Gateshead Safeguarding Adults Annual Report 2023/24

I am very pleased to welcome you to the annual report for Gateshead Safeguarding Adults Board.

Why an annual report?

This is an important time of the year for Gateshead Safeguarding Adults Board as we have both a legal duty to produce an annual report and a strategic plan. They work well together as the annual report outlines how we have met the challenges we set ourselves the previous year and the strategic plan helps to set out the journey that the Board is on in future years. It is rare that we can say things are complete or finished and rightly so, we will always strive to build on what we have achieved to ensure we aim for better things year on year. The annual report holds the detail of how the Safeguarding Adults Board is governed, structured and works, it includes our strategic priorities and outlines our achievements towards those priorities.

My first year

This has been my first year as the independent chair for Gateshead's Safeguarding Adults Board and the production of the annual report offers an opportunity to pause, to reflect and to take stock of our achievements. As a Safeguarding Adults Board we have had ongoing change with the structures across our statutory and non-statutory Safeguarding Adults Board partners, however this has not impacted in any way on the immense commitment, drive and collaboration demonstrated across the Safeguarding Adults Board partnership. I feel we have continued to mature and develop together and have started to really 'own' our collective responsibility for the effectiveness of our partnership work. This is demonstrated in how we challenge, support and hold each other to account and within the strong governance and learning framework we have developed as a board. We are working hard together to ensure we embed the learning from Safeguarding Adults Reviews, and other reviews where vulnerable adults feature. The complexity of some people's lives and situations means an ever more coordinated multi agency response is required to help people remain safe and well. The journey to learn from this type of situation has become increasingly prominent and features heavily within our plans for 2024/25.

Committed to care

The Care Act 2014 challenged Safeguarding Adults Boards and its members to work in person-centred ways that involve listening to the person at risk, ensuring they are involved within decisions about their own safety and wellbeing, and seeking the changes they want wherever possible. Gateshead Safeguarding Adults Board is committed to really listening to people and we have involvement and person centeredness as an ambition that runs through each of our 5 strategic priorities. Over the next year this approach will set the direction for how the Board needs to work, and the expectations for how individual services must work to provide individuals with help and protection across Gateshead.

Listening

As a Safeguarding Adults Board, we have initiated work this year to seek advice, to listen and to learn from people and their families who have been involved in safeguarding directly. This and ongoing work with our community and voluntary sector will help to equip and set the direction for how the Safeguarding Adults Board can make safeguarding truly personal. Each year we will take further steps towards being truly citizen-led in our work.

Partners

As the Gateshead Safeguarding Adults Board Chair, I would like to take the opportunity to thank everyone for their work to help and protect adults in Gateshead. I offer thanks to the Safeguarding Adults Board partners for their commitment and that of their colleagues as this enables the Board to continue to take important strides forward. The Safeguarding Adults Board and its subgroups are made up of committed individuals who go the extra mile each and every week to support the Board's various subgroups and workstreams - these are often the people who 'make it happen'.

Thank you

It is with regret however, that I rarely get the opportunity to thank in person frontline workers across all services and agencies in Gateshead for all they do to support individuals to be safe and to feel safe. It is important we recognise that it is only with the support of frontline teams, services and practitioners that we achieve our ambitions of Gateshead being a safe place for everyone.

Better practice

As a Board we regularly hear about new initiatives and services that will make a difference, we hear about examples of excellent practice through individuals and teams who explore every opportunity in difficult circumstances, to help and minimise the risk to people they support. Introduction from our Independent Chair

Working together

In practice we can only move forward together by listening, by being inclusive and by valuing and respecting each other's unique contribution to safeguarding. The level of work and commitment from partners, from frontline workers to volunteers, unpaid family carers, and those within our communities has been amazing. Together we are making a difference.

Nicola Bailey
Independent Chair, Gateshead Safeguarding Adults Board

Welcome to the Gateshead Safeguarding Adult Board Annual Report. Within the report you will find information on the Boards strategic vision and priorities and an overview of the key outcomes from 2023/ 24.

The report outlines the board priorities/ambitions for the previous year, what we have done to achieve these in part through our subgroup work. The report outlines the Safeguarding Adults Board governance structure and the 3 statutory partner governance structures as they relate to safeguarding adults, internal governance structures for each statutory partner and an update on what they have achieved during the year.

The board has three core duties:

• to publish a strategic plan for each financial year
• to publish an annual report detailing what the board has done during the year
• conduct any Safeguarding Adult Reviews (SARs)

The Gateshead Safeguarding Adults board works to protect an adult's right to live safe, free from abuse and neglect. Ensuring people and organisations work together to prevent and stop both the risks and experience of abuse or neglect. At the same time, we need to make sure that the adult's wellbeing is promoted. This includes, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action, making safeguarding personal.

The aims of adult safeguarding are to:

• prevent harm and reduce the risk of abuse or neglect to adults with care and support needs
• stop abuse or neglect wherever possible
• safeguard adults in a way that supports them in making choices and having control about how they want to live
• promote an approach that concentrates on improving life for the adults concerned
• raise public awareness so that communities, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect
• provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and how to raise a concern about the safety or wellbeing of an adult
• address what has caused the abuse or neglect

The Gateshead SAB became a statutory body in April 2015. The board's vision for adult safeguarding in Gateshead is:

"Everybody in Gateshead has the right to lead a fulfilling life and should be able to live safely, free from abuse and neglect - and to contribute to their own and other people's health and wellbeing."

The board is responsible for assuming the strategic lead and overseeing the work of Adult Safeguarding and Mental Capacity Act arrangements in Gateshead. Within Gateshead we have an independent Chair to enhance scrutiny and challenge.

The board has a comprehensive , which is updated annually, and provides a framework for identifying roles and responsibilities and demonstrating accountability. Our Safeguarding in Gateshead website provides a wealth of information about our SAB and our Gateshead Safeguarding Children's Partnership (GCSP).

Statutory membership

In law, the statutory members of a Safeguarding Adults Boards are defined as:

• the local authority (Gateshead Council)
• the local police force (Northumbria Police)
• the Integrated Care Board (ICB) (North East and North Cumbria Integrated Care Board (NENC ICB)

Wider membership

In Gateshead, we recognise the importance of the contribution made by all our partner agencies and this is reflected by the wider board membership (correct as of June 2024):

• North East Ambulance Service
• Gateshead Health NHS Foundation Trust (GHFT)
• South Tyneside and Sunderland NHS Foundation Trust (STSFT)
• Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust (CNTW)
• Tyne and Wear Fire and Rescue Service (TWFRS)
• Gateshead College
• Probation Service
• Connected Voice Advocacy
• Department for Work and Pensions (DWP)
• Healthwatch Gateshead
• Your Voice Counts (Advocacy)

The Gateshead SAB sits within a clearly defined structure and has close links with other local multi-agency partnerships including the Health and Wellbeing Board, Community Safety Partnership and Gateshead Safeguarding Children's Partnership (GSCP).

Board members are responsible for ensuring that governance and scrutiny arrangements for Safeguarding Adults are incorporated within the structure of their own organisations, and that there are mechanisms for disseminating and sharing information from the Safeguarding Adults Board. The governance and scrutiny arrangements for the three statutory partners include:

Gateshead Council

• The Health and Wellbeing Board receive an annual update from the Safeguarding Adults Board Independent Chair upon publication of the annual report as do the Care, Health and Wellbeing Overview and Scrutiny Committee.
• The Safeguarding Adults Board Independent Chair meets on a quarterly basis with the Portfolio holder for Adult Social Care to provide updates on the work of the board.
• The Gateshead Council Internal Audit service provide assurance that the Board and Gateshead Council are meeting their statutory duties.
• A weekly workbook and report is circulated to practice leads and team managers highlighting key areas of safeguarding, detailing latest comparator information and trends over the last 12 months, and the previous 3 years.
• A monthly Senior Management Team meeting take place which is dedicated to performance management. The performance dashboard is used to highlight areas of good performance and areas for improvement are shared, actions are discussed and set wherever necessary through the senior management team meeting. 
• A dedicated Group Management Team (GMT) focusing on finance and performance is held monthly with relevant senior leaders, where the activity from the previous steps are presented, actions and progress discussed, and further analysis and actions are agreed and taken forward. 
• Safeguarding information is presented to the Gateshead SAB on a quarterly basis a dashboard has been developed which covers safeguarding data relevant to the board this is to provide assurance to the board of good practice and actions taken on areas of improvement.

Northeast and North Cumbria Integrated Care Board (NENC ICB) 

• The ICB Chief Nurse holds the lead for the safeguarding portfolio.
• ICB internal assurance is provided via safeguarding reports to the Area Quality Sub Committee who report to the Quality Safety and Risk Committee (Quarterly).
• Reports provide local updates on the work of the safeguarding partnerships and ensure that key safeguarding risks, issues and developments are reported within the ICB.
• Reports also outline activity relating to Safeguarding Adult Reviews (SARs) Domestic Homicide Reviews (DHRs) and other non-statutory reviews such as Appreciative Enquiries.
• The ICB also has a Safeguarding Senior Leadership Group which coordinates and leads the development of Safeguarding arrangements across the ICB, reporting and escalating issues to the ICB where appropriate and has a key role in leading on assurance and development.
• Governance and scrutiny arrangements will continue to evolve under the new Integrated Care Board arrangements.

Northumbria Police

• All learning from national and local serious case reviews are scrutinised through the Organisational Learning Board and the organisational learning log.
• The organisational learning log is focused on the importance of identifying learning opportunities and drivers, embedding the value of lessons learned, and helping the organisation to become focused on the importance of continuous learning.
• Each Area Command and Department has a responsibility to consider drivers for lessons learned and to encourage organisational learning within their areas of business.
• The organisational learning log is submitted to the Organisational Learning Board for discussion and agreement of new actions, and to ensure organisational wide learning has been considered.
• Agreed recommendations and actions from the relevant ODG or board will be managed by the assigned learning owner.
• Areas of learning and best practice that require Force wide communication or change are escalated through Strategic Management Board.

Quality, Learning and Practice Group (chaired by a senior manager from Gateshead Council)

The Quality, Learning and Practice Group is responsible for:

• monitoring and reviewing performance data and driving forward quality via the quality assurance framework, case file audits and monitoring inspection recommendations
• Collating and reviewing recommendations from statutory Safeguarding Adult Reviews and discretionary reviews and has oversight of multi-agency safeguarding training
• ensuring that the Multi Agency Safeguarding Adults policy and procedures and supporting practice guidance continue to be fit for purpose
• keeping up to date with national policy changes that may impact upon the work of the Safeguarding Adults Board
• the development and implementation of the Communication and Engagement strategy

Safeguarding Adult Review and Complex Case (SARCC) group (chaired by a senior manager from Northeast and North Cumbria ICB)

The Safeguarding Adults Review Group (SARCC) will:

• consider Safeguarding Adult Review (SAR) referrals, commission reviews and subsequently monitor their progress
• oversee discretionary reviews into cases that do not meet the criteria for a SAR, where the group feel that there are multi-agency lessons to be learned
• collate and review recommendations from SARs and other reviews, ensuring that achievable action plans are developed and that actions are delivered
• provide a forum to discuss complex Safeguarding Adult cases that require additional scrutiny and support

Joint Strategic Exploitation Group (chaired by a senior officer from Northumbria Police)

The Joint Strategic Exploitation Group is a sub-group of both the Safeguarding Adults Board and the GSCP.

The Police chair undertakes this role across the Northumbria Police Force footprint (6 LA areas) which promotes sharing of learning and best practice and connectivity across the region in identifying emerging trends or concerns.

The remit of the group is to lead on the development of strategic work in relation to all aspects of exploitation, including but not limited to: Sexual Exploitation; Criminal Exploitation; Modern Slavery and Trafficking and Missing.

Task and Finish Groups

The Board and the three sub-groups regularly commission time limited task and finish groups to undertake specific pieces of project work.

Subgroups Highlight Reports

In 2023 the board requested all subgroups to prepare and present a report at each board meeting. The report covers 4 main areas:

• what is working well?
• what is not working well?
• what difference are we making?
• potential risks

This allows each subgroup to raise the profile of its work and share good practice and outcomes, whilst also highlighting any potential risks to the board so that remedial action can be taken, by the board or by its partners.

The demographics of Gateshead place additional pressures on health and social care, policing, ambulance services and the private, voluntary and independent sector who support the residents of the borough.

The Gateshead Safeguarding Adults Board plays a pivotal role in supporting its partner agencies to meet their responsibilities in relation to safeguarding alongside their statutory responsibilities and their role in service delivery.

 

 

 

The Strategic Plan 2019-2024 was approved by the board in April 2019 and contained five strategic priorities:

1. Quality Assurance

2. Prevention

3. Communication and Engagement

4. Operational Practice

5. Mental Capacity

The board has worked to complete the key actions identified within the plan. For further information on the key actions for each priority go to Appendix 2.

This is the final year of the Strategic Plan in its current format. The board have worked collaboratively to develop and agree its future strategic priorities, see the Strategic Plan for 2024 - 2027 (PDF, 286 KB). 

 

 

The annual report must demonstrate what both the SAB and its members have done to carry out and deliver the objectives of its strategic plan. Some of our key activities for 2023/24 are documented below and are aligned to the following SAB Strategic Priorities.

Quality assurance challenge event

The board held its annual challenge event in September 2023. All statutory partners were represented at the event along with wide representation from other agencies.

The focus of the event was to:

• agree the boards governance and accountability arrangements. The board has developed a governance framework
• review membership and strengthening engagement
• develop the Strategic Plan and Future Priorities for the Safeguarding Adults Board
• agree the format of the Gateshead Safeguarding Adults Board annual report
• review the data which is presented to the Gateshead Safeguarding Adults Board.

The boards Strategic Plan for 2024-2027 was developed from the feedback from partners during the event. Partners were asked to deliver a short presentation on:

• what is working well
• what is not working well (obstacles, barriers and system pressures)
• what the 3 priorities should be from that agency's perspective

The priorities for the new Strategic Plan for 2019-2024 were agreed as:

• strengthening safeguarding
• learning and development 
• data and information
• prevention of harm 
• involvement and engagement

The outcomes from this plan will be shared in the 2024/25 annual report.

Following the event the board started to develop its governance and assurance framework to ensure there was clear evidence of accountability across the partnership. The framework was agreed by the Board in June 2024. Governance data is contained with the Safeguarding Adults Board Data Dashboard to ensure all board meetings are quorate and to ensure we have broad partnership attendance at meetings

The Gateshead Safeguarding Adults Board, Community Safety Partnership and the Gateshead Children's Safeguarding Partnership have worked over 2022/ 23 to improve and strengthen engagement across the partnerships. See Linking with Other Parts of the System Slide for further information.

It was agreed that the annual report should be in a format which is easily accessible and contains the relevant information to evidence the board has worked to meet its strategic priorities and capture the wider work of the partnership.

The board and the local authority performance team began work to improve the Safeguarding Adults Board Data Dashboard which was historically very data heavy. The Dashboard now contains graphs and charts which are used to identify areas of concern and where further analysis is required. Dashboard now contains data from Northumbria Police, TWFRS, Health as well as training information, communication and engagement and assurances around out of borough placements. Work continues to develop the Data Dashboard to ensure it provides useful information, data and assurance to the board.

Prepare Gateshead Safeguarding Adults Board the CQC inspection

The Safeguarding Adults Board has received regular updates on progress with the preparations for the LA CQC Assurance inspections which Safeguarding Adults Boardwill include "How Gateshead ensures safety within the system":

The Safeguarding Adults Board has provided information which has been included in the local authority selfassessment and the Local Authority Information Return (LAIR) which will form part of the CQC overall Assurance Framework.

The Safeguarding Adults Board Independent Chair and Business Manager took part in the LGA ASC Preparation for Assurance Peer Review which took place in March 2023, and supports the local authority's preparations for the formal CQC assurance inspection from the position of a 'critical friend'. The challenge involved exploring the local authority's ambitions and performance and helped to highlight improvements and where effective practice can be shared more widely.

"New Independent Chair has introduced appropriate challenge within the board, with SARs progressed, better use of data and a Learning Register" feedback from LGA ASC Preparation for Assurance Peer Review

Feedback from the LGA ASC Preparation for Assurance Peer Review

Following the peer challenge the board were provided with feedback which suggested that further work needed to be undertaken on:

• developing a robust governance framework
• developing a risk register to ensure the board was aware of and able to monitor any risk which may prevent it from meeting its statutory responsibilities
• monitor learning from SARs and ensure assurances are received from partners on the learning identified following reviews is acted upon
• how do we know people in Gateshead are safe, how do people in Gateshead tell us what makes them feel safe
• review and improve our SAR process

Understanding safeguarding 

The number of inappropriate safeguarding concerns being received by the Local Authority Safeguarding Team in 2023/24 continues to remain high. In response to this the Safeguarding Adults Board developed the Understanding Safeguarding guidance which aimed to provide practitioners with clear guidance on when they should raise a safeguarding concern.

The guidance details the safeguarding concern criteria as defined in the Care Act 2014, and if the case does not meet the criteria what actions the practitioner can take such as requesting an initial care assessment or request a care and support review. The guidance promotes the use of multi-disciplinary meetings as way to bring practitioners together to support an individual.

The guidance gives case examples which help practitioners to reflect on cases they may have had and to consolidate and embed the learning from the guidance.

Exploitation awareness

Following the completion of a learning review in 2022 the NENC ICB Exploitation Nurse developed a short video on Exploitation Awareness, which was launched during 2023/24.

The learning review of a young adult male identified that he had been the victim of exploitation. The video illustrates how to recognise exploitation and also that consideration should be given to gender bias, that exploitation extends beyond the age of 18 and that it often may seem consensual. Helping to recognise the factors which make an individual more susceptible to exploitation is a key feature of the video, along with practical steps that practitioners can take to support someone. The video also raises the complex issue of executive dysfunction and how to deal with capacity issues, all things which were factors in the learning review conducted by the SARCC subgroup.

This short video can be used for any of our multi-agency partners to highlight with employees, volunteers and the public the dangers of not recognising exploitation.

 

Financial abuse and scams

Following a presentation and discussion at the QLP subgroup in April 2023 from the Gateshead Trading Standards Team information advice and guidance was added to the Safeguarding Adults Board website on the Financial Abuse and Scams page.

The information was aimed at supporting the public to recognise scams, who to do if they have been scammed and how they can support others by becoming Scam Champions or Scam Marshalls.

This additional information enhanced the information already provided on financial abuse and the guidance provide in the care act statutory guidance.

Multi-agency learning and development gap analysis

In February 2023 the QLP sub-group were tasked with reviewing the Safeguarding Adults Board multi-agency training offer through undertaking a training gap analysis to review the multi-agency training offer, identify the safeguarding training which partners were providing for their workforce, identify any gaps in our training offer, agree how to provide assurances to the board that multi and single agency safeguarding training is the required quality and standard and discuss the possibility of interagency working and sharing resources.

A task and finish group was set up with representatives from Northumbria Police, NENC ICB, Gateshead Council Safeguarding Adults Team, Gateshead Council Housing Services, TWFR and Gateshead Recovery Partnership.

The group are planning to present their report and recommendations at the board meeting in September 2024.

Partnership reduction of exploitation and missing (Previously MSET)

The JSEG was involved in the regional review of Missing Sexually Exploited and Trafficked (MSET) procedures, which was undertaken towards the end of 2023 and start of 2024. The aim of MSET, introduced in 2018, was to have a corporate approach across the 6 LA's to safeguard and protect those children who were regularly going missing and at risk of or suffering from sexual exploitation. Through the review it was agreed that adult cases would be included in the revised processes.

Partners in Gateshead were key to a multi-agency task and finish group to consider improvements to the system so that the process was standardised across all six LAs in the Northumbria Police area; to include adults in the process; to be outcome focussed; to not only focus on the victim, but also on the offender to remove/resolve the issue and the location.

As a result, a new process was agreed - Partnership Reduction of Exploitation and Missing (PREM) which will put the onus on each local authority to gatekeep cases, which will give back several hours back to partners and ensure a multi-agency problem solving meeting to work together to reduce risk, tackle perpetrators and disrupt hot spot locations. The PREM meeting will be chaired by a Detective Inspector from the Prevention Department, Northumbria Police to ensure a corporate and consistent approach. Following agreement to proceed on this basis in June 2024, a roadshow, training and raising awareness with partners will be undertaken in summer 2024 before the new process is launched in the autumn of 2024. The impact of this new process will be monitored at a strategic level.

Transitional safeguarding

The JSEG oversaw and supported the review of the vulnerable adolescents' services and supported the developing of a new group which will report into the JSEG - the Contextual Safeguarding Group is chaired by the JSEG deputy chair and Local Authority's Practice Lead for Innovation, Transformation and Vulnerable Adolescents. This group collectively informs and influences updates to the JSEG. It focuses on 5 key strands of work: Safeguarding of individual young people; Development of safeguarding places and spaces; Response to child protection; Transitional safeguarding; and Serious Youth Violence.

The Safeguarding Adults Board Business Manager attends the meetings and is the chair of the task and finish group for Transitional Safeguarding.

The Safeguarding Adults Board provided a wide range of learning and development activities during 2023/24, these sessions were linked to learning from SARs, themes from SG Adults week and the core multi-agency training programme.

Learning from Safeguarding Adult Reviews (SARs)

The board continues to offer learning and development opportunities which reflect the learning from safeguarding adult reviews, this includes local and national cases. The board delivers multi-agency interactive workshops which allow practitioners to hear about cases which have been the subject of a review or inquiry and the learning from these. The sessions allow time for practitioners to reflect on the cases and to undertake group work to support their understanding of the key issues and the learning which can be drawn from the cases considering how different actions could have changed the outcomes for individuals.

The board also provides learning and development which covers specific areas of practice development where additional support is required for practitioners. During 2022/23 the board delivered:

an introduction to the Mental Capacity Act and Practical Application of the Mental Capacity Act

• self-neglect
• mate crime
• fire safety
• professional curiosity

Trauma informed practice and professional curiosity

As part of our objective to support trauma informed practice the Safeguarding Adults Board welcomed Lads like Us, Danny and Mike back to Gateshead January 2024. Sharing their lived experience as children and adults trying to navigate the care system, adult social care, mental health services, drug and alcohol services amongst dealings with the police and a prison sentence. The honest and sometimes shocking accounts provided by Danny and Mike, are interlaced with humour and a sense that something good must come from their experiences. With 84 practitioners from 20 agencies in attendance from across Gateshead the session was well received, and the feedback was positive showing how practitioners will aim to improve practice following the session.

The importance of professional curiosity and asking why."

Brilliant session, personal experience and humorous training."

It reminded me to challenge the blaming language that is often used."

Toxic stress: the road to poor outcomes

We also invited Andi Brierley to present to practitioners during 2022/ 23 his session Toxic Stress: the Road to a Poor Outcome, was an insightful session which helped practitioners to understand how children who experience stress in childhood, from family breakdowns, domestic abuse and abuse can go on to be dysfunctional adults. The session based on Andi's own experiences was a powerful reminder of the damage which can be done and the effects of childhood trauma and as adult practitioners we should always consider what has happened to this person in their past.

The language and understanding of language and relationships. I'm going to change engagement to connecting."

People's bad past experiences don't define them, and the door is always open to get things right."

 This session was so helpful in thinking about stress instead of Trauma, because we all know what stress feels like."

 

During 2023/ 24 the Safeguarding Adults Board Business Unit developed, delivered and commissioned some training to enhance the multi-agency core offer.

Understanding safeguarding

Following the development of the Understanding Safeguarding Guidance the Safeguarding Adults Board Business Manager supported by representatives from the Local Authority Safeguarding Team delivered a series of short briefing sessions to introduce the guidance. The sessions aimed to provide an overview of the informal and formal responses to safeguarding adults in Gateshead. The development of the Understanding Safeguarding sessions was in response to the high number of inappropriate safeguarding concerns received by the local authority safeguarding team. The need to raise awareness of the statutory safeguarding criteria and to ensure practitioners are aware of their responsibilities to safeguard the individuals they work with was a key focus of the sessions.

Safeguarding in the real world

The Safeguarding Adults Board worked with Handcrafted a charity based in Gateshead provide training, holistic support and supported housing across Gateshead to provide three training sessions.

The Safeguarding in the real-world session aimed to give practitioners the opportunity to talk about how safeguarding works in practice and to explore some of the dilemmas they face on a daily basis. Gaining first hand advice and guidance from a member of the safeguarding team to improve their knowledge and practice in safeguarding.

Professional curiosity

Professional curiosity is often highlighted in SARs as an area of development for practitioners. In light of this the board commissioned a session which focussed on supporting practitioners to develop skill sin professional curiosity, gathering the information and gaining the full pictures, recognising disguised compliance and challenging decision making.

Training delivered by the safeguarding business unit training for the voluntary, community and social enterprise sector

The Safeguarding Adults Board recognised the need to increase the knowledge and understanding of safeguarding in the voluntary, community and social enterprise (VCSE) sector following the completion of the Thomas safeguarding adult review and the Henry local learning review.

The Thomas SAR recognised the response from the locality hubs in supporting Thomas during the last few months of his life, whilst for Henry who was not known to statutory services community, voluntary and non statutory services had provided him with a huge amount of support over approximately 14 years before his death.

The Safeguarding Adults Board and Gateshead Safeguarding Children's Partnership Business Managers worked with locality co-ordinators to develop a sessions which met the specific needs of the VCSE sector, including the role of trustees and working with the charities commission with the first session due to be delivered in April 2024.

Core training 

The Gateshead Council Workforce Development Adviser worked with the Safeguarding Adults Board, Gateshead Safeguarding Children's Partnership (GCSP) and the Community Safety Partnership to produce a comprehensive training offer for 2023/24. Training courses advertised within the directory are free of charge to practitioners and volunteers within Gateshead. Training has been delivered virtually and face to face to allow delegates to choose the most convenient method of learning to suit their job role.

Prevention mental capacity training 

The need to strengthen the support for practitioners in understanding the Mental Capacity Act, carrying out mental capacity assessments and recording of assessments has been evident from learning reviews which have been undertaken. The board continued to offer Introduction to MCA and Practical Application of MCA during 2023/24 as part of its multi-agency offer.

This offer will be enhanced during 2024/25 with the delivery of sessions on Executive Dysfunction, the course was piloted in 2022/23 and is now delivered by multi-agency partners. The session will provide an overview of executive dysfunction, the impact it has on decision making and the complexity / obstacles to assessment.

Your Voice Counts delivered Advocacy Awareness training which aimed to give individuals legal right to advocacy under the Care Act 2014, the Mental Capacity Act and the Mental Health Act 1983.

Responses from impact evaluation questionnaires highlighted the positive impact that the training had on learners' thinking and practice.

Safeguarding Adults Week 2023

Gateshead Safeguarding Adults Board Safeguarding Adults Week ran from 20 to 24 November 2023. The week is supported and promoted by the Ann Craft Trust and the theme for the week was prioritising the welfare and wellbeing of yourself and others, with each day of the week focusing on a specific theme:

What's my role in safeguarding adults? 

• Let's start talking - taking the lead on safeguarding in your organisation 
• Who cares for the carers? secondary and vicarious trauma
• Adopting a trauma informed approach to safeguarding adults
• Listen, learn, lead - co-production with experts by experience

Networking event

A variety of activities took place during the week to raise awareness of various aspects of safeguarding adults:

Gateshead Safeguarding Adults Board hosted a networking event to open the week. The event provided an opportunity for anyone working with adults across Gateshead to meet representatives from organisations who are working to safeguard adults who are at risk, learn about the work they are doing and share information and good practice.

There were presentations from:

• Connected Voice and Your Voice Counts - Advocacy Providers
• Admiral Dementia Nurses • Northeast and North Cumbria Integrated Care Board
• Gateshead Carers Association
• The Hoarding Network
• Locality Team, Promoting Locality working

"Really well organised day, lots of information and networking - excellent event."

During the week a range of sessions ran to support learning during Safeguarding Week these sessions were open to book by anyone in Gateshead who works with adults:

Tyne and Wear Fire and Rescue Service "I didn't know the fire service did that"

TWFRS delivered a session which gave an over of the services they offer, including Safe and Well visits and community engagement activities, their work to Improve the number and quality of partner Safe and Well referrals and build on the good reputation of the service to reach marginalised individuals and groups.

Learning from SARs - Sandra, Lorel and Kerilyn's Story

The Safeguarding Adults Board were pleased to welcome Lorel, Sandra's daughter to co-facilitate this session based on the SAR which was undertaken by Merton Safeguarding Adults Board. Sandra had a history of mental health illness and was alcohol dependent, her daughter talked openly about the struggles her and her sister faced in supporting their mum and the impact on them of the lack of recognition as them as young carers. The SAR learning included an absence of partnership working, confusion re: Sandra's mental health, mental capacity, risk assessments not completed, poor system response re: self-neglect and addiction, missed opportunities to safeguard Sandra and escalate concerns and Sandra's daughters' needs were not considered.

Looking after the Practitioners - Self Care and Wellbeing

The session delivered by Rockpool CIC focused on vicarious trauma and compassion fatigue and the effect on practitioners of working regularly with trauma and human suffering. The session offered practical advice on self care and recognising stress responses to maintain wellbeing.

Making Safeguarding Personal (MSP)

This session was developed by the local authority safeguarding team and gave practitioners an overview of the Care Act Statutory Guidance and their role in MSP, ensure safeguarding is person centred and focuses on the individual's identified outcomes.

"Really good informative session, good discussions" (MSP)

Toxic Stress: The Road to Poor Outcomes

See Learning and Development Slide from for more information.

Re-Routing Your Neural Pathways - A Guide to Building Resilience

This session aimed to help participants consider how to re-train our brains to break habits and build resilience.

"Thank you for the session. I felt my mood lift and found it very useful to apply in practice"

Friday Friends - Mate Crime

Presented by the Lawnmowers Theatre Company, a theatre company ran by for and with people with learning disabilities who explore the issue of mate crime through a live show. The training involved a 20-minute showing of their play called "Friday Friends." This play highlights the risks that People with Learning disabilities face and how vulnerable they can be. This was followed by a discussion about what true friendship means and how people vulnerabilities can be exploited.

"Great session. Very informative and helps with reflective practice. I feel all AHP/Medics should attend."

Self-Neglect - Lifestyle Choice ​or ​Something More

This session developed and presented by the Local Authority ASSET Team Manager, aimed to reframe how we support people who self-neglect. The session gave a clear overview of the difference between a lifestyle choice and self-neglect, the causes of self-neglect and how to support people.

Trauma Informed Practice

See Learning and Development for more information.

Gateshead Safeguarding Adults Board continues to maximise opportunities to ensure that our resources are accessible to our partners and workforce.

The Safeguarding in Gateshead website is kept up to date and during this year there has been new information added on Exploitation, Financial Abuse and Scams and Understanding Safeguarding.

Our online multi-agency policy and procedures has a useful local practice resources and local guidance section which includes a wealth of information such as our 7-minute briefings and an online video and learning library. We have an active 'X' account @GatesheadSafe which has over 900 followers and is a useful platform to share our resources and new initiatives.

 

The Safeguarding Adults Board devolves responsibility for the undertaking of undertaking of safeguarding adult reviews to the SARCC group. In 2023/24 10 safeguarding adult review referrals were received. 4 cases were discussed by the group using the rapid review process with 2 progressing to discretionary SARs. 6 of the cases did not meet the criteria to progress to rapid review.

Vice chair

In July 2023 the SARCC appointed a new vice chair following a change in representation at the group. Joanne Pendleton, Head of Adult Safeguarding, Gateshead Health NHS Foundation Trust took on the role.

Learning register

The group agreed to work on the development of a learning register to record the learning from SARs and provide a tool for the QLP group to monitor the actions and updates. Work continues to develop the register further to ensure assurance information from our partners is gathered and recorded.

Cross boundary working

One SAR referral involved an individual who had involvement with services from Stockton, Newcastle and Gateshead. The group demonstrated excellent multi-agency and cross-boundary working through the gathering or relevant information from across all LA areas, sharing this information and facilitating a meeting to ensure all partners were engaged and given the opportunity to consider how the case should progress. Safeguarding Adult Reviews

Parallel processes

The Gateshead Coroners office was provided with a copy of the learning review report for the Adult H case, the information provided was welcomed by the Coroner and assisted in establishing whether or not an inquest should take place. The SARCC Group is responsible, on behalf of the Safeguarding Adults Board, for statutory SARs introduced by the Care Act 2014. All reviews and enquiries are reported back to the SAR Group for scrutiny and challenge. Learning from reviews is fed into the Quality, Learning and Practice Group when there are specific actions or learning that needs to be taken forward.

Learning from SARs

There are key actions undertaken following the completion of a SAR In order to ensure the Safeguarding Adults Board takes forward the learning and recommendations:

• a multi-agency action plan is developed, this is agreed by the partners and regular updates are requested by the SG Business Unit. The action plans are monitored and reviewed by the QLP subgroup and any issues with the completion of actions are escalated via the Safeguarding Adults Board Executive
• single agency actions are monitored via the QLP Subgroup, a monitoring tool is used to ensure all actions are responded to by agencies and any issues are escalated via the Safeguarding Adults Board Executive and senior representatives of the agencies involved
• multi-agency briefings are designed and delivered to all partners, sharing the case information and the recommendations and actions with frontline practitioners
• resources and guides are developed and published on the Safeguarding Adults Board website which provides a useful resource library for practitioners

During 2023/24 the SARCC received 10 Safeguarding Adult Referrals, none progressed to mandatory SAR:

Referral 1 (Adult H)

Adult H passed away on 1st April 2023 at the age of 64 years, there was very little information known about him.

On 29 March 2023, a Management Officer from Karbon Homes attended Adult H's home address on a arrears visit as rent had not been paid for one month. It is reported that Adult H crawled to the front door to answer due to a 'fall' he had some weeks early, he could not remember the exact date. Adult H was short of breath and struggling to manoeuvre about. He was also very slim and did not have any food in his cupboards or heating on. The Management Officer called an ambulance.

Adult H told the ambulance crew that he had not eaten for a month due to sanctions on his benefits. He lived alone, there was no food or drink in the property, he had been sleeping on his sofa and going to the toilet there. Northeast Ambulance Service records provided this description "the patient and the home were described as unkempt, only one working light in the property no bulbs in other rooms and the heating system was turned off".

Adult H was transferred to the Queen Elizabeth Hospital in Gateshead on 29 March 2023, where he passed away two days later.

SARCC Recommendation - The case did not meet the criteria to progress to a mandatory SAR however the group felt that there was learning which could be taken from the case. See Learning from SARs for further information.

Referrals 2 and 3

Both of these referrals were in relation to ladies who were experiencing multiple complexity in the context of their alcohol use. There was sufficient evidence from local and regional SAR data and from the Second National SAR Analysis (LGA 2023) as well as local and national health data to suggest that there was a need to provide alternative approaches and care pathways for change resistant drinkers. In response to this the Local Authority have agreed to fund the implementation of the Blue Light Project which provides a model for assertive outreach and focuses on harm reduction and risk management.

SARCC Recommendation - The members of the SARCC group recommended that the cases be referenced in a thematic of cases where alcohol misuse and mental health issues were evidenced, but where the people did not have care and support needs. Work on a thematic review is being undertaken jointing with Public Health.

Referral 4

This lady passed away on 2 November 2023 aged 30 years. She had a history of alcohol dependence and was also the victim of domestic abuse, she had mental health problems but did not appear to engage with services. The death of her mother in 2017 played a significant part in the decline in her mental health. She was often reported to be unkempt, and the condition of her home was at times concerning.

Originally from Stockton-on-Tees she had moved to Gateshead in June 2022, she had a diagnosis of Emotionally Unstable Personality Disorder and Complex Post Traumatic Stress Disorder. She was supported by mental health services (TEWV and CNTW), social care services, and treatment and recovery services. She was supported with accommodations through Gateshead Housing and was a frequent attender at A & E departments in North Tees, Gateshead and Newcastle.

She had engaged with Gateshead Recovery Partnership (GRP) and received support including dayhab, behaviour change and psychosocial interventions but had frequent relapses and continued to struggle with her alcohol use. Quality Assurance - Learning from SARs and other Enquiries The SARCC group reviewed this case in January 2024, and were joined by representatives from Stockton and Newcastle Safeguarding Adults Board areas to consider how partners had worked together to provide support and, it was clear from the information provided that all partners had demonstrated good cross boundary working in light of the difficulties in engaging with this young lady.

SARCC Recommendation - The members of the SARCC group and representatives from Stockton and Newcastle agreed that the case did not meet the criteria to progress to a SAR, however the case would be considered alongside referrals 2 and 3 for inclusion in a thematic review. This action has now been superseded by the LA's funding for the implementation of the Blue Light project.

Referral 5

This case related to a gentleman who resided in a care home in Gateshead. At the time of death, the gentleman was the subject of a Section 42 enquiry relating to injuries he had sustained following an unwitnessed fall.

SARCC Recommendation - The case did not meet the criteria to progress to a SAR and the SARCC asked that a single agency review should be undertaken by the care home in response to the issues raised in the SAR referral.

Referral 6

A SAR referral was received in relation to a lady who died on 24h December 2023. Adult Social Care and Gateshead Housing had worked closely to support this lady and had regular contact with her, raising their concerns with her regarding abuse and neglect by a third party. There was evidence of that the lady used alcohol and issues were raised regarding self-neglect, mental capacity and services being unable to connect with the individual. The lady had been contacted by domestic abuse services but it would appear that she refused to engage with them.

SARCC Recommendation - The cause of death at time of writing is still unknown, the SARCC have agreed to postpone a decision to process until this is available, consideration is also being given to a joint DHR/ SAR, this is pending a response to the police regarding their ongoing investigation into the case.

Referral 7

This case related to a lady who resided in a care home in Gateshead. At the time of death, the lady was the subject of a Section 42 enquiry relating to injuries he had sustained following an unwitnessed fall.

SARCC Recommendation - The case did not meet the criteria to progress to a SAR and the SARCC asked that a single agency review should be undertaken by the care home in response to the issues raised in the SAR referral.

Referral 8 (Adult J)

A Safeguarding Adult Review referral for Adult J was received from the Queen Elizabeth Hospital Safeguarding Team on 31 January 2024 following her death on 27 January 2024. Adult J lived with her daughter and grandson who provided care and support for her. She was of Polish decent and moved to the UK in 2021 following the death of her husband. She spoke no English and relied on her family to interpret for her. The referral raised concerns regarding the care that Adult J had received whilst living at home with her daughter and her grandson and the resulting pressure damage. Questions were raised regarding the family's ability to care for Adult J given her very limited mobility.

SARCC Recommendation - The case was discussed at the SARCC group meeting on 12 March 2024. Information was provided from agencies from both Gateshead and Durham, this helped the group to obtain a fuller picture of Adult J's case, who was providing care and where there were gaps in service or concerns regarding the care provided. It was agreed that although the case did not meet the criteria for a mandatory SAR that there was learning to be considered and that a discretionary SAR should be undertaken. The Assistant Director of Nursing, NENC ICB agreed to chair the practitioner session which is arranged to take place in June 2024.

Referral 9

A referral was received for this gentleman following his death on 12 March 2024. Although there was evidence that he had the appearance of care and support need no care act assessment had been undertaken. Services appeared to have worked together to try and safeguarding him, however agencies were often unable to make contact with him and if they were able to contact him and offer support he declined.

Referral 10

This SAR referral related to a lady who had suffered a double above knee amputation, following a stroke. The SARCC group were considering the case at their meeting in June, following the gathering of further information at which point it was ascertained that there had been a delay in referrals for the lady from their GP to the Vascular Team at the RVI. There was however no evidence that this delay would have changed the outcome for the lady.

SARCC Recommendations: SARCC agreed that the case did not meet criteria to progress to a SAR, however it agreed to ask for assurance from the GP practice concerned that they have robust processes in place to ensure referrals are made in a timely manner.

Two Safeguarding Adult Review were completed during 2023/ 24.

Thomas SAR

The Thomas SAR was undertaken by an independent author with the final report and recommendations presented to the board in December 2024. The full report, presentation and Seven-Minute Briefing can all be found on the Safeguarding Adults Board Website. There were seven recommendations from the review which covered:

1. Safeguarding Adults Board should ensure a collaborative approach by Mental Health and other services to the care of people with complex presentations.

2. Develop a multi-agency protocol on managing people that services find difficult to engage.

3. Public Health Commissioners should ensure that the needs of people with substance use disorders that services find difficult to engage are considered in local needs assessment or commissioning plan.

4. Safeguarding Adults Board should ensure that agencies and individual professionals are recognising the need to safeguard individuals with challenging presentations

5. Safeguarding Adults Board should remind all professionals of the importance of considering mental capacity and executive dysfunction when working with complex and challenging clients

6. Public Health Commissioners and the Integrated Care Board should review the response to people with co occurring disorders to ensure that it is consistent with national guidance.

7. Safeguarding Adults Board should remind all professionals of the importance of collecting accurate data on alcohol and drug use. A multi-agency action plan has been developed from the recommendations and the actions are being monitored through the Quality, Learning and Practice Subgroup.

Henry SAR (Adult H)

Although the SAR referral did not meet the criteria for a statutory review the SARCC group that there was learning to take from the case in relation to information sharing, use of multi-disciplinary meetings (MDTs), provision of informal support from VCS, professional curiosity, self-neglect and digital access to services. Single agency actions were also identified, and an action plan was drafted following a multi-agency learning review.

Terms of reference were drafted for the review and a practitioner event took place in November 2023. The review was chaired by the Director of Public Health with representation from Karbon Homes, Department of Work and Pensions (DWP), Citizens Advice Bureau (CAB), Libraries, GHFT, NEAS, Integrated Adults and Social Care Services, Northumbria Police.

Representatives shared information regarding Henry and identified the learning to be taken from the case. The learning and actions from the review is being monitored by the Safeguarding Adults Board, and assurances are being sought from partner agencies to prevent similar cases in the future.

See the Seven Minute briefing for the case.  

 

Volume of concerns and enquiries

For a concern to progress to a Section 42 Enquiry it must meet the statutory criteria. The Safeguarding duties apply to an adult who:

• has needs for care and support (whether the local authority is meeting any of those needs)
• is experiencing, or at risk of, abuse or neglect
• as a result of those care and support need is unable to protect themselves from either the risk of, or the experience of abuse or neglect

In 2023/24 there were 3862 Safeguarding Adult Concerns which led to 929 Section 42 Safeguarding Enquiries. This demonstrates a significant increase in the number from 2022/23. During 2023/24 the Safeguarding Team introduced a change in process introducing a triage model for dealing with safeguarding concerns. This saw a significant increase in the volume of concerns. The change in process ensures the recording of safeguarding concerns is in line with statutory guidance. Recording of cases which meet section 42 criteria, but risks were managed was revised and this has also demonstrated an increase in S42 enquiries.

See slide 67 for further information on the bespoke strategic safeguarding support from the Local Government Association's Partners in Care and Health programme, which led to the new triage model being implemented permanently.

In percentage terms, 24% of Concerns led to a Section 42 Enquiry. The number of concerns progressing to an enquiry remains lower than both the 2023/24 NE (47.1%) and England (29.47%) averages.

The change in process and introduction of the triage process saw the volume of concerns significantly increase during 2023/24 from the previous years. It has also resulted in an increase in the number of s42 enquiries. This data also shows that a large proportion of concerns do not progress from a safeguarding concern and that people have received multiple concerns in the reporting year.

Work continues to improve the knowledge and understanding of practitioners in what constitutes a safeguarding concern and in providing a robust process for low level concerns.

Categories of abuse

Utilising a count of completed Section 42 Enquiries, and allowing for multiple recording of abuse, the most common category of abuse in Gateshead continues to be Neglect and Acts of Omission which represented 34.9%. In a change to previous years the second most common category was Financial and Material abuse (15.9%) an increase of nearly 4% from the previous year, followed by Physical Abuse (13.5%) a reduction of nearly 5% from the previous year.

Financial and Material abuse has been added to the Safeguarding Adults Board Data Group action plan for further analysis and investigation.

Demographics

In Gateshead in 2023/24 44.7% of section 42 enquiries were for adults aged 18 to 64 which is an increase of over 12% from the previous year. The other age groups saw smaller reductions from the previous year. As a proportion this is now closer aligned to regional and national figures for this age group (43-50%). The gender split is consistent throughout recent reporting years and is aligned to national and regional figures which show a 60:40 split in gender. Proportions of primary support reasons remain consistent with previous years and national data.

Location of abuse

The reporting year saw a shift in location of s42 enquiries where a greater proportion were in a person's own home (52.4%). This could be linked to the increase in the proportion of concerns coming from the 18-64 age group and the likelihood this age group do not reside in a care home. This also aligns our proportions to the previous national and regional figures which is around 45-50%.

Concluded S42 enquiries

The proportion of Action Taken from concluded s42 enquiries is equivalent to regional and national figures however this is the lowest for Gateshead in the past 5 years (Highest 94%, lowest 89.2%). Concluded s42 enquires where the risk remained (12.1%) is the highest it has been in the past 5 years and is slightly higher than previous national and regional figures (5-9%).

Risks expected outcomes and making safeguarding personal figures have been investigated and the service has acknowledged some data quality issues which were attributed to deadlines around the new system implementation and data to be migrated. Closing the volume of enquiries on the system was prioritised over the usual quality assurance to reduce the amount of manual work when Mosaic went live.

Deprivation of Liberty Safeguards (DoLS)

For the period April 2023 to March 2024 Gateshead Council received 2840 Deprivation of Liberty Safeguard applications. This was an increase in activity from the previous financial year (2246). The demands placed on local authorities in meeting statutory obligations remains high. Gateshead are compliant with care home DoLS, and do not have a waiting list.

The highest rate for DoLS applications remains with those over the age of 65. Within Gateshead this represents 2084 applications (73.4% of all applications) and for those aged under 65, 756 (26.6%) for those under 65.

There were 729 applications which have not been authorised, due to various standard reasons. The primary reason for non-authorisation of a DoLS was down to a 'Incomplete', which took place in 564 cases.

Commissioning concerns

The number of provider concerns increased to 262 in 2023/24 from 237 in 2022/23. Medication was the highest category in 2022/23 at 21.3%, this has significantly reduced to 7.25% in 2023/24. Standards of Care was the highest category at 15.6%, followed by Hygiene Issues 11% and then Documentation Issues at 9.5%. Staffing issues remain high at 23.7% this is an increase on 19.5% in 2022/23 and demonstrates the continued difficulty in recruiting staff in the health and social care sector.

OP Residential and Nursing establishments receive the highest number of concerns at 55% of all concerns received, this is an increase from 47.7% in 2022/23 but in line with the figures from 2021/22 at 54.4%. This is followed by Generalist Homecare with 29% of the concerns.

Challenges remain in the system in relation to the high numbers of staff turnover within the health and social care system and the impact of this. There continues to be a poor understanding of the various reporting mechanisms for reporting safeguarding concerns, commissioning concerns and quality of care concerns, which impacts on commissioning's ability to address issues. This is being addressed by the review of the decision-making tool and introduction of more robust processes for triangulating information between adult social care, health and commissioning services.

Monthly cross partnership meetings

In order to ensure effective cross partnership working between the Safeguarding Adults Board, Gateshead Safeguarding Children's Partnership, Community Safety Partnership and the Domestic Abuse Board the business managers for each partnership meet on a monthly. The meetings follow a formal agenda and are used to share information and updates on reviews, projects, changes in legislation and establish where there needs to be cross partnership working to support areas or work.

Updates

In order to ensure each partnership board receives regular updates business managers is updated updates on current how successful adult safeguarding is at linking with other parts of the system, for example children's safeguarding, domestic violence, community safety

Joint safeguarding and community safety newsletter

The first of the joint newsletters was circulated in Spring 2024. The newsletter provides a round-up of the news from the safeguarding and community safety boards and partnerships, along with other relevant pieces of recent local and national information. Partners are invited to provide information on safeguarding activity to include in the newsletter to provide a full overview of work and activities across Gateshead.

Adult Social Care

Quality assurance

In October 2022 in preparation for the CQC Assurance inspections Gateshead Adult Social Care took part in a sector-led improvement exercise. The CQC draft assurance framework allowed the service to assess themselves on how well they were performing against their duties under Part 1 of the Care Act 2014. This included Sections 42-43: Safeguarding enquiries and Safeguarding Adults Boards. The evidence was reviewed by an independent consultant who provided feedback on the areas of good practice and areas for improvement. ASC has developed an action plan to provide a structured approach to the areas which require improvement and is supporting actions for the SAB within this plan.

Prevention

The Gateshead Safeguarding Adults team continue to support the delivery of multi-agency safeguarding training on behalf of the board alongside representatives from partner agencies. The team have been instrumental in reviewing and refreshing the Level 1 and 2 training courses and reinstating the Level 3 course on undertaking enquiries which has been missing from the programme for several years.

The Safeguarding Team Manager and ASSET Team Manager have developed training in Mental Capacity and Executive Dysfunction and piloted the course early in 2023. This provided further insight into factors to consider in relation to mental capacity assessments when working with people with multiple complex needs often linked to alcohol or substance misuse. The success of the pilot session has led to further session being planned for the coming year.

Gateshead's ASSET Team worked in partnership with Tyne and Wear Fire and Rescue Service on a case involving a gentleman who was involved in 3 home fires and required dedicated, consistent and a multi-agency approach to ensure he was kept safe. This was recognised by the SAB as an excellent example of multi-agency working.

Communication and engagement

The Safeguarding Adults team actively supported Safeguarding Adults Week in November 2022. The team staffed the safeguarding stall in the Civic Centre foyer during the week and supported the SG Champions session which focused on organisational abuse and learning from SARs.

Northumbria Police

Quality assurance

Northumbria police have robust systems in place to ensure quality, including a triage system within the Multi Agency Safeguarding Hub.

Force wide 'Vulnerability Matters' training was rolled in 2022 and continues with all new recruits and ongoing refresher training to our front-line staff. This training supports our officers to take a trauma informed approach to dealing with vulnerability and assist officers to identify vulnerable adults in the community. The force ensures a focus on vulnerability and that Protecting the vulnerable is front and centre of our force response. In addition, we are providing bespoke training sessions to our force control room call takers to ensure they can recognise and respond to vulnerability at the first point of contact and get it right. All our leadership courses for newly promoted Sergeants and Inspectors also includes an input on the strands of vulnerability which includes vulnerable adults.

Right Care Right Person

Northumbria Police are following national best practice and implementing Right Care Right Person (RCRP). This will reduce longer term demand by ensuring the public are directed to the right agency at the first point of contact. Since implementing the initial stages and triage process in January 2023 445 missing incidents have not been deployed to, freeing up officer's time to focus on higher risk incidents.

This will continue over the next year where we look to roll out a consistent version of RCRP nationally. We are currently awaiting a national partnership agreement at government level which will agree the threshold of risk for calls for service which police need to attend.

Throughout this implementation we have maintained close working relationships with our partner agencies including our mental health trusts, hospitals, and social care to ensure that we will only withdraw from some of these calls for service when they are ready and equipped to step in to support the individuals involved.

The second phase of RCRP is our hostel policy (opens new window) which went live on 12 June after partnership consultation. This again should reduce demand by ensuring we are responding to missing reports where there is a critical concern for the person. This policy has a robust triage system and a quality assurance follow up.

Communication and engagement

We continue to work closely with the multi-agency partnerships and have shared learning and training over the last year in relation to the growing concerns of children and young people in the transitional period involved in serious youth violence. Our multi agency exploitation hub has attended partnership CPD days to deliver inputs on exploitation and this offer continues to be extended to support the understanding and identification of exploitation.

Through Operation Pecan we have delivered inputs on urban street gangs and continue to work with our partners to develop a focussed deterrence approach.

Operational practice

Throughout 2022 our professional standards department delivered inputs to partners on abuse of position, relating to officer's relationships with victims and witnesses and encouraged partners to consider their own protocols and processes in relation to their own staff.

Mental capacity

Northumbria police continue our close working relationship with Cumbria Northumberland Tyne and Wear NHS Foundation Trust (CNTW) to operate the Street Triage team which is a mixed team of police and mental health nurses. Over the course of the last 12 months with the implementation of RCRP we have utilised the expertise of the street triage officers to spend more regular time within our control room to offer live time advice to call handlers.

We continue to offer regular training to our frontline staff regarding the application of the Mental Capacity Act.

North-East and North Cumbria Integrated Care Board (NENC ICB)

The Newcastle Gateshead Clinical Commissioning Group (CCG) transitioned to NENC ICB on 1st July 2022 with the structure and governance arrangements being formalised at Executive Board level. Richard Scott was appointed as Director of Nursing for the North Integrated Care Partnership (ICP) in December 2022. There is now a Safeguarding Executive meeting chaired by the Chief Executive Nurse which facilitates escalation of safeguarding issues to the ICP. Several additional posts have been appointed to, including an Assistant Director of Nursing for Newcastle Gateshead, having oversight of safeguarding for the North. This development will support the safeguarding agenda throughout the region.

Quality assurance

The Safeguarding Professionals Network continues to provide a forum for safeguarding health staff from both commissioning and providers to develop safeguarding practice and share learning across the Integrated Care System (ICS). A recent review of members by survey, to continue with the forum as an established network for health professionals had a positive outcome, the forum is well attended from all areas.

Prevention

Training for Primary Care staff has continued with sessions being provided online and available as a resource on the GP Team net, this includes sharing of learning from Case Reviews and promoting good practice from recommendations. Several requests are now being received from individual GP practices for face-to-face sessions which is being reviewed in line with resource availability.

Communication and engagement

The ICB Safeguarding team continue to provide support and work collaboratively with multi-agency partners, including attendance at the Safeguarding Adult Broad subgroups and promotion of shared learning from reviews. The Designated Nurse for Safeguarding Adults is currently Chair of the Safeguarding Adults Review and Complex Case Subgroup (SARCC).

Partnership working includes involvement with projects supporting asylum seekers, hate crime prevention, Prevent and Safer Community Boards and Domestic Abuse Local Partnership Board.

Operational practice

Given the significant increase in the number of care home concerns and issues identified during Covid the ICB Safeguarding, and Quality teams have also been working with the local authority in Gateshead to develop an approach to organisational safeguarding which is intended to pick up concerns at an earlier point so that homes can be supported without the need to escalate concerns through the Serious Provider Concerns process. Linked to this work the ICB has scoped out an approach which builds on the multi-agency approach with GPs and will aim to strengthen communication between the care home link GP and local authority safeguarding.

Mental capacity

Liberty Protection Safeguards (LPS) were due to be implemented from April 2022, following further delays it was announced on 5 April 2023 by the Department of Health and Social Care that the implementation of the Liberty Protection Safeguards (LPS) The Mental Capacity (Amendment) Act 2019 will be "delayed beyond the life of this Parliament" (therefore likely beyond Autumn 2024) The ICB will continue to support the improvement of and training in Mental Capacity Assessment for the current DoLs (Deprivation of Liberty) system.

Gateshead Health NHS Foundation Trust (GHNFT)

GHNFT is committed to ensuring safeguarding is part of its core business and recognises that safeguarding young people and adults at risk is a shared responsibility with the need for effective joint working between partner agencies and professionals.

Managing demand

The trust has faced some challenges during 2022/23, including an increase in activity and complex referrals, an increase in care needs, and a lack of care packages and placements within residential and nursing homes. This has resulted in delays in discharges and not being able to discharge patients. Despite these challenges we have still managed to prioritise and maintain a high-quality service for the Trust.

Staff have continued to raise concerns on 1152 occasions relating mainly to domestic abuse, neglect, self-neglect, physical abuse, and financial abuse. Of these concerns 700 were shared with the local authority. The concerns that were not shared with the local authority were managed and addressed within the hospital, working closely with wards and departments, including Patient Safety, the Children's Safeguarding team, Housing, Psychiatric Liaison and Security.

Domestic abuse remains a high priority with 314 domestic abuse concerns raised between April 2022 and April 2023, compared to 374 the previous year with an increase in the number of complex cases. The domestic abuse concerns included 30 staff referrals, which is lower as the 37 received in the previous year.

Communication and engagement

Working in partnership remains an important part of the Safeguarding team's work, with such complex cases including self-neglect, substance misuse and complex health needs. The team continue to play an active role and contribute to various multi-agency meetings, Safeguarding Adult Reviews, Domestic Homicide Reviews, MARAC, MAPPA and MATAC. Focusing on sharing information, any key learning and implementing any recommendations made, which is vital in continuing to improve safeguarding practice within the Trust.

Operational practice

Over the past year we have focused on the level 3 safeguarding training, working closely with the Learning and Development team, and departments to improve our training compliance and raise the profile of safeguarding. Training will continue to be priority and working in partnership with our partner agencies. See case study.

Mental capacity

The Trust continues to raise awareness of the application of the Mental Capacity Act and continues to recognise the challenges in the use of the act for practitioners. There remains a focusing on training compliance though the e-learning package of learning which is available across the Trust.

The Mental Health Legislation service within the Safeguarding Adults team works to ensure that professionals are working in accordance with legislation and ensuring patient safeguards are met by educating staff on the legal frameworks of the Mental Capacity Act (MCA), Deprivation of Liberty Safeguards (DoLS), and the Mental Health Act (MHA). The team supports practice with the provision of training, advice, support, and policies, to ensure the rights of our patients are supported and upheld.

The Safeguarding team review, monitor and report all uses of the DoLS throughout the Trust. Between April 2022 and March 2023, the Trust had 698 DoLS applications submitted. The submission of applications has seen a year-on-year increase with 548 applications in 2021/22 and 420 applications in 2020/21.

Neglect and self-neglect - case study

Gateshead Health NHS Foundation Trust

Miss A lived at home with her father and her brother, she has a diagnosis of a learning disability and ongoing health concerns. A safeguarding concern was raised whilst in A&E on her admission into hospital due to:

• learning disability
• vulnerable adult
• patient arrived in A&E with cellulitis
• patient denied having any contact with her GP
• patient appears to be unkempt, strong-smelling odour, incontinent of faeces, excoriated skin
• concerned for patient's wellbeing, health, and her dignity
• father and brother helping to care and support patient

During hospital admission, there was joint working between the Safeguarding team and the Learning Disability Specialist Nurse to establish vulnerability and care needs to facilitate safe discharge and identify any emotional and physical support.

During admission Miss A began to refuse to mobilise; choosing to be doubly incontinent which then resulted in further moisture damage. Capacity was assessed in relation to her hospital admission. It was agreed that a DOLs was not required, however when Miss A began to refuse treatment, her capacity was re-assessed adapting communication to suit her needs.

It was established that Miss A did not have capacity to retain information in relation to treatment but understood why she was in hospital. Therefore MCA 1 and 2 for treatment was put in place; guidance from the MHA Lead in relation to frameworks was advised.

A best-interest decision was made for all treatment to be given. Collaboration with Miss A was key to help her understand why intervention was needed. It was agreed that two hourly positional changes were to be implemented to prevent any further pressure damage; the tissue viability nurse (TVN) provided support.

Occupational Therapy and Physiotherapy were involved to support Miss A with encouragement to mobilise. Emotional support was provided in relation to low mood and to identify her wishes. Multi-agency working took place to discuss appropriate discharge plans to ensure a safe discharge.

At the point of writing, Miss A is ready for discharge and is awaiting a suitable care package and equipment. A referral to the community Learning Disability team has been made to support with her emotional and physical health. This is a positive outcome and professionals worked together to ensure her needs were met and a safe discharge was arranged.

Probation

Prevention

Safeguarding training is a priority for the Probation Service with mandated training now being linked to staff pay progression via the annual competency-based framework. Records indicate more than 85% of staff have completed the training. The remaining deficit is made up of staff on long-term sick, maternity or new staff recently joining the service who have not reached that section of their training.

Quality assurance

In addition to ensuring staff of all grades have completed relevant Safeguarding and Domestic Abuse training, all cases where there are relevant flags raising concern are subject to additional checks. This is an area of high interest for Probation Service, with regular management oversight to ensure this practice is both completed in a timely manner and is being embedded within teams.

Operational practice

Staff completed relevant referrals to Safeguarding Services where concerns are raised, attend Section 47 meetings as required, ICPC and ongoing child-safeguarding meetings whether this is child protection or child in need.

In October 2022, South Tyneside and Gateshead Probation Delivery Unit underwent HMIP inspection where 100% of cases at sentencing stage had relevant safeguarding enquiries undertaken. Partnership working and safeguarding were highlighted as an area of strength within the PDU.

Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust (CNTW NFT)

Prevention

Significant effort has been made in delivering the Level 3 safeguarding training across the organisation. Training sessions now run three times per week and substantial progress has been made. CNTW Academy continues to offer this training via the Microsoft Teams platform on a weekly basis to ensure consistent compliance. A 'Vulnerability not age' awareness session will be developed and delivered. There has been a sustained increase in safeguarding reporting demonstrating an increased awareness of safeguarding and public protection issues in Trust staff.

MCA learning themes have been shared with Trust MCA lead

A CNTW Domestic Violence training package was developed by Named Nurses utilising learning from local reviews. This so far has been delivered to 300 plus staff and will continue to be rolled out via the SAPP team. CNTW have shared the learning from Domestic Homicide Reviews undertaken within the year with particular focus on addiction services who have received the Trust DV training.

Quality assurance

This learning was reviewed and a Quality assurance document developed to provide assurance against the recommendations of the report. The assurance document will be provided to SAPP group in 2023/24 by locality groups.

A review of the demand and capacity of the SAPP team has been undertaken and the team structure and activities reviewed leading to additional resource at Named Nurse level. Demand and capacity will continue to be reviewed in light of sustained increase in reported incidents and review processes and approaches as necessary to ensure this demand can be met whilst maintaining quality.

Further work is to be undertaken to support accurate safeguarding reporting and data capture to better inform CNTW and external partners of our safeguarding activity and allow targeted improvement work to take place.

We will continue to engage with the PSIRF Implementation group and Safer Care leads or Safety leads who are reviewing and embedding the National Patient Safety strategy including the new incident reporting and review systems, to ensure that the classification of incidents retains relevant safeguarding Information to enable incidents to be reviewed, clinicians supported, and patients safeguarded.

Gateshead Housing

Operational practice

Hoarding disorders feature heavily in self-neglect cases both regionally and nationally. The links between hoarding and increased fire risk have been identified within SARs and learning reviews.

Hoarding cases

Within the Housing Support service, we have supported 17 council tenants with a hoarding disorder within the last 12 months. 10 cases carried over from previous year, seven new cases and eight have been resolved through joint work with Adult Social Care and Housing.

The average length of time taken to resolve hoarding cases is 629 days, due to the time required to build trust with the customer and engage the right type of support to help them address their fears of disposing of collected items.

The main type of hoarding we have experienced relates to rubbish hoarding, with the main customer group being middle aged single men, who have never married or remained in the family home following the death of their parents.

'Less is more' - hoarder support group

In collaboration with Northumbria University, Gateshead Council has established a group of customers identified as having a hoarding disorder, from across the region to share personal experiences and help professionals to understand what type of support helped them to identify that they had a disorder and needed help and ultimately helped them to stop hoarding.

The group, which has adopted the name 'less is more' has met twice this year and a third meeting is scheduled in July. With four current group members, supported by staff from Northumbria University and Gateshead Council's Housing Support Service the group intends to establish terms of reference and encourage new members to join and share their experiences. Longer term the group would like to play an influential role in policy and procedural change within local authority services across the region, to support those with hoarding disorders.

South Tyneside and Sunderland NHS Foundation Trust (STSFT)

Quality assurance

The rigorous programme of safeguarding audits have continued throughout 2022/23 to monitor safeguarding practice across STSFT. These have included MCA/DoLS policy adherence, MCA policy compliance for patients with a learning disability, safeguarding policy compliance (inclusive of routine and selective enquiry), procedural self-neglect guidance and threshold tool compliance and chaperone policy compliance. A safeguarding team service review was conducted via Survey monkey in December 2022. Findings were extremely positive.

A new model for safeguarding visibility has been implemented to increase face to face presence on wards and departments to further support staff and offer safeguarding supervision. This includes daily attendance at Emergency Department (ED) huddles (Monday - Friday).

The safeguarding team continue to complete a daily audit of ED attendances to ascertain if there are any missed opportunities. Any learning to arise from missed opportunities are incident reported. The Named Nurse attends ED Clinical Governance meetings to discuss any reported missed opportunities. The annual audit of ED attendance activity forms part of the safeguarding annual audit cycle.

The safeguarding team have undertaken joint working with ED staff to expand the asking of the safeguarding mandatory questions from initial triage and make them mandatory within Same Day Emergency Care (SDEC) documentation and within the speciality transfer letter.

Safeguarding training compliance has continued to exceed the 90% organisational target and this has been maintained throughout 2022/23. The Trust continues to exceed NHS England's 85% compliance target for WRAP Prevent training and Basic Prevent Awareness training (BPAT).

Prevention

The safeguarding team have continued to work in collaboration with multi-agency partners throughout the recovery phase and longer-term impact of the COVID-19 pandemic to ensure safeguarding measures are in place and learning is shared to support and protect adults at risk and their families. Main emphasis has been around MSP, self-neglect, fire safety awareness, trauma-informed practice, mental capacity, and professional curiosity. These themes have been shared via 7-minute briefings, quarterly Safeguarding Champions forums and bi-monthly safeguarding newsletters.

Safeguarding supervision sessions have been reviewed to ensure that delivery remains impactful and meaningful. A new model for safeguarding visibility has been implemented to increase face to face presence in areas to further support staff in their safeguarding practice and offer safeguarding supervision.

All levels of safeguarding training have been reviewed to ensure they are aligned to both adult and children intercollegiate document. Level 3 face to face 'Think family' training has been amended to reflect learning from recent scoping's, SAR's, DHR's, CSPR's and learning reviews. Slido (opens new window) is now being used to ensure that face to face sessions are more interactive and those delivering training can obtain training evaluations in real time.

MCA training has been reviewed and STSFT now utilise the National e-Learning package resulting in MCA training now being a stand-alone package.

Communication and engagement

A bi-monthly newsletter is shared with all STSFT employees via both the team brief and through the safeguarding champion's forum. This newsletter highlights learning from SARs or DHRs and CSPRs and incorporates any regional or local updates inclusive of 7-minute briefings. The newsletter is held on the Trust intranet site.

STSFT Safeguarding Team continue to be active members of local partnerships ensuring representation and contribution across all meetings and groups.

The Safeguarding Team are active participants within the Complex Adult Risk Management (CARM) meetings within the Sunderland locality and Safeguarding in Partnership (SIPT) meetings in South Tyneside.

The Safeguarding Team has worked closely with the Local Authority to understand the impact and prepare for the forthcoming implementation of LPS.

STSFT safeguarding team actively participated in Elder Abuse Day (15 June 2022), attending wards and departments to raise awareness of elder abuse.

Operational practice

The Domestic Abuse Health Advocates (DAHA) continue to work alongside the Safeguarding team to support staff in the identification and response to any disclosure of domestic abuse. The DAHA's are specialists working with victims of domestic abuse, targeting ward areas, ED and community in supporting staff to recognise and respond to DA. The increased visibility of the DAHA's across the Trust has resulted in increased domestic abuse referral activity. Recent DAHA feedback from both patients and staff include:

"Thank you, I do not know what I would have done if you had not been here to support me."

"Thank you so much you have been amazing in supporting me."

"The DAHA on duty came down to ED and was so kind and helpful and just offered to help with anything we needed. This was so kind, thoughtful and really welcomed."

The safeguarding team have worked alongside STSFT staff to further develop body map documentation to record marks, bruises and pressure damage on admission and discharge from hospital. The body maps are now incorporated into STSFT documentation, alongside a SOP to support practitioners accessing the document.

Mental capacity

An MCA/LPS lead, alongside an MCA Corporate Lead have been appointed to further embed MCA into practice alongside having the skills and expertise to robustly implement LPS once finalised. Improvements have been made to the MCA recording pathway on Meditech to support staff to re-consider MCA assessment and whether a DoLS is required or needs withdrawn. Community EMIS systems have been amended to incorporate MCA assessment within community records.

Connected Voice

During 2022/23 Connected Voice undertook the following in support of the SAB Strategic Plan:

• delivered advocacy awareness session to Safeguarding team to improve referral pathways
• provided training to the VCSE in Gateshead on the role of advocacy in safeguarding four times in the year
• provided a briefing to the SAB on Nice guidance and duties
• reported on safeguarding numbers throughout the year, leading to prevention and education for individuals on reporting concerns
• discussed safeguarding enquiries with Safeguarding team reducing alerts made that do not meet the threshold for Tyne and Wear Fire and Rescue Service

Tyne and Wear Fire and Rescue Service

Prevention

Following the rise in the number of fire deaths across the region during 2022/23 TWFRS have been proactive in their approach to raising awareness of fire risk. TWFRS have taken over chairing of the Regional Fire Risk Task and Finish group which is looking at the provision of information advice and guidance and highlighting the risk factors in relation to age, mobility, smoking, alcohol use, use of paraffin-based emollient creams, self-neglect, hoarding, mental health, living alone and isolation. The proposal is to develop a suite of resources and a video outlining the risks and how to keep safe.

The Safe and Well visits continue to be promoted and with the launch of the new 'When to Refer' card with QR code, this is now easier than ever. The Safe and Well visits are free and will cover fire escape plans, kitchen and cooking safety, electrical safety, smoking safety and candle safety but are also used as a mechanism to build engagement with hard to reach and 'at risk' people. Operatives carrying out the visits are often made aware of safeguarding issues and concerns and can be an essential link to raising concerns and supporting people during the safeguarding process. Some of the excellent work between TWFRS and the local authorities ASSET team are detailed in the case study below. The Safeguarding Champions also received a fire risk briefing in March to highlight the risks and promote the Safe and Well visits.

Operational practice Joint working (fire risk) - case study

Tyne and Wear Fire and Rescue Service and Gateshead Council

In September TWFRS received a 999 call to a house fire in Gateshead resulting from a Carecall monitored alarm activation. Mr D was rescued from the property and conveyed to hospital suffering from breathing difficulties. The cause of the fire was accidental, and a safeguarding referral was submitted to the local authority due to concerns for Mr D including self-neglect, alcohol issues, hoarding and mental health issues.

In October fire crews were called to a second house fire at the same address. Mr D was rescued by fire crews and required hospital treatment for breathing difficulties due to smoke inhalation. A further safeguarding referral was made with the same concerns. Due to the extensive fire damage following the second fire, the property was deemed uninhabitable. Discussions were held with the Gateshead Housing Company and Mr D was relocated to a hotel following his discharge from hospital, until a new property was secured for him. He successfully moved to his new address a short time later.

On 21 December fire crews were mobilised to a fire at Mr Ds new address. Mr D was rescued and taken to hospital for treatment which resulted in a lengthy admission. Another safeguarding referral was submitted, and a request was made for an emergency meeting to be held due to the fact this was an extremely vulnerable individual; elderly, lived alone, smoker, alcohol issues. Mr D had been involved in three significant house fires over a three-month period, on every occasion he had to be rescued by fire crews and required hospital treatment.

An urgent multi-agency safeguarding meeting was held on 22 December. Further meetings led to agreements by partner agencies to carry out the following action:

• as Mr D was known to smoke in bed the existing monitored alarm was extended to include the bedroom
• installation of a misting system (TWFRS Ultimate Protection model) within the property
• joint visit by Housing and TWFRS to conduct a Safe and Well check
• fire-retardant bedding, throw and mat issued
• referral to befriending services for Mr D due to feelings of isolation
• offer of referral to address alcohol dependency, this was declined by Mr D
• referral to the falls clinic
• daily welfare calls from Housing Warden

Between January and February Mr D withdrew his engagement with Housing and refused daily calls from the Warden. He also refused to engage with the Gateshead Recovery Partnership for support with his alcohol dependency and withdrew consent for the installation of the monitored smoke alarm in the bedroom.

Further safeguarding meetings were held to discuss the ongoing and increasing concerns from partners, particularly the high fire risk. Partners worked together to re-engage Mr D and because of hard work and persistence from all partners the misting system and smoke alarm were installed.

A further fire incident has occurred in Mr Ds home, however the heat detector activated causing the misting system to deploy preventing both serious damage to the property but most importantly injury to the occupier.

This case study shows how a high risk and vulnerable occupier can be protected by partner agencies working towards a common goal. Working together with determination and drive. This is an excellent example of partnership working by multiple partners to achieve a positive outcome and highlights potential best practice moving forward. Following this latest incident Mr D is currently engaging with his social worker and other partner agencies.

1. Quality Assurance

The Safeguarding Adults Board will continue to prioritise Quality Assurance in its widest sense. This will enable the Board to demonstrate quality and effectiveness at both strategic and operational levels. It aims to support a better understanding of how safe adults are locally and how well local services are carrying out their safeguarding responsibilities in accordance with the Care Act and the Gateshead Multi-Agency Policy and Procedures. In particular, the Board will ensure that quality is driven by learning.

Key actions:

• develop training for front line practitioners that is guided by learning from reviews and inquiries
• develop and implement annual Quality Assurance challenge event
• enhance our multi-agency approach of sharing learning with front line practitioners
• revise the Safeguarding Adults Review Policy and Practice Guidance to include a strengthened approach to practical application of learning
• prepare our Safeguarding Adults Board for the new CQC regulatory model and assessment framework which is expected to commence in April 2023

2. Prevention

Prevention is one of the six Principles of Safeguarding. Within Gateshead we have prioritised preventative work and have produced a range of practice guidance notes and bespoke training courses to support our front-line practitioners. The Board would like to see Prevention at the forefront of all Policies, Procedures and Practice Guidance and woven into practice.

Key actions:

• develop and implement a Multi-Agency Risk Management (MARM) framework as a mechanism for supporting vulnerable residents who do not meet the statutory criteria for safeguarding adults
• support closer integration of public services across the wider Gateshead System, including the work of Public Sector Reform and the Gateshead Care Partnership. Understand and respond to potential safeguarding implications of the Health and Social Care Integration White Paper.
• become Adverse Childhood Experiences (ACE) / Adult Attachment / trauma informed
• revise the Self-Neglect Practice Guidance note and deliver updated multi-agency practitioner training
• revise the Financial Abuse Practice Guidance note, taking into account the issues arising from implementation of Universal Credit
• strengthen multi-agency arrangements for Modern Slavery in Gateshead; to include awareness raising, responding to pre-planned and unplanned incidents and quality assurance
• raise awareness about Gateshead pathways and provision for all aspects of exploitation, and work in partnership with the new regional Victim Hub
• build community resilience so that our residents are better equipped to keep themselves safe from harm
• develop a more flexible training programme, to include more e-learning and virtual learning opportunities
• develop and implement organisational abuse policy and procedure
• improve partnership working to safeguard people who experience homelessness
• understand the impact of Mental Health Act reform upon the wider safeguarding agenda. Support the Gateshead community mental health transformation programme

3. Communication and engagement

The Safeguarding Adults Board has made significant improvements in Making Safeguarding Personal to ensure that those adults involved within the safeguarding process have their wellbeing promoted and, where appropriate, that regard is given to their views, wishes, feelings and beliefs when deciding any action. Consultation has demonstrated that there continues to be a lack of understanding about Safeguarding within the wider community, which can impact upon the effectiveness of Safeguarding Adults as a whole.

Key Actions 2019 - 24 include:

• effectively communicate and champion our good practice
• enhance communication and engagement with partners and providers who are not routinely engaged with the board and sub-groups
• promote safeguarding adult key messages within our communities
• widely promote our safeguarding website and social media presence
• implement our Safeguarding Adult Champion Scheme and develop safe reporting centres
• develop a safeguarding adult resource library which includes communication and engagement tools, including visual media aids
• develop mechanisms to ensure that the views of adults at risk and carers inform the work of the Safeguarding Adults Board

4. Operational practice

Whilst this is a Strategic Plan, the Safeguarding Adults Board must ensure that operational practice is fit for purpose. Whilst significant improvements have been introduced by the Safeguarding Adults Board and our key partners, we know from our quality assurance processes and the sharing of best practice nationally and regionally that further improvements can always be made.

Key actions 2019 - 24 include:

• work with the Health and Wellbeing Board and Community Safety Board to improve how our partner organisations identify and respond to complex cases
• refresh the Safeguarding Adults Board Multi-Agency Policy and Procedures by enhancing accessibility and simplifying the procedures
• enhance our approach to managing risk, to include:
  • understanding perpetrator motivations
  • person centred approach v managing risk
  • identifying and responding to coercive and controlling behaviour
• improve communication flow with referrers, providers and Adult at risk after a concern has been submitted
• strengthen multi-agency safeguarding transition arrangements, including procedures for responding to child to parent violence
• develop a shared approach to missing adults, including consideration of the use of 'vulnerability markers'
• further embed Making Safeguarding Personal throughout Safeguarding Adults practice
• work in partnership to manage levels of demand. This will include the development of an Adult Concern decision making tool
• develop a Gateshead Safeguarding Adults Board People in a Position of Trust (PIPOT) Policy

5. Mental capacity

Understanding and applying the Mental Capacity Act is central to the Safeguarding Adults process. It remains one of our most common areas for improvement in Gateshead, and beyond. Legislative changes are again on the horizon with the proposed Mental Capacity (Amendment) Bill which will reform the Deprivation of Liberty Safeguards (DoLS) and replace them with Liberty Protection Safeguards. The agenda will continue to evolve as new ways of working and case law is embedded into practice. Practitioners need tools and guidance to support them with the practical application of the Mental Capacity Act within everyday safeguarding, assessment, and care provision.

Key actions 2019 - 24 include:

• understand, and effectively respond, to changes within the Mental Capacity Act (Amendment) Act
• monitor the development of the revised Code of Practice for the Mental Capacity Act and develop a mechanism for assuring that the changes within the Code of Practice are effectively implemented within Gateshead
• develop and implement a programme of awareness raising for front line practitioners, providers, partners and the wider public about the application of the Mental Capacity Act
• explore how a health diagnosis supports the practical application of the Mental Capacity Act
• continue to ensure that referrals for advocacy are made in accordance with the Care Act 2014