Serious Case Review of WL
The Reassurance of Disengagement
Partner agency response and Action Plan
January 2015
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The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan
November 2014
Multi-agency
SCR Finding (insert relevant number)
Response/analysis:
Agency
Agreed Action
SAB
To review and revise the SAB
guidance on responding to cases of
self-neglect. To include an agreed
definition of self-neglect and flowchart.
Then present to SAB for approval and
adoption.
To consider the potential for
commissioning a specialist CBT to
work with people who hoard
Cornwall
Housing,
EHSC,
CFT
SAB
To conduct a themed audit on selfneglect cases to assess impact of WL
action plan
Responsible
officer
Jon Dunicliff
Timescale
Jane Barlow
31/3/15
Jon Dunicliff
31/3/16
31/4/15
Comment/progress
The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan
November 2014
NHS Kernow
SCR Finding 1: Use of IT
Response/analysis:
Agency
NHS
Kernow
Agreed Action
1.
To review with partner
agencies potential for
integrating computer
systems to ensure a more
comprehensive recording
systems.
2. To monitor use of IT within
commissioned services to
ensure that it fully meets
the needs to facilitate
communication between
frontline workers.
Responsible officer
Timescale
1. IT strategy
Lead
1. March
2015
2. Category Lead
supported by
Safeguarding
Adults Leads
2. March
2015
Comment/progress
SCR Finding 2: Triage process
Response/analysis:
Agency
NHS
Kernow
Agreed Action
Responsible officer
Timescale
1. To continue to support
the work and
development of the
safeguarding adults
triage systems.
1. Safeguarding
Adults Leads
1. Ongoing
2. To continue to monitor
that staff in
commissioned services
are fully aware of the
safeguarding adults
triage process and know
how to question triage
decision and how to
access support and
advice for cases that do
not meet the criteria for
safeguarding but still
continue to cause
concern.
2. Category Lead
supported by
Safeguarding
Adults Leads
2. Ongoing
3. To monitor staff support
systems (such as
supervision 1:1 etc.) in
place in commissioned
services.
3. Category Lead
supported by
Safeguarding
Adults Leads
3. Ongoing
Comment/progress
SCR Finding 3: Risk assessment and pathways
Response/analysis:
Agency
NHS
Kernow
Agreed Action
Responsible officer
Timescale
1. To contribute to the
development of a
comprehensive pathway
for self-neglect cases.
1. Safeguarding
Adults lead
1. March
2015
2. To monitor commissioned
services compliance with
a pathway for self-neglect
cases.
2. Category Lead
supported by
Safeguarding
Adults Leads
2. March
2015
Comment/progress
SCR Finding 4: Mental Capacity Act training
Response/analysis:
Agency
NHS
Kernow
Agreed Action
Responsible officer
Timescale
1. To continue to monitor the
quality of MCA training
delivered within
commissioned services and
compliance with training
through contract monitoring
process.
1. Category Lead
supported by
Safeguarding
Adults Leads
1. March
2015
2. To continue to monitor staff
support (such as provision
of supervision and linking
understanding of MCA with
appraisal) within
commissioned services.
2. Category Lead
supported by
Safeguarding
Adults Leads
2. March
2015
Comment/progress
SCR Finding 5: Self Neglect Guidance
Response/analysis:
Agency
NHS
Kernow
Agreed Action
Responsible officer
Timescale
1. To monitor provision of
training for the
management of selfneglect within
commissioned services.
1. Category Lead
supported by
Safeguarding
Adults Leads
1. March
2015
2. To promote/support closer
working between
agencies.
2. Safeguarding
Adults Leads
2. March
2015
Comment/progress
SCR Finding 6: Allocation of resources
Response/analysis:
Agency
NHS
Kernow
Agreed Action
1. To agree with partner
agencies resource
requirements to meet the
needs of individuals who
Responsible
officer
1. Director of
Clinical
and
Corporate
Timescale
1. March
2015
Comment/progress
self-neglect.
2. To agree with partner
agencies how these needs
can be met within existing
resource.
Affairs
2. Director of
Clinical
and
Corporate
Affairs
2. March
2015
The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan
November 2014
Cornwall Partnership NHS Foundation Trust
SCR Finding (2)
Response/analysis: Longer Term Work
Agreed Action
CFT
Staff to be clear about timescale &
when to call a professionals meeting.
Responsible
officer
Sharon Linter
Timescale
Comment/progress
End of
December
2014 plus
on-going
WL case presented at Strategic Leadership days where
Managers and other staff present who deliver direct care.
In addition will be stressed during all Safeguarding
training.
Slides cascaded to all staff.
WL Nov14.ppt
1
SCR Finding (3)
Response/analysis: Human Biases
CFT
Agreed Action
Responsible
officer
Timescale
Comment/progress
Ensure that all training includes
discussion on scenarios re
disengagement and disempowerment
CFT Adult
Safeguarding
Team
On-going
Team to consider this in relation to training
Responsible
officer
Timescale
Comment/progress
CFT Adult
Safeguarding
Team
On-going
Team to consider this in relation to training.
SCR Finding (5)
Response/analysis: Responses to Incidents
Agreed Action
CFT
Review application of Capacity Act
through training by ensuring it is upto-date and appropriate.
2
SCR Finding (6)
Response/analysis: Management Systems
CFT
Agreed Action
Responsible
officer
Timescale
Comment/progress
Recirculate “Self Neglect Guidance”
Sharon Linter
End of
November
2014
Completed
Request SAB review Self Neglect
Guidance to ensure:
• Ease of use
• Flow chart
Sharon Linter
January
2015
Sharon Linter to request as agenda item for SAB.
3
The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan: November 2014
Cornwall Council Education, Health and Social Care Directorate
SCR Report: Overall Agency Response/Analysis.
The Review is thorough and detailed. It makes a significant contribution to our understanding of the strengths and weaknesses in the multiagency system for safeguarding adults from neglect and abuse
The Directorate gives a qualified acceptance to the findings of the Review. Some findings are not supported sufficiently by evidence in the body
of the report or by investigation/review undertaken by the Directorate. The wording for some of the findings is unbalanced and extrapolates
conclusions on the extent of an identified shortfall in the quality of practice that cannot be supported reliably by the methodology of the review.
It does not provide clarity about why practitioners did what they did or not do what was expected of them. At least three key issues described in
the body of the report are not drawn out as findings; the failure to undertake the recommended actions intended to ensure a safe discharge
from hospital; the failure to follow through/up on alerts/referrals to find out what decision and action has been taken; and a reluctance to
escalate an unresolved professional difference when a practitioner does not believe that appropriate action is being taken to safeguard a
person. It is hoped that the Board will follow up these issues. There are some statements in relation to the ethical dilemma of balancing care
and control within the report that are not agreed. These matters were discussed at the multi-agency workshop convened by the Safeguarding
Adults Board on 14 November 2014.
SCR Report: Agency Response/Analysis to Finding 1 – incompatibility of the IT system/infrastructure.
It is not about the IT infrastructure or incompatibility. The current configuration or workflow for adults contact, referral and assessment is not yet
fully fit for purpose. The safeguarding workflow is separate. This can lead to double handling and difficulties in moving cases from one
workflow to another and tracking the progress of a case. Using case notes to pass on further/new information in relation to cases already
known is unreliable.
1
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
1.1 A series of workshops are being
Mark Howe and
Jack Cordery
31/03/2015
Some workshops have already been held to scope the
changes.
Mark Howe and
Jack Cordery
31/03/2015
Plans are progressing to move the Triage Team into the
MARU as the basis of an integrated MARU for Adults
and Children. It is intended that this will happen in
January 2015.
held to reconfigure the workflow
for adults contact, referral and
assessment. This will take into
account the findings of the SCR
1.2 Consideration is being given to
moving the Triage Team into the
MARU at an earlier stage as the
first step towards a multi-agency
safeguarding hub
SCR Report: Agency Response/Analysis to Finding 2 - the label, “Does not meet threshold” minimises risk.
:
An all or nothing approach to determining and describing risk of harm is misleading. Risk of harm is nuanced and personal. The professional
judgement and response should be proportionate. It de-personalises our understanding of how the client is experiencing risk. Describing a
case as “not meeting the threshold for the safeguarding adults process” may be accurate technically but can imply a false positive and
influence the alternative social care response in unintended ways. This is especially the case if the team making the judgement is seen as the
specialist team with authority to make the determination. The team making these judgements is single agency/discipline. The quality of
information provided at the point of contact/alert is variable and this can impact on safe decision-making. There is no single approach to
assessing risk.
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
2.1 The Directorate will work with the
Pete Wild/Jack
Cordery/Karen
Dale
31/03/2015
Action required
SAB to set a standard for the quality
of information supporting an
Alert/Referral and to adopt a more
graduated understanding and
2
definition of risk in its policies,
guidance and procedures
2.2 The SAB should provide a clear
definition for adult protection,
separate from wider safeguarding
concerns (JC 31/03/15).
2.3 In the meantime self-neglect
cases will be considered by the
Triage Team and the Triage Team will
stop using this phrase
2.4 Cases via Triage not put into the
safeguarding process will be marked
as originating as a safeguarding alert.
Pete Wild/Jack
Cordery with the
Q&I Sub Group
31/03/2015
A draft is being produced and will be considered in
January 2015.
Pete Wild/Julia
Parfitt/Rob Warin
Immediately Action completed
Pete Wild/Julia
Parfitt/Rob Warin
Immediately Action completed
SCR Report: Agency Response/Analysis to Finding 3 - the nature of the response when the person has mental capacity and is resistant to
intervention
It is not appropriate or ethical to intervene against the will of a client who has mental capacity and refuses an offer of support from social care.
Agencies are not empowered to do this without the sanction of the Court of Protection. However, depending on the level and nature of selfneglect it is potential professional neglect to simply walk away. The expectation is that practitioners use motivational interviewing techniques to
help those clients at serious risk of harm to reflect on their options and make positive, self-care choices, drawing on the support of family and
friends and other trusted adults or commissioning others who may be better placed to engage with the person. This can take time.
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
3.1 The guidance on self-neglect has
been revised and is re-issued
reflecting these expectations and
including self-neglect as a distinct
form of abuse and neglect within the
safeguarding process.
Pete Wild
Immediate
Action completed
3
SCR Report: Agency Response/Analysis to Finding 4 - the quality of mental capacity assessments is inconsistent
Mental capacity assessments are critical to decision-making in determining the nature and level of intervention. Poor quality assessments can
lead to false positives and, inversely, false negatives. There is evidence that MCA assessments are inconsistent and unreliable. However,
there is no published multi-agency standard for judging the quality of MCA assessments. Case audits, therefore, are likely to apply a different
judgement (not necessarily a more accurate one) and/or risk the bias of hindsight.
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
4.1 Adult Social Care will work with
partners, through the SAB, to improve
the consistency of MCA assessments
and to find a reliable way of
measuring the impact of training and
the accuracy or reliability of
assessments
4.2 Practice skills in key areas –
transferring learning into practice –
will become a key feature of the
career and qualification pathway for
social workers and other social care
practitioners, who will have to
demonstrate the required standard
before they can progress between
levels. Good quality Mental Capacity
Assessments will be one of those key
skills required for progression from a
Newly Qualified Social Worker status.
Pete Wild/Jack
Cordery/Karen
Dale
31/03/2015
Action required
Jack
Cordery/Rebecca
Burden
31/03/2015
Action required
4
SCR Report: Agency Response/Analysis to Finding 5 - most multi-agency professionals either have no knowledge of the guidance or fail to
recognise the implications.
It is difficult to understand how this conclusion was drawn from the methodology or the evidence contained in the report that this finding applies
to ‘most’ professionals in Cornwall or what ‘most’ means in this context.
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
5.1 The guidance has been revised
and re-issued
5.2 The Access Team has been given
a clear definition for self-neglect and
a process to follow if self-neglect is a
feature of the case
5.3 Access workers have taken part
in workshops to discuss how to
identify and respond to self-neglect
5.4 Self-neglect cases are now
passed to the Triage Team and
treated as a safeguarding alert and
appropriate cases are assigned for
ongoing support
5.5 Specialist training on self-neglect
will be included in the core curriculum
for social workers and case/care coordinators
5.6 Self-neglect cases will become a
key focus for quality assurance and
performance management.
5.7 Adult Social Care will work with
partners, through the SAB, to review
Pete Wild/Julia
Parfitt
Pete Wild/Julia
Parfitt
Immediate
Action completed
Immediate
Action completed
Pete Wild/Julia
Parfitt
Immediate
Action completed
Pete Wild/Julia
Parfitt/Rob Warin
Immediate
Action completed
Rebecca Burden
31/03/2015
Action required
Jack
Cordery/Karen
Dale/Pete Wild
Jack Cordery
31/03/2015
Action required
31/03/2015
Action required
5
the application of the guidance across
the safeguarding partnership
(JC/31/03/15).
SCR Report: Agency Response/Analysis to Finding 6 - there is a lack of resource and infrastructure to manage complex cases effectively
Whilst it may be a matter of how resources are deployed, there is no evidence that the issues identified in the Review are about a lack of
resources or the infrastructure to manage complex cases. It is, rather, one of business process design, prioritisation and professional
accountability. It is also about the current focus and reliability of the framework for quality assurance and performance management in Adult
Social Care. The SAB has no power to secure additional resources.
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
6.1 Work is underway to restructure
Adult Social Care in light of the
findings of the Peer Review. The
improvement plan and the medium
term financial strategy have been
approved by Cabinet. This will
address issues of business process
design, prioritisation of complex
cases for ongoing social work
involvement and professional
accountability
6.2 Once the structure is in place the
business process/workflow will be
revised to ensure clarity in
professional accountability and
performance management
Miriam Maddison
31/03/2015 The Improvement Plan is being implemented and the
new structure is being designed.
Jack Cordery
30/06/2015
6
Action required
Single Agency Action Plan in response to the WL SCR (September 2014) – Cornwall Fire & Rescue Service Draft version 1
Outcomes
1
.
Within CFRS there will be a culture and common practice of shared responsibility and management of self-neglecting individuals
who may cause concern but do not fall within the safeguarding policy.
CFRS will;
• share information with services and agencies,
• Where the case isn’t admitted into safeguarding or other care management process, CFRS will identify who is in the
best position to help, and to establish a key worker role/lead through continuance of risk management meetings
• use the referral process as an initial stage to discuss concerns and share responsibility for actions
• record key actions and responsibilities in any risk management action plan
• Share learning and development from individual cases
• Refer back to EHSC Triage if necessary
Organisation (s)
CFRS
Action
• Continue to arrange and facilitate Risk
Management meetings throughout Cornwall
where CFRS have identified self-neglecting
individuals at risk that do not meet the
current threshold of the safeguarding adults
policy.
• These are already being held, and engage
with services and agencies relevant to the
support needs of the individual and facilitate
full information sharing, including
identification of the most appropriate lead
agency.
•
CFRS
•
•
Whilst the SAB action plan for JK SCR
identified 6 pilot area for similar style
meetings, these have not been effective or
promulgated as a method of problem solving
for all agencies.
Continued monitoring/follow up of cases
through the Service Tracker System and by
dedicated safeguarding advocates
Monitoring of caseload and individual cases by
the PP&BS and CS Safeguarding Group
Lead Officer
Simon Mould
Timescale
Commenced
August 2013
Steve Rowell
November 2014
Simon Mould
November 2014
Simon Mould
Ongoing
Progress/Outcome
Await update from EHSC to establish if these 6 pilot
area style meetings (JK SCR) will be fully introduced
and engage with all services and agencies.
What concerns CFRS is that it is not a care
management organisation, but does accept it’s duty
of care towards safeguarding vulnerable people.
CFRS are frequently seen as a respected and trusted
service, and therefore an engagement key for
individuals who are usually unwilling to engage with
other services. This has implications for the service in
terms of capacity and prioritisation of other work
streams, as these cases can be protracted and
resource intensive.
Implemented January 2013 and cases tracked and
monitored through PP&BS and CS Safeguarding
Action learning Group.(To be included/updated in
TOR). To ensure all advocates are aware and that
cases are escalated where relevant
Serious Case Review WL CFRS Action Plan
escalating where necessary.
CFRS
Full understanding by all crew managers,
Station Officers and Safeguarding
Advocates of the CIOS Self Neglect
guidance.
Steve Rowell
Jan 2015
Operational service general note issued within the
service (OSGEN)
Intranet Pages updated
3 x Officer Development days (100%) completed with
focus on self-neglect
Aide Memoire Card to be issued (early 2015) for self
neglect
Safeguarding Aide memoire issued to all service
appliances March 2014.
General information file in fire control created.
Article published in “Beyond Cover” service
magazine.
.
CFRS
Consider and where relevant implement
CFOA Hoarding Working Group advice &
guidance when published
Mark Hewitt
TBC
Establish when guidance etc is due to be published.
Not sure of the full implications at this time, and some
liaison would be useful.
To re-issue CIEH Hoarding advice PDF
Updated CFRS Website Hoarding advice pages
CFRS
Where incidents of hoarding are identified,
liaise where relevant with Environmental
Health & Social Housing providers to
consider legal remedies where engagement
remedies fail locally
CFRS and SWAST already have a protocol
where ambulance trust will make a home fire
safety check referral for hoarding cases.
This protocol to be considered for expansion
with the police
Steve Rowell
Jan 2015
Provision and sign up of a hoarding protocol
Mark Hewitt
April 2015
To investigate if D&C police would be prepared to
participate in this intiative, reporting potential
hoarders for HFSC to CFRS
CFRS
Steve.rowell\Home(H) Safeguarding SCR WL - CFRS Safeguarding Action Plan
2
Serious Case Review WL CFRS Action Plan
2
.
There are sufficient staff who are appropriately trained and given the policy guidance for working together when there are
concerns about;
• A vulnerable adult
• Refusal of services
• Self-neglect/Hoarder
• Risk
• Safeguarding
Organisation (s)
CFRS
Action
Lead Officer
Timescale
Progress/Outcome
Ensure Policy and guidance is available to staff
where there are situations where people refuse
services/support
Steve Rowell
Jan 2015
Recognise the skills required to work with people
who refuse services and are at risk, and ensure
staff receive training and support in this as part of
CPD and update training.
Availability (24/7) of appropriately trained
Safeguarding Advocates to support and advise
crews
Steve Rowell
3 X Officer Development Days (100%) conducted in
September 2014 to raise awareness of the Cornwall
Adult Protection Safeguarding Guidance on
Responding to Cases of Self Neglect for staff with
suggested steps to consider when vulnerable people
and or their carers refuse services. (Included in CFRS
PDR Pro –personal training records)
All Fire Control staff will be receiving specific training
to support crews on the ground throughout November
2014
Need to do more here (On Call- CM)
Availability of documentation on appliances
(Guidance/Aide memoires etc)
Importance of recording information (FC log, Action
plans, Referrals etc)
Cascade training programme scheduled and being
delivered Jan-March 2015 to all stations to raise
awareness.
Steve.rowell\Home(H) Safeguarding SCR WL - CFRS Safeguarding Action Plan
3
Serious Case Review WL CFRS Action Plan
CFRS
Ensure Command and Control systems are
optimised to extract data in support of recognising
and sharing data with partners of self-neglect &
Hoarders throughout Cornwall
Mark Hewitt
Ongoing
Fire Control operational risks detailed on Vision
mobilising computer and can be extracted on key
words. Additionally historic information will be shared
with dispatched crews
GI Files to be checked for relevant data being
provided to EHSC.
CFRS
CFRS to consider how they can promote the
severity of risk posed by self-neglect & hoarding to
other professionals/agencies
Simon Mould
November 2014
CFRS
How will we know that there is improvement in
knowledge ?
Simon Mould
Oct 2015
As in the WL case, the dilution of risk identified by
CFRS was lost in transit through services and
agencies. CFRS to consider how risk of fire and
building collapse can be transported through services
retaining its importance. This issue also to be posed to
SAB.
100 % of staff receiving training and assessment skills
No of referrals
Shared practice and knowledge
Service survey
Steve.rowell\Home(H) Safeguarding SCR WL - CFRS Safeguarding Action Plan
4
The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan
November 2014
Cornwall Housing
SCR Finding Two: Longer Term Work
Agency
Agreed Action
Cornwall
Housing
2.1 Ensure other agencies know to
involve housing or environmental
health – referrals are normally from
neighbours, family or friends but not
often from Adult Care – we need to
ensure we use our powers in a
joined up way.
2.2 Share Hoarding policies
developed by housing providers with
housing and environmental health
colleagues
Responsible
officer
Jane Barlow
Timescale
Comment/progress
March 2015
To promote the role of housing and environmental
health in addressing self neglect
Jane Barlow
March 15
To ensure all have fit for purpose policies and are
sharing good practice
2.3 Ensure Fire Service are informed
of any hoarding cases to maximise
benefit of preventative work but also
ensure Fire Service safety should
incident occur.
2.4 Ensure that any operative or
contractor who enters a property is
aware of the signs of self neglect
and reports them appropriately
2.5 carry out annual tenancy checks
on properties which do not have
annual servicing visits
Finding 3 – Human Biases
3.1 Ensure hoarding policies are
cascaded throughout organisations
and that expectations for persistence
and resolution are clear, in line with
SAB guidance.
Finding 4 – Responding to incidents
4.1 Ensure relevant staff undertake
refresher Mental Capacity Act
4.1 Roll out the Self Neglect training
provided to the Housing
Safeguarding Partnership by CFT.
Finding 5 – Responding to incidents
5.1 Ensure that the SAB guidance
on self neglect is rolled out across
Stuart Blackie
March 15
To ensure relevant information is shared to both
address self neglect and protect staff
Jane Barlow
March 15
To ensure every opportunity to identify and report self
neglect is taken
Stuart Blackie
Commencing
in April 15
As above
Jane Barlow
June 15
To ensure that staff are clear of the expectations of the
agency and the SAB
Mel Palethorpe
September 15
Mel Palethorpe
March 16
To ensure the principles and legal parameters of the
Act are consistently applied.
To increase awareness of self neglect issues and how
to address.
Jane Barlow
March 2015
To ensure the guidance is embedded in practice.
our agencies.
Finding 6 – Management Systems
6.1 Work with Health to develop
protocols around hospital discharge
where hoarding has been identified.
Stuart Blackie
September
2015
To ensure joined up decisions are made regarding
action which needs to be taken to address hoarding
before return.
Serious Case Review – the Reassurance of Disengagement
Response from Cornwall Housing with contributions from Cornwall
Council Environmental Health and the Housing Safeguarding Group (of
social housing providers in Cornwall)
Appendix One – Legislation
Public Health Act 1936
Contains the principal powers to deal with filthy and verminous premises.
Section 83 - Cleansing of Filthy or Verminous Premises:
i. where a local authority (LA), upon consideration of a report from any of their
officers,
or other information in their possession are satisfied that any premises –
a) are in such a filthy or unwholesome condition as to be prejudicial to health, or b)
are verminous
ii. the local authority (LA) shall give notice to the owner or occupier of the premises
requiring him to take such steps as may be specified in the notice to remedy the
condition of the premises
The steps which are required to be taken must be specified in the notice and may
include:
cleansing and disinfecting
destruction or removal of vermin
removal of wallpaper and wall coverings
interior of any other premises to be painted, distempered or whitewashed
There is no appeal against a Section 83 notice and the LA has the power to carry out
works in default and recover costs. The LA also has the power to prosecute.
Section 84 Cleansing or Destruction of Filthy or Verminous Articles: Applies to the cleansing, purification or destruction of articles necessary in order to
prevent injury, or danger of injury, to health.
17
n: miscellaneous: protocol for working with harder to engage clients August 2014
Section 85 Cleansing of Verminous Persons and Their Clothing: The person themselves can apply to be cleansed of vermin or, upon a report from an
officer, the person can be removed to a cleansing station. A court order can be
applied for where the person refuses to comply.
The Local Authority cannot charge for cleansing a verminous person and may
provide
a cleansing station under Section 86 of the Public Health Act 1936.
The Public Health Act 1936 Section 81 also gives Local Authority’s power to make
bylaws to prevent the occurrence of nuisances from filth, snow, dust, ashes and
rubbish.
B. The Public Health Act 1961
The Public Health Act 1961 amended the 1936 Act and introduced:
Section 36 Power to Require Vacation of Premises During Fumigation: Makes provision for the Local Authority to serve notice requiring the vacation of
verminous premises and adjoining premises for the purposes of fumigation to
destroy
vermin. Temporary accommodation must be provided and there is the right of
appeal.
Section 37 Prohibition of Sale of Verminous Articles: Provides for household articles to be disinfested or destroyed at the expense of
Serious Case Review – the Reassurance of Disengagement
Response from Cornwall Housing with contributions from Cornwall
Council Environmental Health and the Housing Safeguarding Group (of
social housing providers in Cornwall)
the dealer (owner).
C. Housing Act 2004
Allows Local Authorities to carry out a risk assessment of residential premises to
identify any hazards that would likely cause harm and to take enforcement action
where necessary to reduce the risk to harm. If the hazard is a category 1 there is a
duty by the Local Authority to take action. If the hazard is a category 2 then there is a
power to take action. However an appeal is possible to the Residential Property
Tribunal within 21 days.
18
n: miscellaneous: protocol for working with harder to engage clients August 2014
D. Building Act 1984
Section 76 is available to deal with any premises which are in such a state as to be
prejudicial to health. It provides an expedited procedure i.e. the Local Authority may
undertake works after 9 days unless the owner or occupier states intention to
undertake the works within 7 days.
There is no right of appeal and no penalty for non compliance.
--------------------------------------------------There is further legislation that relates specifically to people – both the living
and the deceased.
E. Environment Protection Act 1990
Section 79(a) refers to any premises in such a state as to be prejudicial to health or a
nuisance. Action is by a Section 80 abatement notice and the recipient has 21 days
to
appeal.
F. Prevention of Damage by Pests Act 1949
Local Authorities have a duty to take action against occupiers of premises where
there
is evidence of rats or mice. They have a duty to ensure that its District is free from
rats and mice.
G. Public Health (Control of Disease) Act 1984
Section 46 imposes a duty on the Local Authority to bury or cremate the body of any
person found dead in their area in any case where it appears that no suitable
arrangements for the disposal of the body have been made.
The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan
November 2014
Peninsula Community Health
SCR Finding 1:Incompatability of IT Infrastructure
Response/analysis: A small number of PCH Community Services and professionals have access to EHSC IT systems which are complex to
navigate
Agency
Agreed Action
Responsible
Timescale
Comment/progress
officer
PCH
PCH professionals working within the
Early Intervention Service accessing
EHSC IT systems, reminded of the
need to follow PCH Safeguarding
Policy for making Safeguarding and
Self neglect referrals as required
Jan SummersDeane
PCH Named
Nurse for Adult
Safeguarding
12/2014 –
04/2015
Action completed through information cascade with
support of Professional Lead for Intermediate Care
Services
Message reiterated at Level 3 Safeguarding
Training sessions for Managers and Team Leaders.
Training being delivered 12/2014 – 04/2015 by PCH
Named Nurse for Adult Safeguarding
1
SCR Finding 2:Longer Term Work
Response/analysis: PCH professionals will promote the importance of effective risk management and multi-agency working to support people
at risk of abuse or serious self-neglect.
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
PCH
Review of PCH Adult Safeguarding
Policy incorporating new Self-neglect
pathway and more robust guidance
Jan SummersDeane
PCH Named
Nurse for Adult
Safeguarding
12/2014 –
04/2015
Review of Policy underway which will align with newly
reviewed CIOS Multi - Agency Safeguarding Policy.
(JSD part of a multi - agency task and finish group
reviewing CIOS Policy)
Self – neglect pathway and flow chart design underway
Delivery of bespoke Level 3
Safeguarding training for Team
Leaders and Managers
Training sessions for Managers and Team Leaders
underway
PCH professionals have access to Safeguarding
guidance and risk management tools to support people
at risk of abuse or serious self – neglect i.e. Cause for
Concern framework. Adoption of key worker principles ,
multi -disciplinary team and multi-agency working
always actively promoted
2
SCR Finding 3:Human Biases
Response/analysis: PCH professionals will be empowered to support individuals with mental capacity, who self - neglect, are resistant to
intervention and choose to live in an unsafe way with high risk to self and others
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
PCH
PCH professionals are supported in
providing proportionate interventions
for adults in their care with mental
capacity who self – neglect, with
appropriate referrals made to external
agencies as required
Jan SummersDeane
PCH Named
Nurse for Adult
Safeguarding
12/2014 –
On going
PCH and RCHT Named Nurses work closely and
information share for adults who self- neglect and
transfer between health care settings
PCH professionals are provided with
Safeguarding guidance and risk
management tools to support people
with mental capacity who self –
neglect. Adoption of key worker
principles , multi -disciplinary team
and multi-agency working actively
promoted
PCH professionals make every effort to inform adults of
identified concerns relating to self- neglect behaviours
Appropriate risk assessments undertaken to underpin
professional actions and decision making
Full record of intervention and offers of service recorded
and kept under regular review
On-going monitoring maintained to highlight changes to
circumstances
The adult is provided with contact details for multi agency services
Multi agency self-neglect referrals and Safeguarding
alerts reported as indicated
3
SCR Finding 4:Responses to Incidents
Response/analysis: PCH Professionals are required to competently apply the principles and legal parameters of the Mental Capacity Act to
effectively support adults in their care
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
PCH
PCH professionals are provided with
appropriate MCA guidance, tools and
mandatory training
Jan SummersDeane
PCH Named
Nurse for Adult
Safeguarding
12/2014 –
On-going
PCH Safeguarding Unit empowers and supports staff in
the practical application of MCA and related
assessments to improve outcomes for adults
PCH MCA and DoL’s Policy ratified 12/2014
MCA training is available to all PCH professionals via
electronic learning and option of face to face sessions.
PCH Level 3 Safeguarding training reiterates MCA
principles
PCH to identify a designated MCA
PCH Executive
Lead to improve level of available
Lead for
operational leadership and support for Safeguarding
PCH professionals
03/2015
Recommendation to be made to the PCH Board
4
SCR Finding 5:Responses to Incidents
Response/analysis: PCH professionals are required to effectively utilise and apply the available self- neglect guidance
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
PCH
Review of PCH Adult Safeguarding
Policy incorporating new Self-neglect
pathway, flowchart and more robust
guidance
Jan SummersDeane
PCH Named
Nurse for Adult
Safeguarding
12/2014 –
04/2015
Review of Policy underway which will align with newly
reviewed CIOS Multi - Agency Safeguarding Policy.
(JSD part of a multi - agency task and finish group
reviewing CIOS Policy)
Self – neglect pathway and flow chart design underway
PCH Safeguarding Unit support staff to monitor and
manage self-neglect concerns and make multi agency
self-neglect referrals and Safeguarding alerts as
required
Delivery of bespoke Level 3
Safeguarding training for Team
Leaders and Managers incorporates
available multi-agency self - neglect
guidance
Training sessions for Managers and Team Leaders
underway
5
SCR Finding 6:Management Systems
Response/analysis: PCH professionals will support the multi-agency approach to manage complex care cases which require intensive,
responsive and often long term intervention as resource allows
Agency
Agreed Action
Responsible
officer
Timescale
Comment/progress
PCH
PCH Safeguarding Unit will continue
to support community based services
and staff in the risk management and
monitoring of adults who demonstrate
self -neglect behaviours, engaging
with multi agency approach as often
as required and resource allows.
Jan SummersDeane
PCH Named
Nurse for Adult
Safeguarding
12/2014 –
On going
PCH Safeguarding Unit follows up all adult self -neglect
referrals with the professionals who have reported them
and EHSC
PCH Safeguarding Unit will monitor
the volume of adult self -neglect
referrals to improve risk management
and identify need for increased
resource requirements
The revised PCH Safeguarding Policy and self –neglect
pathway directs professionals to report all self –neglect
concerns to the PCH Safeguarding Unit via the
organisations Incident Reporting System –Datix
Quality data relating to self-neglect volume is identified
to the organisation and commissioners
6
The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan
November 2014
Devon and Cornwall Police
Finding 5: Responses to Incidents
Many multi-agency professionals in Cornwall either have no knowledge of, or fail to recognise the implication of the self-neglect guidance, and
therefore fail to act or act in isolation.
Response/analysis:
Agency
Devon
and
Cornwall
Police
Agreed Action
•
Provide an effective service to
promote & identify
Safeguarding Adults, including
those at risk or subject to
Modern Slavery, that supports
the Safeguarding Adult Boards
and in preparation for delivery
against the Care Bill.
•
Delivery of early identification
(of vulnerable adults) (ViST)
Responsible
officer
Timescale Comment/progress
Detective
Superintendent
Public Protection
Unit (PN)
31-Mar2017
D&C Reference C&CJ-A069
The ‘Reassurance of Disengagement’ – SCR
Partner agency response/Action Plan
November 2014
Royal Cornwall Hospital Trust
SCR Finding: 2
Response/analysis: There is the need to minimise the risk when a case of self-neglect doesn’t meet the threshold of safeguarding.
To help minimise this risk the RCHT safeguarding adult’s team will manage self-neglect cases within the Trust.
Agency
Agreed Action
Responsible
officer
RCHT clinical staff will contact the RCHT
Safeguarding Adults team when an
admission occurs where self-neglect is
identified. An internal form to refer will be
completed. A flow chart will be made
available to assist staff in making a
referral.
Safeguarding
Adults Named
Nurse.
Timescale Comment/progress
RCHT
On-going
The new process will be monitored by the Trust’s Safeguarding
Operational Group.
1
SCR Finding 3
Response/analysis: Professionals can often feel disempowered when an adult demonstrates signs of self-neglect (frequently
disengaging and resistant to interventions). Professionals may then not take any further action, but this is often because they do
not know what to do next; wide distribution and adherence to the self-neglect guidance will help support professionals and promote
a multi-agency approach.
Agency
Agreed Action
Responsible
officer
Timescale Comment/progress
Whilst the adult remains within the acute
healthcare setting, members of the Trust’s
Safeguarding Adults Team will empower
and support staff to ensure appropriate
referrals are made to external agencies
on discharge. Members of the
Safeguarding Adults Team will endeavour
to engage with the adult in question,
whilst in our care, by informing them of
the concerns as regards to their selfneglect and the process for the multiagency self-neglect referral process.
Safeguarding
Adults Named
Nurse
On-going
RCHT
In six months the Safeguarding Adults team will conduct a staff
survey as regards the self neglect process and associated
support within RCHT.
The Safeguarding Adults team will record the number of selfneglect cases on a quarterly basis and report to the Trusts
Safeguarding Operational Group to monitor.
SCR Finding 4
Response/analysis: At RCHT we recognise the challenges for the implementation of the principles and legal parameters of the
MCA in practice, especially in the cases of self-neglect.
Agency
Agreed Action
Responsible
officer
Timescale Comment/progress
RCHT
Since the admission of WL to RCHT in
2012, RCHT have appointed an MCA
Lead Nurse. The safeguarding adults
The Mental Health
Act and
Mental Capacity
On-going
Training records as evidence of training being undertaken.
2
training for all frontline staff includes MCA
training. The MCA Lead Nurse also
delivers bespoke training sessions to staff
groups on request. RCHT have a MCA
policy.
Lead Nurse
And Safeguarding
Named Nurse for
Adults
There is a MCA implementation action
plan which is reviewed bi-monthly by the
Trust’s Safeguarding Adults Operational
Group. The aim is to assist, monitor and
ensure that the principles of MCA are
embedded in clinical practice.
The Mental Health
Act and
Mental Capacity
Lead Nurse
On-going
The MCA Lead Nurse completes an annual audit as regards
use of the MCA principles in practice. The first audit led to a
change in the paperwork / practice.
SCR Finding 5
Response/analysis: The WL SCR has demonstrated that the multi-agency self-neglect guidance has not influence practice as it
intended to since 2009. We believe that it requires revising and a multi-agency commitment in dissemination, with a clear definition
for professionals to aid assessment and take appropriate action.
Agency
Agreed Action
Responsible
officer
Timescale Comment/progress
RCHT
The Safeguarding Adult’s Team will
support any revision by the Safeguarding
Adults Board of the self-neglect guidance
and multi-agency definition.
Safeguarding
Named Nurse for
Adults
May 2015
RCHT will include the recognition and
management process of self-neglect
within the level two safeguarding adults
training.
Safeguarding
Named Nurse for
Adults
March 2015
The timescale will need to be agreed by the SAB.
3
SCR Finding 6
Response/analysis: There will be resource implications when engaging with those who self-neglect, these can be complex cases
and RCHT will endeavour to liaise with commissioners to help identify resources needed within the acute Trust.
Agency
Agreed Action
Responsible
officer
Timescale Comment/progress
RCHT
Data collection. Members of the Trust’s
Safeguarding Adults Team will manage
the cases of self-neglect, whilst the adults
are in hospital. The number of patients
supported will be monitored by the Trust’s
Safeguarding Adult’s Operational Group,
via the Named Nurse for Safeguarding
Adults report to ensure that if the numbers
begin to have an impact on service
delivery appropriate actions and/or risk
mitigation is undertaken.
Safeguarding
Named Nurse for
Adults
On-going
Will be monitored and reported on a bi-monthly basis via the
Safe Guarding Operational Group.
4