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Worcestershire Safeguarding Adults Board

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Worcestershire Safeguarding Adults Board Welcome to Learning From our Serious Case Reviews Friday 16th April 2010 * * Andy had capacity but not all our vulnerable ... – PowerPoint PPT presentation

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Title: Worcestershire Safeguarding Adults Board


1
(No Transcript)
2
9.15 Introduction Eddie Clarke 9.25 Serious
Case Reviews Karen Rees 9.35 Short Film 9.50
Adult SCRs in Worcestershire Sue
Pidduck 10.00 SCR 1 Shane Lewis 10.15 Prevention
of abuse Sarah Pilkington 10.30
Break 10.50 SCR 2 Sue Pidduck 11.00 Mental
Capacity Kate Towse 11.10 SCR 3 Sue
Pidduck 11.15 Safeguarding Carers - Rachel
Fowler 11.30 Group Action Planning Sarah
Pilkington 12.15 Feedback 12.30 Close - Susan
Fairlie
3
Introduction from Eddie Clarke Director of
Adult and Community Services
4
Serious Case Reviews
Adult abuse is everyones business
5
but who are these?
6
Serious Case Reviews for Adults Policy
  • ADSS National Framework of Standards for
    Safeguarding Adults Oct 2005
  • States that as good practice SABs should have in
    place a serious case review protocol
  • Government commitment to statutory footing for
    safeguarding adults boards, guidance is awaited
  • Review of No Secrets 2009
  • WSAB Serious Case Review Policy
  • Available on the county council website

7
SCR link to other processes
Serious Case Review
8
SERIOUS CASE REVIEW PROCESS
VULNERABLE ADULTS DIES AND ABUSE OR NEGLECT
APPEAR TO BE A FACTOR IN THE DEATH
REQUEST FOR A SCR
INITIAL MEETING OF SCR SUB GROUP
SCR PANEL MEETS Chair meets with family members
INDEPENDENT MANAGEMENT REVIEWS BY EACH AGENCY
PRODUCTION OF OVERVIEW REPORT BY SCR PANEL CHAIR
REPORT PRESENTED TO WSAB (INCLUDING ACTION PLAN)

9
Why undertake a Serious Case Review ?
  • not to reinvestigate or to apportion blame when a
    vulnerable adult dies or is seriously injured
  • but to learn lessons about the way in which
    local professionals and agencies work together to
    safeguard Vulnerable Adults and develop best
    practice
  • the action plans from serious case reviews are
    monitored by Worcestershire Safeguarding Adults
    Board to ensure all agencies learn from the
    recommendations

10
Adult Serious Case Reviews in Worcestershire
  • One published, two awaiting publication
  • Common themes arising from all three
  • Vulnerable adults fell through the net
  • Agency procedures were not followed by staff and
  • Agencies did not share information or
    co-ordinate plans
  • We will briefly go through the reviews and pick
    out one learning theme from each

11
First Serious Case Review
Shane Lewis Detective Inspector West Mercia
Police Worcestershire Safeguarding Adults Board
police representative
12
missed opportunities?
Sarah Pilkington Learning and Development
Coordinator for Adult Protection
13
prevention before responses!
  • the main purpose of Worcestershires adult
    protection policy is for the prevention of abuse
  • central notion of vulnerability a persons
    inability to protect themselves against potential
    harm or neglect
  • critical factors that can increase vulnerability
  • need for personal care
  • communication difficulties
  • cognitive difficulties
  • prioritise these people for monitoring and review

14
lessons to be learnt
  • This adult had been involved with care services
    throughout his life
  • once he became an adult his needs became almost
    exclusively addressed through his mother
  • there was an ongoing pattern of reluctance to
    engage with services
  • missed out patients appointments
  • cancellation of day and respite care
  • not returning calls
  • not allowing professionals into the home

15
systems failures
  • issuing of repeat prescriptions
  • routine health checks not carried out
  • no direct assessment of James' needs
  • no contact with his by social workers after 2005
  • annual review not carried out
  • no reassessment of need for continence products
  • no reassessment of ongoing needs for medication
  • no assessment of carers needs
  • GP approached for help in 2007 but was not
    identified as carer for adult with complex needs

16
missed signs
  • the last confirmed sighting was 5 months before
    his death
  • subsequent signs that were missed
  • essential medication not collected
  • continence products not collected
  • weight loss
  • dropping out of services after concerns were
    raised
  • various explanations were given but not followed
    up when he still failed to attend care services

17
high risk signs
  • difficulties in gaining access
  • signs that a carer is struggling to cope
  • unexplained deterioration in physical health
  • reluctance to engage with services
  • carer is focus of contact and intervention
  • vulnerable adult lacks an independent voice
  • poor interagency communication
  • lack of assessments and regular reviews

18
if a vulnerable adult lacks an independent voice
we have to make sure we dont lose sight of them
in the process
19
Help and Advice
  • Adult Protection Team 01905 822613 / 01905
    822614 or adultprotectionduty_at_worcestershire.gov.u
    k
  • http//worcestershire.whub.org.uk/home/wcc-social-
    abuseormistreatment.htm
  • Access Centre 0845 607 2000
  • Domestic Abuse 24 hour helpline 0800 980 3331
  • Action On Elder Abuse helpline 0808 808 8141
  • Care Quality Commission 0121 600 5720
  • Health Safeguarding Leads
  • Vicky Preece (PCT) 01905 760072
  • Jane Smith (Acute) 01905 763333
  • Karen Rees (MHP) 01905 733771
  • Police 0300 333 3000 (including Domestic Violence
    Unit and Vulnerable Adults Detective Sergeant)

20
Second Review
Mrs B was living at home with her husband until
the age of 89 when she developed vascular
dementia. She went into hospital with a
fractured leg but did not receive rehab as she
had dementia, and instead went straight to a
nursing home. When her leg was better and she
became mobile, the nursing home found they could
not manage her dementia so she moved to a care
home over Christmas and died after wandering out
of the home overnight.
21
Key messages from the second review
  • Care planning needs to be proactive not crisis
    led
  • Physical health needs must be recognised as
    well as mental health needs in mental health
    care planning
  • The Mental Capacity Act must be followed and MCA
    assessments should be recorded
  • Carers Assessments must be offered and recorded
    for families
  • Dementia care must be person-centred
  • Recording systems should be integrated as far as
    possible

22
Assessing Mental Capacity
Kate Towse Deprivation of Liberty Safeguards
Team
With thanks to Lorraine Currie Shropshire
County Council
23
Meet Lou and Andy
  • Andy and his carer Lou live in Herby City.
    Lou selflessly dedicates his life to looking
    after Andy, who is a wheelchair user and Andy
    selfishly dedicates his life to making things as
    difficult as possible for Lou.

24
Can the Mental Capacity Act help Lou?
  • Andy wants to go on holiday to Helsinki
    despite previously having stated that
  • Finland had a maudlin quality to it and it
    was unsuitable as a holiday destination.

25
Lou looks back at some of Andy's past decisions
  • To specifically decide not to go to the toilet
    before getting in Lous van after 4 pints of beer
    then deciding he needed to as soon as he is in
    the van
  • To insist on a pet snake instead of a rabbit,
    once purchased declaring that he wants a rabbit
  • To buy a card with deepest sympathy for his
    brothers birthday
  • To choose to take books on Chinese history out of
    the library then declare that he cant read

26
Lou considers the 5 principles of the MCA
  • Presumption of capacity.
  • Unwise decisions.
  • Maximise capacity.
  • Least restrictive.
  • Best interests.

27
Lou assesses Andys capacity
  • To lack capacity a person must have
  • An impairment or disturbance that affects the way
    their mind or brain works,
  • Andy has a learning disability

28
Lou assesses Andys capacity
  • Lou explains about Helsinki, he shows Andy travel
    brochures and reminds him of past decisions he
    has made. He makes suggestions such as Florida as
    much better holiday destinations.
  • Lou assesses whether Andy can
  • Understand the information relevant to the
    decision.
  • Retain the information relevant to the decision.
  • Use, or weigh up the information relevant to the
    decision.
  • Communicate his decision.

29
Andys response remains the same
I wanna go to Helsinki
30
Conclusion
  • As the decision maker Lou concludes Andy has
    capacity to choose to go to Helsinki.
  • As the plane takes off Andy is heard to say..

I wanna go to Florida
31
Third Review
  • Mr A, a 50 year old man with a range of physical
    and mental health problems, he had been living
    with his 88 year old mother for nearly a year
    until just before his death. He had been known to
    the Domestic Violence Officer due to suspected
    verbal and physical abuse of his mother.
  • Mr As mother was admitted to hospital and,
    following a multi-agency adult protection meeting
    at this time, it was agreed that he would return
    to his own home before his mothers discharge
    from hospital, for her protection.
  • Mr A was visited by the local community mental
    health team, but became ill and missed a number
    of appointments
  • . Neighbours became concerned and his body was
    discovered at home by the police having been
    there at least five weeks.

32
Key messages from the third review
  • WSAB should provide guidance to staff on
    facilitating family involvement
  • Family members and carers should be clearly
    identified and recorded as part of a standard
    mental health care plan and offered a carers
    assessment
  • Clarity about who should record on the County
    Councils framework-i system should be given
  • A flagging system for adults at risk should be
    considered to be used across agencies

33
Think Family
  • Rachel Fowler

34
How well are we supporting carers?
  • Studies have found that a significant proportion
    of carers face
  • physical and mental health problems that include
    stress and
  • tension, anxiety, depression, disturbed sleep,
    back injuries
  • and hypertension.
  • Nearly half (48) indicated that professionals do
    not spend
  • sufficient time listening to the views of carers
    and 41 do not
  • know where to go to get more help

35
What works well?
  • Carers who receive timely information, are in
    contact with
  • professionals, feel involved, valued and
    respected and have
  • their own needs assessed and met, experience
    fewer and less
  • severe adverse effects to their own mental and
    physical
  • health, family relationships, finances and
    careers and have
  • more time for their own leisure pursuits.
    (Pinfold Corry
  • 2003)

36
Why the concern?
  • The demands of caring
  • Guilt and Resentment
  • Stress
  • Depression
  • Isolation

37
The National Carers Strategy
  • The principles and vision in the strategy.
  • By 2018
  • Carers will be treated with dignity and respect
    as expert care partners
  • Will have access to the services they need to
    support them in their caring role
  • Carers will be able to have a life of their own

38
Summary
  • Right to an assessment carers who provide
    regular and substantial care are entitled to a
    carers assessment, which will look at their
    needs as a carer
  • Carers can also receive services in their own
    right under the Carers and Disabled Children Act
    2000

39
Key Message
  • A carers assessment is not a process for its own
    sake. It should be as simple or as complex as it
    needs to be to deliver an outcome that makes it
    easier for the carer to care and to fulfil some
    of their own needs.
  • It must focus on the outcomes for carers that
    will support them in their caring role and
    maintain their own health and well-being
  • Carers assessments are not just about what is
    available at the end. The process of going
    through the assessment can be a tremendous
    support in its own right.

40
What Support is Available for Worcestershire's
Carers?
41
Information
  • Telephone Helpline
  • (0800 652 3151 or 01905 26500)
  • Information Handbook
  • for Carers
  • Events
  • Newsletter

42
  • GP Registration Card
  • Working with GP
  • practices

43
Carer Groups
44
Advocacy
Onside Advocacy 01905 27525
45
Money and Benefits
  • Benefits Helpline for
  • disabled people and
  • carers on 0800 882200
  • Other local benefits
  • advice agencies.
  • Legal and Financial
  • Training

46
Practical Sessions for Carers Contact Carers
Unit on 0800 389 2896  
47
Carer Assessment Social Care Access Centre
0845 607 2000
48
Carers Back Me Up Service
49
Good News!
  • Worcestershire has a new carers strategy
  • Worcestershire has a dedicated team for carers
  • Worcestershire has some of the most forward
    thinking schemes to support carers
  • New carers e-bulletin for staff
  • New counselling service
  • New flexible breaks service
  • New information advice and support service

50
0800 389 2896
01527 66177
0800 652 3151 or 01905 26500
51
Action Planning
Facilitated Group Work
52
SCR Recommendations
  • There must be an emphasis on prevention as well
    as responses
  • The focus of any intervention must be the
    vulnerable adult
  • There must be clear communication between
    agencies
  • There must be a minimum of an annual review of
    the persons services
  • Carers assessments must be offered for carers of
    vulnerable adults
  • Concerns from third parties should be followed up
  • Actions and contact must be recorded along with
    rationale for decisions
  • The vulnerable adult must be seen in person
  • Where a vulnerable adult is living with family
    they should be assessed in their home environment
  • Managers should ensure that staff working with
    adult protection cases have adequate support and
    supervision
  • Where a vulnerable adult has dropped out of
    services
  • this must be followed up as a matter of
    urgency
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