TRUST BOARD TB(15) 29

Title: Trust response to Kate Lampard’s Assurance Report into matters relating to Jimmy Savile Action: FOR DISCUSSION and NOTING Meeting: 13 May 2015

Purpose:

This paper updates the Board on the outcomes of the independent report conducted by Kate Lampard covering ‘Themes and lessons learnt from NHS investigations into matters relating to Jimmy Savile’, and the Trust’s response to those.

Recommendation:

The Board is asked to note the information contained in the paper and discuss any queries arising.

Name Title Author: Jennie Russell Assistant Director of Nursing Executive sponsor: Mandy Renton Chief Nurse

1

Trust Objectives

How the report supports achievement of the Trust Objective objectives: This report relates directly to the provision of safe and To be recognised as a provider of safe effective services and outlines what processes the and effective services that people want Trust has in place to achieve this, particularly in the to use area of safeguarding. To collaborate with organisations to The report outlines how the organisation collaborates improve the care given to people who with other organisations to improve the care given to use our services people who use our services. This report refers to the processes and procedures in To ensure that the Trust attracts and place to ensure that the appropriate checks have taken retains a quality workforce place for staff recruited into the Trust.

To be a financially sound organisation Not covered by this report. To achieve a contract model that links Not covered by this report. activity to payment To be recognised as a provider of safe and innovative services that helps See under the first objective above. Commissioners achieve their outcomes

Trust risk register Any safeguarding risks are logged locally. None have been escalated to the strategic risk register at the time of writing the report.

Legal and Regulatory requirements: As outlined in the paper at section 2.

Equality and Diversity implications: Whilst the report does not reference the objectives specifically, the procedures and policies referred to in the report have all been developed with the Trust’s Equality and Diversity objectives in mind.

Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Luton, Norfolk, Peterborough and Suffolk 1. Introduction

1.1 There has been widespread media coverage of historical allegations of abuse involving Jimmy Savile which occurred within NHS organisations. As a result of this, both the NHS and Department of Health (DoH) were required to conduct investigations in to Savile’s relationships with NHS organisations and his activities on their premises. Twenty eight organisations across the country have completed their investigation and have published their relevant findings and recommendations. There are around five further individual reports that will be published at a later date. This review process has been overseen by Kate Lampard, a former barrister, at the direction of the Secretary of State for Health with the remit of providing independent oversight and scrutiny.

1.2 As part of her review, Kate Lampard requested to visit a small number of hospitals who were not directly involved in the investigation, in different parts of the country in order to gain a better understanding of current NHS practice and policy connected to safeguarding within a NHS setting. This was with a view to determining how suspicions of abuse are handled and the roles, access and privileges afforded to celebrities and volunteers.

1.3 There are some common themes from the NHS investigations which include a need for: Strong, visible, clear Board leadership Organisational values and behaviours Executive responsibility for safeguarding of children and adults Leadership that fosters curiosity, scrutiny and constructive challenge A secure environment Effective policies for staff to arise concerns Robust recruitment employment checks Zero tolerance for abuse of staff or patients.

1.4 One of the overarching themes that emerged from Kate Lampard’s review was the need for strong visible Board leadership; embedding our organisational values and behaviours; leadership that fosters curiosity, scrutiny and constructive challenge along with a zero tolerance for abuse of staff or patients. This is echoed in the Francis report which was published following the public enquiry in to events in Mid Staffordshire NHS Foundation Trust.

1.5 A significant amount of work has been undertaken in the organisation post the publication of the Francis report. This includes listening exercises that have taken place along with staff engagement. The Trust has remained focused on raising staff awareness of the importance of providing kind and compassionate care, especially for older and vulnerable patients;

1.6 The safeguarding of children and adults is central to the organisational values of protecting individuals from harm and abuse and has received internal and external assurance from audit, and through Care Quality Commission inspection.

1.7 Board leadership is provided by the Chief Nurse who reports quarterly to the Trust Board on all safeguarding activities.

2. Legislation, Regulations or directives relevant to the report

2.1 The Children Act 1989/2004 provides a statutory basis for services for children and young people. The Trust is required under Section 11 of the Children Act, to ensure that it has robust arrangements in place to safeguard and promote the welfare of children and young people. 2.2 Safeguarding Adults is mandated by the Care Act 2014.Safeguarding adults is underpinned by the principles of the Human Rights Act 1998 and further guided by a number of legislation such as the Mental Capacity Act 2005 and Equality Act 2010.

2.3 The Trust has robust procedures in place in relation to the protection of vulnerable children and adults. The key safeguarding requirements for effective arrangements to safeguard vulnerable children and adults are outlined below: Page 3 of 7

Senior management commitment to the importance of safeguarding and promoting children and vulnerable adults welfare A clear statement of the Trusts responsibilities towards vulnerable children and adults is available for all staff A clear line of accountability within the organisation for work on safeguarding and promoting the welfare of children and vulnerable adults Child protection policy and procedures Vulnerable adults policy and procedures Service development that takes account of the need to safeguard and promote welfare and is informed, where appropriate, by the views of children and families Staff training on safeguarding and promoting the welfare of children and vulnerable adults for all staff. Safe recruitment procedures in place Effective inter-agency working to safeguard and promote the welfare of children and vulnerable adults.

2.4 The Trust is able to demonstrate compliance of the above key standards in relation to the safeguarding of children through the Section 11 audits that are required to be undertaken. Section 11 reports are submitted annually to local Children’s safeguarding Boards. The Safeguarding Children and Vulnerable Adults Policy and procedures have been updated in 2014 and 2015 in line with national guidance.

2.5 The Chief Nurse has Board level responsibility for safeguarding children and vulnerable adults. The Safeguarding Team acts on her behalf to ensure that the Board is assured that all necessary measures are taken to safeguard children and vulnerable adults within the organisation and service provision.

2.6 A comprehensive safeguarding training programme is in place across the organisation. Training uptake is monitored on a monthly basis;

2.7 The Trust Safeguarding Committees meets on a monthly basis. The Committees’ function is to ensure that the Trust executes its statutory responsibilities and to ensure that national policy and guidance is interpreted and applied at a local level. The Committees provide expert advice to the Trust in aspects of safeguarding and promoting the welfare of children and vulnerable adults.

2.8 Quarterly reports are provided to the Board of Directors giving an overview of the Trust’s safeguarding activity and performance and compliance with statutory requirements.

3. Safer recruitment and safeguarding

Individuals seeking work in regulated activity.

3.1 Cambridgeshire Community Services NHS Foundation Trust has a primary duty to meet its responsibilities in providing the highest possible standard of health care to its patients. In doing so, it has responsibilities as an employer to apply standards of best practice in the recruitment and selection of staff. The Trust has robust procedures in place in relation to individuals seeking work in regulated activity.

3.2 A recruitment policy and procedures are in place (updated 2015). In developing the policy, procedures and protocols, NHS guidance has been duly considered i.e. NHS Employment Check Standards 2013 (NHS Employers) which includes verification of identity checks; right to work checks; professional registration and qualifications check; employment history and reference checks; criminal record checks and occupational health checks. Managers responsible for recruitment and selection will have undertaken the Trust Recruitment and Selection training.

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Volunteers

3.3 Volunteers help in various ways to provide a wide range of extra services which improve patient experience and complement the work of paid staff across the organisation. This includes information points (greeting people on arrival and directing and escorting patients); general assistance in clinics; magazine and book trolleys and complementary care. The volunteer recruitment and procedures protocol follows the same guidance as set out in the Trust recruitment policy for substantive staff. A Volunteer policy is in place; updated April 2015, and identifies the requirements of the Voluntary Services Co-ordinator (VSC) in maintaining a register of volunteers.

3.4 Each service in the Trust which uses volunteers has a named manager who is responsible for oversight and management of volunteers in that service and act as the VSC.

3.5 On recruitment all volunteers sign a Volunteer’s Agreement with the Trust in which they agree to abide by Trust policies and procedures and follow the volunteer role description, and to abide by this Volunteer Policy and the supplementary Guidelines for Volunteers.

3.6 Each volunteer is accountable to a Voluntary Services Co-ordinator (VSC) who will oversee their volunteering activity. Each volunteer will be responsible to the VSC in their placement area for day to day supervision and support.

3.7 All volunteers must only attend the Trust site to undertake voluntary duties at dates, times and in a location agreed in advance with the VSC or Supervisor responsible for allocating them work

3.8 Recruitment and selection of volunteers is the responsibility of the Voluntary Services Co- ordinator. The Trust’s Recruitment and Selection and Equal Opportunities Policies will be adhered to. All pre employment checks must be made including DBS checks.

3.9 Candidates closely related to or in a close personal relationship with a Trust employee must declare this during the recruitment process. The VSC must consider the appropriateness of appointing the individual in a placement where they would work closely with someone with whom they have such a relationship.

Disclosure and Barring Checks.

3.10 The Trust maintains a robust framework for the management of disclosure and barring checks, with clear identification of levels of checks required for posts and assurance that all staff that require an agreed level of disclosure and barring check meet this requirement. The Independent Safeguarding Authority (ISA) is now part of the Disclosure and Barring Service (DBS).

3.11 All new and current staff recruited to perform regulated activities as specified by legislation, will be required to disclose any spent and unspent convictions, charges and cautions. The Trust has a clear process of escalation regarding vetting the content of a DBS disclosure and any accompanying information. The Trust has a duty to share information with the DBS about individuals who pose a threat to vulnerable groups.

3.12 DBS checks are carried out on individuals dependent on their position that they will be holding within the organisation.

4. Listening to and acting on patient concerns / allegations against professionals or volunteers

4.1 The Trust has clear guidance to follow in the event of allegations against any staff or volunteer in relation to both children and vulnerable adults. This guidance is covered within the Safeguarding Children, Child Protection Procedure and Safeguarding Adults at Risk

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procedures. These procedures need to be read in conjunction with Raising Concerns (Whistleblowing) Policy which was reviewed in 2014 and subsequently in 2015 as a result of the ‘Freedom to Speak Up’ Review. The procedures are explicit that all staff have a responsibility to report if they believe a member of staff is harming, or using unacceptable behaviour towards a child or vulnerable adult. This relates to both professional behaviour and information that may come to light about behaviour out of work which could indicate a breach of acceptable professional conduct.

4.2 The Trust Named Nurses for Safeguarding Children act as the points of contact in relation to Local Authority Designated Officer (LADO) referrals. All allegations made against staff (including volunteers) that call into question their suitability to work with or be in a position of trust with children, whether made about events in their private or professional life, need to be formally recorded and discussed with the LADO.

4.3 Notifications to the LADO encompass the following criteria where it is alleged that a person working with children has: Behaved in a way that has harmed or may have harmed a child Possibly committed a criminal offence against or related to a child Behaved towards a child/children in a way that indicated she/he is unsuitable to work with children.

4.4 Allegations against staff working with adult patients are reported and recorded in compliance with the Trust Safeguarding procedures and reported via the safeguarding adults multi-agency procedures where appropriate. The Safeguarding Adults Trust Lead acts as the point of contact for communication with the Local Authority in relation to the internal investigations of such allegations. The Local Authorities have the opportunity to scrutinise the internal investigation and make recommendations if necessary. All reported allegations against staff working with adult patients are reported in the Safeguarding Adults report to the Safeguarding Committee monthly Quality Committee quarterly.

4.5 Safeguarding training in line with the Intercollegiate Document (children) and Multi-Agency Agreement (Safeguarding Adults) is provided, with compliance monitored via the Trust Dashboard. The training involves discussions on public interest disclosure and cases in the national and local headlines. Staff are advised of the process and procedure to raise and escalate concerns, and have locally identified safeguarding champions to provide immediate advice and support.

4.6 The Trust has a dedicated PALS team and offers support, information and help with queries from patients, their families, carers and friends. The team are able to listen to comments, compliments or concerns about how services are provided. The team are able to assist individuals in resolving any problems or issues that they have about services. The team work closely with service providers and the Trust complaints team. The Complaints policy was reviewed and updated in 2014.

5. Access to patients

5.1 It is uncommon for the Trust to receive requests for VIP visitors to visit the Trust to meet staff and patients. The Trust is developing a guidance document to ensure no VIP can visit without this being planned and supervised.

5.2 The Trust welcomes and encourages patients to have friends and family visit them during their inpatient stay, and it recognises that this can have a positive effect on the patient’s recovery. In some circumstances the presence and involvement of family, close friends, or carers forms a vital therapeutic part of the patient’s treatment and recovery or return to optimal health, for example, children.

5.3 In cases where an adult visiting a child admitted to the Trust has been convicted of offences against children it is important to consider all other children within the Trust. The term “Risk to

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Children” is adopted for those persons who are identified as posing an ongoing risk to a child. Whilst the aim is to involve the family in the hospital treatment of their child, it is important to consider what is in the best interests of that child and others. Therefore, each case should be considered individually with the safeguarding team and decisions about each case is conveyed to the family in writing. Where it has been identified that a person is known to be a risk to children they are not permitted unsupervised visits to the Children’s wards or in department's where children are seen.

5.4 If it is identified that one of the adult patients has committed a sexual offence against a child it is important to assess the risk that person poses to children and young people in that particular area.

5.5 Respect for privacy and dignity is a right for all children and adults, regardless of age, sex, ethnic background or culture. Intimate medical and nursing interventions must be carried out sensitively and in a respectful manner in order to avoid misinterpretation and minimise the potential for allegations of abuse. All patients have the right, if they wish to have a chaperone present during an examination, procedure, treatment or any care, irrespective of organisational constraints or the setting in which this is carried out. The presence of a chaperone must be in addition to the person performing intimate examinations or personal care.

5.6 The primary role of the chaperone is to act as an advocate and to support a patient. However, they can act as an independent witness so as to prevent misinterpretation of events and safeguard against those rare instances of false accusations of abuse.

5.7 A Trust wide chaperoning policy was approved by the Board in 2014. This is available on the Trust intranet and is due for review in 2016. Some areas of the Trust also have local procedures in relation to chaperoning (sexual health and contraceptive services).

5.8 At times children, young people will be required to be taken off a ward for procedures and visits to other departments. The various reports highlight the need for such people to be accompanied. When children and young people are escorted from a ward by a porter the vast majority of them are accompanied by a responsible adult such as their parent or nurse.

5.9 One of the reports highlighted access and abuse to deceased patients when they were transported to the mortuary. The Trust has in place agreements for the respectful and dignified removal of deceased patients by the funeral directors of family choice, direct from the ward.

6. Contracted services

6.1 The Trust contracts services from external providers, as part of the tendering and commissioning arrangements the Safeguarding Children and Adult leads have been actively involved in the contractual processes in terms of scrutinising policies and procedures and arrangements of these external service providers to determine that they are in line with the Trust’s arrangements and that governance arrangements and safeguarding awareness are appropriate.

7. Further Actions Required

7.1 Significant assurance is provided to the Board that the processes and systems in place within the Trust meet the recommendations highlighted in Kate Lampard’s Report.

7.2 The Trust will continue to review these processes and systems in line with best practice and legislative requirements but in the meantime will also put in place a couple of actions: Upgrade the Electronic Staff Register to include a database of volunteers providing assurance of training and DBS checks. Develop a protocol for visitation from VIPs and celebrities. Further discussion is needed to agree the Trust position on requirement for three years DBS checks.

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