1. health and fitness

Clinical Commissioning Group (CCG) Governing Body
Date of Meeting:
Agenda Item:
Subject:
Reporting Officer:
Aim of Paper:
15 November 2013
Paper 16b
Safeguarding Children and Adults Annual Report 2012/13
Hazel Chamberlain, Designated Nurse, Safeguarding
The annual report is to update and inform the Governing Body of health
safeguarding of PCT safeguarding performance for children and adults
for the 2012/13 period.
Governance
CCG Governing Body
Audit Committee
Clinical Commissioning Committee
Finance, Performance and Risk Committee
Quality and Safety Committee
Remuneration Committee
Locality Engagement Group
Health and Wellbeing Board
Other
Meeting Date
Objective/Outcome
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11 October 2013
Approved
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The report will be shared with Rochdale
Borough Children’s Safeguarding Board and
Rochdale Borough Adult’s Safeguarding Board
Governing Body Resolution Required:
For Discussion
Recommendation The Governing Body consider and note the content of the report
Link to Strategic Objectives
Contributes to:
(Select Yes or No)
Improve health and wellbeing and reduce local health inequalities.
Commission high quality, safe, personalised, effective and continuously
improving services.
Embed meaningful engagement with patients, and member practices
Build an effective and innovative commissioning infrastructure.
Be a high performing CCG and use our available resources innovatively.
Develop the CCG to display the CCG values and behaviours.
Yes
Yes
Yes
Yes
Yes
Yes
Risk Level: (To be reviewed in line with Risk Policy)
Amber
Comments
Further work needs to be completed in the 2013/14 period to ensure that
(Document should detail
the CCG can demonstrate that it is fulfilling its statutory duty to safeguard
how the risk will be
the population of the Borough and meet its safeguarding functions as
mitigated)
defined by the Safeguarding Accountability Framework (March 2013).
Content Approval/Sign Off:
The contents of this paper have been
reviewed and approved by:
Financial content signed off by:
Susan Savage
N/A
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
1
Clinical Engagement taken place
Patient and Public Involvement
Patient Data Impact Assessment
Equality Analysis / Human Rights Assessment completed
Completed:
No
No
No
No
Executive Summary
This is the first safeguarding annual report to be submitted to the NHS HMR CCG. It reports on
the safeguarding activity undertaken in the 2012/13 financial year when responsibility for the
function was undertaken by the NHS HMR Primary Care Trust. Many of these safeguarding
functions have been transferred to Clinical Commissioning Groups (NHS Commissioning Board
2013)
Recognition of the need to safeguard vulnerable groups and integration of multi-agency
safeguarding procedures was a core component of the commissioning role of PCTs. This
continued after 2013 with the same duties and responsibilities being required to be undertaken
by Clinical Commissioning Groups. There is a statutory duty for health organisations to ensure
that delivery of health services pays due regard to safeguarding children and child protection.
For commissioners there is requirement that safeguarding children and child protection is
incorporated into health provider contracts and that assurance is sought to ensure that health
activity within provider organisations reflect that such recognition and response of safeguarding
is occurring. Whilst it is not a statutory duty to receive such assurance with respect to adult
safeguarding the Department of Health published guidance for commissioners for their role in
March 2011. Commissioners of health services must give due regard to safeguarding in all
contracts which are commissioned by them. Consideration to make the safeguarding of
vulnerable adults a statutory function continues and this will be a further consideration when the
review of the Health and Social Care Bill goes to Parliament in November 2013.
Nonetheless NHS HMR is a key partner in the commissioning of effective health services to
vulnerable adults and children within the borough and it is already evident through current
partnership arrangements, that there is a commitment within the organisation to ensure that the
duty to meet healthcare needs of vulnerable people are met and monitored and that
arrangements are reflected within commissioning arrangements and monitored through an
effective assurance framework. This includes seeking assurance from health providers. From
April 2013 this function has been transferred to the Clinical Commissioning Group, to Primary
Care Commissioning and NHS England function. The CCG, however, will be responsible for
raising safeguarding concerns to these bodies and will continue to ensure that the health
services which are directly commissioned by the CCG are meeting their safeguarding
responsibilities.
The responsibility to ensure that designated professionals are employed within all local authority
areas will continue to be the responsibility of CCGs. These professionals’ core function is to
offer advice and support on safeguarding issues to all members of the CCG and to ensure that
safeguarding health needs are met for the population which the local authority serves. In
addition from April 2013 Clinical Commissioning Groups are responsible for ensuring that there
are effective health services commissioned and provided within each local authority to children
living within the conurbation who are looked after by the local authority. The statutory
safeguarding guidance, for health services, Safeguarding Vulnerable People in the Reformed
the NHS, Accountability and Assurance Framework was published in March 2013. However, an
interim version of this framework was published in October 2012. The purpose of the latter
document was to assist proposed CCGs to have clarity on what safeguarding accountability
would be afforded to CCGs and the safeguarding structures which would be expected within the
new organisations.
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
2
Safeguarding Children and Adults Annual Report 2012/13
1. Purpose of the report
1.1. To Update the Clinical Commissioning Group (CCG) Governing Body on PCT safeguarding
performance for children and adults for the 2012/13 period
1.2. To provide the safeguarding work plan for health commissioners for the NHS HMR CCG for
the 2013/14 period.
2. Introduction
2.1. Introduction
This is the first safeguarding annual report to be presented to the Clinical Commissioning Group.
The report contains both the adult and children health safeguarding activity which has occurred
within Heywood, Middleton and Rochdale in the 2012/13 period and contains the safeguarding
work plan for the 2013/14 period. This includes the arrangements which are required for
consideration by the CCG Governing Body to ensure that the safeguarding arrangements are fit for
purpose. To a great extent the focus of work in the 2012/13 period was to ensure that transitional
arrangements for health commissioning from Primary Care Trusts to the new organisations of
Clinical Governance Groups met the expected arrangements for CCG and ensured that gaps to
safeguarding service provision were identified to ensure there was no compromise of service
delivery.
3. Report
3.1. Safeguarding Transitional Arrangements
A core component of the clinical commissioning groups’ authorisation process in the 2012/13
period was the need to ensure that clinical commissioning groups (CCG) had arrangements in
place so that the safeguarding and protection of people function could be met. Guidance from the
NHS Commissioning Board (Now NHS England), issued in October 2012, placed clear
responsibility on clinical commissioning groups to be accountable for the commissioning of local
health services to the population which made due regard to safeguarding and protection of
vulnerable people of all ages. It was therefore, necessary for CCGs to ensure that there were clear
arrangements within the CCG to ensure that this requirement could be met. In addition, appropriate
skills were required to be held by key strategic leads within the CCG to be able to interpret the
local and national safeguarding agenda for health services so that safeguarding was embedded
into all functions of the CCG.
3.2. Clinical Commissioning Group Safeguarding Governance Structures
As part of the clinical commissioning group authorisation process groups were asked to provide
reviewers with proposed safeguarding governance arrangements. The purpose was to illustrate
how the CCG would be able to ensure that the safeguarding of vulnerable groups would be
embedded into the commissioning of local health services and that there was facility to
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
3
subsequently monitor quality of safeguarding provision. This included a need to identify board level
arrangements and accountability for safeguarding both across the health economy and partnership
arrangements. (Please see Appendix 1). Governing Body members who were identified as
undertaking safeguarding roles undertook additional safeguarding workshops to assist them in
undertaking this role. Key members of the Governing Body were identified to ensure that
safeguarding duties of the CCG are carried out. There is also clear representation by Governing
Body members at both the Rochdale Borough Safeguarding Children’s Board and the Rochdale
Borough Safeguarding Adults Board. Job descriptions of the members were revised to incorporate
the new responsibilities for safeguarding.
The roles of the designated health professionals for safeguarding children are statutory roles for
services who commission health care. The post holders are required to offer safeguarding advice
and support to commissioners of health services for children across local authority areas and to
offer supervision to safeguarding professionals who work in provider areas. Designated
professionals are responsible for ensuring that safeguarding children and child protection is
incorporated into health services across the health economy for local areas.
Whilst there is no corresponding statutory requirement for the same level of expertise to be
provided to CCG governing bodies for adult safeguarding services, the interim accountability
framework issued by the Department of Health in October 2012 (Safeguarding Vulnerable People
in the Reformed the NHS, Accountability and Assurance Framework) requires CCGs to ensure that
such provision is available. During the 2012/13 period significant work was undertaken by the
designated professionals for safeguarding across the Greater Manchester area to scope the level
of need for a corresponding role for vulnerable adults and to identify any gaps in service. This
identified that there was a clear need for clinical expertise, mirroring the designated professional
role for children and young people.
The structure for ensuring that safeguarding adults and child protection advice was reviewed by
NHS HMR PCT and a named nurse for adult safeguarding was appointed in March 2013. Funding
was also secured for administration support to the Safeguarding Team. Work needs to continue in
the 2013/14 period to ensure that the structures in place are appropriate to ensure that the CCG is
able to be supported to carry out its safeguarding function.
3.3. Ofsted Safeguarding Children and Young People Inspection – November 2012
In November 2012 Ofsted undertook an unannounced inspection of services to safeguard children
and young people within the Rochdale Borough. This is a multi-agency inspection of safeguarding
services to children and families although the lead for service is the Local Authority. The
inspection focused on three key themes these being quality of safeguarding practice offered to
children and families, effectiveness of help to families and leadership and governance. The overall
rating from the inspection was inadequate and the local authority and its partners were required to
make improvements.
For health services a key theme emerged namely the need to lead on and implement early
interventions with families so that the risk of escalation to child protection for families was reduced.
This included engagement of commissioned universal health services to assess levels of additional
needs through the use of assessment tools such as the Common Assessment Framework (CAF)
A Multi Agency Improvement Board has been instigated, with membership of the strategic leads
from organisations to ensure that the actions required by Ofsted to improve safeguarding services
for children and families within the borough are implemented in a timely and sustainable manner.
The work required by health services has been addressed by a health sub group of the
Improvement Board in which measures required to be taken by health services are implemented
and monitored.
Ofsted intend to undertake further review of services in the latter part of 2013 and further updates
will be available to the Governing body after this time.
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
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3.4. Child Sexual Exploitation
In May 2012 nine men were convicted for the sexual exploitation of children and young people
within the Rochdale Borough. There was widespread media coverage as result of this case and
further potential criminal investigations are on-going. A serious case review was published in
November 2012. As a result of the publication and further national work from the Children’s
Commissioner (November 2012) a further two serious case reviews were commissioned by the
Rochdale Borough Safeguarding Children’s Board. To date these are on-going. The following
measures are in place, however, to ensure that child sexual exploitation is addressed within the
borough.




The convening of a Child Sexual Exploitation Strategic Group – this is a sub group of the
RBSCB
The development of the SUNRISE Team
Multi agency training for child sexual exploitation
Revision of safeguarding policies
During the 2013/14 period further work will be undertaken after lessons learnt from the review are
identified.
3.5. SUNRISE Team
As part of preliminary lessons learnt from serious case review, criminal proceedings into the
management of coordination of services for young people who have been sexually exploited the
SUNRISE project was initiated in 2008. This initially consisted of seconded experienced
practitioners from multi agency teams working together to ensure that there was appropriate
response to young people who may be sexually exploited. The impact of the work of the team
brought about the successful prosecution of perpetrators by 2012. By this time, however, review of
operational management of the team identified the need for such a provision to have clear
identified funding and for practitioners within the team to have clear strategic leadership.
During the 2012/13 year Pennine Care Foundation NHS Trust were commissioned by the PCT to
the sum of £66,000 to provide a senior health worker within the SUNRISE Team. The role of the
post holder is to ensure that health care required by the young person and his/her family is
coordinated across the commissioned health providers and that practitioners from other agencies
understand the need for robust health assessments of vulnerable young people and their families.
The PCT through the children’s commissioner, developed performance monitoring of the team
through an agreed multi agency service specification.
During the 2013/14 period there is a continuing need to ensure that the impact of the health worker
role within the SUNRISE Team is monitored. It is intended that the work of the team will be
monitored through the Child Sexual Exploitation Strategic Group- a sub group of the Rochdale
Borough Safeguarding Children’s Board.
3.6. Looked After Children
The Children Act 1989 makes clear that there is a statutory duty for health agencies to ensure that
they work in partnership with local authorities so that the health needs and health monitoring of
looked after children is not compromised.
Delays in carrying out medical assessments of children who were looked after within the borough,
who had been placed from external local authorities led to decommissioning of the service
provision from the commissioned provider during September 2012. From April 2013 this service
will be provided by the Pennine Care Foundation Trust. Further monitoring will be required during
the 2013/14 period to ensure that the health needs for looked after children are met. This work is
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
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being undertaken by the Designated Nurse Safeguarding in conjunction with the Designated
Nurse, LAC.
In addition a finding of the serious case review for child sexual exploitation undertaken in 2012
identified the significantly higher numbers of children living within the Rochdale Borough who were
accommodated by external local authorities. There was no clear evidence held by agencies that
the Rochdale Local Authority was consistently being notified when a child from an external local
authority was accommodated within the borough. This was despite this being a requirement under
the Children Act 1989. The significantly higher figures of children placed within the borough put
significant pressure on the Looked After Children Health Service to provide an effective healthcare
to children and young people. The PCT took action increasing funding for the LAC nursing service.
The service continues to be provided by Pennine Care NHS Foundation Trust.
Since March 2013 the Safeguarding Accountability Framework (NHS England 2013) places
accountability for ensuring that health service provision for children and young people who are
looked after by the Local Authority with the CCG. Whilst this service will continue to be provided by
the Pennine Care NHS Foundation Trust, there have been revised management arrangements to
ensure that there is access to data for looked after children and that the team have clear
supervision arrangements.
3.7. Safeguarding arrangements for local GP Practices
From April 2013 there is the requirement for GP practices to be registered and subsequently
regulated by the Care Quality Commission. As part of the process for regulation there is a
requirement to demonstrate that due regard is made by the practice to the safeguarding of both
vulnerable children and vulnerable adults. This includes being able to provide evidence of the
availability of safeguarding policies to support staff in the expected response to abuse of a patient.
Availability of training must also be evident.
During the latter part of 2012 the Safeguarding Team of NHS HMR PCT offered level 1
safeguarding training to all practices within the borough and included training in adult safeguarding.
The focus of the training was for practice staff excluding GPs.
From April 2013 the monitoring of safeguarding practice of GPs will be within the remit of the Local
Area Team NHS England. There is to date no clear arrangement as to how this function will be
carried out and the Greater Manchester Designated professionals have given commitment to
ensure that GPs and practices within their localities continue to be supported to carry out their
safeguarding function until more substantive arrangements have been made.
3.8. Children and Adult Serious Case reviews, Domestic Homicide Reviews
Under Chapter 8 of HM Government’s guidance Working Together to Safeguard Children (2010:
revised version March 2013) there is a requirement for the Local Safeguarding Children’s Board to
undertake a serious case review if a child dies in suspicious circumstances or if there is serious
injury to a child and child abuse may be implicated. During the 2012/13 year there were a total of
seven serious case reviews which were commissioned by the Rochdale Borough Safeguarding
Children’s Board. This is significantly higher than the national average and with statistical
neighbouring boroughs. Three reports commissioned were as a result of child sexual exploitation
identified within the borough. At the end of March 2013 the following serious case reviews were ongoing:

Children QR – this case was initially commissioned in February 2012. Due to the
complexity of the review and the significant timeline for review the review was still in
progress by end of March 2013. In February 2013, due to on-going court proceedings, it
was identified that the case no longer complied with the criteria for serious case review.
However, given that the case was almost complete decision was made by the Board that
although publication would no longer be required, the lessons learnt from the review were
still worthy of implementation within the Borough
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
6

Adults ABC – this case was initially commissioned in April 2012. The case was one of
historical familial sexual abuse. Although the abuse had occurred during childhood,
disclosure and subsequent prosecution of the perpetrator occurred whilst the victims were
adults. The prosecution was completed in February 2013. The Serious Case Review is still
on-going.

CSE SCR – In February 2012, as a result of Operation Span and the subsequent
prosecution of local men in Rochdale for child sexual exploitation, decision was made for a
serious case review to be carried out. A significant number of young people were initially
screened by the SCR Screening Panel – a sub group of the Rochdale Borough
Safeguarding Children’s Board. Decision was made to focus on the journey of one young
person who received services from a significant number of agencies to gather learning. The
report was published in September 2012. The Government subsequently asked for further
serious case reviews to be initiated by the Children’s Safeguarding Board although the
findings of this review were used as a basis for the learning of subsequent reviews.

Young People 1-6 – Subsequent to the CSE prosecution further screening of young
people were undertaken by the Serious Case Review Screening Panel. Key themes for
further investigation were identified and decision was made to undertake a further review of
six young people in November 2012. Although some of the young people were related their
cases were in parallel to each other and the report has proved to be complex. At the end of
March 2013 the report was still in progress.

YP7- An additional case of child sexual exploitation was identified in January 2013. This
case was also on-going in March 2013. Given some similar themes identified from this
review it is envisaged that both the review of this case and that of YP1-6 will be submitted
for publication at the same time.

Child G - This serious case review was commissioned by the Children’s Safeguarding
Board in January 2013 following the death of a young person who had been subject to child
protection plan. This review is currently on-going.

Baby F – In January 2013 a further serious case review was commissioned after the death
of a baby with injuries related to being shaken. This review was in the early stages of
review at the end of March 2013.

Lessons Learnt Review – JB – this case was a review after the death of a vulnerable
adult from a chronic illness. It was presented to the Rochdale Borough Adults’
Safeguarding Board in June 2012. The case raised learning about the assessment of
mental capacity of vulnerable people by GPs and others. The learning from this review has
been incorporated into the learning events for adult safeguarding which have been
delivered to GP practices across the borough.
3.8.1. Domestic Homicide Reviews
Since March 2011 it has become a statutory duty of agencies, led by the Police and commissioned
by the Community Safety Partnership, to ensure that deaths which have occurred as a result of
domestic violence are subject to multi agency review.
In March 2012 Rochdale Borough undertook its first Domestic Homicide Review. The subject of the
review was a man who was murdered by his partner in August 2011. For health staff issues raised
have been the need to share information between professionals and GPs have recognised the
need for adult safeguarding training to be part of their mandatory training programme. This has
now been included within the GP training programmes and will be developed further during the
2013/14 financial year.
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
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A further review was undertaken in May 2012 following the death of a woman killed by her partner.
The perpetrator was prosecuted and is serving a custodial sentence. The report highlighted similar
lessons learnt to that of the first review undertaken.
3.8.2. Health Action Plans
Action plans which result from serious case reviews and other safeguarding learning events are
monitored through the Safeguarding Boards and through the Community Safety Partnership in the
case of domestic homicide reviews. The Safeguarding Team of the CCG ensure that such learning
is embedded into contract monitoring of commissioned health providers.
The CCG Safeguarding Team have sought assurance from commissioned health providers that
action plans from outstanding reviews have been implemented and that there is an on-going audit
process to ensure that lessons learnt are embedded into clinical practice of health staff. Learning
from single agencies will form part of the monitoring of health provider safeguarding practice during
2013/14
3.8.3. Information sharing
A common theme in collection of patient information data from all reports has been the difficulties
of securing information and having access to case notes. Often the review process requires
information held by practitioners caring for the subject(s) of the review but also of wider family
members. This raises issues, especially in cases of adult serious case reviews of sharing
information being balanced with the risk of breaching confidentiality. Revised Caldicott guidance is
awaited to ensure that there are agreed systems in place for agencies to share information about
vulnerable adults which is legal and justified.
3.9. Policies and Procedures
The NHS HMR safeguarding policy for commissioners was reviewed and ratified at the October
2012 Quality Committee. Further review will occur in the 2013/14 year to incorporate any further
safeguarding guidance to be developed. As part of the CCG authorisation process in 2012
harmonisation of CCG safeguarding policies occurred.
There has been agreement from The Greater Manchester Safeguarding Children Partnership to
adopt a regional set of safeguarding documents for safeguarding and protection of children across
the region. These have been developed from an organisation known as Tri.X. These are likely to
be launched in July 2013. The intent is to ensure that there is a collaborative approach to
safeguarding policy across the region. Each local authority has been requested to ensure that
practice identified within such procedures reflects local need and are adopted as such.
At the present time, however, there is no move to adopt this process to adult safeguarding. There
is on-going work as part of the operational planning sub group of the RBSAB that all multi agency
policies and procedures are reviewed and that single agency policies complement the overarching
documents.
3.10. Safeguarding Training
There is a clear training strategy for children’s safeguarding and child protection training in place
for health commissioners and providers. This is through the publication of the Intercollegiate
document (October 2010) in which the skills and knowledge expected of all practitioners within the
health services, is clearly demonstrated. Health providers have adopted this approach to the
management of a tiered approach to safeguarding training
These are as follows:
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
8
•
Level 1 – all employees of health organisation - training to be received at induction and
then annually as part of mandatory training programme (annually)
•
Level 2 – frontline practitioners who have infrequent contact with children and families but
who may be assessing needs of adults who are also parents. (annually)
•
Level 3 - frontline practitioners who have frequent face to face contact with children and
young people (up to the age of 18 years) ( 3 yearly with annual updates)
•
Level 4 – Named professionals for safeguarding children (five days over 3 year period)
•
Level 5 – Designated professionals (five days over 3 year period)
•
Level 6 - Medical Experts for child protection
A regional safeguarding children and adults training strategy has been devised by the Designated
Nurses to ensure that training content and access to training is streamlined across the region. This
was part of a suite of safeguarding documents presented during the CCG authorisation process.
Further work will be undertaken with the training strategy in 2013/14 period.
Health providers are asked to apportion the number of staff working within their organisations who
require each level of training and to report compliance within this framework. The Care Quality
Commission requests compliance rates for the measurement of health safeguarding training using
the above model.
A similar framework is not currently available for training in adult safeguarding. Despite this most
health providers have been proactive in ensuring employees have some access to training with
some organisations using the same model as that which has been implemented in children’s health
services. Furthermore, as part of the CQC regulations for registration, (Outcome 7) providers are
requested to demonstrate that processes are in place to ensure that staff can recognise and
respond to adult safeguarding. There is also a requirement that staff have received training in the
use of the Mental Capacity Act in their assessments as well as making application for Deprivation
of Liberty Safeguards. Training in response to Domestic Abuse is also required.
NHS HMR, as commissioner achieved 96% compliance with safeguarding children and adult
training level one in the 2012/13 year. This was delivered as an e learning packages in September
2012.
In addition further safeguarding workshops were held with the PCT Board to ensure that there was
understanding of the safeguarding accountability which would be held by the CCG to ensure that
they would be prepared to meet their safeguarding duties as commissioners of health care.
In December 2012 the designated professionals for safeguarding for NHS Bury and NHS HMR
delivered an adult safeguarding event for GPs working within the two boroughs. A further event
was delivered for GPs for the Mental Capacity Act in March 2013. Further sessions were held
locally at practices for adult safeguarding.
In addition safeguarding and child protection training for practice managers, practice nurses and
other frontline staff within the surgery were held across the borough at surgeries. It has been
agreed that safeguarding children training will continue to be offered by the designated
professionals for safeguarding to practices in the 2013/14 year.
In June 2012 the Lead GP for safeguarding children, commissioned by the GP resigned from this
role. This role is currently being provided by a consultant paediatrician working in Pennine Care
NHS Foundation Trust. Level 3 training for GPs has continued to be offered. From April 2013 the
responsibility to provide safeguarding training and to monitor GPs’ compliance with safeguarding
procedures will be the responsibility of the Greater Manchester Local Area Team of NHS England.
However, until there is clarity of service provision, designated professionals for safeguarding have
agreed to ensure that GP services have access to help and support.
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
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3.11. Winterbourne Review
In May 2011 a BBC Panorama programme exposed institutional abuse at a Winterbourne Hospital
for adults with learning disability at Bristol. Castlebeck Health Care was the commissioned provider
of this service and the company operated similar services nationally. A government review of the
care provided to patients at all the Castlebeck facilities was undertaken and was published in
December 2012. The review highlighted issues about multi agency working to protect vulnerable
adults and the lack of coordination of monitoring of care of vulnerable people.
NHS HMR undertook review of all services users who had been accommodated by the PCT either
through Continuing Healthcare or specialist commissioning. This was undertaken whether or not
the commissioned provider was Castlebeck. Some of the reviews for service users who had been
placed in facilities were undertaken by an independent company.
In 2013/14 there is a need for a Winterbourne multi-agency action plan of lessons learnt, led by
Adult Care Services. This will be monitored jointly by the Named Nurse Safeguarding, the Head of
Quality and Safety and the Associate Director for Continuing Healthcare in conjunction with the
Head of Safeguarding at Rochdale Borough Adult Care Services
4. Assessment of Risk
Further work needs to be completed in the 2013/14 period to ensure that the CCG can
demonstrate that it is fulfilling its statutory duty to safeguard the population of the Borough and
meet its safeguarding functions as defined by the Safeguarding Accountability Framework (March
2013).
5. Recommendation
The Clinical Commissioning Group is asked to note the content of the document and to maintain its
continuing support.
6. Next steps
Please see Appendix 2 work plan
Reporting Officer:
Susan Savage/Paul Laker/Hazel Chamberlain/Rob Rifkin
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated
Nurse Safeguarding
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Diagram1: NHS HMR CCG Safeguarding Management Structure
Chief Officer of Governing
Body
Greater Manchester LAT NHS
England
Executive Nurse/Director of
Quality and Safety
Safeguarding Team
•Designated Doctor
•Designated Nurse (8b)
•Adult Safeguarding Nurse (8a)
•Admin Support (4)
GP Governing Body Lead
LAC Team – Provider: PCNHSFT
•Designated Nurse (7)
•Admin Support (4)
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated Nurse Safeguarding
11
Diagram 2: Safeguarding Governance Arrangements
Greater Manchester LAT
(NHS England)
NHS England
NHS HMR (CCG) –Governing Body
Chief Officer
Executive Board Nurse
GP Lead
Rochdale Borough Safeguarding
Children’s Strategic Board CCG
representation
GP Safeguarding Lead (Adults and Children)
Chief Officer
Executive Board Nurse
Working Sub groups of Children’s
Board
Rochdale Borough Adult
Safeguarding Board (CCG
representation)
Rochdale
Borough
looked After
Children
(Pennine Care
Provider
Services
Designated Doctor
(Children) x 3Pas
Designated Nurse
(Children and Adults)
Named Nurse Adult
NHS HMR Quality Monitoring Group Advisory
Group (Chaired by Executive Nurse)
Assurance from Health providers
CCG representation by Designated Nurse and
Doctor
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated Nurse Safeguarding
 Vice Chair: Safeguarding Lead
(Adults and Children)
Working subgroups of Adult
Board CCG representation:

Safeguarding assurance from
commissioned providers:




12
Named Nurse Adults
Pennine Acute Hospitals NHS Trust
Pennine Care NHS Foundation Trust
Nursing Homes
Independent Contractors inc GP services
Appendix 2
No
Action
NHS HMR CCG Safeguarding Work Plan 2013/14
Outcome
Lead
Timescale
Designated Professionals and
key safeguarding leads of the
Governing Body
March 2014
Children and young people and families have access to services
which meet their health and development needs
Chief Officer
Lead GP Governing Body
Designated professionals
March 2014
and on-going
There is readiness for unannounced inspection by health
commissioners and providers across the Rochdale Borough
Designated professionals in
conjunction with key leads in
health and multi-agency
teams
November
2014
There is an effective response to the recognition and response
to the prevention and management of CSE
Designated professionals
There is effective measures in place for commissioning and
monitoring of sexual health services for vulnerable young people
Public Health coordinator and
Designated Nurse
December
2013 and
on-going
November
2013 and
on-going
Concerns about children and young people who are at risk of
Quality Lead/Designated
3.2. Safeguarding Assurance/Governance Structures
3.2.1.
Work needs to continue in the 2013/14 period There are clear safeguarding structures in place which take
to ensure that the structures in place are
account of revisions of key government safeguarding guidance
appropriate to ensure that the CCG is able to
be supported to carry out its safeguarding
function.
3.3.
3.3.1
3.3.2
3.3.3.
3.3.4
3.4
3.4.1
3.4.2.
3.4.3.
Safeguarding Improvement Plan
Ensure that the CCG supports and is a
significant multi agency partner in the
implementation of the Single Improvement
Plan for Rochdale Borough
Support local commissioned health providers
in the development of a multi- agency
approach to service provision for children and
young people
Ensure that the early help model is
incorporated into the safeguarding quality
monitoring of locally commissioned health
providers
Ensure that there is an on-going programme
of health services to ensure readiness for
safeguarding inspection from Ofsted and
CQC
Child Sexual Exploitation
Ensure health contribution is effective to meet
the actions of the multi-agency CSE Strategy
for the borough
In conjunction with public health colleagues
ensure that service specifications and
contracts of sexual health services make due
regard to the recognition of and response to
vulnerable children and young people.
Ensure that quality monitoring of safeguarding
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated Nurse Safeguarding
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On-going
includes the recognition and response by all
commissioned health providers to child sexual
exploitation
3.5.
3.5.1.
SUNRISE Team
In conjunction with the Associate Director for
Joint Commissioner for Children ensure that
the impact of the health worker role within the
SUNRISE Team is monitored through the
CSE sub group of the Children’s
Safeguarding Board
3.6.
3.6.1
Looked After Children and Young People
Ensure that there is effective safeguarding
supervision of the LAC Nurse by the
Designated Nurse Safeguarding
Ensure that health needs of children and
young people who are Looked after are met
3.6.2.
child sexual exploitation are recognised and prompt response is
made by health staff
Nurse
There are measures in place to monitor the effectiveness of the
SUNRISE Team and the impact on children and young people
Director of Joint
Commissioning
Children/Designated Nurse
Safeguarding
On-going
There is effective practice of the LAC nursing team which results
in improved outcomes for LAC and young people
Designated Nurse
Safeguarding in conjunction
with key lead from PCFT
On-going
Designated Professionals
Safeguarding
On-going
Designated professionals
safeguarding in conjunction
with key commissioning leads
March 2014
and on-going
Designated professionals
safeguarding and lead GPs
March 2014
Designated Professionals
Safeguarding
September
2013
3.7
3.7.1
Safeguarding Arrangements for Local GP Practices
Continue to offer safeguarding support and
There is increased awareness of GPs in the recognition and
advice to GP Practices until clarity of
response to safeguarding of children, young people and
arrangements are made with NHS England
vulnerable adults
Local Area Team
3.8.
3.8.1.
Serious Case Reviews/Domestic Homicide Reviews/Adult Serious Case reviews
Continue to ensure that there is engagement
There is clear evidence and review of health practice which
by the CCG in SCR process as set out by the
indicate that lessons are learnt from serious case reviews are
Children and Adult Safeguarding Boards and
implemented and embedded into clinical practice
the Community Safety Partnership
Ensure that CCG/GP action plans from
Serious Case reviews are implemented with
measures taken to audit impact on
safeguarding practice.
Ensure that there are clear safeguarding
There is availability of information from GP services which
information sharing protocols for GP practices assists in the development of improved safeguarding services
for families living within the Rochdale Borough
3.8.2.
3.8.3.
3.9.
3.9.1
Policies and Procedures
Ensure that CCG Safeguarding Policies are
reviewed
There is availability of clear guidance for staff to respond
effectively to safeguarding concerns which may be raised
Safeguarding Annual Report 2012/13 Hazel Chamberlain, Designated Nurse Safeguarding
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3.10
3.10.1
Safeguarding Training
Ensure that all CCG employees have
completed Level 1 Safeguarding Training
CCG Staff are clear of their role in the recognition and response
to safeguarding concerns
CSU Training leads
December
2013
3.11.
3.11.1
Winterbourne Review
Ensure that the joint Winterbourne action plan
between Local Authority and CCG
Safeguarding is implemented and monitored
Ensure that lessons learnt are implemented and embedded into
clinical practice so that vulnerable adults are protected from
harm
Named Nurse Adult
Safeguarding
September
2013 and
on-going
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