Meeting documents

To receive the report.

The Health and Wellbeing Board & Integrated Care Partnership:

·       Received and consider the 2021/22 SSAB Annual Report

·       Continued to promote adult safeguarding across the County Council and in the services that are commissioned.

The Chair invited Keith Perkin, Independent Chair-Adults and Health Services, to present the annual report from the Somerset Safeguarding Adults Board (SSAB).  He noted that the SSAB is a statutory body with three statutory safeguarding partners; i.e., the local authority, the ICB and the Police.  He stressed that there is a misconception about the SSAB, with it thought to be a catch-all for all vulnerable adults, when in reality it focuses on the care and support needs of those who are experiencing, or are at risk of, abuse, neglect, or exploitation and cannot protect themselves.  The SSAB works closely with other boards such as the Children’s Board and the Community Safety Partnership, but its focus is on the cohort with those specific care and support needs.  The report notes that the SSAB’s role is to have oversight of safeguarding arrangements within the County, not to deliver services or be involved in the operations of individual organisations; and they are required to produce and publish an Annual Plan and Report each year.

Section 2.1 of the report relates to Improving Lives, priorities, and outcomes; Paragraph 2.1a offers some good news in that Somerset has seen a decline in the rate of safeguarding concerns, contrary to current national trends.  This has been made possible in part by the work done with Somerset Direct and much triaging, which has helped in signposting those people with concerns to the most appropriate person or group who can assist.  Also, the SSAB and their partners have worked hard on producing practice guidance for the website, particularly about what to do if a concern does not regard safeguarding; certain concerns may require care and support but are missing the elements of abuse, neglect or exploitation, so they will be signposted elsewhere.  Coming out of the Covid pandemic, the referrals are now more complex and take longer to resolve, so it is necessary to allow those specialist resources to prioritise and focus on those who need safeguarding.  In order to ensure that this decline in the rate of safeguarding concerns is genuine, the performance sub-group has set up a task and finish group to test the hypothesis that this is the result of the work that has been done, in order to ensure that nothing is being missed. 

Paragraph 2.1b of the report discusses the national trend toward neglect in people over 65, including self-neglect; there are many referrals regarding this, and reports reveal that it is the predominate category.  They will have a thematic board in 2023 pick up the learning from local and national reviews and to develop a strategy and plan for dealing with this problem. 

Paragraph 2.1c of the report relates to the work which Healthwatch led about a quality assurance framework and templates which the board has picked up; the performance subgroup is trying to get more information into the system and support the work.

Safeguarding Adults Reviews (SARs) – This is a statutory responsibility; there is a structure and criteria for reviewing the cases of those who have died or suffered severe neglect, and we feel that there could be improvements made within the partnership system where partners/agencies could have worked better together.  There is a safeguarding adult review group that analyses the referrals and then make a proposal as to whether a SAR should be commissioned; in this analysis, a spike in SAR referrals since Covid was seen, for example, both nationally and in Somerset.  Reviews can be expensive, particularly if they involve full methodology with an independent lead reviewer; there are alternatives, such as a one-day learning event or a local learning review.  Where there is a complex case with a number of agencies involved and new learning for the partnership/agency, they tend to utilise the full methodology approach.  This process involves a specialist carrying out an audit and analysis of the agency and chronologies of their service to the person in question, with the agency providing documentation; then the lead reviewer brings in practitioners who come together to discuss and make recommendations.  After this, a report is written by the lead reviewer, and most reports are published, excluding those where the individual in question is still alive, which will be signed off only by the executive.

A case study about a SAR for someone named Matthew was discussed; Matthew died from pneumonia and COPD after substance abuse, obesity and self-neglect despite a number of agencies trying to help him.  The review identified several missed opportunities, whether they contributed to his death or not, that could be learned from; these related to community hospital admission and monitoring of the safeguarding and response on an ongoing basis, especially the allegations of financial abuse.  A principal theme around the case was Matthew’s mental capacity, as he refused help and advice, which made it very difficult for agencies to deal with.  Seven recommendations came out of the review for the SSAB, the SCC, ASC, the ICB and the Somerset FT. 

Finally, it was pointed out that the SSAB’s SARs link into the national system; in January there will be a meeting of regional chairs in the South West where they will discuss a review that is about to be published on exploitation.  They feel that there is a gap in the legislation regarding the protection of those adults who are being "cocooned", so the review will be brought to the Home Office in an attempt to enhance the support for those suffering from exploitation.

The Chair invited the Board to discuss and ask questions.  Lou Woolway, Deputy Director of Public Health, said that if the Board could put in place the correct structure and governance, they could then pull together all of the reviews being done regarding domestic homicide, non-accidental injury, and others in order to make the most of the similar themes emerging.  Keith Perkin agreed with this point and noted that 12 months ago the ICB (formerly the CCG) appointed a lead quality improvement role who will bring together these reviews.  They have often had joint reviews with the Community Safety Partnership, as they have members in common, so learning has been across a piece of work rather than in separate entities.

Prof Trudi Grant, Director of Public Health, agreed with Lou Woolway’s comment and requested that there be a section in the report going forward that gives a combined view of all the many different death reviews.

Cllr Trimnell questioned whether there was a contradiction in the report regarding Paragraph 2.1a, which has seen a decline in the rate of safeguarding concerns, and another part of the report stating that Somerset has seen a rise in SAR referrals.  Keith Perkin responded that there are two separate processes; Section 2.8 reflects a decline in concerns, but with respect to SAR referrals specifically, the increase in referrals may be due to increased awareness of the issues on the part of agencies.  Also, sometimes there are referral which could regard single agency concerns, but there will not be a SAR undertaken. 

Cllr Trimnell also asked about self-neglect, noting that sometimes people refuse help and don’t help themselves, and wondering if there is a way of reporting it if someone becomes aware of potential self-neglect by another person.  In response, Mel Lock, Lead Commissioner for Adults and Health, made the important point that people may have the capacity and make the choice to live in different ways, so there is a real balance between choosing a certain lifestyle versus having a lack of capacity, and we must work with individuals and respect their choices.  We will work with those who do not have capacity, and also those who are considering changing.  We don’t always know about self-neglect behind closed doors, but if someone has a concern about someone else, they can ring Somerset Direct.

Katherine Nolan, SPARK Somerset CEO, stated that the situation in Somerset is very fortunate, as the voluntary sector is very vibrant and there are large organisations that are very well linked with adult social care.  However, there are some small, informal groups who aren’t yet aware of safety responsibilities, so SPARK is working to raise their awareness and support them as a DBS registered provider.  She wanted to make Board aware of this assistance in case they come across voluntary sector organisations that need help.  She is grateful to the SSAB for their work and support. 

Cllr Keen asked if, as part of the review, first-hand evidence could be taken from housing providers, both in the social and private sector, regarding early warning signs when there is a need for intervention regarding self-neglect, albeit while still respecting individual choice.  She also noted that many females over 65 a very vulnerable to exploitation.  Keith Perkin replied that there are good links with housing providers, who do give them information and a chronology of the situation during reviews. 

Dr Robert Weaver, representing Primary Care, noted that as a medical examiner, he can advise that starting in April there will be a new legal process requiring scrutiny of all community deaths, so referrals must be made to the coroner in all self-neglect cases.  This will be an opportunity for an increase in the number of referrals which will allow scrutiny of those deaths.

Mel Lock advised that this would be Keith Perkin’s last meeting as Independent Chair, as every three years there is a change in that post, so she wanted to thank him for all the work he had done; he expressed his thanks to all partners and board members and agencies, noting that there were very strong partnerships in Somerset with individuals working together, as evidenced through Covid and the recent care homes inquiry.

The Chair stated that this was the type of working that this Board hope to achieve as well, and he summed up that there were many learning opportunities across the system.

The recommendation was that the Health and Wellbeing Board & Integrated Care Partnership:

·       Receive and consider the 2021/22 SSAB Annual Report

·       Continue to promote adult safeguarding across the County Council and in the services that are commissioned.

The Board approved these recommendations.