Safeguarding

Welcome

Welcome to the annual report of the Barnsley Safeguarding Adults Board (BSAB)

I would like to thank you for taking interest in the work of Barnsley’s Safeguarding Adult Board.

As the Independent Chair, I am pleased to report that there has been progress against the board’s objectives. Partner agencies continue to show their commitment to working together to keep vulnerable adults safe.

Examples of positive work undertaken by the board include.  The public awareness raising, mainly during the Safeguarding Awareness Week.  This is considered to have contributed to the increase in safeguarding referrals coming from members of the public and individuals.  Case audits leading to changes in policies.  These include: ‘Self Neglect and Hoarding’ and ‘People in Positions of Trust’.  Also the creation of a multi agency panel to look at high risk cases.  Including young adults with more work planned with the Barnsley Safeguarding Children Partnership.

During the year that this report covers, there was one Safeguarding Adult Review. More details of which can be found on page 12.  The review confirmed to me that the partnership is keen to learn from cases. Wanting to improve the services that it provides to vulnerable people. I'm confident that the learning points will be actioned. It also confirmed to me that front line workers do face challenges.  This is when working with people who face struggles in their lives.

Perhaps the issue that has most concerned the board during the year.  Is the difficulty in ensuring that safeguarding training is delivered to all staff who work with vulnerable adults. The larger settings, such as the Local Authority, Health and the Police, have their own training programmes. However we have lacked a multi-agency training offer that we can deliver to a much wider group of staff. We have struggled to get reassurance all staff have received the level of training appropriate to their role. I'm pleased to say that there is progress on this issue. I'm quite confident that we'll be able to employ a Safeguarding Trainer in the coming year.  This will go a long way to addressing those concerns.

The lockdown, triggered by the Covid 19 crisis. Which came into effect just as the year being reported upon was coming to an end. It's more appropriate to comment more on that situation in the next annual report. For the purpose of this report, I can say, as an Independent person.  That the agencies which work with vulnerable adults have shown great resolve in their passion to provide support.

Members of the public have a key role to play in keeping people safe. Communities can assist in identifying those in need of help and alerting the relevant agencies. Those who live alone, who perhaps have limited or no family support, can sometimes struggle.  More information on how to report a Safeguarding Concern can be found on page 4. Please remember, Safeguarding is Everyone’s Business

Bob Dyson QPM,DL

Independent Chair Barnsley Safeguarding Adult Board

Adult safeguarding

What is abuse?

Any action, deliberate or not intentional.  Or a failure to take action or provide care that results in harm to the adult (this is called neglect). There are many different types of abuse; more details about abuse can be found on the Safeguarding Web site https://www.barnsley.gov.uk/safeguarding

The website tells you how you can tell us if you or someone you know if being harmed or abused.

Who do we help keep safe?

All adults aged 18 and over who:

1. Need care and support, even if they are not getting care or support now (AND)
2. They are facing, or at risk of, abuse or neglect (AND)
3. As a result of their care and support needs.  They are unable to protect themselves from either the risk of abuse or the experience of abuse or neglect.

Adults who are not able to speak up for themselves are more vulnerable. We all need to speak up to keep them safe.

Safeguarding data

Who told us they had concerns an adult was being hurt?

In 2019/2020, Adult Social Care received 1969 concerns, compared with 2067 received in 2018 – 2019. The number from Care Homes, Ambulance and SYP all reduced.  Reflecting the work to drive up the quality of concerns sent to Adult Social Care. The percentage received from adults who were facing abuse doubled (1% in 2018/19 to 2% in 2019/20), though the numbers remain low. Care agencies sent in more concerns, reflective of the number of adults they support.  This was up from 5% to 6% and the conversion rate is higher than that of the care homes.

Location of abuse

The total number of concerns received for abuse taking place in care homes dropped from 52% to 44%.  Due to the increase in concerns received from other bodies. We are pleased to report a significant increase in reporting of abuse in the community. Up from 1% - 5% and an increase of concerns about harm in the adult’s home, up from 36% - 40%. This is testament to the work throughout the year to  raise awareness of abuse in the community. This increase is comparable with both national and local data, but is still lower than many other areas.

Types of abuse

The significant reduction in the number of organisation abuse cases from 10.7% in 2018 – 2019 to 4% in 2019 – 2020. This is reflective of the increased role of joint commissioning and the creation of a specialist adult social care team.  Those working with care homes to provide high quality care. The doubling of reports of financial abuse to 15% during the year reflects the training and media campaign completed.  These help staff and volunteers identify and report it. We are still below national averages but we're confident that the reports will continue to rise in 2020 – 2021. This will be as we continue to raise awareness of the issue.

Self neglect and hoarding concerns have also increased from 2.3% in the previous year to 4% this year. Research suggests that 2 – 4% of adults self neglect and/or hoard.  Whilst not all of these require any intervention, it does suggest that the numbers reported should be higher.

Safeguarding Adults – S42 enquiries

A section 42 enquiry begins when an adult meets the three stage test (see page 4). Also they agree they want help to stop the harm (this is a  S42 enquiry). Or it's in their “best interests” as they're unable to make this decision for themselves. They lack capacity to make this decision due to dementia etc. In 2019/20;  26% of concerns met this criteria in the year overall, a reduction from 38% in the previous year.  The introduction of a new recording system in August 2019 provides more robust data – see page 8). The conversion rate of concerns meeting the threshold for a section 42 enquiries varies from 22% to 54%. This will be addressed in the coming year to improve the quality of concerns received. Also  to provide assurance of the consistency of decision making within adult social care.  The remaining 74% of cases that did not meet the safeguarding threshold. Will have been offered support through one of the following:-

• An assessment or review of care by Adult Social Care
• Signposting information to specialist services
• No further action as the adult declined any help at this time

The adults we supported to stop harm and abuse via a S42 enquiry

The increase in reporting of abuse involving men is positive (up from 30% to 43%). They are often under represented in the data as they more likely to decline support.  The rise in the number of adults aged 65+ (up from 70% in the previous year to 80% this year).  This is in line with national data. It reflects their increased reliance on services or family support. The proportion of Black and minority ethnic adults referred in for safeguarding support (4%) is in line with our demographic data.

Our partners

Thank you to all our partners who have worked with us. They demonstrate what they are doing to prevent harm and abuse every day.

• Barnsley Carers Service
• Barnsley College
• Barnardo's
• Barnsley Hospital
• Barnsley Safeguarding Children's Partnership
• Berneslai Homes
• Care Quality Commission
• Centre point
• Healthwatch Barnsley
• Humankind
• IDAS
• NHS England
• NHS South West Yorkshire Partnership
• NHS Barnsley Clinical commissioning group
• Northern College
• Recovery Steps
• South Yorkshire Community Rehab Company
• South Yorkshire Fire and Rescue
• South Yorkshire Police
• South Yorkshire Police and crime commissioner
• National Probation Service
• Umbrella

Case studies

'Cuckooing' safeguarding case

South Yorkshire Police (SYP) and Barnsley Metropolitan Borough Council (BMBC) Shared Housing Team worked with Marie (49). She struggled with alcohol misuse, aggravated by the recent death of her husband. A man (Harry) well known for dealing class A drugs and violent offences.  He moved into her property and very quickly.  He began to deal drugs from the house, with a group of knife carrying enforcers.

Harry took over the bedroom and controlled who entered the property.  Leaving Marie frightened and often limited to the floor or sofa to sleep. Marie and her neighbours contacted the police in August and they quickly acted. Raising a safeguarding concern, securing and executing a search warrant based on the information from Marie, neighbours and the landlord.

Following the search, Harry left the property and moved to another address in Barnsley. The police asked the courts for a civil injunction to ban Harry from Barnsley. Due to the level of risk he posed to Marie and other vulnerable adults. This was granted and no further issues have been reported

Marie was supported by BMBC Housing Options to secure alternative housing. Marie has had no contact with Harry since the search warrant and reports feeling much safer in her new home.

(Please note these are not the real names of the individuals involved)

Making safeguarding personal (adult social care)

Jason is a man in his thirties. He is terminally ill and receives support from a domiciliary care and district nurses to manage his personal care needs. He has developed a number of pressure ulcers.  This is due to his limited mobility and lack of sensation on his lower body. Both the District nursing service and the domiciliary care service were responsible for the management of these risks.

Jason developed a pressure ulcer that did not appear to have been identified by either service involved with his care.  This progressed rapidly and resulted in an admission to hospital, where Jason remained for over 12 weeks. During this period he was admitted to intensive care. There were concerns that he may not recover from the infection resulting from the pressure ulcer.

Jason and his wife raised concerns that neither service had picked up on the pressure ulcer. A safeguarding enquiry then commenced.  Adult Social Care worked closely with Jason and his family to agree what he wanted to achieve via the safeguarding.  Jason was involved in both the planning meeting that tasked the domiciliary care service and district nursing. This was to review how they missed the new pressure ulcer including their conflicting policies. Learning was identified for both bodies and action plans were agreed.  Jason was asked whether he wanted a decision on neglect. He stated that he believed errors had been made. However felt that lessons had been learnt to protect him and others in the future. Jason noted that he wouldn’t want a decision to impact on the level of care he got in the future. He was reassured that this would not be the case and both companies were deemed to have neglected Jason.  Happily Jason’s health improved to a level that he could return home. He had the same providers and no further issues have been identified.  Jason was part of his planning meeting and due to not been able to sit for long periods.  He was contacted via video call for his outcomes meeting. Here he and his wife were support by an advocate.

Berneslai Homes and partners

Ryan is a 26 year old single male.  He has significant learning difficulties, but had not been formally diagnosed.  Ryan had maintained his own flat for a 2 year period, with support from his mother.  At the end of November 2019, Ryan’s mum contacted the Housing Management Officer (HMO).  She informed them that Ryan was too afraid to return to his flat as he was being financially abused. Also threatened with violence by people in the community. To protect Ryan the details were shared.  This was with both South Yorkshire Police (SYP) and a safeguarding referral made to Adult Social Care. Contact was made with Homeless Housing Advice to explore alternative housing options. This resulted in a move to an alternative (safe) temporary housing.   

Ryan was assessed by adult social care and safeguarded. Berneslai Homes and partners completed a risk assessment that resulted in a Band 1 priority (top priority) being awarded. This supported a move to a new permanent home.  Due to Ryan being vulnerable he was added to the Berneslai Homes vulnerable list.  This was to help him to bid for a new home. Ryan and his mum (with his consent) had regular contact with the HMO, SYP, adult social care, homeless team.  This had a positive impact on Ryan’s physical and emotional wellbeing. Ryan was successfully rehoused in March 2020 where he remains  with ongoing support.

The names have been changed to protect the adult involved.

Strategic plan – what we've achieved

Priority 1 – Making Safeguarding Personal (MSP)	Action
Embed MSP into all safeguarding practice.  Seek feedback from adults about their experience and provide this data to the Board	Safeguarding Adults Forum by Experience  (SAFE) have designed a leaflet for use by workers and volunteers.  This is to help adults understand the safeguarding journey and who to contact with any concerns. It will be reviewed in the coming year to make sure it is helpful to adults.
Work with SAFE. Increase their involvement in the production of the Board’s plans to keep adults safe.	SAFE have worked with Sheffield Safeguarding customer group to share ideas. They've suggested the creation of a universal health passport for any adult who may need support to access health care. In addition to the sub group they have been an active voice in board meetings.
Review the impact of our publicity campaigns and whether it increases the number of referrals from them	The regular campaigns around safety have been well received.  The number of referrals received from adults, relatives and neighbours has increased in the last year.
Work in partnership with Barnsley Safer Partnership and Health and Wellbeing Boards to address issues that affect all adults	Joint work has been started.  This is around the increased risk of abuse faced by adults who are lonely and/or socially isolated. Areas for joint work around the learning disability strategy commenced. BSAB received updates on LeDeR reviews into the deaths of adults with learning disabilities.

Priority 2 – prevention of abuse and neglect	Action
Deliver multi agency training to support the use of the Decision support guidance	Training has been delivered to over 120 workers, the guidance is available on the website. However additional work will be needed in 2020-21 as too many concerns don't meet the threshold for a safeguarding enquiry.
Increase our contact with the voluntary and independent sectors.	Barnsley council for voluntary services (BCVS) now sit on the Board and sub groups. BCVS have agreed to complete a training needs analysis in the voluntary sector. The Board Manager regularly attends the provider forums. A member of the voluntary sector chairs one of the sub groups.
Seek assurance that all care provision in Barnsley is safe for adults who use them	People from joint commissioning provide data to the Board quarterly and attend meetings to answer questions. We also have an annual attendance by people from the Care Quality Commission (CQC).  This is to share their findings about local care providers
Review data from all partners to provide evidence that services are safe.	All partners produce data covering training, recruitment, safeguarding activity every quarter.

Priority 3 – making sure safeguarding arrangement work effectively	Action
Deliver learning events to share the findings from Safeguarding Adults Reviews (SAR) and audits.	140 staff attended two self-neglect learning events to  explore  how to work with adults who self-neglect and/or hoard. Presentations from a specialist barrister and a researcher were well received. Specialist training was provided to adult social care staff, BIADS dementia service and to South West Yorkshire Partnership Trust  (SWYPFT)
Receive regional and national safeguarding data to help us evaluate how well we are doing to keep people safe	Data from both regional and national sources are used to evaluate performance at least bi- annually. The learning informs the contents of the performance dashboard produced by all partners every 3 months
Receive assurances that staff are correctly trained to recognise and respond to abuse	We are satisfied that all staff have access to basic information.  We are less confident that staff requiring more specialist training are receiving this. This will be carried over to 2020- 2021
Continue to complete quarterly audits to improve policies and practice	Audits have been completed into self-neglect and hoarding, management of People in Positions of Trust ( PIPOT) cases this year. Both audits resulted in changes to the policies which have been re-issued. An audit into the interface between safeguarding and homeless was started but not completed due to COVID 19
Implement robust, open and honest challenge processes at the Board and its sub groups	All partners contribute data every quarter which is examined by the Board. All bodies are required to share information about risks to their ability to keep adults safe. An annual development is held

Priority 4 – Transitions. Making sure all young people who need safeguarding into adult hood have support	Action
Work with the Barnsley Safeguarding Children’s partnership (BSCP). To reduce the risks of young people being harmed as they become adults.	Audits, completed by BSCP, have provided assurance about young adults with disabilities, those who are “looked after”. However young adults have been identified and work has taken place to create a multi agency panel.  This is to address the safety concerns of 17 – 25-year olds.
Facilitate with Barnsley Safeguarding Children’s Partnership (BSCP) a public facing safeguarding week	A highly successful week took place in July and involved schools, colleges, health, police and others. It highlighted support available to all citizens of Barnsley to prevent and stop harm and abuse.

Budget 

Year-end 2019/20

Cost	Income	Expenditure
Employee costs	-	43,327
Public transport	-	290
Supplies services	-	19,746
Business support	-	25,000
NHS Barnsley CCG	26,648	-
Miscellaneous contributions	3,115	-
Police and Crime Commissioner	5,595	-
BMBC	53,005	-
Total	88,363	88,363

Safeguarding Adults Review and lessons learnt

We worked with the family of “Clive” to complete a safeguarding adults review.  This looked into his death as a result of self-neglect.  Clive lived alone, following the death of his parents. He became more isolated partly due to his anxiety about leaving the property. Also his obsessive hand washing and fear of “germs”. He was often discharged from services as he did not respond or failed to attend appointments. This included access to Department of Work and Pensions benefits. Several actions have been identified to increase our ability to work with adults like Clive in the coming year. The full report will be published on the safeguarding adults’ website.

The coroner referred Mrs H, as a possible SAR, due to his concerns about self-neglect and hoarding. The Board have agreed that a review is required.  Looking into the circumstance of her and her husband’s living conditions and contact with services. An external author has been appointed, however as this was received in 2019, it will not be completed until summer 2020.

Key achievements

Policy updated

Following an audit into self-neglect and hoarding cases. Also the review of Clive’s death the self-neglect and hoarding policy was updated. A new risk tool developed to help workers assess the risks faced by people who hoard. Also a list of key contacts was developed. (This is not a photo of Clive)

The SAFE group have produced a leaflet for workers and volunteers.  This is to leave with an adult who has been harmed or abused. It explains the safeguarding journey and who they can contact for help. Links have been made with the Sheffield Safeguarding Customer Forum. It's hoped that joint work can be completed in coming year. Sadly, due to COVID 19, members of the group were not able to attend a regional event on customer groups. It's hoped that this will take place in 2021. The group have started working with Public Health to create a universal health passport.  This is for all adults to use to help them get health services.  For when they will struggle to communicate their needs, due to learning disabilities, dementia etc

The Board keeps in touch with colleagues in Yorkshire and Humberside. It was involved in a Local Government Association led event. This was about decision making which safeguarding concerns are screened into safeguarding (three stage test).

• Community volunteers and their managers were provided with safeguarding training to support them to keep adults safe during lock down.
• Safeguarding champions were identified and given training and resources to help them support staff and volunteers. Helping them to respond to harm and abuse promptly and correctly
• A specialist conference into Self Neglect and Hoarding was held with input from a specialist barrister and a leading researcher
• To respond to the low numbers of financial abuse cases reported locally. Over 160 staff and volunteers attended four sessions run by the police and the Board manager. Learning about scams, cyber-crime, financial abuse. Also what can be done to help adults stop and ideally prevent financial abuse/scams
• A session to learn from safeguarding adults’ reviews (local and national cases) was held. It was used to develop and improve practice and the way we work together
• Barnsley struggles to deliver the multi agency training needed as the Board does not have access to a training post.

The People in Positions of Trust policy has been updated.  This follows audits to include workers and volunteers who are alleged to have harmed adults at risk outside of Barnsley. The new policy is on the website.

South Yorkshire Safeguarding Awareness Week July 2019

Another packed week of training for staff, volunteers and the public were held. Including coffee mornings in all the area councils. 379 members of the public engaged with the 19 companies at an all-day public event at the transport interchange. 36 adults were referred for additional support. 50 workers and volunteers used the opportunity to update their knowledge. A South Yorkshire training event was held to support the management of workers and volunteers know as (PIPOT). The Clinical Commissioning Group (CCG) helped us produce a short animation explaining self-neglect and hoarding. (https://www.barnsley.gov.uk/services/children-families-and-education/safeguarding-families-in-barnsley/safeguarding-adults-in-barnsley/for-professionals-and-volunteers/ )

Pathways and Partnerships have produced guidance and policies to support safeguarding practice. These include – Sexual Safety, How to complete a section 42 enquiry, Wilful neglect – how to recognise it. Also React to Red (tissue viability) and Financial abuse and scams. We have worked with our local domestic violence service to receive assurance that we are protecting older adults.  Those who are victims of domestic violence. (see website for copies of the guidance).

Our active media programme has helped the public in Barnsley stay safe. Also to look out for more vulnerable neighbours and friends.  The work to highlight scams and bogus callers, mainly since COVID 19 have been well received. It's prevented the increase in scams seen in other parts of the country. Thanks to our comms colleagues for their help with this.

We have said goodbye to some longstanding members of the Board and the sub group. We want to thank them for their work to help keep adults safe. We welcome the new member to Barnsley Safeguarding Adults Board.

The Board has contributed to a national SAR library. Also a research project to identify trends from SARs and lessons learnt. We've agreed to look at how we safeguarding adults who are homeless or insecurely housed. We started an audit of four cases of adults who sadly died this winter. We have updated our “risk” register to help us prioritise the work we do. We'll continue to develop this in the coming year. If you have any suggestions about work the Board should be considering please do contact the Board Manager – CathErine@barnsley.gov.uk

Barnsley Safeguarding Adults Board structure

• Independent Chair: Bob Dyson
• Barnsley Safeguarding Adults Board
• Performance Management and Quality Assurance Sub Group
  • Chair: SYP
• Safeguarding Adults Forum by Experience
  • Chair: Margaret Baker (member of SAFE)
• Pathways and Partnership Sub Group 
  • Chair:  CCG and  Independent Sector
• Learning and Development Sub group
  • Chair: Barnsley Council

•  SAR and DHR Sub Committee

  • Chair: Bob Dyson. Independent Chair of BSAB

Our vision

Statutory Responsibilities of BSAB :

• Publish a Strategic Plan – what we will do
• Publish an Annual Report – detailing what we have done to keep people safe.
• Complete Safeguarding Adults Reviews when adults die or are seriously injured as a result of abuse/neglect.

BSAB Role is to:

• Put the adult who has been harmed or at risk of harm at the centre of everything we do.  Listen to their views about how we can help keep adults safe.
• Hold board members to account – are we/they doing enough to keep adults safe
• Collect and share information about how well we are keeping adults safe and what more we could do
• Make sure our workers and volunteers get the training they need.  In order to provide safe services and to share concerns if they think an adult is being hurt or abused
• Review our policies and guidance to make sure we are constantly improving.

BSAB Structure:

• Board with Independent Chair.
• Performance Management & Quality Assurance Sub Group.
• Pathways and Partnership Sub Group.
• Domestic Homicide Review (DHR)/Safeguarding Adult Review (SAR) executive group
• Safeguarding Adults Forum(by) Experience
• Learning and Development Sub Group

BSAB priorities

• Strategic Priority 1 (Making safeguarding personal) - Support adults who have been abused to stop the harm and feel safe.

• Strategic Priority 2 (Prevention) - Preventing abuse and neglect from taking place and supporting people to feel safer.

• Strategic Priority 3 - (Accountable) - Making sure safeguarding arrangements work effectively.

• Strategic Priority 4 - (Transitions) Working with young people to reduce the risk of abuse as they become adults.

Barnsley Safeguarding Adults Board Strategic Plan 2020 - 2021 – what we will do

• Use data from adults who have been safeguarded to improve practice.
• Employ a multi- agency trainer to coordinate and deliver high quality education to all workers and volunteers.
• Hold all partners to account by robust challenge at Board and via quarterly dashboard.
• Hold an annual safeguarding awareness week with the Children’s partnership.
• Work in partnership with the Community Safety, Health and Wellbeing Boards.  Looking at issues that affect all groups such as Safeguarding, homelessness and cuckooing.
• Increase our contact with the voluntary and independent groups in Barnsley to help them keep adults safe.
• Receive regional and national safeguarding data and information. Helping us evaluate how well we are doing compared with other Local Authorities.
• Work with the Children’s Board and the Safer Barnsley Partnership Board. With an aim to reduce the risks of vulnerable young adults being harmed or abused as they become adults
• Embed Making Safeguarding Personal (MSP). Using the new leaflet and collecting data from adults about their experience of Safeguarding.
• Receive data that helps us to drive up the quality of all care providers locally.
• Receive data from the subgroups to confirm that adults are safe, by use of audits and sharing of good practice.
• Use the learning from Safeguarding Adults Reviews and other sources to deliver a high-quality service to young adults.
• Review the impact of publicity on public awareness and the number of concerns raised by them
• Deliver learning events to share learning from Safeguarding Adults Reviews, jointly with the other Boards.
• Embed the learning from Safeguarding Adults Reviews to improve practice and keep adults safe.
• Continue to improve the quality of safeguarding concerns received from all organisations.