District. The Board will have an effective communication strategy that enables learning to be disseminated across the partnership and drives improvement in practice.
Activity identified under priority 3:
1. A scrutiny and challenge of safeguarding issues so that change is effected and maintained 2. A review of the Learning and Improvement Framework for effectiveness and rigour
3. To improve the methods of shared learning to enable a wider reach across the partnership 4. To implement a comprehensive training needs analysis framework 5. To improve communication channels to ensure that front line staff understand the priorities 6. To ensure that front line practitioners understand the importance of effective information sharing, the expectations for practice, and the implications for children of poor practice.
Achievements to date:
1. The Board has continued its policy of carrying out multi-agency challenge panels on identified themes. Cases are selected for the panels at random following case audits carried out by service providers. Two challenge panels have taken place over the period of this report. The first challenge panel was completed on disabled children, the outcome of which identified that all assessments, and in particular child assessment framework (CAFs) should routinely consider disability. A further recommendation was that all front line practitioners should receive training on how to include this area in their assessments.
The second challenge panel was a follow up on children at risk of sexual exploitation (CSE). Children’s Social Care had commissioned an audit of 75 cases where CSE had been identified as an issue. The challenge panel then reviewed 6 cases under a multi-agency spotlight. The outcome report identified a number of issues around analysis and assessment, potential role confusion, access to medicals and the allocation of work to appropriately experienced workers.
In addition to the deep dive focus of the challenge panels, individual partner agencies also provide reports on the audits they have carried out over the period and these are considered in the PMAE sub group to identify good practice, risks and areas of improvement. A quality and assurance framework is being developed to ensure that the salient points are identified and action plans are in place for improvements. Each sub group has been tasked to ensure that minutes and actions reflect the process of holding each other to account, and what action is to be taken to answer the challenge. The Minutes format now includes an actions field to facilitate progress and clarity around responsibility for the tasks. 2. The learning and development sub group (L&D) has been working in consultation across the Board sub group system to review the current Learning and Improvement Framework (LIF). A dissemination of learning pro forma has been created to facilitate the analysis of learning arising from an event or process and how the learning is to be delivered. The learning and improvement activity across the Board currently takes place within each area of a sub group’s responsibility and relies on communication between the groups being effective and consistent. This is currently an area for improvement and is part of the review taking place. Page 184 28
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The L&D sub group has set up two multi-agency task and finish groups to take forward the work on sexually harmful behaviour and female genital mutilation and the sub group will then progress the learning needed to support the pathways and procedures. Further areas of work being undertaken by the sub groups are the Neglect Strategy, Missing Children – Children not at Home, Thriving families and Co-sleeping. Learning from each of these areas of work are being considered by the L&D group in terms of how each area will be delivered. 3. At present, shared learning is delivered through a range of conferences, seminars, forums, E learning and face to face events, briefings and Safeguarding Week. The learning is derived from BSCB and partner agency activity through audits, SCRs, agency reviews, challenge panels and from national reviews and changes to guidance and law. It is acknowledged that there are gaps in the current delivery methods in terms of the number of staff and volunteers that can be reached through these methods. The Board’s business unit is currently working on the redevelopment of the Board’s website to include further media opportunities to deliver podcasts and safeguarding messages that can be accessed by the whole of the safeguarding workforce in the Bradford district. 4. A comprehensive training needs analysis of safeguarding learning and development was carried out by the L&D sub group, which reported back to the Board in January 2016. The report identified that the majority of partners said they did have the capacity to meet the needs of their staff however there was a suggestion that some of it could be provided on an interagency basis by one respondent. Conversely another respondent highlighted the difficulties of releasing staff to attend multi agency training. Further, the answers indicated a wide range of methods of delivery were used on a single agency basis – E learning and briefings most popular closely followed by full and half day courses newsletters and websites.
The requirement to cover a range of issues within safeguarding training on the whole appears to be met. There are some gaps and uncertainties about coverage around the topics of “Young Carers “and “Children of Prisoners”. These could be topics for consideration in the BSCB annual programme. The report has highlighted the difficulty some organisations had in responding to the request for information, it evidenced the need for partner organisations to have a system in place for gathering training needs intelligence which includes safeguarding children training needs data. This information is needed in order to ensure that the multi-agency programme compliments the single agency training partners are providing their staff / volunteers.
A review of the Section 11 area for training was also carried out. The review identified that organisations were not evidencing their training strategies effectively, and this issue is being responded to through the PMAE sub group in their responsibility for monitoring the Section 11 process. 5. Communication with front line staff is currently achieved through messages being taken back through the Board and sub group attendees, messages on the website and through the learning and development events. Development of the BSCB news-letter is tied to the re- development of the Board’s website and is currently an area for improvement.
The review of the Board’s communication strategy is underway, and will consider a wider range of methods of getting the Board’s priorities out to front line practitioners, local communities and families. Many new opportunities will be available when the website is redesigned.6. Current case audits and the outcome of the challenge panels have indicated that there is no block to the sharing of information under child protection and child in need processes. This also true for early help cases where consent has been agreed with the family. The on-going challenge for the partnership is the how the fullness of a child’s history is captured and relayed throughout the case’s activity.
A review of the Information Sharing protocol is taking place in the multi-agency safeguarding hub to ensure that the current version is fit for purpose and meets the changes needed to protect children under the safeguarding challenges of CSE, FGM, SHB and forced marriage. All learning and development events now highlight front line worker’s responsibility to share information fully and effectively.
Priority 3: - work achieved by safeguarding partners: Page 185 29
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Bradford Health Economy – Have developed a policy and procedural document for tackling Domestic and sexual abuse within the Bradford health services. NSPCC – has produced the draft strategy for Neglect Public Health Bradford – have produced a leaflet on the risks of co-sleeping West Yorkshire Police – Prevent – Have established the Chanel panel, delivered a presentation on the work of the panel to the BSCB and are delivering training to schools in Bradford on the risks and responsibilities around radicalisation. Youth Offending Service – are completing the strategy and process on sexually harmful behaviour.
How have these achievements made a difference to children and their families:
1. The improvement in practice resulting from the audit and challenge panel process means that children now receive an effective assessment that has clarity around risk and need, that their history and the impact of this is taken into account to inform decision making. Consequently, children are receiving services targeted to their need more efficiently and at the right level. 2. The process of continuous improvement driven by the LIF means that services and practice are continually under review and that the improvements result in more effective safeguarding services for children aimed at reducing harm and promoting welfare. 3. Children are being better safeguarded throughout the District as the front line staff they encounter at all levels have the skills required to equip them to carry out their safeguarding responsibilities. 4. Children are being more effectively safeguarded as all safeguarding providers have access to the required levels of safeguarding training that ensures their front line workers are skilled and equipped to carry out their duties. 5. Front line workers know and understand the priorities and expectations of the safeguarding partnership in Bradford, and through this knowledge are working to reduce harm to children in the district. 6. Front line workers have been skilled and equipped to share information effectively when participating in assessments, all children focused meetings and conferences. Consequently, children’s needs are being effectively and efficiently identified and harm is being reduced in a timescale appropriate to the child’s needs.
What needs to happen next: The next series of themed single agency audits and challenge panels needs to be planned into the sub groups work plans. The review of the LIF is to be a continual process that responds to changing demand and new forms of abuse, and the improvements to the framework will be routinely disseminated across the partnership. The review and update of the BSCB website is to be completed and launched across the partnership. The BSCB communication strategy to be revised in line with the opportunities presented through the revised website. All agencies need to review the effectiveness of their practice expectations around information sharing by their front line workers within the safeguarding system. This will include clear guidance on the completion of case summaries that provide an holistic overview of the child’s history, and how this has impacted on the child over time.
Priority 4: Responding to Existing and Emerging Safeguarding Issues Priority Outcome: Safeguarding all children who are vulnerable, including those vulnerable to newer challenging forms of abuse.
An outstanding Safeguarding Children Board is highly influential in improving the care and protection of children.
The BSCB has a responsibility to ensure that the safeguarding arrangements within the District are robust and effective, and are able to respond to changing demands that arise when newer forms of abuse come into focus.
Activity identified under priority 4: Page 186 30
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1. Tackling child sexual exploitation 2. Counter radicalism
3. Online safety 4. Neglect 5. Female genital mutilation 6. Private fostering 7. Child death overview Panel – priority issues storyboard
Achievements to date: 1. In the Bradford District, partner organisations have decided that Bradford Safeguarding Children Board (BSCB) is the lead strategic body for the development and implementation of the District’s response to CSE. The BSCB, in consultation with partner agencies developed a 9 point strategic response and action plan that identified key priorities for combatting the impact of CSE in the district. The priorities are: • Our partnership response to CSE is child and victim focused. • To successfully prosecute those who perpetrate or facilitate CSE. • To limit the opportunities for organised criminals and potential perpetrators of CSE to traffick and abuse children and young people in this way through the use of all the regulatory functions of the Council and the legal remedies open to the safeguarding partnership. • To support families and communities who are dealing with the consequences of CSE • To develop preventative services which raise awareness of CSE among children, young people, parents and the communities of the District; • To develop community resilience to the potentially divisive and damaging impact of CSE on the Bradford District and its constituent communities; • To offer support and therapeutic services to survivors of CSE; • To develop interventions to ensure that identified and potential perpetrators can participate in programmes to tackle behaviour and attitudes that can lead to further offending; and • To ensure that arrangements are in place to undertake any necessary investigations into historic cases of CSE.
Through the 9 point strategic response, the BSCB continues to seek assurance from the partnership that the needs of children and young people who have been, or may be, sexually exploited and their families are considered as they: • Plan and commissions services; • Develops policies and procedures; • Ensures that appropriate training is in place; • Communicates and raises awareness; and • Monitors and evaluates the work that is being done.
The BSCB and individual agencies working with children and families are continuously developing procedures, guidance and information about resources for preventative work and direct work to support children and families during and after victimisation through CSE. It is important that professionals working with children and families ensure that they are familiar with the knowledge and skills involved. In order to achieve this position, the BSCB has developed a multi-level training plan for all professionals and leaders regarding CSE, in particular training and support for schools to provide the skills and awareness required to enable pupils and teachers to recognise the signs of being groomed for CSE.
It is recognised that CSE is a dynamic and changing phenomenon. The BSCB and all its partners continue to be vigilant in recognizing the need for new responses and the need to learn from emerging evidence. All partners are committed to utilising data and research to engage in intelligence led resource planning to inform the responses to the changing risks to children. The monitoring and scrutiny of the CSE action plans is being overseen through the CSE sub group and reported to the Board.
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Beginning in December 2015, the BSCB undertook a partnership review of the multi-agency CSE hub. A task and finish group, including representatives from 8 partner agencies, met to consider a range of issues that included levels of staffing and their support, roles and responsibilities; how the hub interfaced with CSC teams, the missing children services and communities across the district; support for victims and their families; procedures, pathways, the current risk assessment tool and the quality of practice; and recording systems, data collection and analysis and intelligence led service planning.
The outcome of the review was the development of a detailed framework for professionals working with children who experience or are at risk of sexual exploitation. This is further underpinned by revised, detailed practice guidance for all agencies located in, or working closely with the CSE hub.
The Board was also instrumental in commissioning an educative drama for year 10 students in schools across Bradford. An outcome of the success of this initiative has been to arrange a short tour of the play to 9 primary schools in the district funded by the Police and Crime Commissioner (PCC). The evaluation of these performances has been positive and work is currently being undertaken to extend the programme out to year 6 pupils.
The BSCB has supported two successful applications for funding for CSE support services. The Board supported an application for funding from the community safety partnership (CSP) for male workers to work with men and boys from the BME community to raise awareness of the risks of being groomed for CSE and other safeguarding risks. The Board also supported a further application from the CSP to extend the work of the Banardos Night Watch initiative. The project offers advice, guidance, training and support to businesses across the Bradford district, and engages in awareness raising for communities and the general public. It particularly focuses on the night time economy in keeping children safe after dark. 2. The BSCB received a presentation on their Prevent Duties in July 2015 to ensure that all partnership leads are fully aware of their duties and responsibilities under the Prevent regulations. The presentation highlighted key functions as follows: Bradford Safeguarding Children’s Board and the ‘Prevent’ Statutory Duty The duty for the BSCB is likely to be relevant to fulfilling safeguarding responsibilities, and organisations working with young people should ensure that there are clear and robust safeguarding policies in place to identify children at risk. There are three themes throughout the sector-specific guidance: effective leadership, working in partnership and appropriate capabilities. These form the basis for the Bradford District Sector Prevent Plans. Working in partnership Prevent work depends on an effective partnership. To demonstrate effective compliance with the duty, specified authorities and their LSCB’s must demonstrate evidence of productive co-operation. In particular with local Prevent co-ordinators, the police and local authorities, and the co-ordination of activity through existing multi-agency forums for example, Bradford District Prevent Safeguarding group.
All specified authorities and their Boards, subject to the duty will need to ensure they provide appropriate training for staff commensurate with their role and responsibility. Training is now widely available, a nationally recognised product - WRAP has been developed to facilitate this delivery.
WRAP is a one and a quarter hour interactive facilitated workshop centred around a DVD and is intended to achieve an awareness and understanding of the Prevent agenda and the safeguarding role of staff; the ability to use existing expertise and professional judgement to recognise potentially vulnerable individuals, who may be susceptible to messages of violence and the confidence to use a common sense-based response.
To date, over four thousand staff in the District have received WRAP training.
The multi-agency Channel Panel is in place and is actively reviewing cases. A guidance paper is in place to advise professionals on the purpose and role of the panel and how to make a referral on a child of concern and is available on the BSCB website. Page 188 32
Bradford Safeguarding Children Board Annual Report – 2015/2016
The Board has been asked to consider whether the representation on the panel is sufficient and this is being considered in line with review and evaluation of the Prevent Strategy.
The child protection procedure on radicalisation was amended in November 2015 and is available on the BSCB website. 3. The BSCB continues to monitor and scrutinise partnership activity on online safety. The risks in this area have grown to include cyber bullying, sexting and grooming for CSE and radicalisation and the use of social media to engage with children. Online safety is now recognised in the prevent strategy, sexually harmful behaviour strategy and the CSE hub review. The BSCB is a member of the West Yorkshire child protection procedures consortium and consulted on the review of the child abuse and information communication technology procedure which was updated in November 2015. The BSCB also consulted on the child sexual exploitation procedure which now provides guidance on the monitoring of social media by a skilled professional when a CSE risk is identified in relation to a child. This update was completed in April 2015. The child protection procedures are available on the Board’s website.
The Board’s website also has pages for parent and for children. Both pages have direct links to online safety websites that target support for parents in recognising the risks and enabling them to take preventative action to protect their child; and for children who are worried about online safety, and who need support to take action to keep themselves safe.
The BSCB’s safeguarding advisor to faith settings continues to provide online safety training in schools and faith settings for parents and the wider community. The Faith Setting area of the website provides a range of information and links to information sites and these are highlighted to faith setting leaders and attendees through Emails and training events.
As part of Safeguarding Week 2015, the Airedale conference agenda included a targeted focus on online safety delivered to a multi-agency audience.
The Universal sub group carried out a survey on bullying, including online bullying across the schools in the district. The survey received responses from 94 children who identified that online bullying was a significant factor in their experiences of being bullied. A recommendation of the survey was to revise the bullying strategy and this work is to be undertaken by a task and finish group under the Safeguarding in education sub group. 4. The Board has continued to monitor the progress of the revision of the neglect strategy through the proactive and responsive safeguarding sub group (PaRS). The strategy is being drafted in consultation with the revised threshold guidance to ensure coherence between the two documents, and it is anticipated that they will both be approved by the June 2016 Board. 5. The PaRS sub group has overseen the FGM task and finish group. FMG: Home Office Annex A and Child/Young Adult documentation was distributed to the sub group. This document makes reference to a link on pages 36/37: Department of Heath Guidance, FGM Risk and Safeguarding; Guidance for professionals. This was also circulated to the members of PaRS. A number of health professionals were now using this as good practice. The group members agreed this was a helpful Checklist and despite this being DRAFT members felt this should be circulated to professionals to be adopted as good practice. In the interim, the group is working to complete a referral pathway that will assist professionals in understanding the process and providing the knowledge on how to progress a case.
The West Yorkshire child protection procedure on FGM was updated in 2015 to ensure that the procedure was compliant with the changes in guidance. There is a link on the BSCB website to access the E learning course being offered by the Home Office and the Health economy provided training on FGM across their sessions during safeguarding week to 81 professionals across the partnership. 6. The Board continues the welfare and protection of children privately fostered within the Bradford District. In May 2015, the BSCB received the bi-annual report on private fostering from the local authority along with the statement of purpose. Within the 2015 – 2016 period, there were 21 notifications of children being privately fostered within the district and 33 children were identified as meetingPage the criteria 189 for being privately fostered. These figures are in 33
Bradford Safeguarding Children Board Annual Report – 2015/2016 line with national figures on privately fostered children. The information on privately fostered children is monitored bi-monthly within the PMAE sub group and reported to the Board.
The Board produced a 10 point briefing for Bradford primary and secondary schools on how to recognise and respond to situations of, or of suspected private fostering. This has been sent out through the schools online network to all schools in Bradford. There is also a private fostering area on the website that links professionals to the current child protection procedure on children living away from home, and a leaflet on private fostering has been produced to be distributed to agencies for dissemination to the public. 7. CDOP – please see story board page
Priority 4: - work achieved by safeguarding partners: 1. BMDC – Require private hire and hackney carriage operators to undertake a specific module on CSE. Training is mandatory for all new license applications and license renewals. To date more than 3500 drivers have been trained. In June 2015 all operators were written to regarding their responsibilities in relation to CSE. They were provided with posters and leaflets about the issue, and were required to display the posters in their base for both the public and staff to see. Record of compliance is now routinely checked by the BMDC licensing officers and partners. Barnados – are providing a number of preventative programmes for children and their parent’s where concerns around CSE have been identified. Barnardos – ‘Turnaround’, in conjunction with national experts on CSE, have also produced an Education pack for parents that enables them to participate and contribute to the safety and protection of their children. West Yorkshire Police (WYP) – in partnership with BMDC have established a specialist team focusing on non-recent sexual exploitation. Currently there are 12 on-going investigations and 127 potential victims have been identified and interviewed. BLAST – are working with boys and young men who have experienced or are at risk of being sexually exploited. They offer therapeutic responses to meet the level of need required, and provide training to multi-agency groups and individual agencies. The Muslim Women’s Council (MWC) and the Keighley Association, Women and Children’s Centre – have established the ‘Fragile’ project. Skilled staff work with women and girls in the BME community to raise awareness of safeguarding issues including CSE. Women and girls are provided with key information on recognising abuse and how to report it. Individual support is provided to support them through and after the disclosure of concerns. 2. Bradford Health Economy – have policies and procedures in place on how to respond to the prevent agenda. They have carried out a programme of WRAP training across the workforce. BMDC and WYP – are providing leadership and championing the prevent agenda across the partnership. Bradford Schools – have pro-actively taken up the prevent agenda and have accessed the WRAP training. 40 state secondary and 140 primary schools picked up the training to date. 3. BMDC – Education Innovation service has provided advice, guidance and training for non-maintained schools in the Bradford District. 4. NSPCC – has provided consultation and research on the drafting of the neglect strategy. 5. Bradford Health Economy – A multi-agency flow chart is being developed for the referral process for FGM cases. 6. BMDC – CSC – New process Private Fostering - Through training workers will be supported in ensuring they fully understand what the needs are for every privately fostered child and their carer. The new process will be embedded and briefings undertaken for all staff Visits to privately fostered children will be undertaken every 4 weeks in line with CIN, LAC and CP cases. Close scrutiny will be undertaken of the process and compliance with procedural expectation, ensuring these children are given the priority they should have. All managers including Service managers will monitor and take corrective action if there are any risks of not meeting expectations. A 3 monthly exceptions report will be produced by the lead service manager and scrutinised for compliance.
How have these achievements made a difference to children and their family’s:
1. Through a range of strategic and operational activities that have raised the quality of front line practice, heightening awareness for parents and communitiesPage and 190targeted specific services, businesses and providers where 34
Bradford Safeguarding Children Board Annual Report – 2015/2016 children are at high risk of sexual exploitation, children vulnerable to this form of abuse in the Bradford district are more effectively protected from harm. 2. Through the effective delivery of WRAP training across the partnership and in particular across 170 schools in the district, front line professionals have the skill and knowledge to recognise and respond to the prevent agenda and the risk to children vulnerable to radicalisation has been reduced. 3. Online safety is now considered as part of the safeguarding agenda across a number of strategies that are in place to reduce harm to children vulnerable to organised or targeted grooming, exploitation and bullying. Front line practitioners are being provided with the knowledge required to underpin their skills in recognising and responding to these forms of abuse. Consequently, children in the Bradford district are more effectively safeguarded across the partnership through improved practice in these areas. 4. The revision of the neglect strategy has brought into focus the key issues facing children vulnerable to or experiencing neglectful care. The BSCB’s training team have taken the issues and devised learning and development events to ensure that front line workers are fully skilled to be able to respond effectively to neglect. As a result harm to children from this form of abuse will be reduced. 5. Front line practitioner, teachers and health professionals now have the tools in place to assess the risk to children vulnerable to the risk of FGM. This will result in an effective assessment of the risk to children and result in a proportionate response to the risk. 6. Regular reporting to the BSCB of children in private fostering placements means that their safety and welfare are kept under scrutiny by the Board and the services they receive are being monitored for compliance and quality.
What needs to happen next: 1. The CSE sub group will continue to monitor the activities laid out in the CSE action plans. - The CSE sub group will review the work of the task and finish group on disabled children vulnerable to sexual exploitation and set a timescale for the completion of the work. 2. The Board will agree a reporting format with the channel panel so that assurance can be provided to the Board that children are being effectively safeguarded from radicalisation. 3. A multi-agency task and finish group will be constructed to formulate a comprehensive strategy to address the range of issues now prevalent under online safety. - The safeguarding in education sub group will revise the bullying strategy. 4. The draft neglect strategy will be agreed by the Board and launched across the partnership. 5. Work with the Safeguarding in Health group to arrange the launch of the multi-agency FGM pathway. 6. To monitor the local authority reports on private fostering for compliance on process and duty.
Activity 7 - CDOP
Child Death Overview Panel (CDOP) storyboard
Improving Safeguarding Outcomes 2015/2016
Safeguarding Issues addressed over this period:
During the year April 2015 – March 2016, 61 child deaths were reported to the Bradford child death review team. The Bradford CDOP reviewed a total of 79 child deaths of children under 18 years during 2015/16; this includes the reviews of 45 of deaths that occurred in 2014/15 and the review of 3 deaths that occurred in previous years. This brings the total number of deaths reviewed by the Bradford CDOP to 607 since April 2008, out of 647 deaths reported (94%).
Of the 79 cases reviewed between April 2015 and March 2016, the majority of these deaths were infants under 1 year of age (63%) and 37% were children over the age of 1. There are 10 categories for cause of death (see Appendix 2 of the CDOP Annual Report 2015/16). The most Page common 191 cause of death out of the 79 reviewed cases were 35
Bradford Safeguarding Children Board Annual Report – 2015/2016 chromosomal, genetic and congenital anomalies (Category 7), and perinatal/neonatal events (Category 8), which accounted for 51% and 19% of the reviewed deaths in 2015/16 respectively. There were significantly more children dying in Category 7 in the Bradford district when compared to national CDOP data, and children of South Asian ethnicity were over–represented in the reviewed deaths (63%).
A total of 8 deaths were considered to have modifiable1 factors in 2015/16, which was 10% of the total deaths reviewed, compared to 24% nationally. These modifiable deaths were in Category 2 (suicide or deliberate self- inflicted harm), Category 5 (acute medical or surgical condition), and Category 10 (sudden unexpected and unexplained death).
Recommendations identified in the 8 deaths with modifiable factors from 2015/16, covered the following areas: Formalise and circulate guidance on gastroenteritis; Discuss actions with specialist drug and alcohol team to reduce the risk of death in vulnerable people in relation to substance misuse; Continue awareness of safe sleeping through multi-professional work and media work and feed into the maternity network – this included an updated e-learning package on safe sleeping and a repeat audit of all deaths due to Sudden Infant Death (SIDS)/Co-sleeping; Work across local organisations to understand the management of asthma in young people with additional complex health needs.
Further to the recommendation set out above, issues were logged which although were not identified to cause the death of the child, were of note and required follow up with appropriate action with organisations or lead clinicians where needed. The issues identified were as follows:
Smoking in pregnancy. Obesity in pregnancy. Diabetes in pregnancy. Mental health issues. Domestic abuse. Consanguinity. The importance of offering genetic counselling, where appropriate, to parents and siblings of those affected by genetic conditions and ensuring appropriate referrals to specialist services. The importance of rapid, high quality clinical assessment, transfer (if necessary) and management for acutely ill children and young people in relevant setting including: primary care, secondary care, urgent care centres and ambulance services. The importance of post mortems in ascertaining cause of death, which may influence management of future pregnancies. Access to timely and appropriate bereavement support. Access to chaplaincy services when required for parents/family. The importance of flagging the need for early foetal anomaly scans for future pregnancies, where risk is present of congenital abnormality. The continued access to high quality end of life care offered by Martin House Hospice, if children are on Intensive Care Units. Children who died abroad – in instances where a child died abroad there has been insufficient information to carry out a review. Foetal Magnetic resonance imaging (MRI) for diaphragmatic hernia is good practice. Early testing for Guthrie (MCADD) where possible. The importance of ensuring other diagnoses are kept in mind in categorisation of death, where the child has died due to a head injury.
1 A child death is defined as modifiable if “the Panel have identified one or more factors, in any domain, which may have contributed to the death of the child and which, by means of locally or nationally achievable interventions, could be modified to reduce the risk of future child deaths”. Note: Modifiable death definition changed from April 2010 onwards, whereby the classification was changed from preventable/potentially preventable to modifiable factors. Page 192 36
Bradford Safeguarding Children Board Annual Report – 2015/2016
Our Journey so Far – what are we doing/done:
A detailed Action Plan for modifiable causes identified is in place to audit the response to the recommendations and ensure all organisations have completed their actions. Further to these recommendations, the panel records an issues log which leads to more general recommendations by CDOP and emerging themes worthy of being highlighted are identified and monitored. Work is on-going in many groups and networks to reduce the risk factors which contribute to the high childhood mortality rate in the Bradford district; the Every Baby Matters (EBM) steering group for example leads the partnership working to reduce infant mortality rates. Specific strategies and actions plans such as the Road Safety Plan and a range of interventions to reduce accident rates in children for the district. CDOP had led on-going awareness around specific areas encouraging parents to adopt safe sleeping practices and avoiding co-sleeping with their babies when additional risk factors are present and, in previous years, awareness around not leaving young children unattended in baths. CDOP has led work to update the e-learning package to promote safe sleeping in infants and will be re- launching this in the Autumn. In addition sessions around the work of CDOP will feature in the Safeguarding week in October 2016.
Findings from CDOP are shared with key groups and leads such as the Every Baby Matters steering group, Road Safety Team and Maternity Network and are also shared as part of Safeguarding Week.
What Difference has this made:
Some encouraging signs of improvement; the three year infant mortality aggregate rate has reduced year on year for the last seven years especially in deprived populations and the child mortality rates are reducing too – although still higher than national and regional infant mortality rates. Emergence of key themes for 2008-2016 for potentially modifiable causes, which include co-sleeping and sudden infant deaths syndrome (SIDS), road traffic collisions, specific clinical incidents, and four serious case reviews over this period. Less common themes identified, include drowning in baths, death in fires, asthma, suicide in teenagers, and swine flu. All of these areas have been addressed via a range of groups and forums across the district Implementation of specific recommendations from Serious Case Reviews and Serious Clinical Incidents. Increased clinical awareness of management of specific medical conditions. CDOP Alerts to raise public awareness of the risks of leaving children bathing alone/supervised by another young child. Road Safety Actions to reduce further deaths from road traffic collisions. Swine flu vaccination programme in Special schools. CDOP Alerts re Safe sleeping practice and update on current E learning package for Safe sleeping for babies.
Areas for further action:
The Bradford CDOP will continue to monitor overall causes of death for children, with a focus on modifiable causes; identifying specific recurrent issues and themes as well as conducting an annual CDOP Away Day, which allows panel members to assemble as a group and to examine the key factors of child deaths in more detail. Continue to work with partners to raise the profile of the Child Death Overview Panel and the understanding as to why children die in Bradford district thus ensuring all partners work towards reducing the risk of death in children in the district for the future We will review our criteria for modifiability of deaths in discussion with partners in the national CDOP network as our percentage of modifiable deathsPage is well 193 below the national average. 37
Bradford Safeguarding Children Board Annual Report – 2015/2016
What are the Key things we are doing next:
CDOP will continue to meet monthly to review child deaths and will keep the Modifiable Action Plan and Issues Log updated and monitored. In this way we will identify any new emerging themes and any actions required by partners across the district. In addition, we will hold an Annual Away Day in May 2017 to review all the data and findings for 2016/17 and will look at some areas in more depth.
Author: Shirley Brierley Chair of Child Death Overview Panel and Consultant in Public Health Organisation: Public Health Department City of Bradford Metropolitan District Council
Chapter 4: Partner Agencies – Individual ‘Improving Safeguarding’ Stories
1. Childrens Social Care (CSC) storyboard
Improving Safeguarding Outcomes 2015/2016
Safeguarding Issues addressed over this period:
Implement the’ Journey to Excellence’ model Development of the MASH Participated in the review of the CSE Hub and provided additional social work resource Challenge Panel – OLA Challenge Panel Arranged meetings with health colleagues and paediatricians to discussion and improve joint working. Undertook an audit of health referrals to assess quality and recommend improvements Developed a Missing Strategy and action plan currently in draft form awaiting sign off at relevant safeguarding sub group Implemented a Domestic Abuse Hub as part of the MASH Involved in the review of the CSE hub. Independent case file audit of 73 CSE case file audits and developed an action plan to address findings Participated in the BSCB Challenge and Scrutiny session on CSE and Missing Provided training for all social work staff on Signs of Safety and PACE Set up weekly missing meetings with senior managers and the police Implemented a Case Review Panel Review of Private Fostering and implement changes Implementation of Family Drug And Alcohol Court (FDAC) pilot project Revised the recruitment and selection process for social workers Working with radicalisation cases procedures for legal intervention Human trafficking processes Modern day slavery processes Meetings taking place with private children’s homes providers in the district to improve communication and joint working Development of a Rapid Response out of hours service
Our Journey so Far – what are we doing/done
The ‘Journey to Excellence’ is an improvement programme for Children’s Services. CSC is developing Bradford’s integrated ‘Early Help’ offer across all key agencies to provide One Early Help Gateway for the public and staff. Implementing a shared ‘Signs of Safety’ approach to need and risk assessment, ensuring the child’s safety while using a family’s strengths to promote change and Implementing Signs of safety - training . Page 194 38
Bradford Safeguarding Children Board Annual Report – 2015/2016
Creating smaller Children’s Homes; providing more foster carers for teenagers, developing a shared model of support across care, health, education and other key services. Providing a better, faster response to children in crisis with more joint working across social care and key health teams and more safe spaces for children to be supported. Creating a new service for young people aged 14-25 years with complex health and/or disabilities: Improving transitions by closer working between children’s and adult’s services and promoting self – direction of support through increased use of personal budgets. Updated section 11 Virtual College tool for Children’s Specialist Services and shared the learning with partners.
Established a Case Review Panel The Case Review Panel meets weekly every Tuesday morning, to ensure robust decision-making regarding accommodation, gateway meetings and care proceedings. Bradford Children’s Services in co-operation with the other 4 regional Authorities (Leeds, Calderdale, Kirklees and Wakefield) and has developed a pilot FDAC Team. The Specialist Team have taken lead responsibility for interacting with the FDAC, undertaking assessments, drawing up intervention plans, co-ordinating / implementing activity and reviewing the progress of the families involved. A focus on close multi-agency working with Adult Treatment Service, Domestic Abuse Programmes, Housing Providers, Family Support Services and CAMHS to deliver a problem-solving therapeutic approach to working with substance misuse. A Private Fostering review has been undertaken to ensure visits were undertaken within timescales and the regulation 8 visits carried out. The profile and importance of private fostered children is fully understood and managers are overseeing the process. Bradford has a Multi-Agency Safeguarding Hub (MASH) that provides effective responses to contacts and referrals. This is comprised of a multiagency team of social workers, police officers, a health professional and an education professional. A Performance Dataset for accurate CSE and Missing information is available and a performance management tool named ‘the Racetrack’ is currently being developed with partner agencies for the CSE Hub. A data intelligence analyst and a Missing Coordinator have been appointed and sit within the hub. CSC, education and the police have delivered two multi agency training days on the strategic response to ‘Missing in Bradford’, this included a member of the Youth Council giving a young person’s perspective. CSC and Bradford Police made a presentation to the West Yorkshire Police senior leadership team on responses to children missing in the Bradford District. All young people who go missing in the district are offered a return to home interview. Front line professionals are being trained in a different approach to working long term with young people in order to improve relationships. Managers of private residential homes are engaged with local safeguarding arrangements to improve responses to missing children, and attend meetings to monitor effects. Children’s Social care has appointed a permanent Principal Social Worker. CSC has established a monthly case file audit process across the service. CSE Hub open days for professionals and councillor have taken place. A Domestic Abuse Hub is now established as part of the MASH. CSS and WYP have provided a FTE experienced member of staff, to ensure that each and every occurrence reported to the police regarding domestic abuse / violence where a child was present or lived in the household was screened / reviewed and an appropriate level of support provided. Placement Support Service staff now provide an out of hours Rapid Response to work alongside Police colleagues and support the work of Emergency Duty Team. The team have access to a children’s room at Sir Henry Mitchell House (SHMH). A single point of contact for missing has been created within the MASH. A daily report from the Police is received in relation to all missing children and all Police ‘safe and well’ checks are shared with CSS. A weekly Page 195 39
Bradford Safeguarding Children Board Annual Report – 2015/2016
meeting chaired by CSS deputy director is in place to ensure a close oversight of all missing activity, actions and plans. There are a significant number of children in Bradford who regularly go missing and so In order to review and manage the most persistent and vulnerable cases, a monthly Missing and Exploited Tasking (MET) multi- agency meeting has been set up. Voiceability has been given funding to recruit a further worker to complete return to home interviews for looked after children (LAC) who have been missing and the Placement Support Service now offers an interview to all children and young people who are reported missing from home. The service has achieved 98% completion of interviews since starting in February. New guidance has been issued to all placement providers on how to prevent a young person going missing and how to respond when they do. There has been investment in the children’s homes to provide an improved environment and additional recreational facilities. A Missing Children multi agency strategy 2016- 18 and Action plan is in draft format, this will underpin the work of a partnership missing meeting that will meet on a quarterly basis. The group will report to the CSE / Missing vulnerable sub group of the BSCB.
What Difference has this made:
The Journey to excellent plan around targeted early help has an ambition to reduce the number of inappropriate contacts to the front door of social care. By establishing a coherent early help offer in the district there will be earlier intervention and families will receive appropriate help at the right level to prevent re referrals into service. This ambition will over time reduce the number of children who become looked after and reduce the workloads within social care. The Section 11 Audit process has helped identify areas where agencies can improve e.g. training for staff, identifying gaps and areas of strength. The Case review panel ensures that any decision making regarding accommodation and care proceedings is made robustly in line with the child’s needs. Oversight of children missing in the district is more robust, all occurrences are subject to scrutiny. Young people are spoken to after missing occurrences. The information gained is shared with partners to promote the child’s welfare and safeguarding. Within the MASH - the co-location and increase in resources has led to better overall services for children and families – we are better placed to assess risk which leads to more informed decisions to provide support and intervention. Good quality, strategy discussions take place. The Rapid Response team have reduced the number of emergency admissions to care and supported the police in responding to, and supporting missing children. Our response to children missing from home or care now meets the revised ‘statutory guidance on children who run away or go missing from care’ January 2014. The themes from individual interviews are now collated and reported to inform intelligence led service planning. Children’s homes now have access to a car to go and collect young people or go looking for them. Liaison has been undertaken with Ofsted and new guidance follows the principle of acting as a good parent. Young people can be prevented from leaving late at night and doors are now locked if this is appropriate. Recent checks have shown that the revised recording system is creating a more accurate record of missing episodes. The approach to missing is seen as good practice within West Yorkshire Police Senior management and leaders are fully engaged and aware of the issue in connection with children missing in Bradford. The Domestic Abuse Hub in the MASH has resulted in a faster multi-agency response to families. Joint CSC and Police assessments for DA/DV, early indication of risk, good quality strategy discussions are now routinely carried out within a multi-agency approach. The co-location and increase in resources has led to a more effective service for children and families – the multi-agency hub is better placed to assess risk which leads to more informed decisions to provide support and intervention. Through private fostering training, workers will be supported in ensuring they fully understand what the needs are for every privately fostered child and their carer. The new process will be embedded and briefings undertaken for all staff. Visits to privately fostered children will be undertaken every 4 weeks in line with CIN, LAC and CP cases. Close scrutiny wPageill be undertaken 196 of the process and compliance with procedural 40
Bradford Safeguarding Children Board Annual Report – 2015/2016
expectations, ensuring that privately fostered children receive the appropriate response. All managers including Service managers will monitor and take corrective action if there are any risks of not meeting expectations. As this is the inaugural pilot year of Family Drug and Alcohol Court (FDAC) a formal evaluation is still to take place and will be completed after the initial pilot year concludes. Outcomes from the initial cases selected for FDAC indicate that the process has been successful in a number of key areas. The FDAC cases have led to timely decision making for all the children involved to date. For those children unable to return to the care of their birth parents this has meant early decisions about their permanence. Proceedings were extended in one case given the progress made by the parents in FDAC. The final outcome being that their two children remained in their care subject to Supervision Orders. The families involved have had the experience of a less adversarial and more restorative way of conducting care proceedings. FDAC has encouraged effective joint working with adult drug and alcohol treatment services with the effect of promoting mutual professional understanding.
Areas for further action:
A new Transition (Preparation for Adulthood) Service for children with disabilities aged 14 plus is to go live in September. Early Help Single Point of Access & the new Early Help plan is to go live across the district from October. A Multi agency consultation and Safeguarding Board approval for the revised ‘threshold of need‘ is underway. The ambition is to create a clearer partnership understanding of a whole family approach, and how staff implement this. Pursue multi-agency agreement that the Early Help assessment is aligned to Signs of Safety approach, and agree timescales for this to be introduced as a replacement for the CAF. Implementing the Council’s Children’s Services restructure, including embedding the children’s centres contribution to the Early Help framework. o Re-align key teams in Social Care to targeted Early Help, for example Initial Contact Point, Family Centres, Child in Need work. o Create the necessary I.T. infrastructure to support service delivery o Update the Council’s Children’s Services Commissioning Team to support the framework. The DA Hub has continued to develop its processes and procedures, and is now moving towards a system of notification of contacts to schools for each child of school age 5-18yr and also for those in higher education establishments. o Development of Early Help and how this fits within the DV/DA process. o Development of the Signs of safety approach, particularly around DV/DA and how these can be screened under the signs of safety tools. o Understanding the increase in work load around notification and making this meaningful. On-going development of the placement strategy to reduce the number of young people placed in external placements will mean that local provision will be accommodating more challenging young people. The placement of children into the local area by other local authorities and those externally placed by Bradford requires close working between the local authorities and the police forces involved. CSS and partners need to undertake ‘mapping’ of data in relation to missing children in order to Increase understanding and awareness of missing children issues, around children, their parents and carers as well as professionals. The challenges to CSE information sharing with Education providers, needs addressing. While information is passed from CSC daily there is a lack of confidence that safeguarding leads in schools receive, act on and submit information about Children at Risk of CSE. There remains some uncertainty about referral responsibility to enable children to access mental health provision and the therapeutic support capacity of 3rd Sector Support Services. The volume of referrals can lead to delays in work being completed, or at times, periods where agencies won’t accept referrals. Work is taking place to explore a CAMHS presence in the Hub – part of the improvement for greater therapeutic support for children who experience or at risk of experiencing CSE. To fully implement the BSCB ‘9 point CSE strategic response’. Ensuring that the development of the Early Help service complements and fits within the MASH Development / Introduction of the “Signs of Safety” approach, particularlyPage 197 around the initial screening of contacts. 41
Bradford Safeguarding Children Board Annual Report – 2015/2016
Planning for the longer term development of the CSE Hub. On-going development of new areas of work, such as FGM, human trafficking, modern day slavery and radicalisation and extremist ideology. Improvements in social care Out of Hours responses and working on developing a multi-agency, rapid response service. Development work is underway to change the Case Review Panel to a gateway and care proceeding panel. Sustainability of the FDAC pilot - The pilot is approaching its initial end date of November 2016. Discussions to determine sustainability are on-going at both local and regional level. Capacity - The pilot has made a good start, with core business being met by existing staffing. Further consideration needs to be given to how best to offer administrative support to practitioners, and as demand for FDAC increases, how best to extend the capacity of the service to respond. Review of the pilot - FDAC is returning data to the National Unit to inform their research and evaluation programme and partnership development. Outreach activity by staff, to inform stakeholders and other interested parties is on-going. FDAC Bradford has benefited from the support of clinicians within CAMHS. Further discussion is to take place to formalise that involvement, depending on referral rates there may be an opportunity to explore options for FDAC in pre-proceedings.
What are the Key things we are doing next:
Evaluate the Early Help pathfinders launched in Keighley and Better Start (BD3, 4 & 5). Testing the new Early Help plan for ways to better identify children and provide specific support. Recruitment to the service manager post for the new Transition (Preparation for Adulthood) Service. Decision to be made on whether to bid for Social Impact Bond funding. Ensure consultation with parents influences the Early Help offer. Train approx. 1300 staff on “Signs of Safety” by the end of 2016. Deliver child protection conferences and planning under Signs of Safety framework by the end of 2016. New Transition (Preparation for Adulthood) Service for children with disabilities aged 14 plus to go live in September. Early Help Single Point of Access & new Early Help plan to go live across the district from October. To consider expanding the capacity of the workforce within the DA/DV area of the MASH to take on the additional role of notifying schools, health visitors, school Nurses, nursery schools, higher educational establishments, children and families centres for each child where there has been an incident of Domestic abuse /violence, to ensure that relevant welfare support is in place for the 24hrs following the incident. To refer to the relevant early help/universal support services if needed. To ensure that there is an audit trail - SW footprint on file that information has been shared. To review each case graded standard to look for patterns re-occurrences and take appropriate action on that case. To develop a system to ensure there is wrap around support during school holidays. The ‘missing coordinator’ post will provide a higher level of analysis of the issue to the service and partners. This analysis will improve the partnerships understanding of and swift response to changing circumstances. The post will also oversee the accuracy of recording of missing incidents to ensure that recent progress is maintained. We need to undertake ‘mapping’ of data in relation to missing children in order to Increase understanding and awareness of missing children issues around children, their parents and carers as well as professionals. MASH Review of the function and make-up of the CSE Hub. Review of threshold so that it is better understood by all partners. Improve the quality of case file recording and addressing and responding effectively to an increase in work load. Ensure that the progress of the areas identified for further action will monitored through the CSC senior management structure for compliance with timescales and ambitions. The FDAC Regional Meeting to consider sustainability during the September 2016 Presentation to the Adult Services, divisional management meeting. Meet with CAMHS Management to consider Information Governance and clinical support services to FDAC – September 2016 Participate in National FDAC Celebration October 2016
Author: Di Watherston Organisation: Children’s Social Care Page 198 42
Bradford Safeguarding Children Board Annual Report – 2015/2016
2. BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST (BTHNHSFT) storyboard
Improving Safeguarding Outcomes 2015/2016
Safeguarding Issues addressed over this period:
Revision of policies and procedures, including supervision policy. Updated section 11 Virtual College tool. Ensured full BTHFT representation at all BSCB subgroups, Health Safeguarding Group and MARAC. Secured Named Midwife post plus an additional 15 hours per week of seconded midwifery time to support the Named Role. Created Training Strategy for Safeguarding children following 2014 CQC report which highlighted low levels of training – strategy also involved re-levelling of ALL staff within the trust against the 2014 Intercollegiate training levels. The percentages trained at all levels has steadily increased until the re-levelling exercise in April when a significant number of staff were moved from level 3 to Level 3 Specialist and this caused a fall in compliance as expected. There are numerous opportunities for training within the Trust and externally, including through BSCB. Introduction of Integrated Safeguarding Committee for the trust which promoted collaborative working for safeguarding vulnerable adults and children. Re-instated regular meetings with Senior Social Care staff to discuss operational issues and joint work, eg auditing the quality of referrals. New audit strategy – see link. In addition, recent audit looking at evidence for benefit of flagging medium risk CSE children as well as those that are deemed high risk. In addition, we are involved in numerous rolling audits (including audits of documentation in the TOP clinic and the paediatric ward, audit of DNAs). We carry out an on-going monthly audit of high risk CSE which ensures that the correct action has been taken by our staff and liaison with partner agencies has been completed. If not, the audit acts as a safety net, and liaison is then completed. Contribution to regional meetings about the future of sexual assault services in West Yorkshire (on-going) and setting up of a local service for assessment, following non-acute sexual assault. Case management meetings for high risk CSE children who are frequent attenders to the Emergency Department, in order that care is streamlined and responds to individual needs. Safeguarding Children Medical Conference day October 2015 – well received. Established formal Peer Review process for Paediatric Consultants.
Our Journey so Far – what are we doing/done:
Key Achievements 2015-16 1. Policy
Child Sexual Assault guideline created and ratified. Safeguarding Supervision policy revised and updated. DNA (Did not attend) policy revised for the trust regarding children’s attendance. FGM (female genital mutilation) policy, procedure and national reporting requirements developed. Contribution to the development of the multiagency FGM pathway district wide. Expansion of the safeguarding children’s website to hold all policy and procedure together. Flagging system developed to identify Looked After Children (LAC) and children identified to be high risk CSE who attend the trust. Development of policy and procedures for receiving information from the Child Protection Review Unit and sending of medical reports for the organisation. Shared contribution to the domestic and sexual violence policy. Audit strategy written. Page 199 43
Bradford Safeguarding Children Board Annual Report – 2015/2016
2. Training
Safeguarding children’s training is now mandatory for all staff at their assigned level. Training matrix updated to bring training requirements in line with national requirements (Intercollegiate document 2014) and all staff levelled according to their roles and responsibilities within the Trust. On-going monitoring of training figures and training booked to allow the required numbers of employees to attend to meet mandatory training requirements. Safeguarding children’s training figures are presented at both children and adult steering group and the team has the ability to identify non- compliance down to a specific member of staff. Level 3 training sessions written and delivered to cover multiple subjects across the Trust and bespoke clinical governance sessions offered. Maternity services have increased delivery to twelve 2-hour sessions per year. Hosted lessons learned event following Trust serious Incident. Organised events on FGM, PREVENT (government’s work to deter people from terrorism) and medical aspects of the child protection process, as part of safeguarding week in October 2015, attracting delegates from within the trust and the district.
3. Supervision
Number of supervisors has now increased and safeguarding supervision is being provided for staff in a variety of areas throughout the trust. Roll out of safeguarding supervision throughout the Trust to all staff continues. Introduction of peer review for all paediatric consultants as recommended by the Royal college of Paediatrics and Child Health (2016).
4. Management
Expansion of Safeguarding Children Team Autumn 2015 – includes a second Safeguarding Specialist Practitioner (Band 7), 1.4 WTE Paediatric Liaison Nurses (Band 7), and formalisation of the Named Midwife role. EPR (electronic patient records) has seen significant contribution from the safeguarding Childrens team, with consideration for national systems to be introduced in the future CPIS (child protection information system). The team has made a significant contribution to Joint Area Targeted Inspection (JATI). Contribution to BSCB-led Challenge Panels and Serious Case Review
5. Other
Major update of section 11 audit November 2015 – presented at the PMAE subgroup Exploring benefit of flagging Medium Risk CSE children in Trust, following recent audit Introduced provisional medical report slip for Child protection Medicals to hand over to accompanying Social worker/Police officer, in order to ensure clear communication Collection of good practice examples held internally – specific health cases
6. Example of good practice in health
Health agencies are often at the forefront of recognition in child protection. Through the persistence of safeguarding leads in the various local health agencies, via the Health Safeguarding Children’s Group (HSCG), challenge panels were set up recently to explore a number of cases which were felt to hold common themes for learning. These were cases which fell into two mina groups: 1) where there had been a non-accidental head injury to a child and 2) where a child had presented with further episode of injury whilst on a child protection plan. This led to further scrutiny of all partner agencies in a more formal approach through the BSCB, rather than simply holding a” health- only” review with incomplete information about the children and their circumstances. It was clearly very apparent, once the cases were considered and the full picture understood, that there was additional strength in assessing these groups of cases in such a way and this has led to the creation of further actions and learning across the locality. Page 200 44
Bradford Safeguarding Children Board Annual Report – 2015/2016
What Difference has this made:
Thorough revision and update of the section 11 audit process it has allowed us to critically assess Safeguarding within our Trust and to identify areas of strength plus gaps and challenges. This led to a comprehensive action plan which we have steadily worked through. We were highly commended by the PMAE subgroup of the Board for the work we had completed. Improved communication with other agencies through BSCB subgroups, JTAI work, new process for child protection medical provisional reports, regular meetings with social care managers and contact details for staff to approach with more urgent concerns, which now get resolved more easily after escalation. More robust arrangements for Safeguarding Supervision and Peer Review – improved confidence in practitioners and ensured no silo-working; also provides a safety net. Improvement in quality of training and number of staff trained. Still some way to go as demonstrated by recent knowledge and awareness audit. Enhancement of PLN role in Emergency Department has resulted in improved communication with community staff, CAMHS, Social Care Involvement in the Electronic Patient Record development has ensured that safeguarding children is inherent in and stretches throughout the system, including for example safety net questions for safeguarding and domestic violence. Readiness for CQC and JTAI inspections. Overall improvements in our safeguarding ability as a Trust body and therefore better outcomes for children and young people.
Areas for further action:
Explore ways of obtaining views of child/young person and family to inform and improve our service development within safeguarding. Safeguarding team to explore how to capture information about staff contributions to CAF and Early Help process, and to re-launch notification process for when staff are involved in a CAF. In addition need to identify measurable outcomes regarding effectiveness of Early Help. Improvement in SG services for 14-17 year olds placed on adult wards, as part of Paediatric Liaison Role. CSE HUB development remains on-going as with development work on the 9 point strategic plan.
What are the Key things we are doing next:
Template created for” Voice of the Child “ to enable practitioners to demonstrate consideration of child- centred approach - piloting in Community Paediatric Nursing Audit of patients, families and accompanying professionals’ opinions of the service for child protection medicals – demonstrated user involvement Development of joint safeguarding children and adult work within areas of shared responsibility eg. DHR’s where children involved, FGM, DV, PREVENT Development of a Safeguarding nurse forum, to enable individuals to cascade key messages in relation to SG children within their areas of work. Creation of new e-learning package for Level 2 reflecting LOCAL issues as well as usual level 2 training
Author: Jo Sims, Named Doctor for Safeguarding Children, Karen Bentley Named Nurse for Safeguarding Children Organisation: Bradford Teaching Hospitals NHS Foundation Trust
3. NPS: Bradford and Calderdale (B/C) storyboard
Improving Safeguarding Outcomes 2015/2016 Page 201 45
Bradford Safeguarding Children Board Annual Report – 2015/2016
Safeguarding Issues addressed over this period:
NPS has responded to requests for increased involvement in Interagency working There has been increased focus on risk of CSE in case management NPS issued new Safeguarding Guidance: Our “full part” in August 2015, which introduced revised expectations
Our Journey so Far – what are we doing/done:
NPS contributes to daily DRAM (DV Hub) by screening referrals for NPS and CRC cases. NPS sends an Officer to MARAC meetings to represent cases with NPS involvement. We have amended our ‘known person check’ to include CSE and Early Help referrals. The Safeguarding Lead created an Action Plan with RAG rating in January 2016 to Review ‘Our “full part”, which has been updated in August 2016. In addition to being a panel member for the ‘Clare’s Law’ Disclosure meeting, NPS contributes to the IOM Meeting for High Risk DA Perpetrators.
What Difference has this made:
A tighter system is in place to check that ‘known person checks’ are responded to in a timely fashion, and now include those below the threshold. There is now a Safeguarding Lead Probation Officer for each Offender Management Team in B/C. The Safeguarding leads are booked onto Signs of Safety 1 day training. All B/C NPS operational staff have completed E learning on DA and Safeguarding over the last year.
Areas for further action:
Working through actions in B/C Safeguarding Action Plan. Ensure that young people supervised by YOT, who will be transferred through to adult services, have a smooth transition.
What are the Key things we are doing next:
B/C NPS is liaising with MASH to ensure that there are no gaps, if there is any NPS involvement NPS NE is working on a system to capture named children at High Risk of Harm for senior management oversight. Safeguarding leads are due to cascade NPS Team Briefing with perpetrators of CSE. Safeguarding Lead is reviewing process for transfer of YOT cases to adult services, to ensure these fit with NPS/YOT guidelines for best practice as per the Joint National Protocol.
Author: Karen Tate Organisation: NPS
4. Bradford District Care Foundation Trust (BDCFT) storyboard
Improving Safeguarding Outcomes 2015/2016
Safeguarding Issues addressed over this period:
Theme: Coping with Crying Theme: Meeting the needs of young people who have a learning disability who have experienced or who are at risk of child sexual exploitation/sexualPage abuse 202 (BDCFT) 46
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Theme: Elective Home Educated children where families are not engaging with services and child not being seen. Theme: Meeting the safeguarding needs of children with complex physical or mental health needs or disabilities. Identification of a learning gap and subsequent development of a specialist safeguarding training package. Theme: External agencies report difficulties accessing and/or understanding referral pathways and thresholds into specialist CAMHS, particularly when children are at risk and/or in mental health crisis and those from identified Vulnerable Groups.(Both locally and nationally CAMHS services have seen significant increases in referrals. In Bradford this has risen from 2096 in 2012 to 2937 across 2015).
Our Journey so Far – what are we doing/done:
The Coping with Crying programme consists of a short film that is shown to parents that aims to influence the way they respond to their baby’s crying. The film was part of an innovative research project developed by the NSPCC and implemented within BDCFT Worked with the safeguarding adviser for the office of the police and crime commissioner (West Yorkshire) to undertake multi agency work to identify key work streams necessary to effectively safeguard children with learning disabilities from Child Sexual Exploitation (CSE) and Child Sexual Abuse (CSA) both online and in person. Organised CSE/ CSA – Children with learning disabilities workshop event (June 2016) Development of a School Nurse - Missing from Education Standard and flow chart for Home Educated children, which incorporates guidance around geographical cover for children not in school and making contact with families A collaborative safeguarding disabled children ‘workshop style’ training package was developed, and delivered to a multi-agency audience during Safeguarding Week in October 2015. This package was further developed and delivered in August 2016. The sessions had an evidenced based focus on working with children and families who are considered to be on the margins of child protection processes. The underlying theme of the training in October 2015, was ‘Effective support and Respectful Challenge’. CAMHS is currently commissioned to accept referrals from professionals working with children who are experiencing mental health problems, which are having a moderate to significant impact upon their functioning, and are at moderate to significant risk of harm. CAMHS offer specialist assessment, formulation and interventions within a Multi-disciplinary team. BDCFT First Response is an ageless open door crisis response service offering direct support and intervention to anyone in mental health crisis (working to all BDCFT Safeguarding Policy and Procedures and appropriate referral pathways for such vulnerable groups).
What Difference has this made:
Due to the emotive content of the film, ‘Coping with Crying’, BDCFT’s health visitors have been highly motivated to show the film and encouraged parents to view and talk about it.
Has identified ways to hear the’ voice of the child ‘on how best to deliver support services to children.
School Nurses have developed a good practice Standard for Home Educated children to ensure that they are still offered an equitable School Nursing Service and that children do not become invisible. BDCFT staff have a clear pathway to follow when children/families become missing including multi-agency information sharing Reactive evaluation of the targeted training session indicated that practitioners had begun to embed the learning into practice. A Crisis Care Concordat for Children with an action plan for the development and delivery of a coherent 24/7 crisis response services. This includes membership of the LA, Police & Health. Funding has been allotted to increase specialist CAMHS capacity and expertise within the First Response Service.
Areas for further action: Page 203 47
Bradford Safeguarding Children Board Annual Report – 2015/2016
To make health visitors aware that even though the pilot has finished they need to continue to show the film making all parents aware of non-accidental head injury. Raise staff awareness in regard to the CSE risks related to children with learning disabilities. The Specialist Safeguarding Practitioner, BDCFT Safeguarding Team, to attend the newly commenced weekly Safeguarding Education Hub multi-agency meeting to ensure safeguarding concerns regarding children are documented and shared with relevant BDCFT health staff in a timely manner and any actions required by health are requested. Participants need to be asked to consider how the training influences decision making around supporting and safeguarding the well-being of vulnerable children and their families and to develop actions for their practice Continue to provide specialist training for practitioners working with caseloads of disabled children with complex health needs/ mental health needs. On-going work to improve inter-agency relationships and working, and increased understanding of CAMHS services.
What are the Key things we are doing next:
Incorporate the NSPCC’s evaluation findings into practice. Incorporating key messages within BDCFT Safeguarding Team’s CSE training, newsletters and supervision. BDCFT Specialist Practitioner, Safeguarding Team, will continue joint working with Education and multi- agency team, and engage in any new developments regarding Home Educated and Missing children and to incorporate messages regarding missing children into training. A further specialist training session is planned for practitioners working with caseloads of disabled children with complex health needs/ mental health needs, and this will be delivered on the 20th October 2016 - as part of Safeguarding week. The underlying theme of the 2016 training is ‘Grief, beliefs and conflict’ – and how these issues impact on safeguarding disabled children. Formal agreements are required regarding the model of CAMHS input into Early Help Hubs and to support Journey to Excellence objectives, and improved experiences and outcomes for those children that are Looked After. Completion of an internal review alongside stakeholders, children and young people and their families to inform necessary service changes.
Author: Amanda Lavery Safeguarding Service Manager Bradford District Care NHS Foundation Trust
5. AWC, BC and BD CCGs storyboard
Improving Safeguarding Outcomes 2015/2016
Safeguarding Issues addressed over this period:
CSE Domestic abuse Female Genital Mutilation
Our Journey so Far – what are we doing/done:
Cross-health CSE Specialist Practitioner post on CSE Hub –commissioning of one year’s secondment. Cross-Health Domestic Abuse Manager (Health) commissioned on a permanent basis. Page 204 48
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Designated Nurse led a cross-health group to develop a co-ordinated response to identifying and making appropriate referrals re risk of, or harm from, FGM. This then fed into the multi-agency pathway (currently in final draft form).
What Difference has this made:
Leadership and co-ordination re CSE across health, and more effective multi-agency working around CSE, via Hub post. Leadership and co-ordination across health re domestic abuse, and more effective implementation of the Local Health Economy Domestic and Sexual Violence Strategy. Advice and support to GPs around FGM, via Domestic Abuse Manager (Health). Strengthening the referral and feedback mechanism for GPs re MARAC, via Domestic Abuse manager (Health).
Areas for further action:
Development of a Domestic Abuse Policy for primary care. Review of the flagging options, to identify children at risk of CSE across the various health recording systems.
What are the Key things we are doing next:
Policy development as above. Dissemination of key messages from SCRs, DHRs and Challenge Panels to GPs via the CCG safeguarding team training programme. Leading the review of the multi-agency sexual assault pathway.
Author: Sue Thompson, Designated Nurse – Safeguarding children and Looked After Children AWC, BC and BD CCGs
6. Children missing from Education (CSC) storyboard
Improving Safeguarding Outcomes 2015/2016
Safeguarding issues:
3000+ Children Missing Education (CME) referrals each year Between 70%-80% of all referrals relate to children from Central and Eastern Europe (C&EE) High mobility rate of C and EE families Only a limited number of resources to gather information from specifically regarding children and families leaving the UK The situation as we understand it - the ‘Out of School Register’ on Thursday 7 April 2016 shows 483 live CME cases in four referral categories, Children missing with their families, Children living in Bradford but not on the roll of a school, Children who have lost their places in school having failed to return from extended leave of absence, Other Local Authority enquiries
Our journey so far….what we are doing:
Since 2006 the Education Social Work Service has designed and developed processes and procedures for the management of CME cases Schools, generally know what action to take when a child stops attending school and they and their families whereabouts are unknown Page 205 49
Bradford Safeguarding Children Board Annual Report – 2015/2016
Agencies know what to do if they come across a child who is not registered at a school and This will be re- enforced through multi agency ‘Missing’ workshops 12 and 20 May 2016 (2 sessions per day) The Education Social Work Service has ensured that sufficient resources are in place to manage the high volume of CME work CME caseloads and reviewed regularly via supervision to ensure timeliness and appropriateness of intervention Current service position. The service has 3 officers who work specifically with CME cases and all Education Welfare Officers and Education Social Workers carry a number of CME cases in addition to school attendance cases. There is also significant Admin support for the CME process Work with partners – The Education Social Work Service work closely with partner agencies, Schools, Children’s Social Care, Health, Housing, Police, Welfare Benefits, Council Benefits and Other Education Services and Other Local Authorities to gather and share information regarding Children Missing Education The Education Social Work Service are routinely made aware of children on a Child Protection Plan who have moved into the area. Support is provided to Children’s Social Care to identify school places and ensure timely admission.
What difference has this made:
Missing Children and children not on the roll of a school once identified are responded to in a timely manner. Between 01.09.15 and 01.04.16 ESWS intervention with 1300 children referred as CME led to: - 58% of those children being found in or admitted to a Bradford school - excluding the 9% who had left Bradford or the country, and the 1% who opted for Home Education. - 14% of children not located after all enquiries were exhausted. - 27% remaining open with enquiries on-going. - What challenges remain for safeguarding children - It is not always possible to trace every missing family - Admission to a school is not always timely due to a shortage of school places in certain areas of the city - a reluctance on the part of schools to admit some pupils due to the possible impact on results.
Areas for further action:
The register of CME contacts in each Local Authority, maintained by the DfE and updated yearly is at times, out of date. This results in delays in making contact with other LA’s. We cannot be entirely confident that Independent and Private Schools are routinely following Children Missing Education Procedures The resources available to LA’s to trace families are limited and this results in a number of cases been closed without the families being found. Whilst there are good local systems in place for tracing children, national support is limited. For example, no access to DWP Child benefits systems and information regarding families leaving the country. A shortage of school places in areas of the city delays admission to schools.
What are the key things we are doing next:
Preparation for and the implementation of the changes to the Pupil Registration Regulations which will require all schools including Independent and Private Schools to inform the Local Authority of any child the remove from or add to the school roll from September 2016 Engage with the Private and Independent schools to ensure they comply with the regulation changes Develop stronger links with private and independent schools to promote the proposed changes to the Pupil Registration Regulations and reinforce the safeguarding messages and risks to children who slip through the net of education. Develop links with UK Border Agency and the Immigration and Asylum Team regarding families deported and assisted to return to their country of origin. Engage with the DfE to explore ways of maintaining the LA CME contacts list to facilitate quick and efficient communication between authorities. Continue to explore new information sources to assist in tracing missing families Contribute to the planned Missing Children –Page Partnership 206 Workshops (May 2016) 50
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CME is a key agenda item of the newly formed BSCB Safeguarding in Education Sub Group and the partnership Education Hub.
Neil Hellewell; Principal Education Social Worker CBMDC.
7. West Yorkshire police (WYP) Night Time Economy storyboard
Improving Safeguarding Outcomes 2015/2016
1. Taxi operators and drivers:
What was the issue:
Recognition of taxi involvement in CSE offences within Bradford and on the national stage. Intelligence suggesting that Bradford vehicles were involved in facilitating offences by transporting children to locations of concern. Between 3500 and 3800 licenced drivers in the Bradford District. Many on contracts transporting vulnerable children.
Our Journey so Far – what are we doing/done:
Strong partnership links developed between the police and taxi licensing. All drivers and operators have been required to attend CSE training and awareness seminars – including how to report concerns. All new taxi licence applicants receive mandatory training in CSE awareness and reporting.
What difference has this made:
There has been an increase in intelligence and referrals made to the police on CSE. Evidence from cases supports that children have been safeguarded due to improved recognition and reporting Drivers are now engaged with safeguarding, challenging situations such as parents wanting to place young children in the taxi alone. Drivers now understand and consider the level of personal responsibility involved whilst conveying children. Drivers and operators can no longer argue a lack of awareness if issues occur.
Areas for further action:
Debate is on-going on in-car CCTV – mainly based on cost. Utilising SRANS colleagues for increased roadside checks.
What are the Key things we are doing next:
Consideration is being given to develop a CSE special constable by dedicating 2 officers to work with taxi enforcement officers. Identify suitable timescales for refreshing CSE training and awareness raising to ensure a continued focus and compliance on the issue.
2. Oversight of premises and disruption activity:
What was the issue:
Intelligence connecting premises to drugs and sexual offences against children. Lack of co-operation with neighbourhood policing team when challenged. Difficulties in addressing concerns due to obstructivePage behaviour 207 from staff. 51
Bradford Safeguarding Children Board Annual Report – 2015/2016
No regulatory body had direct responsibility as there was no licensing requirement. Despite general intelligence and concerns, no disclosures identifying the premises as a scene of crime were made.
Our Journey so Far – what are we doing/done:
PC CSE problem solver (PCCSEPS) role was created in the WYP to target locations such as these. Staff/owners confronted robustly with regular visits detailing ownership and daily operations. Errors found in practice around insurance, music licences and health and safety provisions resulted in owners requiring to undertake actions to address the issues. Legislation was identified that could enforce closure of the premises – Section 136.Sex Offences Act 2003 This legislation was used to close a business in November 2015 by Bradford Magistrates at a civil hearing (First use of this legislation in England and Wales).
What difference has this made:
Appropriate media exposure was utilised when the business was closed – sending out a message about disruption across the Bradford District. Similar businesses are now aware of this legislation and the impact it has when used by the police. Owners of businesses now understand the benefit of engaging with the police. Risks to children have been reduced as owners now understand there are legal and financial consequences for failing to protect children.
Areas for further action:
Extend training for premises staff in CSE awareness. Monitor businesses on re-opening and to ensure that improvements are maintained. Implement a shared responsibility for visits between the PCCSEPS, neighbourhood teams and specialist roads policing officers. To identify where CCTV systems need to be installed in premises of concern.
What are the Key things we are doing next:
Maintain an overview of operations between police teams. Identify the exact nature of businesses that re-open and any relevant partners that will support the process. Work with premises owners and staff to ensure written safeguarding policies are in place.
Inspector Esther Hobbs PC Matt Catlow West Yorkshire Police.
8. Voluntary and Community Sector Organisations (VS) / Young Lives Bradford
Improving Safeguarding Outcomes 2015/2016
Safeguarding Issues addressed over this period:
There is a wide variety of voluntary and community sector (VCS) agencies that work on a number of specialist areas of safeguarding including Child Sexual Exploitation, Domestic Violence, Mental and emotional health, substance misuse and bullying. Other agencies work with a broad cross section of young people. They ensure that their provision has appropriate safeguarding in place and respond to safeguarding issues that emerge. Page 208 52
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Young Lives Bradford as the network of VCS organisations that work with children and young people has worked to o Promote safeguarding across the VCS o Ensure VCS org are active in safeguarding developments across the district o Support local safeguarding initiatives and priorities
Our Journey so Far – what are we doing/done:
Young Lives co-ordinated sharing of information on and VCS input into various safeguarding issues including:
o Supporting the development of the Journey to Excellence, including Early Help and Signs of Safety. o Support work on safeguarding in Eastern European communities, in particular the Safeguarding Board’s conference. o Raising awareness regarding the work of the Safeguarding Board. o Ensure as many voluntary sector organisations receive information /support regarding safeguarding issues. o Promoting safeguarding week and ensuring VCS contributions. o Informing the VCS about the Prevent agenda and their role in supporting it. o Promoting training and opportunities. o Supporting the Board’s work on Bullying ( in the lead up to the conference). o Supported the development of a section 11 audit tool for VCS organisations to use to support their work. o Supported engagement in serious case reviews and dissemination of learning across the VCS.
What Difference has this made:
All VCS organisations that responded to YLB’s survey have safeguarding polices and a majority update these each year. VCS organisations report that they have an increased awareness of safeguarding issues and use the information to inform their safeguarding practice. Organisations have been supported to develop their safeguarding policies and procedures. Knowledge, skills and intelligence has been shared with the Safeguarding Board and its sub groups. The VCS has had a high uptake of Signs of Safety training. Individual agencies are also able to demonstrate the impact that their work has had.
Areas for further action:
There will be a continuing need to support the development of Early Help and the roll out of Signs of Safety. There will be a need to support organisations with completion of Section 11 returns. We need to be clear on the sector’s future priorities based on dialogue between the district VCS and BSCB.
What are the Key things we are doing next:
Young Lives Bradford will
Continue to work on Early Help and signs of safety. Identify key priorities for VCS safeguarding steering Group. Respond to emerging need. Undertake work to promote VCS services to schools and education providers.
Author: Peter Horner and Dave Benn Organisation: Young Lives Bradford
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9. FAMILY ACTION HOPE SERVICE Improving Safeguarding Outcomes 2015/2016
The HOPE Post Domestic Abuse Service works with children and young people aged 5 - 13 years old and their families, in all areas of Bradford and Keighley who are living in a safe situation free of domestic abuse. The aim of the service is to support recovery from trauma, repair family relationships and improve emotional wellbeing of children and families who have lived with domestic abuse.
Safeguarding Issues addressed over this period:
Children who live with domestic abuse experience trauma which impacts on their emotional health and their social, intellectual and behavioural development. Living with domestic abuse affects whole families and family relationships. Domestic abuse impacts on children’s emotional attachments and relationships with safe parents, as well as abusive parents. Children who live with domestic abuse need to feel safe before recovery. Some children and young people reproduce abusive behaviour modelled to them and can pose a risk to peers, siblings and non abusive parent who may already be traumatised by domestic abuse. Awareness of children who are sexually or physically abused within families are often invisible and the focus on CSE although crucial sometimes distracts from this. There are many crossovers for traumatised children who can experience neglect, sexual abuse and also live with domestic violence. There are well evidenced links between experience of physically abusive parenting and the development of young people’s own abusive behaviour and this includes sexually harmful behaviour. Current research (Women’s Aid new model ) suggests an over reliance in addressing domestic abuse, on management of risk rather than building on strengths of families and assessing needs. Incorporating learning from new legislation such as including coercion and control in definitions of domestic abuse. Make links with other agendas where harmful practices occur such as FGM and forced marriage and PREVENT.
Our Journey so Far – what are we doing/done:
Hope service was previously delivered by two different agencies- Family Action in Bradford and in Keighley by DVS and since July 2015 it was agreed delivered solely by Family Action. This brings consistency and is rooted in a safeguarding child centred organisation, with strong safeguarding and domestic abuse policies and focus. In 2015 our first goal was to improve quality of risk and needs assessments ensuring they are holistic and include family and professional system around the child. We now deliver assessment of unique family needs and offer packages of support in line with Bradford early help vision of thinking family. The Hope service was previously focussed primarily on individual work with children, this is still important, but is only one aspect of the service offer. Our second goal was to widen the range of services available to meet needs of whole family, including therapeutic work with child, or family, or parent and child and also group work and consultation to other professionals around the child and family. Within this to ensure the service for children who have experienced domestic abuse is trauma informed and has attachment and systemic focus.
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A package of support can now include other family action services such as practical benefits advice following domestic abuse (Canterbury Advice service) and also recovery work for parents with mental health issues, from Building Bridges sister project. Our third goal was to research and develop evidence based services to improve safeguarding outcomes. We bought licence, manual and training for DART recovery programme from NSPCC and are sharing this with early help partner agencies. Staff are now trained in Signs of Safety Model of risk assessment and created SOS Practice lead to attend Bradford Practice lead Sessions and service manager part of SOS steering group to drive SOS forward in Bradford voluntary sector and is part of VCS safeguarding steering group. Created senior practitioner role as safeguarding lead and to quality assure assessments. Created systemic family practitioner role to ensure skills in working with whole families and professional systems. Staff has access to systemic trauma informed consultation on monthly basis. Staff have accessed training in working with families and working with trauma and group work skills as well as NSPCC DART training. We have developed a strategy of supporting parents as volunteers and we have one parent who is now a group facilitator for the Dart programme.
What Difference has this made?
Assessments are now holistic and family focussed and support is bespoke to family’s needs. Following assessments we have also been able to signpost families to more suitable services or refer back to CSC if safety not yet achieved for children. We have been able to provide systemic family work which has included previously abusive parents and we are now more inclusive of fathers in our assessments and service delivery. We have been able to pilot evidence based group work (DART) with a focus on repairing attachment relationships between mothers and children and also customise and deliver the programme on a 1:1 basis where group work is not suitable using our learning from the DART manual (HEART programme). The Keighley pilot of NSPCC DART evidence based group work programme for mothers and children recovering together from Domestic Abuse was positively evaluated by parents and children. A short community film has been produced with joint funding from Family Action national DA coordinator (Comic Relief funding) to share information about the DART pilot. We have been able to share learning with other partner agencies delivering support to families experiencing domestic abuse, such as Families First (Brathay Trust) currently co delivering our second pilot of the DART programme in Bradford. The quality and depth of assessments and multiple levels of intervention with families and parents as well as children means our numbers of open cases are small. This is significant as we have a waiting list for the service. Comments from parents
Areas for further action: I am more confident and stronger.
The Hope Project received 164 referrals from the 1st April 2015 to I understand my child better. the 31st March 2016, however we are commissioned to provide Everyone is in/ has been in similar an in depth assessment and recovery service to 50-60 children situations so they understand you. and families, which illustrates the need. I feel DART has helped us as a family more than I could ever imagine
We need to secure longer term funding for the service for more than 1 year at a time. The short term funding situation makes it difficult to recruit and retain staff and plan services which affect quality and Page 211 55
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quantity of service delivery and innovation. Our funding ends in March 2016 which leaves 22 weeks of service delivery and all our therapeutic programmes are for 10-12 weeks following 4 weeks assessments. We would like to explore with our Bradford commissioners the discrepancy between funding for children who have been sexually abused and those who have experienced domestic abuse as we receive a small amount CCG health funding for recovery sexually abused children and we know there is a much larger need for this service. Our domestic abuse recovery service is funded from early help and not funded by health. Our vision would be for one trauma and loss recovery service within Family Action for all traumatised children whatever the form of sexual or physical violence, with ideally joint funding. This would allow us to work with children and parents at an earlier stage and also do more support work with parents and psycho educative groups for parents of the children who have been sexually and physically and emotionally harmed, so that they can support their children’s emotional needs and manage their behaviour. We would also like to meet with the Police Crime Commissioner to discuss needs of Bradford children who are victims of familial abuse and explore potential other sources of funding. There may be a gap in service for young people over 13 years old for a recovery service and this needs to be explored with other local services who provide youth work, such as Bradford Women’s Aid and other providers. A forum of service providers for children would be useful to ensure we are mapping local services to be most effective. This is also crucial as we know that the most important way to keep children safe is to support prevention and early intervention which means working in schools on healthy relationships and definitions of gender and masculinity.
What are the Key things we are doing next?
Evaluating second pilot of DART group work programme with Families First (Brathay Trust) and exploring how we can embed the learning into the wider early help strategy. Hope staff are to be trained in enough is enough programme currently being delivered by Families First, so that we can meet the needs of our families where children are abusive to their parents or siblings. Exploring outcome tools for family work and models of working with whole families including fathers. Family Action has whole family services in Wales and we would like to learn from their experience. Further staff training on working with trauma is planned for December 2016. Embed SOS model to HOPE service and amend paperwork in line with SOS developments as they evolve, such as early help assessment. Building relationships with other partners working with domestic abuse to maximise positive outcomes for children. We have developed an equality and diversity forum within Bradford Family Action to look at how we can increase access to our services to families from marginalised communities. Seeking clarity on the early help strategy and how we can support the development of a mature model of early help with evidence based services. Raising awareness of HM Government Ending violence against women and girls Strategy 2016-2020 (March 2016). Within this document there is the demand to stop violence to women and girls and for local services to ensure all victims get the right support at the right time, driving a real transformation of service provision, providing support to local commissioners so that all areas rise to the level of the best. The government is pledging to ensure all local partnerships will have access to the best examples of local practice, along with the data, tools and information they need to provide an integrated, effective, whole family approach to addressing and stopping violence and abuse Also raising awareness of Domestic violence and abuse: NICE quality standard 3 [QS116] February 2016 which underlines the importance of appropriate support for children and families from specialist supports services which address the emotional, psychological, physical and sexual harms arising from domestic violence and abuse.
Author: Debra Glover , Service Manager Page 212 56
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Organisation: Bradford Family Action Therapeutic Services. Contact: [email protected] October 2016.
Chapter 5 – Ensuring the workforce is skilled and equipped to carry out their safeguarding roles and duties. 1. Learning and Improvement - Dissemination of Key Messages LOCAL LEARNING
BSCB has a local Learning and Improvement Framework, which means that a range of quality assurance activities are on-going these include single and multi-agency audits of practice, multi-agency challenge panels, local learning lessons reviews and Serious Case Reviews.
In addition to highlighting where practice needs to improve there are also examples of good practice which is useful to share. It is important that key learning is disseminated to all partner agencies so that practice can be developed with the ultimate aim of keeping children safe.
There is a template which partners complete to record key learning which is collated by the BSCB Learning and Development Coordinator. In the last quarter there have been contributions from BDCFT, BSCB, and Airedale NHSFT.
Key Messages
Theme:-Recognising the importance of the role of fathers and men in the lives of children and young people
An audit of records in found there was evidence of good practice where clinicians actively encouraged the involvement of fathers. However there were some inconsistencies in how and where in clinical notes the names and contact details of parents and carers were recorded.
Where it is not appropriate to involve fathers it is still important to think about the significance and history of this relationship when working with a child and family. Therefore family history, names, contact details should be recorded clearly , this information should be requested on the form for the initial appointment , clinicians should go through this form with parents/ carers and the young person and discuss consent
Key Learning - all agencies should ensure that their work with children and families includes fathers and that their processes for recording contact encourages this from the first meeting.
Partners - Are you confident your organisation has such processes in place? Staff - Do you make sure you include the role of the father in your assessments even when it is not appropriate to include them in direct work?
Theme:-CSE - Spotting the signs, information gathering and sharing
An individual management review found that there was a need to improve information gathering and sharing for all children attending Emergency Departments and Children’s Services within the hospitals.
There is now a requirement that the social circumstances of all children attending Emergency Department (ED) / children’s services is checked and that ED staff have to inform school nurses of children attending as a result of a fight.
In addition there is a requirement that all ED consultants and paediatricians should complete level 3 safeguarding training within 3 months of starting employment.
Key learning - is the importance of the timely gathering and sharing of information with the most appropriate staff in other organisations and the need to ensure that key staffsPage are appropriately213 trained within a specified time frame. 57
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Partners - Are there robust arrangements for ensuring staff are trained and that this is monitored and reviewed in your organisation? Staff - Are you clear on when to share information and who it should be shared with?
West Yorkshire Information Sharing Procedure which can be found on the BSCB website. This policy is being updated. It can be found at http://westyorkscb.proceduresonline.com/chapters/p_info_shar_confid.html
The Bradford Protocol is being updated
Theme:- Supervision Practice and recording
A partner undertook an audit which focussed on the recording of safeguarding supervision and adherence to their “Safeguarding Children Supervision Policy”. There was evidence of timely recording in both electronic systems in use in the organisation e.g. 83%.
However not all recording was compliant with the use of the SBAR tool (Situation, Background, Assessment and Recommendation) which is part of the policy.
Key Learning - Therefore there is a recommendation that all staff need to follow the policy about how to record supervision in order for full assurance to be achieved.
Partners - Do you have a policy for supervision which includes good practice and an expected timeframe? Staff - Are you clear about your organisations supervision policy and do you adhere to its requirements?
Theme:-CSE Review of Practice – Risk assessment Template
The BSCB led a multi-agency challenge panel case file audit on CSE which included the use the current risk assessment template.
Good practice - There was consistent appropriate involvement of CAHMS and generally appropriate flagging on hospital systems for children at risk.
Areas to improve - There were concerns that the current risk assessment tool should always be used and professionals must use the case history and an analysis of the child’s journey, which should be in the chronology. The chronology should not be just a list of events it must always include analysis considering “what does this mean for the child”.
Key Learning - There needs to be a purpose and focus on all interventions, each of which should have measurable outcomes, this will ensure that risk is assessed appropriately.
Recording about missing episodes needs to be kept up to date especially when children are placed out of area.
When a number of professionals are involved it is especially important to be clear about roles and responsibilities and make sure the child and family is clear who is doing what
Recommendations
- complex cases should be allocated to experienced social workers - a paediatric medical assessment should always follow an alleged assault. - make use of the Fair Access panel to assist finding suitable school placements
BSCB - Needs assurance that
All staff use the local procedures for completing a CSE Risk assessment There is information and advice about ChildPage Sexual 214 exploitation on the BSCB website 58
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http://bradford-scb.org.uk/cse.htm
Safeguarding Children from Sexual Exploitation E learning includes all the up to date documentation and advice for completion of a risk assessment http://bradford-scb.org.uk/training/e_learning.htm
Medical assessments are undertaken as expected detailed in the Safeguarding Board procedures http://westyorkscb.proceduresonline.com/chapters/p_sec_47_cor_ass.html#med_assess Assessment and analysis and planning is meeting expected standards http://westyorkscb.proceduresonline.com/chapters/contents.html#assessing_need http://bradfordscb.org.uk/training/pdfs/2016_17/Safeguarding%20Assessments%20Flyer%202016_17UPDA TED.pdf
Local Lessons Review neglect and physical injuries
1. The BSCB undertook a local lessons review on cases of young babies with non-accidental head injuries which recommended that:
Training on neglect to focus on professional judgement, professional curiosity and challenge, disguised compliance and overcoming acclimatisation to a neglectful presentation and the rule of optimism. A course has been developed. A multi-agency neglect one day course “Neglect can you recognise it what should you do?” is available now details of how to book can be found on the BSCB website http://bradford-scb.org.uk/training/pdfs/2016_17/Neglect%20- %20Can%20you%20recognise%20it%20and%20what%20should%20you%20do%202016-17.pdf Working with Disguised Compliance - details of how to book can be found on the BSCB website http://bradfordscb.org.uk/training/pdfs/2016_17/Working%20with%20Disguised%20Compliance%20Flyer% 202016-17.pdf Working with resistant families details of how to book can be found on the BSCB website http://bradfordscb.org.uk/training/pdfs/2016_17/Working%20with%20Resistant%20Families%20Flyer%202 016-17.pdf
2. New National E Learning
Seen and Heard - The Children’s Society have created a 60-minute video-based e-learning session to help you build your awareness to make sure young people who have been abused are seen and heard.
2. Learning and Improvement report:
Terms of reference
On behalf of the BSCB, to coordinate and evaluate the effectiveness of safeguarding children learning and development activity in the Bradford District so that those working with children, young people and families are appropriately skilled and competent.
Contextual information
- Sue Thompson has continued in the role of Chair of the sub-group throughout the year. - The police now have a representative on the group, education have not been represented this year. Main issues covered and analysis of sub-group’s effectiveness
During 2015-16, a variety of learning experiences was offered on a multiagency basis including:
1250 on the annual training schedule; Page 215 59
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80 participants attended other learning and development events - briefings, focus groups; 5150 professionals registered for e-learning courses, some of the most popular ones were:- o Awareness of child abuse and neglect 1734 o Safeguarding Children from abuse by Sexual Exploitation 773 o Awareness of Domestic Violence and Abuse including the Impact on Children, Young People and Adults at Risk 325 o Hidden Harm - The effects of parental problem substance use on children 178 o Safeguarding Children Refresher Training 137
Approximately 2000 local workers attended learning events, lectures and workshops during 'Safeguarding Week 2015' – which is a practice-focussed collaboration between Bradford Safeguarding Children Board, Bradford Safeguarding Adults Board and the Sexual violence and Domestic Abuse Board.
During the week over 60 events took place across the district all with the focus on “Safeguarding – its everyone’s responsibility”.
A key development this year has been the delivery of advanced CSE training for practitioners who work directly with children at risk of CSE. The programme was reviewed and developed throughout the year. The personnel involved in delivering the course changed due to staff changing roles and a decision was made to re - commission training for 2015 /2016 based on feedback from the evaluations.
Another significant development was completion of the review and update of the E-Learning Programme Missing Children – Bradford protocol -so now all practitioners working with this vulnerable group of young people have access to up to date training to help them put into practice the local procedure.
In February 2016 the BSCB added the Safeguarding Children refresher Training to the courses freely available to all partner agency staff to use to update their safeguarding training as required.
The Learning and Development Coordinator has worked with partners in the BMDC and Collingwood Learning to develop a series of web based training materials, “Real Safeguarding Stories”. These are case scenario based and performed by professional actors they will be freely available for use in training and development sessions.
Evaluation of training has continued to be developed working towards an electronic pre and post course follow up system through the purchase of a software package “Paper data”.
Alongside this courses have been evaluated through some telephone follow up which produces good qualitative information but is very labour intensive.
BSCB commissioned a follow up embed session for the Working with Resistant Families course which provided very detailed feedback and evidence of impact of learning.
A report was produce for the BSCB and a further session was commissioned to take forward some of the themes with board members at the BSCB Development day.
A training needs analysis was undertaken by the BSCB which highlighted that some of our partner agencies were not able to easily provide data about compliance with training requirements.
The BSCB has challenged partners to ensure that this improves. For example the local authority has recently invested in a new learning management system which they have assured the BSCB will mean they will be in a position to provide data in the future.
Links to other sub-groups
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The Learning and Improvement Framework has been re written and as part of this process it was reviewed by the sub-group. There continues to be the need for strong links between the Serious Case Review group and the Performance Management, Audit and Evaluation Sub-group.
Priority issues for 2016-17
To develop the Training Needs Analysis process to give the BSCB assurance that partners are meeting their statutory training requirements To develop the impact of safeguarding training and quality of frontline practice and outcomes for children, through use of the Paper data tool. To consider the new BMDC Evolve LMS and how BSCB can make use of this for evaluation and training booking To embed the Learning and Improvement Framework and its comprehensiveness with particular focus on identified learning needs emerging from the work of all the sub-groups.
Sue Thompson Designated Nurse CCGs Chair of the Learning and Development sub Group.
3. Training Needs analysis report 2015-2016
Safeguarding Training Need Analysis Questionnaire:
Organisation / partner Completed Partial Completion No response Other ANHST X BDCFT X Banardo’s X BTH - NHS X BMDC Workforce Development X BMDC CCHDT x BMDC Fostering Service x Bradford YOT X BLAST X CCG + GP X CAFCASS* X Connexions X Education BMDC X Education X Schools Horton Housing X National Probation Service X NSPCC X Oasis X WY Police X BMDC Youth Service X
*Provided own written report did not complete the questionnaire. Responses and Commentary:
Responses provided by and range of compliance
Airedale 59.4% - 100% BDCT 51% - 92% Banardo’s 80% – 100% Bradford Teaching Hospitals 70 %– 100% Page 217 61
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BMDC CCHDT 100% Bradford YOT 75% - 100% Blast 100% CCG/GP 64% - 100% Connexions 100% Horton housing - 100% Oasis – 100%
2.2 In your service/organisation, do you have the capacity to meet the safeguarding children training needs of all staff/volunteers to the required standards/professional requirements?
Please specify
Yes – what evidence can you provide?
o All answered yes to this and gave examples of evidence.
No – what are the gaps / issues?
o Some difficulties highlighted in releasing staff for training, not having all the records due to changes the organisation, some specialist staff needing level 3 training on a multi-agency basis
Is this likely to change in the next 12 months?
Please indicate Yes / No
o No was the majority response
3. Please indicate if in your single agency training/updates, you cover basic definitions/awareness of:
Yes No Unsure
Domestic Abuse 13
Child Sexual Exploitation 14
Female Genital Mutilation 12 1 1
Forced Marriage 13 1
Prevent 12 1 1
Children with Additional Vulnerabilities
Yes No Unsure
Children with disabilities 12 1 1
Young carers 8 4 2
Children of prisoners 7 5 1
4.1 Single agency - What methods of delivery do you currently use to enable your staff to meet their safeguarding training needs?
Indicate with an X where appropriate Page 218 62
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E-learning 14
Full day course 11
Half day course 11
Briefing 13
Practice forum 5
Blended Learning (mix e-learning/face to face) 9
Distance learning 4
Self-directed learning/reflection 10
Newsletter 10
Websites 10
Other please specify ***
*** Themed supervision, shadowing, booklets, network meetings, reflective case discussions, conferences, external trainers. Mentoring for ASYE, team meetings, policy and procedures
4.2 Multi-agency – BSCB - What methods of delivery do you require the BSCB to use to enable your staff to meet their safeguarding training needs?
Indicate with an X where appropriate
E-learning 14
Full day course 14
Half day course 14
Briefing 9
Practice forum 9
Blended Learning (mix e-learning/face to face) 6
Distance learning 2
Self-directed learning/reflection 5
Newsletter 11
Websites 10
Other please specify Conferences and workshops
5. How many of your staff are currently active safeguarding children trainers?
Number of trainers
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Multi-agency – BSCB Training Pool 11
What topics do they cover? Variety
6. Is your service/organisation able to support staff to become part of the multi-agency pool of safeguarding children trainers?
Yes / No How many staff could you support to become part of the multi-agency pool of safeguarding children trainers? Number : The majority who already part of the pool willing to continue but could not offer any additional trainers. West Yorkshire Police offered 1 or 2 Horton housing offered 9? Blast if funding provided Connexions 1
Do you have staff you would like to develop as safeguarding children trainers on a single agency basis? Yes / No If Yes how many? Horton housing 8 CCG / GP Leads potential interest
Commentary: Completion A completed questionnaire was received from a range of partners; however some of the key partners did not provide any response and / or were unable to readily provide the data needed.
This highlights the need for organisations to have in place mechanisms for knowing how many staff they have and what their safeguarding training requirements are, especially as it is a statutory duty of such organisations to safeguard children they need to be able to show they are compliant.
It might be possible for partners to learn from each other / share ideas about systems they have in place to be able to monitor and report on progress in relation to safeguarding children training.
Summary of Responses
1. All organisations had a range of ways of collecting information about training needs
2.1 The information from this table indicates that there are a number of organisations who are 100% compliant at all levels and in the main these were smaller organisations.
It is recognised that this is a snapshot of the current situation and that training programmes are delivered on a rolling annual programme.
It is interesting from the point of view of providing a multi-agency programme that in “Target groups 3 and 4” there was a range from 51 – 100% and 71 – 100% respectively of compliance. These are the target groups that the majority of the multi-agency programme is aimed at – could the BSCB Training programme assist with this? 2.2 The majority of partners said they did have the capacity to meet the needs of their staff however there was a suggestion that some of it could be provided on an interagency basis by one respondent. Conversely another respondent highlighted the difficulties of releasing staff to attend multi agency training. 3. The requirement to cover a range of issuesPage within safeguarding 220 training on the whole appears to be met. 64
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There are some gaps and uncertainties about coverage around the topics of “Young Carers “and “Children of Prisoners”. These could be topics for consideration in the BSCB annual programme. 4.1The answers indicated a wide range of methods of delivery were used on a single agency basis – E learning and briefings most popular closely followed by full and half day courses newsletters and websites. 4.2 Regarding what is required from BSCB, E learning, full and half day courses were all equally popular, followed closely by newsletter, websites, practice forum and briefing. 5. In total there are 31 active safeguarding trainers, 11 of which are currently part of the multi-agency training pool. Most organisations felt this was as much as they could offer currently. Although there was an offer of 9 trainers from Horton Housing and a suggestion that CCG / GP leads would welcome some “Training for Trainers” to help meet some of their training need gap. In addition BMDC workforce development response indicates that there are 25 trainers who will deliver some aspect of safeguarding training as part of their role. Conclusion
This exercise has provided some useful information, however in relation to planning for the annual programme the information is limited.
It has highlighted the need for partner organisations to have a system in place for gathering training needs intelligence which includes safeguarding children training needs data.
This information is needed in order to ensure that the multi-agency programme compliments the single agency training partners are providing for their staff and/or volunteers.
Julie Evans Learning and Development Coordinator BSCB
Chapter 6 – Responding to Serious Incidents and Child Deaths
1. CDOP - The work of the Child Death Overview panel was a business priority for this period of the Board’s activity and their storyboard is in place under Priority 4 on page . The full CDOP report is available at appendix 3.
2. Case Reviews – The LSCB must undertake reviews of serious cases in specified circumstances. Regulation 5(1) (e) and (2) of the Local Safeguarding Children Boards Regulations 2006 set out the LSCB's function in undertaking reviews of serious cases and advising the authority and their Board partners on lessons to be learned.
A serious case review (SCR) takes place after a child dies or is seriously injured and abuse or neglect is thought to be involved. It looks at lessons that can help prevent similar incidents from happening in the future. (NSPCC)
In Bradford serious cases are referred to the Serious Case Review (SCR) sub group, who after reviewing the evidence available at that point, make a recommendation to the chair of the Board on whether the case reaches the threshold of a serious case review, or whether another type of review should be held. Ultimately, it is the Chair’s decision on how the Board will respond to the case.
Work completed in this period During the period covered by this report, the Board has received one serious case review (SCR) which has been completed and the Chair has agreed to two further SCRs which have been started. Partner agencies are also involved in two domestic Homicide reviews (DHRs), one locally and one with another local authority.
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The completed SCR - On March 22nd 2016, Bradford Safeguarding Children Board (BSCB) published the overview report of a serious case review (SCR) that is commissioned following the tragic death of Diljeet (not real name). Diljeet died on 18th February 2014 as a result of significant injuries experienced whilst in the care of her mother. This case has been the subject of both a criminal trial and a coroner’s inquest.
The two new SCRs started in the period are both cases of Child Sexual Exploitation. One involves the exploitation of a female child by a criminal gang resulting in sexual offences being committed against the child, a number of criminal trials and twenty sentences being handed down to the perpetrators. The second involves online sexual exploitation resulting in sexual offences being committed against a male child which also resulted in successful criminal prosecutions against twenty one offenders.
In both cases, work was carried out under the guidance for SCRs where criminal investigations and proceedings were taking place and this had an impact on the timescales for the SCRs so that there was no prejudicial impact on the prosecutions. The work on the DHRs is on-going, as both cases involve families where there are children involved, and the safeguarding partnership is active to support the process.
Learning and Improvement arising from the reviews The need to ensure how critical and significant information is held, shared and understood across the front line of the partnership has been the subject of all learning events being held on the cases. As a result all agencies have agreed to implement the ‘Signs of Safety’ (SOS) approach to their practice when carrying out assessments of children and their carer’s and analysing risk through the ‘Danger Statements’, a tool in the SOS approach. Multi agency and single agency training is being commissioned to ensure that all professionals engaged in these processes will be skilled to use the approach. The need to ensure that all professionals understand the impact of group think, when working in a multi- agency safeguarding system of protection or child in need, when decisions are being taken a round planning services for the child or evaluating the progress of the work taking place. All agencies professionals are being reminded of the need to challenge decisions or assessments when they have a different understanding of the risks evident to the child. This includes assessments around domestic abuse and mental health issues with professionals in the vulnerable adults services. The need to ensure that professionals understand each other’s roles and responsibilities when working on a case where more than one agency is involved. Effective communication between agencies has been raised as a critical factor in safeguarding children, and that there needs to be clarity around who is involved with the child’s case and bringing together that knowledge so that risks can be effectively assessed and reduced. The need to ensure that issues of culture and ethnicity are challenged and reflected upon within supervision sessions for front line professionals, and that decisions are not made based on subjective assumptions around gender, the ability to protect or driven by systems thinking based on a particular mind-set. What difference has this made A full account of the impact from the learning reviews is contained in Chapter 5 The impact on practice and service planning and delivery is contained in Chapters 1 & 2 What needs to happen next
The learning and Development sub group is looking at different media opportunities to disseminate learning from the reviews to the widest possible audience, including to children and communities, so that everyone understand the challenges of safeguarding children, and what works to reduce the risk of abuse and harm. The Performance Management Audit & Evaluation sub group is planning a programme of challenge panels to address priority areas of concern for the BSCB while scrutinising and monitoring the progress of the action plans arising from the activity.. The Serious Case Review Sub Group will continue to monitor and scrutinise progress of the BSCB and individual agency action plans to ensure that improvement to practice continues to make progress.
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Chapter 7 – The Board’s overall Performance and Priorities for 2016 - 2018 1. The Board’s Overall performance
This has been a very busy year for the Bradford Safeguarding Children Board. Evidence provided throughout this report has demonstrated the significant level of safeguarding activity taking place under the Board business plan and within Individual agencies. The overall evaluation of this activity shows that the Bradford Safeguarding Children Board is fulfilling its statutory responsibilities under the Children Act 2004 and the Local Safeguarding Children Board Regulations 2006. The individual agency storyboards further demonstrate the co-ordination of the range of safeguarding activity taking place within the Bradford District to promote the welfare of the children, protect them from abuse and reduce the risk of harm. It shows how the Board has organised the work under the business plan and the frameworks in place to scrutinise and monitor the activity taking place and provide challenge where needed to hold each other to account.
2. Priorities for 2016-2018 Previous BSCB business plans have been of one year’s duration, and this has raised concerns that not all work can be completed within this timeframe. Consequently, the Business plan for the next Board period will stretch over two years to allow for improvements to be fully embedded in practice and a period of time to elapse to enable a rigorous evaluation of impact to be undertaken and fully understood. It will also enable longer term priorities to reach fruition and ensure real progress can be made.
The extended period for the business plan will also facilitate a proactive approach to emerging safeguarding themes and trends within the District, the West Yorkshire partnership and nationally, while enabling the Board to react where necessary to changes in Law and Statutory Guidance. The longer timescale for the plan will also enable a balanced approach to be taken over the focus of the Board’s activity. As understanding grows about the nature of the abuse of children through female genital mutilation and forced marriage, and in the exploitation of children through criminal targeting, online grooming, sexual abuse, trafficking and radicalisation; the Board will use intelligence led problem solving techniques to gain an understanding of the scale of the problem and to ensure that safeguarding responses are effectively targeted and proportionate. Thereby ensuring that all children in the District are effectively safeguarded, their voices are evident in the activity and the wider safeguarding landscape is kept in focus.
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The Business plan for 2016-2018 has been developed in consultation with the safeguarding partnership throughout the Board, and is leaner and focused on three key areas of activity as follows:
Ensure that the care and protection of By ensuring we have strong and The high level risks experienced by all children in the Bradford District effective safeguarding arrangements marginalised and/or highly remains the highest priority while and a collective accountability across vulnerable children are understood delivering the improvement the system the Board will improve and targeted through intelligence programme: outcomes and reduce the harm to led problem solving, and receive a
children in the district: proportionate multi-agency Scrutinise, challenge and response: evaluate the impact of the Journey to Excellence strategy Develop a range of multi-
on its role in the safeguarding media approaches to of children in Bradford. communicating across the Online Safety - grooming, The high high level level risks risks experienced experienced by marginalised by marginalised and/or Evaluate and challenge multi- whole safeguarding sexting and cyber highly vulnerable children are understood and targeted agency safeguarding landscape. and/or highly vulnerable children are bullying. performance on neglect. Develop a culture of through intelligence led problem solving, and receive a Grooming and understood and targeted through intelligence Ensure that safeguarding constructive challenge and proportionate multi-agency response: exploitation of children practice meets the needs of openness within the led problem solving, and receive a through gangs, children experiencing Violence accountability framework to radicalisation, sexual proportionate multi-agency response: in the Home. improve the impact and abuse and trafficking. Ensure that the therapeutic quality of safeguarding Online Safety - grooming, sexting and cyber Prevention and disruption needs of children who have services. bullying. strategies to address the suffered abuse or neglect are Ensure that learning from Grooming and exploitation of children through perpetration of abuse and met through a range of services challenge, audit and case gangs,Online radicalisation, Safety - grooming, sexual abuse sexting and trafficking. and exploitation across the Tiers of Need. reviews is disseminated cyberPrevention bullying. and disruption strategies to address Motivation of children Evaluation of the effectiveness effectively across the the perpetration of abuse and exploitation who go missing Grooming and exploitation of children of child protection processes partnership and is evaluated Motivation of children who go missing Misuse of substances through gangs, radicalisation, sexual and plans. for impact. Misuse of substances Work with communities and Female genital mutilation abuse and trafficking. Female genital mutilation children to raise awareness of Forced marriage PreventionForced marriage and disruption strategies to safeguarding risks and seek Disabled children Disabled children address the perpetration of abuse and their engagement in identifying effective exploitation Motivation of children who go missing responses. Work effectively as a Misuse of substances partnership in response to a Female genital mutilation climate of changing expectations for the Board. Forced marriage Disabled children
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The report – This report is published by the Chair of the Bradford Safeguarding Children Board –
David Niven
Date of Publication – December 2016
Approved by – The Partner membership of the Bradford Safeguarding Children Board
Copyright – This report is a public document and is published on the BSCB website.
Authenticity of information – This report is based on evidence contained within Board records, contributions from The high level risks experienced by marginalised and/or agencies across the partnership and information provided by the safeguarding highly vulnerable children are understood and targeted
community in the Bradford District. through intelligence led problem solving, and receive a
proportionate multi-agency response:
Contact details - Bradford Safeguarding Children Board Business Unit - [email protected]
Online Safety - grooming, sexting and cyber bullying. Grooming and exploitation of children through gangs, radicalisation, sexual abuse and trafficking. Prevention and disruption strategies to address the perpetration of abuse and exploitation Motivation of children who go missing Misuse of substances Female genital mutilation Forced marriage Disabled children
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Appendix 1 Safeguarding Children Performance Information
BSCB frequently monitors information and data regarding the performance of partner agencies in their work with the most vulnerable children in Bradford. This information is considered by the BSCB Performance Management, Audit and Evaluation Sub Group, which has a role in ensuring that BSCB has a thorough understanding of the effectiveness of services in keeping children safe in the Bradford District. This section summarises the key performance information and analysis for the year 2015-16.
Any references made to national and regional comparator data is from 2014-15 as this remains the most recent available data. The Department for Education will produce a statistical release containing national and Local Authority level data for 2015-16 in autumn 2016.
Child Protection Data
Number of 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 children subject of:
Referrals 7547 5777 4712 4609 5246 5011 5549
Section 47 1539 1534 1431 1844 1810 1938 2351 Enquiries
Initial Child 504 441 376 406 568 569 540 Protection Conferences
Child Protection 405 379 390 374 577 513 511 Plans at year end
Referrals
When a member of the public or a professional has concerns about the welfare of a child, a referral should be made to Local Authority Children’s Social Care Services, who have a duty to investigate any concerns.
In 2015-16 there were 5549 referrals made to Bradford Council’s Children’s Social Care Services. This is a rate of 360.6 per 10,000 child population which is much lower than the national rate for 2014-15 (548.3 per 10,000). The number of referrals in the year was about 11% higher than in 2014-15; this is a fairly steady increase across all age groups with the overall proportions by age band very similar to previous years. 96.3% of referrals went on to further action (similar figure to last year).
Re-referrals
When working with vulnerable children and families, it is important that professionals try to develop a prompt and accurate assessment of what help is required, from the start, at the point of referral to Children’s Social Care Services. One method of judging this is the number of children and families who needed to be helped repeatedly. The “re-referral rate” for Children’s Social Care Services in 2015-16 at 14.7% was a reduction on 16.7% in the previous year and lower than the national average re-referral rate of 24% in 2014-15.
Section 47 (S47) Enquiries and Initial Child Protection Conference (ICPC) Page 226 70
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A S47 Enquiry is a child protection investigation. Where a child is believed to have suffered or be at risk of significant harm, a strategy discussion takes place. Professionals from the relevant agencies will meet to decide whether to initiate a section 47 enquiry. This refers to an enquiry under section 47 of the Children Act 1989 and initiates further investigation. The social worker leads an assessment gathering more information from the child, parents, family members and other professionals in order to determine whether the child is in need or at risk of continuing harm. If the section 47 enquiries substantiate concerns about a child, an ICPC will then be convened.
The ICPC is held to decide whether or not to make a child subject to a CP Plan. The conference should be attended by the child or the child's representative, child protection social workers, other relevant professionals who have been involved with the assessment process, and family members.
There has been a 21% increase in children subject of Section 47 Enquiries in 2015-16 (2351 compared to 1938 in the year before). Bradford’s rate of 169.2 per 10,000 child population is higher than what the national rate was in 2014- 15 (138.2).
23% of children subject of S47 Enquiries in the year progressed to ICPCs - lower than 29.4% last year. ICPCs were held in respect of 540 children in the year (38.9 rate per 10,000); this is much lower than the 2014-15 national rate of 61.6.
Timeliness of ICPCs has much improved over the last 3 years; 93.4% were held with within 15 days of the S47 Enquiry compared to 15% in 2013-14. This is higher than the national average of 74.7%.
Child Protection Plan (CP Plan)
A CP Plan contains details of how Children's Social Care Services will check on the child's welfare, what changes are needed to reduce the risk to the child and what support will be offered to the family.
511 children and young people were subject to a CP Plan as at 31st March 2016, with more males than females. This compares to 513 as at 31st March 2015; the numbers of children on CP Plans remained stable this year after a fall in the previous year. Bradford’s rate per 10,000 child population was 36.8; lower than the national rate for 2014-15 (42.9).
Children with a CP plan on 31/03/2016
Series1, Unborn, 4, 1%
Series1, Female, 225, 44% Series1, Male, 282, 55%
The ages of these children were roughly evenly split between the age groups 5 to 9 and 10 to 15, with slightly fewer 1 to 4s, a small number of babies under 1 and a very small number of young people aged 16 to 17.
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Children with a CP plan on 31/03/2016 Series1, Series1, 16+, Under 1 24, 5% (including unborns), 52, 10%
Series1, 10- 15, 152, 30% Series1, 1-4, 130, 25% Series1, 5-9, 153, 30%
Children from a black and minority ethnic (BME) background are under-represented in terms of being subject of a CP plan (35%), compared to 47% of BME children and young people in the District. However, this is still an increase compared to 32% from the previous year. There has been a slight rise in the proportion of children from Eastern European countries subject of CP plans at 31 March 2016 (11%) in comparison to 9.5% at 31 March 2015.
Children with a CP Plan on 31/03/2016 - Ethnic Origin
Other 1% Not Know n Mixed 3% 10%
Black / Black British 2%
Asian / British White British Asian 52% 22%
Other White groups 10%
Emotional abuse (45%) is the main CP category for children being subject of a CP plan at 31st March 2016. This is followed by neglect (42%); sexual abuse (7%); and physical abuse (6%).
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Children with a CP Plan 31/03/2016 - Category of Abuse
Neglect Emotional Abuse 42% 45%
Sexual Abuse Physical Abuse 7% 6%
The number of children who newly became subject of a CP plan during the year was 524. Of these, 83 children (15.8%) became subject of a CP plan for a second time in their lifetime compared to 12.2% the year before. The national average in 2014-15 for this performance measure was 16.6%.
In the year, there were 522 children whose CP plans ended of which the proportion that lasted over 2 years was 4.2%. This is a reduction compared to 6.5% in the previous year at a time when the national average was 3.7%.
The percentage of children subject of CP plans who had all their review meetings held within required timescales was 95.63%, down from 98.3% last year.
Looked After Children
848 children in Bradford were looked after at 31 March 2016, a 3.7% reduction on the previous year (880). The graph below shows the number of LAC at 31 March over the last 6 years.
Number of LAC as at 31 March
900 895 890 885 880 880 880 875 870 860 850 848 840 830 820 2011 2012 2013 2014 2015 2016
86% of children were looked after due to abuse and neglect reasons, a slight increase on last year’s figure of 85%. The national figure at 31 March 2015 was 61%.
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The proportion of young people looked after by age groups has remained very similar to last year. There has been a slight decrease in the percentage of 0-4 and 5-9 year olds and a slight rise in the percentage of 10-15 and 16+ year olds as shown by the graph below.
Looked after children by age band as at 31 March 2016 45% 42% 39% 40% 36% 35% 30% 25% 25% 22% 23%23% 2013-2014 20% 21% 20% 16%16% 17% 2014-2015 15% 2015-2016 10% 5%
0% 0-4 5-9 10-15 16+
561 children looked after at 31 March 2016 were of White British origin compared to 582 last year. The number of BME children looked after has increased slightly, 271 compared to 266 last year.
In terms of legal status, 573 children were looked after under a Full Care Order (67.5%), this is an increase on last year of 528 (60%). 114 (13%) under an Interim Care Order, compared to last year of 124 (14%). 52 (6%) under a Placement Order same as last year of 6%. 93 (11%) on a Section 20 single placement compared to last year of 13%.
Looked after children by Legal Status as at 31 March 2016 80% 68% 70% 60% 60% 60% 50% 2013-2014 40% 30% 2014-2015 20% 14% 13% 14% 15% 13% 10% 11% 2015-2016 10% 6% 6% 0% Full care Order Interim Care Placement Order S20 single Orders placement
167 children were placed Out of District at 31 March 2016; a 10% decrease on last year’s figure of 186. 61% are placed with foster carers or friends and family carers, whilst 22% are Residential Purchased. The majority of children placed out of district are in the 10-15 age group.
Author – Saheed Khan Performance Officer - BSCB
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Appendix 2 Safeguarding Audit Strategy Bradford Teaching Hospitals NHS Foundation Trust Updated July 2016
Topic Start Date Completion Area and Aims Key Findings Action Points Status and re- Date lead audit date
The Health March Jan 2014 Across All 1. To audit 1. Medical 1. Explore need Update Response to 2013 Health medical Examination for presented to the Children Organisations examination s carried out Colposcope Trust following a H Jepps against in keeping for out of Safeguarding sexual assault RCPCH with RCPCH hours steering group standards standards medicals July 2015. New 2.To study 2. Only 2 cases 2. Ensure Colposcope liaison across had optimal medical purchased and partner sharing of reports old one now for agencies in information disseminated use on ward 2. Health 3. Good appropriately 3. To study if records information within acute recorded Trust appropriately
Quality of Completed re-audit Paediatrics To audit the 1.High quality of 1. Results to be Yet to be Medical Feb 2013 planned for J Sims and quality of medical reports presented to commenced Reports August 2016 R Skelton medical in general paediatricians reports 2.Clarity of at consultants produced opinions could be meeting. against improved in 2. Recommend RCPCH some cases avoiding guidelines jargon and increasing clarity 3. Further training to be provided
Child Feb 2011 Completed Paediatrics To determine 1. Significant 1.Update guide On-going annual Protection but on-going Jo Sims and number of number of and training for re-audit, data is Medicals Ruth Skelton medicals medicals social care re presented in the carried out, occurring when medicals annual Board along with out of hours. should take place report for place for 2. Commonest out of hours safeguarding medical, reason for children 2016 referrer and referral reason for physical referral. abuse. 3. Limited findings on sibling medicals.
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Communication including report writing and training.
Topic Start CompletionDate Area Aims Key Findings Action Points Status and Re- Date and audit date lead Most staff Action plan Complete July Local knowledge February On-going spot Trust- To determine aware child is created July 2016. of safeguarding 2016 to checks wide Knowledge of local up to age 18 2016 – to be Re-audit July policy date. for all procedures and and that SG is reviewed at 2017 nursing policies amongst everyone’s SG Team and staff on paediatric responsibility. meeting, medical wards. Varied actions staff. response to already questions underway. about different categories and risk factors, but better in areas where high SG. Need to increase access to newsletter and website.
Safeguarding June On-going Sally 1. To re-audit 1.Highlighted 1. Individual On-going cycle. Practice in A&E 2013 monthly Guest medical record need for on- staff audit keeping where going training feedback caution codes in A&E 2. On-going are in place assuranc 2. Ensure that all e safeguarding regarding flags and actions the flags are actioned. and alert process for safeguar ding. Safeguarding June On-going 1.To audit written 1.Highlighted 1.Individual On-going cycle. Practice in A&E 2013 monthly Sally safeguarding need for on- staff feedback audit Guest information, going training 2.On-going including the in A&E assurance accompanying adult regarding the is and does the child flags and alert have current process for children’s social care safeguarding involvement.
Safeguarding January On-going A&E Vetting of teenage Feedback for Still some Ongoing cycle – Practice in A&E 2016 Sally attendance cards in missed caution missed – method of Guest A&E for quality codes feedback “safety netting” assurance and directly to attendances, missed staff and also particularly for opportunities. To included in CSE provide direct the ED feedback to staff and Safeguarding discuss during Supervision training sessions. sessions Page 232 76
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Patient Satisfaction.
Topic Start Completion Area and Aims Key Findings Action Points Status and Re- Date Date lead audit date June Patient and 2016 Jo Sims 1.To explore the Audit work just professional patient, family and commenced Satisfaction professional June 2016 – following Child experience of audit protocol Protection having a child submitted and Medicals protection medical accepted, data at BTHFT. collection underway.
Adolescent Jan Aug 2014 Vicky 1.To determine if 1.The majority of 1.Ensure staff Complete. admission. 2014 cotter SG children between children over 15 were who are children’s 14-18 years were admitted to adult looking after team. offered the choice wards. children in of adult or adult areas are children’s wards. trained in safeguarding children. 2.Ensure all adult wards have all the SG children’s information readily available. 3.Regular training compliance monitored for adult areas and levels to be fed back through both adult and children’s steering groups.
Documentation.
Topic Start Completion Area and Aims Key Findings Action Points Status and Re- Date Date lead audit date Safeguarding Aug October Vicky 1.To audit if 1.Results of the audit 1.Re-audit Complete with families 2015 2015 Cotter antenatal were fed back to the April 2016 re-audit documentation. SG safeguarding NNU and maternity scheduled for children’s concerns were staff at a formal April 2016. team. transferred into lessons learnt event baby notes. regarding a joint SI.
2.Further education required from the Named Midwife to reinforce the need to transfer the information across. Page 233 77
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Safeguarding Sept Feb 2015 Vicky 1. To explore the 1.Lack of clarity and 1. A Complete children’s 2014 Cotter types of diversity regarding standardised To audit documentation and SG documentation places to document approach to completion of development of children’s used to capture SG concerns within where new Profile A Profile A team. SG information trust records. information is on paediatric within the recorded is wards January paediatric areas. required in 2016 – done. relation to SG. Now moving to 2.Revision of Electronic one the profile Patient record A to (EPR) and incorporate all similar info the relevant built into this SG as in Profile A. information. Lilac and Trinity Jan March Vicky 1.To monitor if 1.The use of a 1.Justification March 2014 (GUM) 2014 2014 Cotter safeguarding specific SG Performa for on-going documentation SG information was used within the used of the (adolescent children’s captured in records, increased specifically documentation) team. patient records, the consideration for designed specifically for SG and raised the Performa adolescents. number of moving 2. To be able to notifications forward. monitor the number of notification sent to the team.
Risk factors for safeguarding.
Topic Start Completion Area and lead Aims Key Findings Action Status and Date Date Points Re-audit date Are patients January November Joint 1.To find out if 1.Despite this 1.Repeat December being asked 2015 2015 safeguarding patients were being a audit to look 2015, audit routinely about Children’s/adults/ being asked mandatory at barriers complete. domestic abuse maternity. about routine question for to asking the plans for and sexual In maternity and enquiry. areas like question. further re- violence? A&E attendance. maternity, 2.Re-audit audit are evidence was to look at currently found that this compliance under review did not happen by the new district wide VAWG manager.
Late Bookers for Sep Aug 2013 Midwifery 1. To study Presented to Michelle Presented to antenatal care 2012 Karen Bentley associated links Trust Steering Khan Trust Steering Named Nurse between late Group manager for Group and Safeguarding bookers in Noticed VAWAG for Midwifery children. pregnancy and prevalence of health to re- safeguarding ‘toxic trio’ audit. concerns, amongst late especially bookers, alcohol abuse, highlighting need domestic for caution violence and mental health issues Page 2342.To study 78
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social care involvement in women who book late
Medium CSE July Karen Bentley 1 to review all July 2016 all cases being 2016 attendance to data has been flagged A&E of children collated and who have been currently id is risk assessed waiting for by the CSE HUB analysis. as being at medium risk of CSE to review safeguarding assessment and information and communication to identify if had they been flagged additional practice would have taken place. Lilac clinic DNA March July 2016 Jemma 1.To follow the 1 inconsistent Audit report and 2016 Tesseyman management management of finalised mid safeguarding of under 18s children who July 2016, who DNA to DNA for TOP at finding to now Lilac clinic Lilac clinic. be feedback 2.To ensure a to women’s standardised services approach is developed if not in place. High risk CSE Nov Monthly - Safeguarding 1.On-going 1.On-going flagging 2015 ongoing children team audit of assurance procedures. flagging of all provision. children who 2.Identification have been of training needs. notified of being at high risk of child exploitation on a monthly basis. 2.Ensure that staff are recognising the flag and notifying the safeguarding children’s team, to ensure all relevant safeguarding concerns have been Pagecommunicated. 235 79
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Multiagency audit
Topic Start Completion Area Aims Key Findings Action Status and Date Date and Points re-audit lead date Multi-agency June June 2016 Karen 1.To review NAHI Multiagency General LSCB joint challenge panel 2016 Bentley that have been action plans are themes action audit re Non presented to the currently being were: plans Accidental Head SCR sub and not produced. Back to currently Injury (Health met the criteria, basics. being Safeguarding to review if any Toxic trio. developed Children joint health Bruising in a July 2016 Group/BSCB) lessons learnt can non-mobile be established. child. 2.To review Professional children who had reassurance. received Professional significant injuries challenge. whilst being Judgements subject to a child and protection plan. professional curiosity. Multiagency March Final write Helen 1.To look at which Recommendations 1.Meeting Currently health audit of 2015 up due sept Jepps professionals are currently planned for waiting for hospital DNAs 15 were informed being produced by January 2016 people to about non- Dr Jepps as of to discuss be attendance. December 2015 DNA allocated to 2.To determine if management complete the appropriate with the the work. health elective However, professionals access new received letters re treatment Standard a child’s DNA. group. operating 3.To establish if Procedure safeguarding created and concerns became ratified for apparent for a within period of time Trust, following the regarding non-attendance paediatric at hospital. DNAs. 4.To make recommendations to health partners regarding children who do not attend for their medical appointments. Audit of practice February August Ruth Study the number 1.Wide variation Information Complete in sexual assault 2014 2014 Skelton of medicals at in quality of forwarded as August medicals in the different sites, medicals part of the 2014. Yorkshire who referred, 2.Half of medicals regional region. whether FME done out of hours SARC present, findings 3.Other types of planning. and management. abuse picked up Page 236 80
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New development audits
Topic Start Completion Area Aims Key Findings Action Points Status and Date Date and re-audit date lead
Integrated July Karen To capture the KB meeting Assessment 2016 Bentley number and with senior Team: Quality quality of social care of children’s referrals to manager July social care children social 2016 to referrals. care from BTHFT review referrals and plan the audit work.
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Appendix 3
BSCB Membership
Independent Chair
Vice Chair and Director of Collaboration, Airedale, Wharfedale and Craven, Bradford City and Bradford Districts CCG
Strategic Director, Children’s Services, City of Bradford MDC
Interim Chief Nurse, Bradford Teaching Hospitals NHS Foundation Trust Deputy Director, Education, Employment and Skills, Children’s Services, City of Bradford MDC NHS England
Public Health Consultant, City of Bradford MDC Police Superintendent West Yorkshire Police Deputy Chief Executive / Director of Nursing, Bradford District Care NHS Foundation Trust Deputy Director of Nursing, Children’s and Specialist Services, Bradford District Care NHS Foundation Trust
Children’s Service Manager Banardo’s representing Young Lives Bradford,
NSPCC Service Manager Leeds and Bradford Page 238 82
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Assistant Director, Performance, Commissioning & Partnerships, City of Bradford MDC
Director of Nursing, Airedale NHS Foundation Trust Service Manager, Bradford & District Youth Offending Team Head of West Yorkshire National Probation Trust (Bradford & Calderdale)
Head of Bradford and Calderdale Probation, The West Yorkshire Community Rehabilitation Co. Ltd Lay Member
Lay Member
CAFCASS
Head Teacher, Crossley Hall Primary School Head Teacher, One in a Million Secondary School, Head Teacher, Horton Grange Primary School Head Teacher, Oastlers School Chair of Community Advisory Group Muslim Women’s Council Head Teacher, Bradford Academy Yorkshire Ambulance Service
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Appendix 4
ATTENDANCE OF REPRESENTATIVES AT BSCB MAIN BOARD DURING 2015-2016 1st April 2015-31st March 2016
Number of Number of Apologies % of AGENCY Meetings meetings attended Provided Attendance Invited to attend
BSCB Independent Chair: JJ / DN 6 6 N/A 100% Adult Services: Advisory Board Manager: Paul Hill 6 6 N/A 100% Advisory Designated Doc’s CCGs – KW / RSk 6 6 N/A 100% Advisory Designated Nurse: STh 6 5 1 83% Advisory Legal – MM 6 4 2 67% Airedale NHS Trust: RD 6 4 1 67% BDC FT: CW 6 6 - 100% BDMC (Public Health): SB 6 3 2 50% BTH FT: SS / JR / KB 6 3 2 50% CAFCASS 6 5 1 83% CCGs – NO’N 6 5 1 83% Children’s LA DCS: MJ 6 4 2 83% Children’s LA CSC – GM 4 4 100% Children’s LA Education: LM /JK 6 5 100% Community Rehabilitation Co: NH 6 6 1 100% Lay Members x 2 6 6 2 100% Lead Elected Member 6 1 3 NHS England: EC 6 2 1 NSPCC: SP 6 6 N/A 100% Police: VF 6 6 1 83% Probation 6 4 1 84% Prospects: JC 6 6 N/A 100% School Head: Primary – CS / MT 6 3 2 50% School Head: Secondary – JS/ GD 6 6 N/A 100% VCS: DB 6 6 N/A 100% Youth Offending Team - CJ 6 6 N/A 100%
Notes Adult Services – no representation Gani Martins – attending the Main Board as of September 2015. Where the number of attendances and apologies does not add up to six, there was no attendance or apology for thatPage particular 240 agency on one or more occasions. 84
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Appendix 5
Bradford Safeguarding Children Board Child Death Overview Panel
Annual Report
April 2015 – March 2016
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CONTENTS
1 Introduction and Key findings
2 Background
3 CDOP process
3.1 Membership of the Bradford CDOP
3.2 Notification of Death
3.3 Serious Case Reviews
3.4 Sudden Unexpected Death in Childhood (SUDIC)
4 Population Demographics
5 Process report, 2008/09 – 2015/16
6 Analysis of child deaths reviewed by CDOP in 2015/16
6.1 Demographics, 2015/16
6.2 Category of death classification, 2015/16
6.3 Modifiability classification, 2015/16
6.4 Issues highlighted, 2015/16 reviews
6.5 Recommendations, 2015/16
7 Analysis of child deaths reviewed by CDOP, 2008/09 – 2015/16
7.1 Demographics, 2008/09 – 2015/16
7.2 Category of death classification, 2008/09 – 2015/16
7.3 Expected/unexpected deaths, 2008/09 – 2015/16
7.4 Preventability/modifiability classification, 2008/09-2015/16
7.5 Recommendations summary, 2008/09-2015/16
7.6 Risk factors
8 Comparison to Infant and Child Mortality Rates
8.1 Infant Mortality Rates (under 1 year)
8.2 Characteristics of infant deaths reviewed by CDOP, 2008/09-2015/16
8.3 Child Mortality Rates (1-17 years)
8.4 Characteristics of child deaths reviewed by CDOP, 2008/09-2015/16 Page 242 86
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9 Actions to reduce infant and child mortality
10 Conclusion
10.1 Specific recommendations
10.2 General recommendations
References
Appendix 1 (CDOP): CDOP Terms of Reference
Appendix 2 (CDOP): Preventable and Modifiable factors definitions and 10 Categories for Cause of Death
Appendix 3 (CDOP): BSCB Board Structure
Appendix 4 (CDOP): Characteristics of deaths reviewed by CDOP
Appendix 5 (CDOP): Infant and child mortality rates
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1. Introduction and Key findings
In April 2008, the Bradford Safeguarding Children Board (BSCB) established the Child Death Overview Panel (CDOP) in response to the statutory requirement set out in Working Together to Safeguard Children2,3,4,5. The aim of the CDOP is to systematically review all child deaths from birth to 17 years 364 days of age in order to improve the understanding of how and why children in Bradford die, identify whether there were modifiable6 factors which may have contributed to each individual death, and use the findings to take action to prevent future such deaths.
During the year April 2015 – March 2016 (2015/16), 61 child deaths were reported to the Bradford child death review team. Bradford CDOP reviewed 79 child deaths during 2015/16; these reviews included 45 deaths that occurred in 2014/15 and 3 deaths that occurred in previous years. This brings the total number of deaths reviewed by Bradford CDOP to 607 since April 2008, out of 647 deaths reported (94%).
The CDOP has a role in the judgement regarding whether there were modifiable factors in relation to the deaths reviewed and makes recommendations and learning points which are communicated to both national and local agencies as appropriate, ensuring an effective inter-agency response to child deaths. The CDOP also has a role in categorising a child’s death into one of the 10 cause of death categories highlighted in Appendix 2.
A total of 8 deaths were considered to have modifiable factors in 2015/16, which was 10% of the total deaths reviewed. These modifiable deaths were in Category 2 (suicide or deliberate self-inflicted harm), Category 5 (acute medical or surgical condition), and Category 10 (sudden unexpected and unexplained death).
Four main recommendations arose from the 8 deaths reviewed in 2015/16 which were identified as having modifiable factors:
Formalise and circulate guidance on gastroenteritis; Discuss actions with specialist drug and alcohol team to reduce the risk of death in vulnerable people in relation to substance misuse; Continue awareness of safe sleeping through multi-professional work and media work and feed into the maternity network – this included an updated e-learning package on safe sleeping and a repeat audit of all deaths due to Sudden Infant Death (SIDS)/Co-sleeping; Work across local organisations to understand the management of asthma in young people with additional complex health needs.
Key themes for the whole period 2008-2016 for potentially modifiable causes of are:
Co-sleeping and SIDS Road traffic collisions7 Specific clinical incidents over a range of causes There have been 4 Serious Case Reviews over this period and a Learning Lessons Review identifying specific areas of neglect
2 Department of Children, Schools and Families (2006). Working Together to Safeguard Children. Available from: http://webarchive.nationalarchives.gov.uk/20130401151715/http://www.education.gov.uk/publications/eOrderingDownload/WT2006%20Working_together.pdf 3 Department of Children, Schools and Families (2010). Working Together to Safeguard Children. Available from: http://webarchive.nationalarchives.gov.uk/20130401151715/https://www.education.gov.uk/publications/eorderingdownload/00305-2010dom-en-v3.pdf
4 Department for Education (2013). Working Together to Safeguard Children. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417669/Archived-
Working_together_to_safeguard_children.pdf
5 Department for Education (2015). Working Together to Safeguard Children. Available from: https://www.gov.uk/government/publications/working-together-to-safeguard-children--2 6 A child death is defined as modifiable if “the Panel have identified one or more factors, in any domain, which may have contributed to the death of the child and which, by means of locally or nationally achievable interventions, could be modified to reduce the risk of future child deaths”. Note: Modifiable death definition changed from April 2010 onwards, whereby the classification was changed from preventable/potentially preventable to modifiable factors. 7 No such cases reviewed in 2015/16 (One child death abroad due to road traffic accidentPage – insufficient 244 information to review) 88
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Less common themes occurring include:
Drownings in bath and death in fires8 Asthma Suicide in teenagers Swine Flu9
Further to the recommendations set out above, the panel records an ‘issues log’. The log includes issues which did not cause the death of the child but were identified as a contributing factor. Identifying potential issues surrounding the child’s death allows follow up action to be taken with organisations or lead clinicians, which in turn can potentially impact on the reduction of future child deaths. In 2015/16, the following issues were highlighted:
Smoking in pregnancy Obesity in pregnancy Diabetes in pregnancy Mental health issues Domestic abuse Consanguinity The importance of offering genetic counselling, where appropriate, to parents and siblings of those affected by genetic conditions and ensuring appropriate referrals to specialist services The importance of rapid, high quality clinical assessment, transfer (if necessary) and management for acutely ill children and young people in a relevant setting including: primary care, secondary care, urgent care centres and ambulance services The importance of post mortems in ascertaining cause of death, which may influence management of future pregnancies Access to timely and appropriate bereavement support Access to chaplaincy services when required for parents/family The importance of flagging the need for early foetal anomaly scans for future pregnancies, where risk is present of congenital abnormality The continued access to high quality, end of life care offered by Martin House Hospice, if children are on Intensive Care Units Children who died abroad – in instances where a child died abroad there has been insufficient information to carry out a review Foetal Magnetic resonance imaging (MRI) for diaphragmatic hernia is good practice Early testing for Guthrie (MCADD)10 where possible The importance of ensuring other diagnoses are kept in mind in categorisation of death, where the child has died due to a head injury
Specific common risk factors noted in the issue log were obesity in pregnancy, smoking in pregnancy and consanguinity; whilst it is not possible to state specifically that these risk factors caused an individual child’s death, national evidence clearly demonstrates the factors all increase the risk of infant death at a population level.
Bradford CDOP will continue to monitor overall causes of death for children, with a focus on potentially modifiable causes, identifying specific recurrent issues and themes as well as conducting an annual CDOP ‘Away Day’, which allows panel members to assemble as a group and examine the key factors of child deaths in more detail.
8 Encouragingly it should be noted that there were no such cases reviewed in 2015/16. 9 The last case of Swine Flu was reviewed in November 2015
10 The neonatal heel prick or Guthrie test is a screening test done on newborns. The blood samples can be used for a variety of metabolic test to detect genetic conditions, including Medium-chain acyl-coenzyme A dehydrogenase deficiency (MCADD) Page 245 89
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Analysis of the reviewed deaths for 0-17 year olds for the full period 2008-2016 reveals that 73% of all the deaths reviewed, were in Category 7 (chromosomal, genetic and congenital anomalies) and Category 8 (perinatal/neonatal). Infants (aged under 1 year old) accounted for 69% of all child deaths. South Asian children are over–represented in the deaths (63%) compared to the demographic profile of the Bradford District. There is a higher proportion of Category 7 deaths in the district, compared to national CDOP data11,12,13,14,15,16 and this analysis is used to inform the focus of key work to reduce death rates in children in the future.
Overall child mortality rates in the Bradford district are higher than national and regional averages, and the Bradford district infant mortality rate remains higher than nationally and regionally. However, there are some encouraging signs of improvement; the three year infant mortality aggregate rate has reduced year on year for the last six years17 especially in deprived populations and the child mortality rates are reducing too (see Figures 3 and 7, Appendix 5 for details).
Chair of the Bradford Safeguarding Children Board
Work is on-going in many groups and networks to reduce the risk factors which contribute to the high childhood mortality rate in the Bradford district; the Every Baby Matters (EBM) steering group for example leads the partnership working to reduce infant mortality rates18.
There are also a number of specific strategies and actions plans such as the Road Safety Plan, and a range of interventions to reduce accident rates in children for the district.
In addition, CDOP has promoted awareness around specific issues, encouraging parents to adopt safe sleeping practices and avoiding co-sleeping with their babies when additional risk factors are present. In previous years, CDOP promoted awareness around not leaving young children unattended in baths. CDOP has also led work to update the e-learning package to promote safe sleeping in infants and will be re-launching this in the Autumn. Sessions around the work of CDOP will feature in the Safeguarding week in October 2016.
CDOP continues to work with partners to raise the profile of the Panel and the understanding as to why children die in Bradford district thus ensuring all partners work towards reducing the risk of death in children in the district for the future.
David Niven Independent Chair of Bradford Safeguarding Children Board
11 Department for Education Statistical Release (2016). SFR23/2016 Tables. Available from:https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2016 12 Department for Education Statistical Release (2015). SFR23/2015 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2015 13 Department for Education Statistical Release( 2014). SFR21/2014 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-march-2014 14 Department for Education Statistical Release (2013). SFR26/2013 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2013 15 Department for Education Statistical Release (2012). OSR14/2012 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-completed-in-england-year-ending-31- march-2012 16 Public Health, City of Bradford Metropolitan District Council (December 2014). Why children die in Bradford District 2008-2014: differences between local and national CDOP profiles. Presentation at the first National Network of Child Death Overview Panels’ Conference on Investigating Child Deaths, Warrington. 17 Source: Office for National Statistics (ONS) 18 Every Baby Matters details Available from: https://www.bradford.gov.uk/health/improvePage-your 246-childs-health/every-baby-matters/ 90
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2. Background
This report details the work of the Child Death Overview Panel (CDOP) during 2015/16. Having been established for eight years Bradford CDOP is able to identify emerging trends and themes in the data, and this enables the panel to make more meaningful recommendations. We now have 4 complete years of reviewed deaths (100%) from 2008/09 to 2011/12, and near complete reviewed deaths (95%) between 2012/13 and 2014/15 (see Figure 2: Child deaths reported to and reviewed by CDOP, Section 5).
CDOP looks for factors contributing to a child’s death that could have been modifiable, and where shared learning could reduce the chances of a recurrence of the circumstances around that death. This in turn would lead to a reduction in child mortality rates in the future. In addition, CDOP identifies and collates key issues in relation to individual child deaths, including risk factors. Whilst it is not possible to state specifically that these risk factors caused an individual child’s death, they are relevant to the child population as a whole.
3. CDOP Process
The remit of CDOP is fully documented in the Terms of Reference in Appendix 1 (CDOP).
3.1 Membership of Bradford CDOP
CDOP is composed of a standing core membership as follows:
Specialist Children’s Services Health – Primary care Education Police Coroner’s Office Hospital Chaplain Public Health Sudden Infant Death in Childhood (SUDIC) paediatricians Health – Acute Trusts Health – Bradford Teaching Hospitals NHS Foundation Trust and Airedale Hospital NHS Foundation Trust Other members as co-opted to specific meetings Also in attendance is the manager of the Bradford Safeguarding Children Board, as an advisor, and the CDOP Manager.
Figure 1: Membership of the Bradford CDOP
Name Role Organisation
Dr Shirley Brierley - Consultant in Public Health City of Bradford Metropolitan Chair District Council (CBMDC)
Louise Clarkson SUDIC/CDOP Manager Bradford Teaching Hospitals NHS Foundation Trust (BTHFT)
Paul Hill Bradford Safeguarding Children Bradford Safeguarding Board Manager Children Board
Dr Eduardo Moya Consultant SUDIC Paediatrician BTHFT
Dr Catriona McKeating Consultant SUDIC Paediatrician BTHFT Page 247 91
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Dr Louise Clarke Clinical Specialty Lead for NHS Bradford City Clinical Children and Young People Commissioning Group (CCG), NHS Bradford Districts CCG and Named Doctor for Safeguarding NHS Airedale, Wharfedale and Children Craven CCG
Jude MacDonald Deputy Designated Nurse for NHS Bradford City CCG, NHS Safeguarding Bradford Districts CCG and NHS Airedale, Wharfedale and Craven CCG
Joanna Fraser Serious Case Review Officer West Yorkshire Police
Malcolm Dyson/ Coroner’s Officer Coroner’s Office
Sam Cariss
Cath Dew Service Manager Specialist Children’s Services, CBMDC
Linda Chavasse Principal Educational Bradford Children’s Services, Psychologist CBMDC
Shaheen Kauser Muslim Chaplain BTHFT
Dr Chakra Vasudevan Consultant Neonatologist BTHFT
Dr Kate Ward Consultant Paediatrician Airedale NHS Foundation Trust
Karen Bentley Named Nurse Safeguarding BTHFT
The Bradford CDOP meets on a monthly basis. Additional members have been co-opted to the panel when relevant, for the cases scheduled to be reviewed. Since the establishment of CDOP in 2008, the panel has consistently strived to increase the number of cases reviewed each month, and additional meetings are held if required to ensure a backlog does not build up. This also allows for modifiable factors and issues to be identified sooner, and changes to practice can be implemented. This year a new database has been set up to allow accurate transfer of information between the CDOP Manager and Public Health to assist with analysis.
3.2 Notification of Death
Any professional who becomes aware of a child death is required to notify the Child Death Manager at the Child Death Review office either by completing a notification form or by telephoning the office. The Coroner’s Office and the Registrar of Births Deaths and Marriages have a statutory responsibility to engage in the child death review process by notifying the Manager of all deaths reported to them. There can be confidence, therefore, that information on all deaths is captured by the Child Death Review Manager.
Each agency involved with children and families has a nominated individual who takes responsibility for coordinating the information required for the review of each death. The data collection forms (Agency Report Forms – Form B)
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Bradford Safeguarding Children Board Annual Report – 2015/2016 are distributed via the administrator and copies of the various forms can be found at the Department for Education on the Gov.uk website19.
3.3 Serious Case Reviews
Local Safeguarding Children Boards (LSCB) commission serious case reviews (SCR) when a child has died or been seriously harmed through abuse or neglect. The purpose of the SCR is to ensure that lessons are learned which help to better protect children in the future.
The CDOP may refer a case to its LSCB Chair, if it considers the criteria for an SCR may be met, and an SCR has not yet been initiated. Any case that is considered under the remit of SCR will not be reviewed by CDOP until the SCR has taken place.
3.4 Sudden Unexpected Death in Childhood (SUDIC)
BSCB funds a full-time Child Death Manager post. The three local CCGs20, also provide funding for a part-time SUDIC (Sudden Unexpected Death in Childhood) Paediatrician post, which became operational in November 2008. Bradford Teaching Hospitals NHS Foundation Trust hosts both the SUDIC and Child Death Manager posts. The SUDIC protocol for Bradford and Airedale has been updated. The rapid response process has been improved, with a multi- disciplinary team discussion surrounding sudden unexpected deaths in children being brought to Accident and Emergency units.
Samples are taken at the earliest opportunity to try to identify a cause of death. With the Coroner’s approval, tests are undertaken to identify metabolic or microbiological cause of death. This is especially important as inherited metabolic diseases are a relatively common cause of death in the Bradford district and these conditions can be identified in early sampling.
4. Population Demographics
Bradford has a significantly higher proportion of children and young people than the UK average. According to the 2011 census, the population of the area served by Bradford Council was 522,45221. A large proportion of the Bradford population are from ethnic minority communities, which comprise nearly one quarter of the population total; around 23% of the population described themselves as Pakistani (20%) or Indian (3%)22. Just under two-thirds (64%) of the population describe themselves as White British.
The birth rate in Bradford District is continuing to grow and the proportion of the population that is children and young people is forecast to rise at a greater rate in Bradford than nationally. Bradford has a young population with one of the highest percentages of young people in England23. The 136,57924 children in Bradford aged 17 and under represent 26% of the Bradford population, which compares with 21% in England as a whole25 In the 2011 census26, 37% of Bradford’s children (under 18 years of age) were South Asian of Pakistani, Indian or Bangladeshi heritage, and 10% were described in other Black and Minority Ethnic group categories and 50%. Across England, these figures were 8% and 14% respectively, and 75% were White British.
19 Child death reviews: forms for reporting child deaths. Available at: https://www.gov.uk/government/publications/child-death-reviews-forms-for-reporting-child-deaths
20 Bradford City CCG, Bradford District CCG and Airedale, Wharfedale and Craven CCG 21 Data taken from the Office for National Statistics 22 Data taken from the Office for National Statistics 23 Data taken from the Office for National Statistics 24 Data taken from the Office for National Statistics 25 Data taken from the Office for National Statistics 26 Data taken from the Office for National Statistics Page 249 93
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5. Process report, 2008/09-2015/16
The following data includes the deaths of children under 18 years of age27, resident in Bradford District who died between April 2008 and March 2016.
Figure 2: Child deaths reported to and reviewed by CDOP, 2008/09-2015/16
Source: Bradford 2008/ 2009/ 2010/ 2011/ 2012/ 2013/ 2014/ 2015/ CDOP notifications 09 10 11 12 13 14 15 16 data and Public Reviewed Health Analysis deaths from 85 108 108 70 67 63 75 31 Team, City of that year Bradford Metropolitan District Reported Council deaths from 85 108 108 70 68 67 80 61 that year
% of deaths 100% 100% 100% 100% 99% 94% 94% 51% reviewed
A total of 607 deaths of the 647 notified deaths (94%) have been reviewed over the eight years between April 2008 and March 2016. This is an improvement on 2011/12 when only 81% of all reported deaths since April 2008 had been reviewed. This is also higher than the last publication of national estimated figures, which indicated 82% of notified deaths had been reviewed between 2009 and 201428. Of the 79 deaths which were reviewed in 2015/16, 31 of the reviewed deaths occurred in 2015/16, 45 deaths occurred in 2014/15, and 3 deaths occurred in previous years. Delays due to inquests, and other investigations outside the control of CDOP, can effect the year in which a death is reviewed. There are 10 categories for cause of death (see Appendix 2).
6. Analysis of child deaths reviewed by CDOP, 2015/16
6.1 Demographics, 2015/16
Of the 79 cases reviewed between April 2015 and March 2016:
50 were of children less than a year old (63%) 29 of children over the age of one (37%)
43 were male (54%) 36 were female (46%)
50 were children of South Asian ethnicity (63%) 23 were children of White British ethnicity (29%) 6 were children of other ethnicities, including Eastern European and Mixed (8%)
6.2 Category of death classification, 2015/16
Of the 79 cases reviewed between April 2015 and March 2016 70% were in Category 7 or Category 8 as below:
27 Up to the 18th birthday and described as 0-17 years 28 Department for Education Statistical Release (2014). SFR21/2014 Tables. AvailablePage from: https://www.gov.uk/government/statistics/child 250 -death-reviews-year-ending-march-2014 94
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40 deaths were categorised as chromosomal, genetic and congenital anomalies (Category 7) (51%) 15 deaths were categorised as perinatal/neonatal events (Category 8) (19%) 24 deaths fell into other categories (30%)
6.3 Modifiability classification, 2015/16 reviews
See Appendix 2 (CDOP) for the definition of modifiable factors and categories of death
Of the 79 cases reviewed between April 2015 and March 2016:
8 deaths were considered to have modifiable factors (10%) The deaths were categorised as suicide or deliberate self-inflicted harm (Category 2), acute medical or surgical condition (Category 5), and sudden unexpected or unexplained death (Category 10).
6.4 Issues highlighted, 2015/16
For individual children there may be issues identified which are not classed as modifiable factors in the child’s death, but are of note and require follow up with organisations or lead clinicians. Any specific issues identified for individuals results in recommendations being produced, whereby CDOP ensures the appropriate action has been taken by the relevant agency e.g. if referral to genetic counselling was confirmed this would be followed up with the relevant clinician. The following issues are identified as risk factors:
Smoking in pregnancy Obesity in pregnancy Diabetes in pregnancy Mental health issues Domestic abuse Consanguinity The importance of offering genetic counselling, where appropriate to parents and siblings of those affected by genetic conditions and ensuring appropriate referrals to specialist services. The importance of rapid, high quality clinical assessment, transfer (if necessary) and management for acutely ill children and young people in relevant setting including: primary care, secondary care, urgent care centres and ambulance services. The importance of post mortems in ascertaining cause of death, which may influence management of future pregnancies. Access to timely and appropriate bereavement support Access to chaplaincy services when required for parents/family The importance of flagging the need for early foetal anomaly scans for future pregnancies, where risk is present of congenital abnormality. The continued access to high quality end of life care offered by Martin House Hospice, if children are on Intensive Care Units Children who died abroad – in instances where a child died abroad there has been insufficient information to carry out a review Foetal Magnetic resonance imaging (MRI) for diaphragmatic hernia is good practice Early testing for Guthrie (MCADD) where possible The importance of ensuring other diagnoses are kept in mind in categorisation of death, where the child has died due to a head injury.
6.5 Recommendations, 2015/16
Recommendations identified in the 8 deaths with modifiable factors from 2015/ 2016 covered the following areas:
Formalise and circulate guidance on gastroenteritis; Discuss actions with specialist drug and alcohol team to reduce the risk of death in vulnerable people in relation to substance misuse; Page 251 95
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Continue awareness of safe sleeping through multi-professional work and media work and feed into the maternity network – this included an updated e-learning package on safe sleeping and a repeat audit of all deaths due to Sudden Infant Death (SIDS)/Co-sleeping; Work across local organisations to understand the management of asthma in young people with additional complex health needs.
The summary Action Plan for Modifiable deaths is updated and audited regularly to ensure the actions recommended are completed in a timely manner by relevant organisations.
General recommendations arising from issues identified from the CDOP meetings in 2015/16 included:
1. To make the ‘Away Day’ held in May 2016 an annual event. At the 2015/16 event, the panel considered analysis, and trends for deaths reviewed in 2015/16 and the total period 2008–2016. The event also included sessions on genetic inheritance led by the Regional Genetic Service and a presentation on the recent Born in Bradford infant death research. This event will be repeated in 2017. 2. To continue to monitor key themes for modifiable child deaths to include drowning in baths, co- sleeping and Sudden Infant Death Syndrome (SIDS) road traffic accidents and clinical incidents over the next year and seek assurance organisations have addressed the key areas of concern and monitor any new similar cases arising. 3. To monitor other recurrent, issues, which may not be identified as modifiable factors for an individual child but are relevant at a population level. Examples include smoking and obesity in pregnancy which are linked to increase risk of infant death, and consanguinity which is linked to an increased risk of congenital abnormalities and in some cases infant death. CDOP will continue to seek assurance that organisations and partners are also addressing these key areas of concern.
7. Analysis of child deaths reviewed by CDOP, 2008/09 – 2015/16
This section provides an overview of all reviewed child deaths in the Bradford District from April 2008 until March 2016. The data has been collated from the deaths of children aged under 18 years of age who have been formally reported to and reviewed by the panel over the course of the eight years from April 2008 to March 2016. It must be noted that the analysis only includes deaths reviewed by the CDOP between April 2008 to March 2016; totalling 94% of all child deaths which occurred in this period.
Tables containing a full breakdown by different characteristics can be found in Appendix 4.
7.1 Demographics, 2008/09 – 2015/16
Age
Of the 607 cases reviewed between April 2008 and March 2016, 69% were infants (aged under 1 year old) and 31% were children (aged 1-17 years).
Figure 3: Age distribution for Page 252 96
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reviewed infant deaths (<1 year old), 2008/09-2015/16
Source: Bradford CDOP review data
There were 419 cases aged under 1 year old reviewed between April 2008 and March 2016. Figure 3 shows that the majority of reviewed infant deaths (62%) were aged under 28 days old. A further 20% of the infant deaths were aged 28 days to 3 months old.
There were 188 cases aged 1-17 years reviewed between April 2008 and March 2016. Figure 4 shows there was more variation in the ages of the reviewed child deaths than there was in the infant deaths. 55% of the reviewed child deaths were aged 1-4 years old, 19% of the reviewed child deaths were aged 14-17 years old.
Figure 4: Age distribution for reviewed child deaths (1-17 years old), 2008/09-2015/16
Source: Bradford CDOP review data
Sex
Of the 607 cases reviewed between April 2008 and March 2016, 54% were male and 46% were female.
Ethnicity
Of the 607 cases reviewed between April 2008 and March 2016:
380 deaths were South Asian (63%) 184 deaths were White British or White Other (30%) 17 deaths were Eastern European (3%) 16 deaths were mixed ethnicities (3%) 10 deaths were other ethnicities (2%) including African, East Asian and Other
NB: Percentages may contain rounding errors Page 253 97
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South Asian children are over–represented in the reviewed deaths compared to the comparable population in Bradford for all children under 18 years of age.
7.2 Category of death classification, 2008/09 – 2015/16
There have been 607 cases reviewed between April 2008 and March 2016 where it was possible to classify the cause of death into one of the ten categories used nationally (Appendix 2). The most common causes of death out of all the reviewed cases (children aged under 18 years old) were chromosomal, genetic and congenital anomalies (Category 7) and perinatal/neonatal events (Category 8); these two categories of cause of death accounted for 73% of all reviewed deaths 2008-2016.
Figure 5: Category of death classification for reviewed deaths by age group, 2008/09-2015/16
Source: Bradford CDOP review data
Figure 5 shows that the most common causes of death for infants (under 1 year old) were Category 7 (chromosomal, genetic and congenital anomalies) and Category 8 (perinatal/neonatal event) which accounted for 42% and 31% of the reviewed infant deaths respectively. Out of all the child deaths attributed to Category 8 (perinatal/neonatal event), 98% of the reviewed deaths were infants (under 1 year old).
For children (aged 1-17 years old), the most common cause of death (41% of reviewed deaths) was Category 7 (chromosomal, genetic and congenital anomalies). After this, the causes of death for children were split over more categories than for infants and included Category 3 (trauma and other factors), Category 4 (malignancy), Category 5 (acute medical or surgical condition), Category 6 (chronic medical condition) and Category 9 (infection).
When comparing reviewed deaths for 0-17 year olds in the district to National CDOP data29,30,31,32,33,34, pooling data between 2010 to 2016 reveals that nationally 24%, of all the deaths reviewed, were in Category 7 (chromosomal,
29 Department for Education Statistical Release (2016). SFR23/2016 Tables. Available from:https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2016 30 Department for Education Statistical Release (2015). SFR23/2015 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2015
31 Department for Education Statistical Release( 2014). SFR21/2014 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-march-2014 32 Department for Education Statistical Release (2013). SFR26/2013 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2013 33 Department for Education Statistical Release (2012). OSR14/2012 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-completed-in-england-year-ending-31- march-2012
34 Public Health, City of Bradford Metropolitan District Council (December 2014,). Why children die in Bradford District 2008-2014: differences between local and national CDOP profiles. Presentation at the first National Network of Child Death Overview Panels’ Conference on Investigating Child Deaths, Warrington. Page 254 98
Bradford Safeguarding Children Board Annual Report – 2015/2016 genetic and congenital anomalies). The proportion of deaths attributable to Category 7 deaths in the District is significantly higher (43%) than the national figure (Figure 7, Appendix 4).
7.3 Expected/unexpected deaths, 2008/09 – 2015/16
Of the 607 cases reviewed between April 2008 and March 2016:
448 deaths were expected (74%) 154 deaths were unexpected (25%) 5 deaths were unknown (1%)
Figure 10 shows the most common cause of unexpected deaths for infant (under 1 year old) were Category 7 (chromosomal, genetic and congenital anomalies), Category 8 (perinatal/neonatal event), and Category 10 (sudden unexpected deaths), which accounted for 27%, 24%, and 20% of the reviewed infant deaths, respectively.
For children (aged 1-17 years old), the most common cause of unexpected deaths were Category 3 (trauma and other factors), Category 9 (infection), and Category 7 (chromosomal, genetic and congenital anomalies), which accounted for 23%, 19% and 17% of reviewed child deaths, respectively.
7.4 Preventability/modifiability classification, 2008/09 – 2015/16
Of the 607 cases reviewed between April 2008 and March 2016:
62 cases were deemed to have been preventable, or to have had modifiable factors (10%) 541 cases were deemed to have been not preventable or to have had modifiable factors (89%) 4 cases were deemed to have insufficient information to make classification (1%); this is where the child has died abroad
The classification was changed from preventable/potentially preventable to modifiable factors in April 2010 (see Appendix 2).
For the 62 cases deemed to have been preventable or to have had modifiable factors, the causes of death related to:
deliberately inflicted injury, abuse or neglect (Category 1) suicide or deliberate self-inflicted harm (Category 2) trauma and other external factors (Category 3) malignancy (Category 4) acute medical or surgical condition (Category 5) chromosomal, genetic and congenital anomalies (Category 7) perinatal/neonatal event (Category 8) infection (Category 9) sudden unexpected or unexplained death (Category 10)
Analysis of themes and trends over time for 2008-2016 for modifiable deaths showed the following recurrent causes:
Co-sleeping and SIDS Road traffic collisions35 Specific clinical incidents over a range of causes 4 Serious Case Reviews over this period
Less common themes include:
35 No such cases reviewed in 2015/16 (One child death abroad in 2015/16, due to road trafficPage accident – 255insufficient information to review) 99
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Drownings in bath and death in Fires36 Asthma Suicide in teenagers Swine Flu37
All the above have specific recommendations made and these have been monitored and audited by CDOP to seek assurance all actions have been completed.
7.5 Recommendations summary, 2008/09-2015/16
Examples of key recommended actions from the panel over the 7 year period for modifiable deaths have included the following:
o Implementation of specific Recommendations from Serious Case Reviews and Serious Clinical Incidents o Increased clinical awareness of management of specific medical conditions o CDOP Alerts to raise public awareness of the risks of leaving children bathing alone/supervised by another young child o Road Safety Actions to reduce further deaths from road traffic collisions o Swine flu vaccination programme in Special schools o CDOP Alerts re Safe sleeping practice and update on current E learning package for Safe sleeping for babies
7.6 Risk factors
Data is collected by the CDOP on a range of risk factors that potentially influence child deaths. These include, for example, smoking, alcohol intake, obesity and domestic violence. Some of these risk factors have a clear link with poor outcomes; for example, smoking in pregnancy is known to be associated with increased low birth weight rates38.
Further classifications have been agreed by the CDOP to describe precisely the more common causes of death in Bradford. To help investigate perinatal/neonatal events (Category 8), extreme prematurity is recorded.
For chromosomal, genetic or congenital anomalies (Category 7), since September 2011, there has been sub classification of the genetic conditions to indicate whether the deaths were due to an autosomal recessive condition, autosomal dominant condition, a sporadic genetic cause or if this information was not known. Sporadic causes are not predictable and can occur across all communities. In communities where consanguinity (marriage between cousins) is more common – such as in the Pakistani community in Bradford district - it is more likely that genes that are rare within the general population are carried by both parents. Therefore, a child born from a consanguineous relationship is at greater risk of inheriting genes which could cause congenital anomalies or chronic diseases; in some cases the conditions are fatal in childhood.
A paper published in the Lancet 2013, based on the Born in Bradford cohort, confirmed an increased risk of congenital anomalies within the South Asian population in consanguineous marriages from 3% to 6% and also increased risk of congenital anomalies for older White women39.
36 Encouragingly it should be noted that there were no such cases reviewed in 2015/16. 37 The last case of Swine Flu was reviewed in November 2015 38 National institute for Health and Care Excellence (NICE) (2010). Quitting smoking in pregnancy and following childbirth. Available from: http://www.nice.org.uk/guidance/ph26
39 Sheridan, E. et al (2013). Risk factors for congenital anomalies in a multiethnic cohort: an analysis of the Born in Bradford study. The Lancet. Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61132-0/abstract Page 256 100
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In summary, specific common risk factors noted in the issue log were obesity in pregnancy, smoking in pregnancy and consanguinity; whilst it is not possible to state specifically that these risk factors caused an individual child’s death in many cases, national evidence clearly demonstrates they all increase the risk of infant death at a population level.
The CDOP panel will continue to monitor the data and information for both deaths of infants and children up to the age of 18 years and as more data becomes available over time these will inform future recommendations. The information collated at each CDOP meeting also informs the CDOP issues log. These issues lead to more general recommendations by CDOP and emerging themes worthy of being highlighted are identified and monitored. Findings from CDOP are also shared with key groups and leads such as the Every Baby Matters steering group, Road Safety Team and Maternity Network and are also shared as part of Safeguarding Week.
8. Comparison of Infant and Child Mortality Rates
There was a higher proportion of deaths due to chromosomal, genetic or congenital anomalies (Category 7) deaths in Bradford compared to national CDOP data – this difference in the profile of category of death could in part explain some of the differences between local and national infant and child mortality rates. The proportion of perinatal/neonatal events (category 8) for 2010/11-2012/13 was similar to the national CDOP data40,41,42,43,44,45 but, overall, neonatal mortality rates are higher than regional and national averages (Figure 1, Appendix 5). This analysis indicates CDOP’s focus to reduce child deaths should cover all cause of death for children but a significant focus should be on preventing deaths in Category 7 and 8.
8.1 Infant Mortality Rates (under 1 year)
Infant mortality is defined as the number of deaths in the first year of life per 1,000 live births. The latest infant mortality rate for Bradford District (5.8 per 1,000 live births) remains above the England average (4.0 per 1,000 live births) for the period 2012-2014. The rate has decreased each year for the last six years. Although the Bradford infant mortality rate remains high compared to regional and national rates, the gap is reducing. See Figures 1 and 2, Appendix 5 for more information.
The infant mortality rate in the most deprived quintile in Bradford has reduced much faster over time than the Bradford, Yorkshire and The Humber and England rates (Figure 3, Appendix 5).
8.2 Characteristics of infant deaths reviewed by CDOP, 2008/09-2015/16
The number of infant deaths being reported each year to the CDOP has decreased from a peak of 77 deaths in 2009/10 to 39 deaths in 2015/16 (Figure 4, Appendix 5).
Using previous years’ CDOP data - for which almost all infant deaths have been reviewed (99%) - a comparison can be made between 2009/10-2011/12 and 2012/13-2014/15 to look at differences over time.
There were 54 fewer infant deaths in the three year period 2012/13-2014/15 compared to 2009/10-2011/12. There were fewer reviewed deaths between the two time periods attributed to all of the ten categories of death, more
40 Department for Education Statistical Release (2016). SFR23/2016 Tables. Available from:https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2016 41 Department for Education Statistical Release (2015). SFR23/2015 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2015
42 Department for Education Statistical Release( 2014). SFR21/2014 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-march-2014 43 Department for Education Statistical Release (2013). SFR26/2013 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2013 44 Department for Education Statistical Release (2012). OSR14/2012 Tables. Available from: https://www.gov.uk/government/statistics/child-death-reviews-completed-in-england-year-ending-31- march-2012
45 Public Health, City of Bradford Metropolitan District Council (December 2014,). Why children die in Bradford District 2008-2014: differences between local and national CDOP profiles. Presentation at the first National Network of Child Death Overview Panels’ Conference on Investigating Child Deaths, Warrington. Page 257 101
Bradford Safeguarding Children Board Annual Report – 2015/2016 noticeably reducing in Category 7 (chromosomal, genetic or congenital anomalies), Category 8 (perinatal/neonatal events) and category 9 (infection) (Figure 5, Appendix 5).
The proportion of deaths within each of these categories has changed between the two time periods, there was a greater proportion of deaths due to chromosomal, genetic or congenital anomalies (Category 7) and a smaller proportion of deaths due to both perinatal/neonatal events (Category 8) and infection (Category 9) (Figure 6, Appendix 5).
8.3 Child Mortality Rates (1-17 years)
Child mortality is defined as the number of deaths for children aged 1-17 years old per 100,000 population. The child mortality rate for Bradford has been consistently higher than the national rate; in 2012-14, the child mortality rate for Bradford District was 17.3 per 100,000 compared to 12.0 per 100,000 for England. The gap between the local and national rates is narrowing over time (Figures 1 and 7, Appendix 5).
8.4 Characteristics of child deaths reviewed by CDOP, 2008/09-2015/16
The number of child deaths (aged 1-17 years old) notified to the CDOP has fluctuated over time and there has been year on year variation with no discernible trend. There have been much smaller numbers compared to the number of infant deaths which makes it difficult to draw comparisons to the child mortality rate.
Using previous years’ CDOP data - for which almost all child deaths have been reviewed (95%) - a comparison can be made between 2009/10-2011/12 and 2012/13-2014/15 to look at differences over time.
There were 27 fewer child deaths in 2012/13-2014/15 compared to 2009/10-2011/12.
The number of deaths in each of the ten categories varied between the two time points, and there was variation as to whether there was a greater or lesser number of deaths in each category (Figure 8, Appendix 5).
The proportion of deaths within each of the categories has also changed between the two time periods, and shows variation as to whether there was a greater or lesser proportion of deaths in each category. Notably however, there was a greater proportion of deaths due to chromosomal, genetic or congenital anomalies (Category 7) and a smaller proportion of deaths due to chronic medical condition (Category 6) between the two time periods (Figure 9, Appendix 5).
9. Actions to reduce infant and child mortality
There are a range of strategies across the district to reduce infant and child deaths.
The very high rate of infant mortality in 2000-2002 initiated an independent Infant Mortality Commission in Bradford District in 2004-2006. The Commission investigated why some babies born in the District die during their first year of life and a key report was produced which demonstrated that infant mortality is linked with poverty and deprivation as well as other risk factors such as smoking, alcohol and substance misuse, young motherhood and consanguinity40. Young motherhood, smoking, alcohol and substance misuse are significantly higher risk factors within the White population of the District and consanguinity, which is linked to an increased risk of congenital anomalies, is common in the South Asian community – around 60% of marriages within the Pakistani population in Bradford District are consanguineous46,47,48.
46 Sheridan, E. et al (2013). Risk factors for congenital anomalies in a multiethnic cohort: an analysis of the Born in Bradford study. The Lancet. Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61132-0/abstract Page 258 102
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The work of the Commission and further in depth analysis of data on infant deaths continues as part of the Every Baby Matters Steering Group agenda; the current Strategy and Action Plan focuses on the 10 recommendations within the original report to continue to reduce infant mortality rates41,49:
Recommendation 1a – To reduce poverty in families in Bradford Recommendation 1b – To reduce unemployment in families in Bradford Recommendation 2 – To improve the availability of good quality and affordable housing for families Recommendation 3a – To improve the health and nutrition of women, before and during pregnancy, and their babies Recommendation 3b – To increase breastfeeding rates Recommendation 4 – To ensure equal access to all aspects of pre-conception, maternal and infant health care Recommendation 5 – To improve social and emotional support for vulnerable parents Recommendation 6a – To reduce smoking rates in the district with a focus on women during pregnancy Recommendation 6b – To reduce high levels of alcohol and/or non-prescribed drugs in pregnancy Recommendation 7 – To increase community understanding of genetically inherited congenital anomalies Recommendation 8 – To ensure these recommendations are shared widely Recommendation 9 – To develop further data collection and monitoring procedures Recommendation 10 – To conduct future research to understand causes of death
To reduce the risks of child death, some of the strategies and action plans in place across the District include the following:
Accident Prevention work across the district Road Safety Plan Bradford Children Safeguarding Board – Serious Case Reviews and Learning Lessons Reviews Implementation of Recommendations from Serious Clinical Incidents Alerts re risks of drowning in baths Increased awareness amongst clinicians regarding management of specific clinical conditions
10. Conclusion
10.1 Specific Recommendations
The focus of this report is on the recommendations for 2015/16. These were identified in the 8 deaths with modifiable factors reviewed in 2015/ 2016 which covered the following areas:
Specific actions with Out of Hours provider regarding use of gastro-enteritis pathway and also highlighted with all clinicians across the district Risk of suicide with drugs highlighted with Substance Misuse and Alcohol team working with young people and fed into district wide work on Suicide Prevention
47 Bradford District Infant Mortality Commission (2006). Summary report. Available from: https://www.bradford.gov.uk/media/1881/infant_mortality_report.pdf
48 Born in Bradford (BiB) (2012). The Born in Bradford (BiB) cohort study: Summary statistics by ethnic group. Available from: http://www.borninbradford.nhs.uk/uploads/downloads/research_and_scientific/cohort_information/Baseline%20Summary%20Factsheet%20BiB.pdf
49 Every Baby Matters Strategy and Action Plan Bradford District. Available from: https://www.bradford.gov.uk/health/improvePage 259 -your-childs-health/every-baby-matters/ 103
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Alerts with regard to safe sleeping for babies based on latest evidence sent by CDOP to key organisations and staff in the district , update on E learning package on safe sleeping is underway and a repeat audit of all deaths due to SIDS/Co-sleeping is due for completion in Sept 2016 Recommendations made with regard to management of asthma in young people with additional complex health needs and shared with key organisations
The summary Action Plan for Modifiable deaths is updated and regularly audited to ensure the actions recommended are completed in a timely manner by relevant organisations. In addition, CDOP provides a valuable opportunity to review all causes of death in detail and hence every year the updated analysis for 2008-2016 is also reviewed. This information is fed into key networks, groups and safeguarding week to inform plans to reduce the risk of child deaths in the future.
General Recommendations for 2016/17
CDOP’s ‘Away Day’ in May 2017 will consider all key analysis, trends for deaths for 2016/17 and the total period 2008-2017 CDOP will review its criteria for modifiability of deaths in discussion with partners in the national CDOP network as the percentage of modifiable deaths in Bradford and District is well below the national average. CDOP will continue to monitor key themes for modifiable child deaths to include co-sleeping and Sudden Infant Death Syndrome (SIDS), road traffic accidents and clinical incidents over the next year, and will seek assurance organisations have addressed the key areas of concern and monitor any new similar cases arising. CDOP will continue to identify and monitor recurrent issues, which may not be considered ‘modifiable’ factors for an individual child, but are relevant at a population level. Examples include smoking and obesity in pregnancy which are linked to an increased risk of infant death, and consanguinity, which is linked to an increased risk of congenital abnormalities and in some cases death in childhood. CDOP will continue to seek assurance from organisations and partners that they are addressing these key areas of concern.
Report Authors:
Shirley Brierley - Chair of Bradford CDOP, Consultant in Public Health
Louise Clarkson - CDOP Manager
Saira Sharif - Public Health Information Analyst
September 2016
Appendix 1 (CDOP): Terms of Reference
1 Purpose
The purpose of the Child Death Overview Panel is to: a) Collect and analyse information about each child’s death with a view to identifying:
i) any case giving rise to the need for a seriousPage case 260 review 104
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ii) any matters of concern affecting the safety and welfare of children in the area of the authority; and
iii) any wider public health or safety concerns arising from a particular death or from a pattern of deaths in that area b) Put in place procedures for ensuring that there is a coordinated response by professionals to an unexpected death.
The Panel will review deaths of all children aged 0-17 (excluding stillbirths) normally resident in the Local Authority area of the BSCB. Where the Panel is made aware of the death of a child in their area who would normally be resident in another Local Authority area, or vice versa the Child Death Review Administrator will liaise with his/her opposite number in the other Local Authority area to ensure both Panels are notified of the death and to determine which Panel is best placed to carry out a review of that child’s death. Where possible it is advised that the panel in the child’s area of residence takes responsibility for the review although it is recognised that circumstances will dictate the most appropriate outcome.
2 Functions
The Child Death Overview Panel:
Meet regularly to complete a multi-agency evaluation of all child deaths in their area;
Where appropriate undertake a detailed and in-depth evaluation into specific cases, including all unexpected deaths, assessing all relevant social, environmental, health and cultural aspects, or systemic or structural factors of the death, along with the appropriateness of the professionals’ responses to the death and involvement before the death, in order to complete a thorough consideration of whether and how such deaths might be prevented in future; Collect and collate information using the agreed templates and where relevant seek further information from professionals and family members; Identify local lessons and issues of concern, requiring effective inter-agency working; Identify and report any local Public Health issues and consider, with the Director of Public Health and other provider services how best to address these and their implications for both the provision of services and for training; Identify and advocate for needed changes in legislation, policy and practices, or public awareness, to promote child health and safety and to prevent child deaths; Ensure concerns of a criminal or child protection nature are shared with the police, children’s social care and the coroner; Ensure any case identified as meeting criteria for a Serious Case Review are referred to the chair of the BSCB; Provide information to professionals involved with families so that this can be passed on in a sensitive and timely manner; Implement, review and monitor the local procedures for rapid response arrangements in line with Working Together; Monitor the quality of information, support and assessment services to families of children who have died; Co-operate with any regional and national initiatives in order to identify lessons on the prevention of child deaths.
3 Accountability
The Child Death Overview Panel will be responsible, through its chair, to the chair of the BSCB. The Panel will provide to the BSCB and all constituent agencies, an annual report (in which all information should be aggregated and anonymised) which shall be a public document. In addition, the Panel will report to the BSCB any matters of concern arising from the course of its work as set out above.
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The BSCB will take responsibility for disseminating the lessons to be learned to all relevant organisations; ensuring that relevant findings inform the Children and Young People’s Plan; and acting on any recommendations to improve policy, professional practice and inter-agency working to safeguard and promote the welfare of children.
The BSCB will supply data regularly on every child death, as required by the Department for Education, to bodies commissioned by the Department to undertake and publish nationally comparable, anonymised analyses of these deaths.
Appendix 2 (CDOP): Definition of Preventable and Modifiable Deaths and 10 Categories for Cause of Death
Definitions Used as cited in Statistical Release for Child Death Reviews: year ending March 2011 Dept for Education July 2011:
1. Preventable/Potentially preventable death: Definition used from April 2008 to March 2010
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Preventable - A preventable child death is defined as events, actions or omissions contributing to the death of a child or a sub-standard care of a child who died, and which, by means of national or locally achievable interventions, can be modified.
Potentially preventable - A potentially preventable death with same definition as above.
2. Modifiable death: Definition changed from April 2010 onwards
A modifiable death is defined as “The Panel have identified one or more factors, in any domain, which may have contributed to the death of the child and which, by means of locally or nationally achievable interventions, could be modified to reduce the risk of future child deaths”.
10 Categories for Cause of Death
Category 1 – Deliberately inflicted injury, abuse or neglect: this includes suffocation, shaking injury, knifing, shooting, poisoning and other means of probable or definite homicide; also deaths from war, terrorism or other mass violence; includes sever neglect leading to death Category 2 – Suicide or deliberate self-inflicted harm: this includes hanging, shooting, self-poisoning with paracetamol, death by self-asphyxia, from solvent inhalation, alcohol or drug abuse, or other form of self-harm. It will usually apply to adolescents rather than younger people. Category 3 – Trauma and other external factors: this includes isolated head injury, other or multiple trauma, burn injury, drowning, unintentional self-poisoning in pre-school children, anaphylaxis and other extrinsic factors. Excludes deliberately inflicted injury, abuse or neglect (Category 1). Category 4 – Malignancy; solid tumours, leukaemias and lymphomas and malignant proliferative conditions such as histiocytosis, even if the final event leading to death was infection, haemorrhage etc. Category 5 – Acute medical or surgical condition; for example Kawasaki disease, acute nephritis, intestinal volvulus, diabetic ketoacidosis, acute asthma, intussusception, appendicitis; sudden unexpected deaths with epilepsy. Category 6 – Chronic medical condition; for example, Crohn’s disease, liver disease, immune deficiencies, even if the final event leading to death was infection, haemorrhage etc. Includes cerebral palsy with clear post-perinatal cause. Category 7 – Chromosomal, genetic and congenital anomalies; Trisomies, other chromosomal disorders, single gene defects, neurodegenerative disease, cystic fibrosis and other congenital anomalies including cardiac. Category 8 – Perinatal/neonatal event; Death ultimately related to perinatal events, e.g. sequelae of prematurity, antepartum and intrapartum anoxia, bronchopulmonary dysplasia, post-haemorrhagic hydrocephalus, irrespective of age at death. It includes cerebral pals without evidence of cause, and includes congenital or early-onset bacterial infection (onset in the first postnatal week). Category 9 – Infection; Any primary infection (i.e. not a complication of one of the above categories), arising after the first postnatal week, or after discharge of a preterm baby. This would include septicaemia, pneumonia, meningitis, HIV infection etc. Category 10 – Sudden unexpected death; where the pathological diagnosis is either ‘SIDS’ or ‘unascertained’, at any age. Excludes Sudden unexpected death with epilepsy (Category 5)
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Appendix 3 (CDOP)
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Appendix 4 (CDOP): Characteristics of deaths reviewed by CDOP
Characteristics of the child deaths reviewed between April 2008 and March 2016.
NB: Percentages may contain rounding errors
Age
Figure 1: Age distribution of all reviewed deaths, 2008/09-2015/16
Number Percentage
Under 1 year 419 69%
1-17 years old 188 31%
TOTAL 607 100%
Source: Bradford CDOP review data
Figure 2: Age distribution of all reviewed infant deaths, 2008/09-2015/16
Number Percentage
Under 28 days 260 62%
28 days to 2 months 82 20%
3 months to 1 year 77 18%
TOTAL 419 100%
Source: Bradford CDOP review data
Figure 3: Age distribution of all reviewed child deaths, 2008/09-2015/16
Number Percentage
1-4 years old 104 55%
5-13 years old 49 26%
14-17 years old 35 19%
TOTAL 188 100%
Source: Bradford CDOP review data
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Sex
Figure 4: Sex distribution of all reviewed deaths, 2008/09-2015/16
Number Percentage
Male 326 54%
Female 281 46%
TOTAL 607 100%
Source: Bradford CDOP review data
Ethnicity
Figure 5: Ethnicity distribution of all reviewed deaths, 2008/09-2015/16
Number Percentage
South Asian 380 63%
White British or White Other 184 30%
Eastern European 17 3%
Mixed ethnicities 16 3%
Other ethnicities including 10 1% African, East Asian and Other
TOTAL 607 100%
Source: Bradford CDOP review data
Category of death
Figure 6: Category of death distribution of all reviewed deaths, 2008/09-2015/16
Number Percentage
Category 1 9 1%
Category 2 2 0%
Category 3 30 5%
Category 4 21 3%
Category 5 21 3%
Category 6 23 4%
Category 7 256 42%
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Category 8 188 31%
Category 9 37 6%
Category 10 18 3%
No category 2 0%
TOTAL 607 100%
Source: Bradford CDOP review data
Figure 7: Comparison to national CDOP data: proportion of reviewed deaths by category of death, 2010/11 – 2015/16
Source: National CDOP review data, and Bradford CDOP review data
Modifiability
Figure 8: Modifiability classification of all reviewed deaths, 2008/09-2015/16
Number Percentage
Preventability/potentially 62 10% preventable/modifiable
Not modifiable 541 89%
Inadequate information 4 1%
Proportion of reviewed deaths by category of Bradford National Difference death, 2010/11-2015/16
Deliberately inflicted injury, abuse or Cat 1: 2% 1% 0% neglect
Suicide or deliberately inflicted self- Cat 2: 0% 2% -2% harm
Cat 3: Trauma and other external factors 5% 6% 0%
Cat 4: Malignancy 3% 7% -4%
Cat 5: Acute medical or surgical condition 3% 6% -2%
Cat 6: Chronic medical condition 3% 5% -2%
Chromosomal, genetic and congenital Cat 7: 43% 24% 18% anomalies
Cat 8: Perinatal/neonatal event 31% 35% -4%
Cat 9: Infection 6% 6% 0%
Cat 10: SUDI 3% 8% -5% Page 267 111
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TOTAL 607 100%
Source: Bradford CDOP review data
Expected/unexpected deaths
Figure 9: Expected/unexpected classification of all reviewed deaths, 2008/09-2015/16
Number Percentage
Expected 448 74%
Unexpected 154 25%
Unknown 5 1%
TOTAL 607 100%
Source: Bradford CDOP review data
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Appendix 5 (CDOP): Infant and child mortality rates
Figure 1: Mortality rates, 2012 – 2014
Neonatal (<28 Infant (<1 year) Child (1-17 years) days) mortality mortality rate, per mortality rate, per rate, per 1,000 live 1,000 live births 10,000 population births Bradford 3.8 5.8 17.3 Yorkshire and The 2.8 4.2 13.3 Humber England 2.8 4.0 12.0 Sources: Health & Social Care Information Centre Indicator Portal, and Child Health Profile 2016, ChiMat
Figure 2: Infant Mortality Rates for Bradford District vs England and Yorkshire and The Humber, 2005-07 to 2012- 14
Source: Office for National Statistics (ONS) data
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Figure 3: Infant mortality rates in the most deprived quintiles
Bradford District, Region and England during 2007-09 to 2012-
2014
Yorkshire Bradford’s most Year Bradford and the England deprived quintile Humber
2007-2009 10.6 7.9 5.3 4.6
2008-2010 10.2 7.9 5.2 4.4
2009-2011 9.0 7.5 5.0 4.3
2010-2012 7.8 7.0 4.6 4.1
2011-2013 6.9 5.9 4.5 4.1
2012-2014 6.6 5.8 4.2 4.0
% Change between 2007-2009 and 2012- -39.2% -26.6% -20.4% -13.0% 2014
Source: Public Health Analysis Team City of Bradford Metropolitan
District Council, based on ONS data
Figure 4: Numbers of deaths notified to the CDOP by age category and year of death, 2008/09 to 2015/16
2008/ 2009/ 2010/ 2011/ 2012/ 2013/ 2014/ 2015/ 9 10 11 12 13 14 15 16
Under 1 year 63 77 74 44 45 48 50 39
1-17 year old 22 31 34 26 23 19 30 22
No date of 85 108 108 70 68 67 80 61 death in notification
TOTAL 170 216 216 140 136 134 160 122
Source: Bradford CDOP notifications data
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Figure 5: Numbers of reviewed infant deaths in each category of death, 2009/10-2011/12 compared to 2012/13- 2014/15
Source: Bradford CDOP review data
NB: The deaths with inadequate information to make a category of death classification were removed from the analysis
Figure 6: Proportion of reviewed infant deaths in each category of death, 2009/10-2011/12 compared to 2012/13-2014/15
Source: Bradford CDOP review data
NB: The deaths with inadequate information to make a category of death classification were removed from the analysis
Figure 7: Child mortality rates over time, 2008-10 to 2012-14
Source: Child Health Profiles, ChiMat
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Figure 8: Numbers of reviewed child deaths (1-17 years old) in each category of death, 2009/10-2011/12 compared to 2012/13-2014/15
Source: Bradford CDOP review data
NB: The deaths with inadequate information to make a category of death classification were removed from the analysis
Figure 9: Proportion of reviewed child deaths (aged 1-17 years old) in each category of death, 2008/09-2010/11 compared to 2011/12-2013/14
Source: Bradford CDOP review data
NB: The deaths with inadequate information to make a category of death classification were removed from the analysis
Figure 10: Proportion of expected/unexpected infant deaths in each category of death, 2008-2016
Source: Bradford CDOP review data
NB: The deaths with inadequate information to make a category of death classification were removed from the analysis Page 272 116
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Figure 11: Proportion of expected/unexpected child deaths in each category of death, 2008-2016
Source: Bradford CDOP review data
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This page is intentionally left blank S A F E G U A R D I N G A D U L T S B O A R D
REPORT 2015-16
SAFEGUARDING ADULTS BRADFORD Page 275 Contents Page
Foreword by the Safeguarding Our vision Adults Board Independent Chair 3
Bradford Safeguarding Adults Board 4 ‘Bradford SAB expects that all agencies will work together to Bradford Safeguarding Adults make sure that all those with Reviews (SARs) 7 care and support needs can Bradford Safeguarding Adults live the best lives they can, Board Principles 8 without fear, and safe from Financial arrangements 22 abuse and neglect.’
Appendix 1 – 23 Strategic Plan for 2015-18 Appendix 2 – 25 Members of the Safeguarding Adults Board in 2015-16 Appendix 3 – 27 Examples of Abuse Appendix 4 – 30 Bradford Safeguarding Adults Activity 2015-16
Delivering Safeguarding Bingo Incommunities – 20 October 2015
The wording in this publication can be made available in other formats such as large print and Braille. Please call 01274 434747. Older People’s Week event – 2 October 2015
Page 276 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 2 Foreword by the Safeguarding Adults Board Independent Chair
I am delighted to present the Bradford Safeguarding Adults Board (SAB) report for 2015 to 2016. The year was a very busy one for all the agencies involved as it was SAFEGUARDING the first year that we operated under the ADULTS Care Act 2014. BRADFORD At the heart of the Care Act is the expectation that people with care and support needs are helped to keep safe in the way that they l lead on making sure that we make want. This can be hard for professionals and safeguarding personal and work with families alike as it can mean allowing people individuals who need protecting to find to take decisions that might seem unwise. For solutions that they agree with example; If a grandson is taking excessive l make sure that the SAB works closely amounts of money from his grandad you with other partners focussing on sexual might want to stop the contact. But if the exploitation, identifying people vulnerable grandad loves going to football with him every to terrorism and domestic violence. week and doesn’t want that to stop you have to find a compromise. That’s what makes the I would like to pay tribute to the many people work that staff do every day so challenging in Bradford, both paid and volunteers, who and often rewarding when solutions that work work hard to provide the best service they can can be found. to people with care and support needs. So the SAB has been developing its training They know, as I do, that we have more to do approach, trying to engage more with people to make sure that everyone is safe in care who use services and has produced an easy settings and that families at risk of being read guide to support people who want to overwhelmed by caring responsibilities are report abuse. well supported. There is much more to do as we look to the But in Bradford the commitment and future. This report sets out what we have willingness to improve is there and I look done to meet our overall objectives and some forward to continuing to work with partners to of the challenges we still have. achieve our vision that: I have agreed some key objectives with “Bradford SAB expects that all agencies Kersten England, the council’s chief will work together to make sure that all executive. They are to: those with care and support needs can live the best lives they can, without fear, and l make sure we have a clear strategic plan safe from abuse and neglect.” l engage with a wider group of people who use services and the public Jonathan Phillips OBE l make sure we learn from events and are open and honest about where we can Independent Chair – Safeguarding Adults Board improve December 2015
Page 277 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 3 Bradford Safeguarding Adults Board
Who might be an abuser? Anyone might be responsible for abuse, for example: l a partner, relative or family member l a friend l an organisation, a paid carer or volunteer l another service user l a neighbour l a stranger.
Holding stall at Frizinghall Medical Centre – Where does abuse happen? 5 October 2015 Abuse can happen anywhere, for example: l in a person’s own home What is safeguarding? l in the street Safeguarding is protecting people with care l in a care home and support needs from abuse, preventing l in a day centre or hospital. abuse from happening and making people aware of their rights. Is abuse a crime? Yes. These forms of abuse are crimes: Whose responsibility is it? l physical abuse Safeguarding is everybody’s responsibility. l sexual assault For example: members of the public, l neighbours, staff and carers. psychological abuse l harassment and stalking What is adult abuse? l fraud and theft l Abuse is when someone does or says things domestic abuse to another person to hurt, upset or make l wilful neglect. them frightened. Adult abuse is wrong and can happen to All crimes should be reported to the Police. anyone who is over 18 years of age. Read more about reporting adult abuse on Abuse can happen anywhere and can be our website: https://www.bradford.gov.uk/ committed by anyone. adult-social-care/adult-abuse/report-adult- Abuse can happen in many different ways. – abuse/ See Appendix 3 which explains these in more detail. Page 278 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 4 Who is at risk? The chair is accountable to the local authority chief SAB Adult abuse can happen to anyone aged executive. Vision over 18. The SAB achieves its aims Some adults find it harder to get help and and objectives through may be more at risk of harm and exploitation, a structured planning for example: process, with the strategic l people with a disability plan informed by the Strategic SAB’s vision and, in turn, Plan l people with a mental health condition informing the SAB detailed l people with a temporary or long term delivery plan. illness or SAB members have a duty l frail older people. to co-operate and the SAB Other adults at risk could be carers such as itself must: Delivery partners, relatives or friends; they can also l publish a strategic get help if they are being abused. plan that has been Help and support is available – see developed with Appendix 3. local community involvement and working alongside Why do we have a Healthwatch. Safeguarding Adults Board l publish an annual report on what it (SAB)? has done over the past year, detailing members’ contributions to the strategy The Care Act 2014 made it a statutory and how they have implemented requirement for all local authorities to set personalisation in safeguarding. up a SAB. The SAB’s statutory partners l are the local council, the NHS Clinical Conduct Safeguarding Adults Reviews Commissioning Group (CCG) and the Police. (SARs) Bradford SAB has strong partnerships and The first strategic plan, for 2015-18, is has an independent chair and members intended to meet the first of these duties; drawn from a range of different agencies, drawing on a range of consultation activities, including the Police, NHS and voluntary and the experiences of the last year, self- community sector. You can find a list of the assessment of the SAB by its members and partners in Appendix 2. the development day held on 6 May 2015. Bradford SAB exists to ensure that local The SAB strategic plan is supported by a safeguarding arrangements and partners detailed delivery plan which is informed act to help and protect adults in the Bradford by analysis of safeguarding activity data district who: and performance information alongside the l have needs for care and support (whether partners’ self assessment exercise which or not these needs are being met) and; is carried out each year. We also consult regularly with people who use our services l are experiencing, or at risk of, abuse or and carers. neglect and; l as a result of these care and support needs, are unable to protect themselves from either the risk of, or the experience of abuse or neglect. Page 279 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 5 Despite changing personnel here, I anticipate that we will continue to chair the Communication, Engagement and Training sub-group and support the Business Plans, In an ideal world we would all like more resources, but given the resources we have I feel the Police allocate a suitable proportion to the safeguarding adults agenda. I do think though that we need to further improve our understanding of how other agencies work. A way we could achieve this would be by taking best practice from Safeguarding Children, who seem to work together in a more integrated way. Terry Long Detective Chief Inspector, West Yorkshire Police
We will be working with other partners to develop a better service for elderly offenders who come to the end of their time in prison. We will be looking for co-operation from partner organisations because some service users have serious health needs of their own, as well as monitoring any potential threat to the community. There are fewer hospital secure units resulting in more people in the community. Maggie Smallridge Head of the National Probation Service, Bradford and Calderdale Safeguarding Week launch event – 19 October 2015
Page 280 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 6 Safeguarding Adults Reviews (SARs)
Above and below: Safeguarding Week – A SAR is carried out when an adult at risk the role of the Adult Protection Unit – 22 October 2015 dies or has experienced serious neglect or abuse, and there is concern that agencies could have worked more effectively to protect the adult. A SAR is a multi-agency learning process. It aims to: l identify and promote good practice l encourage effective learning l make recommendations for future practice so that deaths or serious harm can be prevented from happening again. The SAB is awaiting the publication of two SARs from 2015-16, one relating to a domestic homicide and one to a mental health homicide. Once these are published we will give consideration to the recommendations and publish an update.
Page 281 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 7 The Safeguarding Adults Board Principles
‘The Care Act 2014 introduced six key principles that underpin everything the SAB does. The principles are outlined below with examples as to how we have worked together with partners across the Bradford district to respond and achieve these.
EMPOWERMENT PROPORTIONALITY ‘I am asked what I want as the ‘I am sure that the professionals outcomes from the safeguarding will work in my interest, as I process and these directly inform see them and they will only get what happens’ involved as much as needed’
In our last annual report we said we would . . .
l ensure that ‘Making Safeguarding l make sure that it incorporates service Personal (MSP)’ is implemented across user and carer perspective by creating Bradford and that agencies empower opportunities to listen to their stories. people to achieve the safeguarding MSP means that safeguarding arrangements outcomes they want. should be person led and outcome l ensure that SAB and services in Bradford focused. Using this approach will ensure have fully embedded the empowering the above principles are embedded in the ethos of the Care Act within safeguarding way everyone works. The following case arrangements. study demonstrates this approach. Please note names have been changed to protect identities
Safeguarding Week – the role of the Adult Protection Unit – 22 October 2015 Page 282 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 8 Case Study: Making safeguarding personal
Jinnah is a 25 year old woman with Over fifteen months, a young daughter. The daughter lives further progress with Jinnah’s parents a few miles away. included allocating Jinnah lives with the father of her child Jinnah to a and his mother. They are both known for psychologist who criminal activity including class A drug invited Jinnah use, theft and begging. Jinnah’s mother to a weekly group reported concerns about Jinnah’s safety with other vulnerable and welfare to Bradford Adult Services. A women. safeguarding referral was made. Further The psychologist, along with social concerns were raised about financial, services, met her family and broached physical, sexual, emotional, psychological the possibility that removing some of the abuse and neglect. pressure to return home might open up A social worker visited Jinnah with the other options for Jinnah. Police to get Jinnah’s story and offer Within two weeks of that meeting Jinnah support. Jinnah was underweight and contacted an old friend on Facebook who appeared vulnerable. She acknowledged agreed that she could stay. concerns but didn’t feel that she was being abused and wanted to stay where Since moving Jinnah disclosed further she was. Jinnah agreed to meet with a abuse which the Police investigated. social worker once a week. Gradually Now she is thriving. She has moved into Jinnah began to open up and disclose her own flat and is planning to start a some abuse. Social Services made a new college course. She is in regular contact safeguarding concern and Jinnah agreed with her daughter, family and friends. to a new safeguarding enquiry. This positive ending has been achieved Jinnah decided to visit her family and by keeping Jinnah at the centre of the daughter regularly. She also transferred safeguarding process. some of her benefits to her mother’s account so that she had some money when she visited.
The regional Making Safeguarding Personal Conference was held in early 2016, hosted by Bradford Safeguarding Adults Board. The event was contributed to by regional Safeguarding Adult Board partners and ADASS. The day was well attended by 111 people from a range of agencies and organisations from across the health and social care sector. The conference contained presentations from Regional and National Safeguarding Leads and also had some significant and positive contributions from individuals who had directly experienced the adult safeguarding process themselves. The conference established some positive ‘ways forward’ for the implementation on ‘making safeguarding personal. Robert Strachan – Team Manager Adult Protection Unit, City of Bradford MDC
Page 283 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 9 We must ensure that we engage people in the conversation about how best to respond to their safeguarding situation, in a way that enhances involvement, choice and control as well as improving quality of life. To do this the SAB will establish a specific project in the coming year that will: 1. Ensure that ‘Making Safeguarding As a result of a Making Safeguarding Personal’ (MSP) is implemented across Personal (MSP) conference in Bradford, Bradford and that agencies empower staff working within BDCFT are being people to achieve the safeguarding encouraged to share good practice outcomes they want. relating to working with adults at risk. In 2. Embed that MSP is a shift from process June 2016 we will update the managers’ supported by conversations, to a series training package for safeguarding adults. of conversations supported by a process. However there is a growing pressure on This approach is to facilitate a shift in front line Staff and the fact that the Local culture and practice and a commitment Authority are making financial cuts means to improving outcomes for those we carry an ever increasing workload. experiencing abuse or neglect. Amanda Lavery Safeguarding Service Manager & Alison Wright, Named Nurse Safeguarding (Adults We will report back in next year’s & Children)Bradford District Care annual report. Foundation Trust
We will continue to share the wider message of making safeguarding personal with all staff, through our safeguarding newsletter, EComms and the updated safeguarding webpages. We also have supervision sessions for safeguarding coordinators and enquiry officers. Amanda Lavery Safeguarding Service Manager & Alison Wright, Named Nurse Safeguarding (Adults & Children) Bradford District Care Foundation Trust
Safeguarding Week launch event – 19 October 2015
Page 284 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 10 PREVENTION PROTECTION ‘I receive clear and simple I get help and support to report information about what abuse is, abuse and neglect. I get help so how to recognise the signs and that I am able to take part in the what I can do to seek help’ safeguarding process to the extent to which I want’
We said we would . . . l Raise the profile of SAB’s activities with l Help people who have experienced abuse communities and organisations who are or neglect to be more resilient and to feel less aware of adult safeguarding. and be safer in the future. l Be assured that support to carers is l Identify ways in which individuals may be helping prevent carer stress and abuse or better protected by working with people neglect. who have caused abuse.
We were one of the first areas in the region to employ a Named GP to support primary care with Safeguarding Adults and this role was really embedded in 2014-15. The CCG has two posts dedicated to safeguarding adults, but is also supported by colleagues Bradford District Care in the wider safeguarding team, Foundation Trust developed a including a domestic violence Carers’ Hub to support people manager. in their caring role. The Hub We will continue to promote the at Horton Park Health Centre use of Personal Health Budgets, gives carers the chance to meet helping to support families and other carers, get free advice carers, as well as embedding and support, get involved in the empowering ethos of the activities and take time out for Mental Capacity Act and ensure themselves. personalised approaches to care. Amanda Lavery Safeguarding Nancy O’Neill Director of Service Manager & Alison Collaboration – Bradford Wright, Named Nurse District, Bradford City and Safeguarding (Adults & Airedale, Wharfedale and Children) Bradford District Craven CCGs Care Foundation Trust
Page 285 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 11 The National Probation Service A survey of service users found that engages in Multi-Agency Risk 85% were satisfied with the service. Assessment Conferences (MARAC). This exceeds the national target of Probation officers attend conferences 75%. As a result of survey feedback we to discuss real life cases of domestic made changes so that Service Users abuse and how to protect victims. understand their supervision plans better. Maggie Smallridge Head of the Maggie Smallridge Head of the National Probation Service Bradford National Probation Service Bradford and Calderdale and Calderdale
Mental Capacity Act/DoLs
The Mental Capacity Act 2005 offers legal protection to people lacking capacity to make their own decisions. It is unlawful for decisions to be made for them or restrictions placed upon them unless it is clear that these are in their best interests and they are unable to communicate a preference on the particular issue. There are extra safeguards called the Deprivation of Liberty Safeguards (DoLS) that can only be used if the person will be deprived of their liberty in a care home or hospital. In other settings the Court of Protection may be requested to rule on whether a person can be deprived of their liberty.
Nationally the Mental Capacity Act continues to be a major challenge to local authorities representing a significant additional responsibility implemented without adequate national funding.
As awareness of safeguarding grows the With our bigger teams we now have demand for DoLS Assessments has continued more capacity to provide day to day to increase which has inevitably increased support and advice to clinical staff. pressure on the Service. We are putting a particular focus on DoLs this coming year and our We have worked with local universities to plan is to build on the work already increase our number of internal Best Interest started to improve knowledge of Assessors. We now have 41 Best Interest the issues surrounding Mental Assessors and a further 11 in training and we Capacity and Dols. We will continue are committed to continue to increase capacity to audit our practices and improve The SAB will continue to monitor the Council’s education and training. performance and activity during 2016/17. Sally Scales – Deputy Chief Fred Bascombe – Service Manager Nurse Bradford Teaching Safeguarding and DoLs, Adult And Hospitals NHS Foundation Trust Community Services CBMDC
Page 286 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 12 The new Supreme Court ruling in 2014 redefined the threshold of the definition of a deprivation of liberty. As a result many more people who lack mental capacity to consent to their arrangements and who meet the ACID TEST are now defined as being deprived of their liberty. This means we now have to assess many more cases to ensure that the correct legal framework is in place. However manpower continued to be an issue for us so we appointed a a further 23-hours/week post. We now have one full time and one part- time person in post to meet the increasing safeguarding agenda. Elaine Andrews, Assistant Director Nursing and Safety Airedale NHS Foundation Trust
To assure the SAB that support to carers is helping prevent carer stress, abuse or neglect the Local Authority will carry out the national Carer Survey During 2015-16 the Clinical Commissioning during October 2016. This will be sent Groups worked with partners to develop out to approximately 1300 carers during the Mental Capacity Act template October. We will use the outcome of the within SystmOne, our NHS IT system. survey to help shape the SAB Delivery The template helps practitioners work Plan to further identify what we need to through and document mental capacity do and publish the findings in next years assessments and best interest decisions, annual report. when people can’t make decisions for themselves. The Local Authority will implement SystmOne as its case management system during the Summer of 2016 enabling Health and Social Care to move a step closer to shared records for patients and service users. Nancy O’Neill Director of Collaboration – Bradford District, Bradford City and Airedale, Wharfedale and Craven CCGs ‘Our plan for the coming year is to build on the work already started and continue to improve knowledge of the issues surrounding mental capacity and DoLS. We will continue to audit our practice and improve education and training’ Amanda Lavery Safeguarding Service Manager & Alison Wright, Named Nurse Safeguarding (Adults & Children
Page 287 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 13 PARTNERSHIP ACCOUNTABILITY ‘I know that staff treat any personal and ‘I understand the role of everyone sensitive information in confidence, only involved in my life and so do they’ sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.
We said we would . . .
l Cooperate with other strategic the likelihood of individuals supporting a partnerships to prioritise and coordinate violent extremist ideology or becoming work streams that affect adults at risk, terrorists The SAB now has a representative including; frauds/scams, forced marriage, from the Adult Protection Unit who links with violent extremism and sexual exploitation. Prevent meetings in order to discuss and l Strengthen local arrangements to identify agree ways of addressing the very real risks and monitor care settings where there that some of these cases face. may be increased risks of abuse and The range of safeguarding issues continues neglect. to grow and includes human trafficking and l Be assured that local safeguarding modern-day slavery, female genital mutilation, arrangements support effective domestic abuse, so called ‘honour based interagency working and information. violence’ and violent extremism. These issues often affect both children and adults, l Be assured that there are effective including many adults who are not considered arrangements to share good practice and ‘at risk’ under the Care Act (2014). Overall learn from SARs. responsibility for these areas is shared with l Strengthen assurance that all partners the safeguarding children board or other contribute appropriately to local strategic partnerships, making effective safeguarding work and have effective multiagency working even more complex arrangements which are consistent with and challenging. Sexual exploitation is now local multiagency safeguarding adults also included and to address this the Adult policy and procedures. Protection Unit cooperates closely with child sexual exploitation services to ensure l Strengthen relationship with the Health intelligence is exchanged. and Wellbeing Board, Children’s Safeguarding Board, Domestic Abuse The Police report that Hate incidents in the Partnership and other key partnership Bradford district have gone up from 870 per bodies. year to over 1,300 and the rise of reported domestic abuse and mental health incidents During 2014-15 SAB worked more closely are putting further strains on staff. with Prevent which is one of the four core elements of the Government’s CONTEST Self neglect was a big focus during 2015-16. strategy for countering terrorism. The The SAB worked with partners both locally other three elements are Prepare, Pursue and across the region to develop procedures and Protect. Prevent is a distinct part of to allow us to respond appropriately to Self the CONTEST Strategy focusing on early Neglect. Self neglect is now an element of intervention through strategies which reduce safeguarding as defined by the Care Act 2014. Page 288 ANNUAL REPORT 2014-15 Bradford Safeguarding Adults Board 14 As Head of the NPS for Bradford and Specialist practitioners from Calderdale I am a member of the Bradford the Safeguarding Team have Domestic Abuse Strategic Board and we are developed effective partnership always represented on the SAB and relevant working on domestic abuse. This sub-groups if appropriate. The National involved working with the Police, Probation Service make referrals to the Local Local Authority, Education and Authority where NPS staff assess that an adult Domestic Violence Services. Good is experiencing or is at risk of experiencing working relationships have been abuse or neglect, including financial abuse, forged out of a unifying aim to and is unable to protect themselves. safeguard victims regarding the All Multi-Agency Public Protection effects of domestic abuse. Regular Arrangements (MAPPA) category offenders communication and timely safety are screened and if required a Multi-Agency planning has improved outcomes Public Protection meeting is held to ensure for adults at risk and their families. agencies are working together to protect the The Trust last year seconded a public and service users.’ specialist safeguarding practitioner into the Adult Protection Unit ‘Our safeguarding leaders co-operated with (APU) and learning from this other strategic partnerships which has helped experience will help to develop the to prioritise work in areas such as frauds/ safeguarding service. The post has scams, forced marriage, hate crime, violent proved invaluable in forging closer extremism, sexual exploitation and human working relationships with the APU trafficking. We have also worked with other and other agencies. agencies on PREVENT, which enabled us to focus on protecting individuals at risk from Amanda Lavery Safeguarding becoming radicalised before any criminal Service Manager & Alison Wright, activity took place. Named Nurse Safeguarding (Adults & Children)Bradford Maggie Smallridge Head of the National District Care Foundation Trust Probation Service (Bradford and Calderdale)
Bradford Teaching Hospitals NHS Trust has been involved in several collaborative work streams. One example is the group that developed the district wide strategy for tackling domestic and sexual violence 2016-2020. We have developed a Policy in the Trust to guide staff on how to identify and support Patients or service users who are suffering from abuse. We have also developed our capacity and went from two to three members of the team. Our Lead team member is from a nursing background in mental health, and we have two specialist practitioners from nursing and social work backgrounds. They all have extensive safeguarding adults experience. Sally Scales – Deputy Chief Nurse Bradford Teaching Hospitals NHS Foundation Trust
Page 289 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 15 Working with Care Providers
There has been lots of effective partnership working. We work hard to align so many organisations and all work towards the same end result e.g. the CCG Safeguarding, Quality and Continuing Healthcare Teams work closely with the Local Authority and CQC, sharing information about our care homes and helping to support improvements in safeguarding or the quality of care where there are concerns. Nancy O’Neill Director of Collaboration – Bradford District, Bradford City and Airedale, Wharfedale and Craven CCGs
The SAB works closely with our Care Providers to ensure that they are confident at recognising and responding to abuse. We provided training to around 230 people from across the Independent Sector; this included residential and home care providers. During early 2016 the LA and CCGs implemented an Integrated Serious Concerns Procedure that sets out a new approach to the contract management of risks across health and social care providers across the District. Where things do go wrong, and services fail it is important that Service Users and significant others know what will happen next. This quality approach will set out what will happen. It will outline the process and roles and responsibilities for the Commissioners’ employees and Providers to ensure that things are improved for the person concerned and other people are not similarly affected. The procedures have been published in the recent Integrated Framework Tenders for Personalised Care and Support, Residential and Nursing services and are underpinned with template documentation to ensure consistency and transparency. This enables us to publish how we will manage areas of non- compliance or where a home receives inadequate ratings from the regulatory body CQC. Providers who have been supported by operations management have given positive feedback regarding the benefits of this ‘critical friend’ approach and stated that the support has enabled them to review their systems, procedures and documentation, where required, to develop their organisations. Susan Anderson-Carr Assistant Director Integration and Transition City of Bradford MDC
Page 290 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 16 Safeguarding Week 19th- 23th October 2015 Safeguarding
‘A Great Success’ It’sWeek everybody’s business
19th 20th It is the fourth time we have held a 21st October 2015 22nd multi-agency joint adult and children’s 23rd Programme of learning events Safeguarding Week and we are very proud #SafeguardingWeek of the commitment and enthusiasm from partners and services, including young people and service users who organise and deliver events throughout the week. The theme ‘Safeguarding - It’s Everybody’s sessions and full day courses. There were Business’ was used to promote the week on also displays and drop in opportunities all brochures, banners on partner organisations’ over the district. websites and email signatures. The week proved a great opportunity to raise It proved a very successful week with many awareness of safeguarding children, adults opportunities for learning and development. and domestic abuse. It was a real example There were 60 organised events advertised of partnership working both in putting the through the brochure, local radio and the programme together and delivering the Bradford Safeguarding Children’s Board sessions. There were many opportunities website and feedback indicates that about for staff from a range of adult and children 1,200 participants attended a mixture of full service providers to learn and develop day conferences, half day sessions, drop-in together.
G SAFEGUARDING B I N O WORKSHOP Throughout the week the Safeguarding Voice group delivered a Safeguarding Bingo Workshop to support, care and housing providers in the Bradford district. The aims of the workshops were to raise awareness of different types of abuse and discuss the ways to report and stop abuse, in a fun and interactive way. The Voice Group had previously delivered a number of these sessions during last year’s Safeguarding week and they were a great success. Nine sessions were successfully delivered to 101 people throughout the week. Double the amount delivered in the previous year! This year the Voice Group is again proud to have delivered a series of Safeguarding Bingo workshops. Safeguarding Bingo aims to educate and empower people, raise awareness of different types of abuse and explain the ways in which abuse can be reported and stopped. The bingo session was reviewed this year by the Training Task sub-group and was updated to include on-line and social media abuse. The group have committed to training others in the District to learn how to deliver safeguarding bingo. The aim is to empower people to become Safeguarding Champions in their own organisations. Training Sessions have been scheduled for September and October 2016.
Page 291 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 17 Safeguarding Week 2016
The focus of Safeguarding Week 2016 is to provide a range of learning and development opportunities for staff and volunteers working Safeguarding in the sectors of safeguarding children, Week adults and domestic abuse. Safeguarding week will run from Monday 17th October to Friday 21st October 2016. Safeguarding Week 2016 programme is now It’s everybody’s business available on-line: www.bradford-scb.org.uk/safeguarding_ week_2016.htm
17th 18th 19th 20th 21st The team is putting on innovative October 2016 #BradfordSafeguardingWeek training sessions for professionals Programme of learning events about MSP during Safeguarding Week in October 2016. Amanda Lavery Safeguarding Service Manager & Alison Wright, Named Nurse Safeguarding (Adults & Children) Bradford District Care Foundation Trust
Delivering Safeguarding Bingo Incommunities – 20 October 2015
Page 292 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 18 Listening to your views . . . The Safeguarding Voice Group has been running since 2011. It’s the Board’s community reference group made up of service users, carers and members of the general public. All members have an interest in safeguarding adults. The group aims to: l listen to people’s views and experiences of safeguarding adult issues and work l help the Board towards improving services and how things are done to safeguard adults better in the district l help people speak up, have a voice and Jonathan Phillips, SAB chair at September’s Voice keep everyone safe. Meeting
It’s been a busy year for the Voice Group; this is what Voice has been doing over the past 12 months:
What we discussed . . . What we did . . .
Keeping everyone safe As a result the Voice group has developed a Toolkit ‘Keeping People Safe in your organisation’ which includes questions and a checklist. The Toolkit will be published in the Summer, 2016. https://www.bradford.gov.uk/media/3159/keeping- people-safe-in-your-organisation-toolkit.docx
Making safeguarding adults information on the The Voice group has been reviewing and updating website accessible pages relating to safeguarding adults on the Councils website. The new information will be changed over on the website by the end of Autumn, 2016.
Making safeguarding adults information Bradford Talking Media have produced a Simple accessible for staff, volunteers and carers Guide to Safeguarding Adults. https://www.bradford.gov.uk/media/3081/simple- guide-to-safeguarding-adults-what-staff-and- volunteers-have-to-do.pdf
Raising Safeguarding Awareness with service Bradford People First took the lead in producing users, carers and the general public a series of short films on how to report abuse in different ways. The films were launched during Safeguarding Week 2015 and are available on YouTube. https://www.youtube.com/channel/ UCodDZ_5e0AzdWv5bis494DQ
Educating and Empowering Voice Members In June 2015, the Hate Crime Project from Bradford People First came and ran a session with Voice members on Hate and Mate Crime.
Page 293 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 19 SAB Improvement Programme 2016/17
During 2016/17 we intend to strengthen the board by reviewing the Board Governance Arrangements and updating our Board Constitution. Following the merger of the board sub-groups in early 2016 the SAB will continue to work on detailed delivery plans for each of its sub- groups to facilitate smarter ways of working of delivering our strategic plan. We will continue to improve the use of data from across the district to ensure that our delivery plans accurately reflect the safeguarding needs for the district. Safeguarding Week launch event – Training 19 October 2015
In 2015-16 the SAB provided multi agency We also rolled out face to face training to 300 training to almost 1,000 people. Courses people to support the implementation of the included Recognising and Responding to Care Act 2014 and our Care Act e-learning Abuse, Training Managers and additional package was successfully completed by 250 trainers to support the ongoing development people from across the district. of the workforce across the district. Partner organisations continue to provide staff to help deliver multi agency training on behalf of the Board.
Page 294 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 20 In line with national guidance Bradford Teaching Hospital NHS Trust reviewed our training needs and as a result more people now get enhanced levels ‘In 2015-16 we have updated the of training to ensure they have better Trust’s mandatory training as a result awareness of adult safeguarding, can of emerging trends such as human identify people who are at risk of abuse, trafficking and radicalisation. Our and know what to do to support and Organisation also reviewed its training protect them from harm. needs to incorporate multi-agency Sally Scales – Deputy Chief Nurse training. Our focus in the coming Bradford Teaching Hospitals NHS year will be to develop a more robust Foundation Trust annual audit plan to ensure that policy continues to translate into practice’ Elaine Andrews, AD nursing and safety ANHST
In 2015-16 we trained staff involved in safeguarding to make sure they keep up-to-date with changes in the Care Act. We now have approximately 30 staff and officers working in adult safeguarding who all need to understand changes in the process of referring adults at risk to services that can support them. In the coming year we will continue to Chair the Communication engagement and Training Subgroup and further develop our sub group implementation plan to support the delivery of the strategic plan. Terry Long – West Yorkshire Police
To underpin the strategic importance The CCG Safeguarding Team of safeguarding adults the National give two days a month to help Probation Service have introduced a deliver the Multi Agency ‘Role mandatory, one-hour e-learning module of the Safeguarding Manager which all staff must pass. This is to Course’ ensure that everyone is at the same Nancy O’Neill Director of level of understanding about key issues’ Collaboration – Bradford Maggie Smallridge Head of the District, Bradford City and National Probation Service (Bradford Airedale, Wharfedale and and Calderdale) Craven CCGs
Page 295 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 21 Safeguarding Adults Board Financial Arrangements
Safeguarding is funded primarily by the the Safeguarding Adults Board Sub-groups Council with contributions from the NHS and Project Groups. Clinical Commissioning Groups (CCGs) In 2014-15 we said that we would develop a and the Police. Bradford District Care Trust more detailed budget - This work is ongoing. (BDCT) funds a Safeguarding Adults Co- ordinators Role and all partners contribute to
Salary costs 170,343.08 This includes the Independent Chair’s fees, the salaries of key staff who support the board, and a proportion of the salaries of other staff with wider responsibilities.
Travel (staff and Service Users 587.44
Hospitality 10.35
Facilitator (SAB Dev Day) 675.00
Printing (SAB Booklets, posters etc) 1,412.15
Safeguarding event 900.00
Membership AEA 52.00
Total 173,980.02
Page 296 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 22 Safeguarding Adults Board Appendix 1 Financial Arrangements Strategic Plan for 2015-18
This is the strategic plan for the SAB for the l Raise the profile of SAB’s activities with next 3 years. It will be updated annually and communities and organisations who are is supported by a detailed delivery plan less aware of adult safeguarding. It is informed by consulting with people l Be assured that support to carers is who use services and carers along with the helping prevent carer stress and abuse or partner self assessment carried out during the neglect. year and analysis of data and performance. l Help people who have experienced abuse or neglect to be more resilient and to feel and be safer in the future. Empowerment and proportionality l Identify ways in which individuals may be In partnership with communities and local better protected by working with people organisations, the SAB will work to support who have caused abuse. people to make their own safeguarding decisions, whilst acting in a proportionate way to protect those who can’t make decisions for Partnerships and accountability themselves. The SAB will work jointly with communities, To do this, the SAB will work with its partner agencies and other strategic partnerships agencies to: to make sure that everyone meets their l Be assured that ‘Making Safeguarding obligations and makes the best use of Personal’ is implemented across Bradford available resources to tackle abuse and and that agencies empower people to neglect of adults at risk. achieve the safeguarding outcomes they To do this, the SAB will work with its partner want. agencies to: l Ensure that SAB and services in Bradford l Cooperate with other strategic have fully embedded the empowering partnerships to prioritise and coordinate ethos of the Care Act within safeguarding work streams that affect adults at risk, arrangements including; frauds/scams, forced marriage, l Ensure the range of locally available violent extremism and sexual exploitation. independent advocacy supports the l Strengthen local arrangements to identify empowerment of adults at risk. and monitor care settings where there l Make sure that it incorporates service may be increased risks of abuse and user and carer perspective by creating neglect. opportunities to listen to their stories. l Be assured that local safeguarding arrangements support effective interagency working and information Prevention and protection sharing. The SAB will work with the full involvement l Be assured that there are effective of all partners and people who use services, arrangements to share good practice and to be assured that people are supported to learn from Safeguarding Adults Reviews. feel and be safer, when they are at risk of, or experiencing abuse or neglect. l Strengthen assurance that all partners contribute appropriately to local To do this, the SAB will work with its partner safeguarding work and have effective agencies to: arrangements which are consistent with Page 297 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 23 Appendix 1 continued
local multiagency safeguarding adults policy and procedures. l Strengthen relationship with the Health and Wellbeing Board, Children’s Safeguarding Board, Domestic Abuse Partnership and other key partnership bodies
Page 298 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 24 Appendix 1 continued Appendix 2
Members of the Safeguarding Adults Board 2015-16
Independent Chair Bradford District Care Foundation NHS Jonathan Philips Trust Nicola Lees, Deputy Chief Executive and Director City of Bradford Metropolitan District Council of Nursing BDCT Department of Adult and Community Services Cathy Woffendin, Deputy Director of Nursing and Janice Simpson, Strategic Director Adult and Specialist Services Community Services (to June 2015) Bernard Lanigan from June 2015. West Yorkshire Fire and Rescue Services Susan Anderson-Carr, Assistant Director - Thomas Rhodes, District Prevention Manager Integration & Transition Nazir Hussain, District Prevention Assistant Fred Bascombe – Operational Services Robert Strachan, Senior Adult Protection National Probation Services Coordinator Maggie Smallridge – Head of Bradford and Kathryn Lamb – Programme Management Calderdale NPS Housing: Yusuf Karolia, Head of Housing Access, Strategy West Yorkshire Community and Homelessness Rehabilitation Company Department of Environment and Sport Billy Devenport, Operational Manager Val Balding, Community Safety Partnership, Domestic Abuse Partnership Incommunities Harry Whittle, Director of Estate and Support West Yorkshire Police and Deputy Chair Services Terence Long, Detective Chief Inspector
Independent sector Yorkshire Ambulance Service NHS Trust Konrad Czajka, R.N.H.A. Yorkshire Branch, Sarah Gallagher, Named Professional for Bradford Care Association Safeguarding Adults
NHS England Bradford District, Bradford City and Airedale, Wharfedale and Craven CCGs Sue Cannon, Director of Nursing and Quality West Yorkshire Area Team to January 2015 Nancy O’Neil, Director of Collaboration Emma Corbet, Quality & Safety Manager Matt O’Connor, Head of Safeguarding (Adults) NHS England (Yorkshire & The Humber – commenced March 2015) Airedale NHS Foundation Trust Currently Julie Finch, Deputy director of Nursing Elaine Andrews, Assistant Director for Patient NHS England North (Yorkshire & Humber) Safety Noel McEvoy, Named Nurse for Safeguarding Stonham Housing Sheree Bosco, Senior Client Services Manager Bradford Teaching Hospitals Foundation NHS Trust Alzheimers Society Sally Scales, Deputy Chief Nurse Paul Smithson, Support Services Manager
Page 299 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 25 Appendix 2 continued
Choice Advocacy Safeguarding Children’s Board David Rosser, Director Paul Hill, Bradford Safeguarding Children’s Board Manager Hanover (Housing) Frank Hand Tom Brown, Director of Extra Care and Services Strategic Disability Partnership/ Arthritis care group Healthwatch Gill Bowskill, SDP Representative Andrew Jones, Healthwatch Project Manager
Keighley and Ilkley Voluntary Community Action Andrew Makin
Sub-group Chairs
Chair, Delivery Group Chair, Performance and Quality Sub-group Bernard Lanigan, Assistant Director - Mark Nicholas, Service Manager Integration & Transition (Safeguarding and Performance Management) to May 2015 Chair, Training Task Sub-group Noel McEvoy, Named Nurse for Safeguarding Chair, Communication and Engagement to October 2014 Sub-group Helen Hart, Safeguarding Manager (Adults), Terence Long, Detective Chief Inspector CCG’s – commenced January 2015 Andrew Howard from September 2016
Improving Practice Sub-group MCA/ DoLS Sub-group Matt O’Connor, Head of Safeguarding (Adults) Fred Bascombe Service Manager (Adult and Community Services
Page 300 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 26 Appendix 3
Examples of Abuse
Physical abuse l verbal abuse l bullying and cyber bullying Physical abuse is causing physical pain, injury l isolating or suffering to someone else. l threatening to harm or abandon (leave Some examples of physical abuse include: someone in need) l hitting l coercion l slapping l stopping someone from seeing other people l pushing e.g. their friends and family l l kicking stopping someone to have access to services or support l burning l not giving someone their medication, or too much medication or the wrong medication Financial and material abuse l the use of illegal restraint for example, where someone holds another person by forcing Financial and material abuse is when someone them down takes someone’s money or things without asking. l inappropriate physical sanctions like locking someone up in a room or tying them to Some examples of financial and material furniture abuse include l theft, which is stealing money, benefits or Sexual abuse things l fraud l Sexual abuse is when someone does sexual misuse of a person’s property or things things to another person who does not want l internet scamming it happening to them or may not understand l Putting pressure on someone to change what’s happening their financial arrangements, such as wills, Some examples of sexual abuse include: property or inheritance. l forcing someone to have sex against their l misuse of any lasting power of attorney or will, which is known as rape appointeeship. l sexual assault l touching Neglect and acts of omission l making sexual remarks l making someone take part in sexual acts, Neglect is when someone says they are going to like made to watch sexual activity or films help someone by giving them care and support but they do not. l sexual exploitation Acts of omission is when someone ignores situations when someone else is being Psychological abuse neglected. Some examples of neglect include: Psychological abuse is also known as emotional l leaving someone alone for a long time abuse. This is when someone says and does l bad things to upset and hurt someone else. ignoring medical or physical care needs l Some examples of psychological abuse include: failing to provide access to the right health or social care services l humiliating l withholding of medication, adequate nutrition l blaming and heating l controlling l intimidating l harassing Page 301 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 27 Appendix 3 continued
Organisational abuse Examples of domestic violence include: l emotional abuse l Organisational abuse is when any form of abuse physical abuse is caused by an organisation. It can includes l sexual abuse neglect and poor practice within a specific care l financial abuse setting such as a hospital or care home, or where l honour based violence care is given to someone in their own home. l forced marriage l Self-neglect female genital mutilation
Self-neglect is when someone does not take care Modern slavery of themselves properly. Examples of self-neglect include, neglecting Modern Slavery is slavery that happens today. one’s own: Slavery is when someone is forced to work or do other things they don’t want to. l personal hygiene l It’s a growing problem that can happen to men, personal health women and children. People are treated like l personal surroundings slaves; they are forced and tricked into a life of l living in hoarding conditions abuse. It’s treating people in an inhumane way which Discriminatory abuse means when someone is cruel and does not treat people like humans. Does not have compassion and makes people suffer. Discriminatory abuse is when someone says or does bad things to someone else because they Modern Slavery can take many forms some are different to them. examples include: l People are treated unfairly because of their trafficking people where the traffickers are the slave masters l race or religion l forcing someone to work, they can be made l gender, gender identity or sexual orientation to work for free in a shop, in a factory or even l age sell sex l disability l forcing someone to be a domestic slave and Some examples of discrimination include: not letting people have their own life If you l harassment or someone you know have been abused, l verbal abuse contact. l physical and psychological abuse l hate incidents or hate crime
Mate crime
Mate crime is a form of disability hate crime. It happens when someone pretends to be a friend and then uses, manipulates or abuses the person.
Domestic violence and abuse
Domestic violence and domestic abuse happens between people in relationships or family members. It is a pattern of behaviour which involves violence or other abuse by one person against another in their own home.
Page 302 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 28 Appendix 3 continued
What should I do if I think someone is being abused?
If you have been told or notice abuse or neglect: on 101 l Ensure the immediate safety and welfare of l Preserve any evidence the adult and any other person at risk l Accurately record the incident, any action or l If urgent attention is needed for health or decisions. Make sure you sign it and add the safety dial 999 date and time l If a crime needs to be reported call the Police
If you or someone you know have been abused, contact . . . The Police If you are unable to complete the online form call the Adult Protection Unit on 01274 431077 l For emergencies 999 Monday to Thursday: 8.30am to 4.30pm l For non–emergencies and advice 101 Friday: 8.30am to 4pm l Open all day and all night. Out of Hours Emergency Duty Team Bradford Council Telephone 01274 431010 (outside office hours) Monday to Thursday: 5pm to 7.30am If you think an adult is at risk of abuse or you are worried that someone might be abused raise Friday to Monday: 4.30pm to 7.30am your concern at: www.bradford.gov.uk/makeanalert
What do we do when we receive a concern?
When the concern is received we must first find If the abuse is within a care setting we work with out if the person is facing such a risk. the care provider, the service commissioners and Sometimes we find that, happily there is no the regulators CQC to ensure it is stopped. abuse or neglect; sometimes people do not want any help to stop what is happening to them but in most cases health, social care, Police and other agencies work together to help the person live a safer life.
Page 303 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 29 Appendix 4
Bradford Safeguarding Adults Activity 2015-16
This section details a range of information about In 2015-16 Bradford Council Adult Protection Unit adults at risk of whom safeguarding concerns and received 4,504 concerns. This figure continues enquiries were opened during the reporting period to rise year on year, with a 17% increase on the 2015-16. It also contains details for safeguarding previous year. enquiries which concluded during the year. Out of the 4,504 concerns raised, 1,036 (23%) Bradford data collection meets the requirements were screened out on the basis that they sent of the Health and Social Care Information Centre in error, they were duplicates or they were not (now known as NHS Digital) Safeguarding Adults relevant to adult protection. Collection (SAC) which is the mandatory data return for enquiries made under Section 42 of the This left 3,468 concerns that required initial Care Act 2014 (referred to in the report as Section investigation to establish if they were to progress 42 enquiries). All data is scrutinised and used to through the full safeguarding enquiry process. inform prevention work and reviews of guidance The outcome of the 3,468 was as follows: and policy. l 2,472 (71%) were subsequently ‘closed as a This is the first report since safeguarding adults concern only’. This means that following initial became a statutory duty on the 1st April 2015 fact finding it was identified that no further when the Care Act came into effect. Terminology action was required and the case was closed. and definitions have changed from previous l 996 concerns that progressed to the enquiry publications to meet the Care Act requirements. stage. A safeguarding concern is where the council is l Of the 996, 30 went through the process but notified that an adult is at risk of abuse which the outcome was recorded as Non Section 42 instigates an investigation under the local when the case was closed. safeguarding procedures. This initial investigation l may then develop into a formal investigation This left 966 section 42 cases that went known as an enquiry. Enquiries categorised as through the full safeguarding enquiry process. open during the year may not necessarily be concluded during the reporting year.
GRAPH 1 Adults at Risk – cases closed in 2014-15 and 2015-16 2014-15 % refers to total number of individuals with closed enquiries 2015-16 30%
20%
10% 26 cases 10 cases 245 cases 222 cases 209 cases 210 cases 239 cases 170 cases 179 cases 147 cases
0%
Physical Vulnerable Mental Learning Drugs/ Disability Adults Health Disability Alcohol
Page 304 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 30 Appendix 4 continued
In 2015-16 people with Physical Disabilities requiring support were most often reported to Safeguarding in Bradford. This is in line with the national picture where physical support is the highest category at 42% of all individuals with section 42 enquiries.
Enquiries by Type of Risk Graph 2 shows the distribution of type of risk (i.e. the type of abuse that was recorded as having taken place). Nationally new categories were introduced under the Care Act; these include modern slavery and Hanover Housing Residents Event – sexual exploitation 28 January 2016
GRAPH 2
Count of abuse types – cases closed 2014-15 % refers to total number of recorded abuse types, some adults at risk 2015-16 experience more than one type of abuse
30%
20%
10% 1 case 3 cases 3 cases 2 cases 2 cases 0 cases 0 cases 53 cases 6 cases 67 cases 61 cases 15 cases 10 cases 55 cases 297 cases 383 cases 356 cases 242 cases 283 cases 188 cases 276 cases 141 cases
0%
Neglect Psychological Organisational Discrimination Self- Modern Neglect Slavery Physical Financial Sexual Domestic Sexual Abuse Exploitation
2015-16 saw a significant increase in the category There were only 3 cases of self neglect reported neglect in Bradford, an 11% increase on the during 2015-16 however the SAB will work on previous year. Nationally this was also the most guidance during 2016/17 to ensure that people common type of risk recorded accounting for 34% understand self neglect as a type of abuse. of all risks recorded. Physical abuse has dropped by 5 % from 356 to 242 in 2015-16. We need to undertake additional work to understand why. Page 305 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 31 Appendix 4 continued
GRAPH 3 As can be seen on Graph 3 there has Enquiries by Location of Risk been a 19% increase in Care Setting % refers to total number of abuse settings for all closed enquiries as the location of risk and a decline 60% of 16% in Own Home. This is not in 2014-15 line with National Data for this period 2015-16 which concluded that the most common 50% location of risk was the persons own home. We will undertake further 40% analysis as to establish the reason why this has changed and differs to the 30% national picture.
20% 89 cases 48 cases Enquiries by action Taken 328 cases 425 cases 481 cases 287 cases and Result 10%
Following a safeguarding enquiry a 0% decision is taken regarding whether Care Setting Own Home Other actions needed to be taken as a result.
Graph 4 shows the percentage distribution of concluded safeguarding enquiries by the action taken and outcome of the action. As can be seen on Graph 4 there is some improvement in reducing risk during this year. However Bradford currently records 64% of closures as no further action which is high compared to the national average of 25%. One of the main reasons for this we believe is our current recording system is limited in its recording abilities. We are in the process of moving to a nationally recognised case management system which will improve reporting accuracy in the future and also improve our ability to produce shared data with our partner agencies.
GRAPH 4 Action and result of SA process – cases closed in Case conclusions 2014-15 and 2015-16 % refers to total number of abuse settings for all closed enquiries There were 759 cases closed in 2015- 70% 16 which was an 11% increase in this year in relation to the number of received enquiries. 60% 2014-15 For 2015-16 National Data set please go 2015-16 to: 50% NHS Digital – Safeguarding Adults Annual Report England 2015-16 40% http://content.digital.nhs.uk/ article/2021/Website-Search?productid 30% =22101&q=title%3a%22Safeguarding+ Adults%22&topics=13206&sort= 82 cases 34 cases 114 cases 114 cases 110 573 cases 484 cases 20% 131 cases 129 cases Relevance&size=10&page=1&area= both#top and the Safeguarding Adult Collection 10% (SAC) Comparator Dashboard content.digital.nhs.uk/catalogue/ 0% PUB21917/SAC_1516_ann_e_ No further Action taken Action taken Action taken comparator_dashboard.xlsx action under and risk and risk and risk safeguarding removed reduced remains required Page 306 ANNUAL REPORT 2015-16 Bradford Safeguarding Adults Board 32 Page 307 Bradford Safeguarding Adults Board ANNUAL REPORT 2015-16 33 The wording in this publication can be made available in other formats such as large print and Braille. Please call 01274 434747. Page 308