Norfolk review

That the Department of Health & Social Care provide guidance and examples of good practice for practitioners on assessing risk of harm to others where someone affected by dementia exhibits or starts to exhibit, behaviours which are challenging, or which present an obstacle to the cared for person receiving the safe care they need.

All practitioners working with adults should be aware of the signs and symptoms of dementia, be able to act in accordance with best practice to support the person concerned and their family member/s, undertake an assessment of risk to the person concerned, and the potential of risk to others which might arise from their behaviours which may be challenging.

To better inform policy and service development that the Crime Survey for England and Wales remove its upper age limit of 74years of age for collecting data on domestic abuse victims and perpetrators to provide a complete picture of the scale of domestic abuse across the entire adult population.

The primary care networks who have a role in developing lead practitioners and identifying a uniform approach for patients with complex needs, should ensure that such cases have a named practitioner to coordinate their needs and those of their carer (where a carer exists) which should be reviewed at regular multi-disciplinary team meetings as per NICE Guidance.

For the Home Office to consider whether the methodology and guidance for a DHR could be modified for a more proportionate review, where the perpetrator is diagnosed as not of sound mind due to dementia and there is no evidence to suggest any historic domestic abuse.

Where fire hazards are identified during home visits by clinicians and/or practitioners, the Fire Service should be contacted to offer a home safety assessment and guidance to the service user.

Adult Social Care to amend Section 5 page 4 ‘Refusal of Assessment’ of the new Carer’s Assessment Guidance for Practitioners issued in February 2020, to include the need for practitioners to reoffer support and assessment at intervals during their contact with service users and their carers, in recognition that needs change over time and support may be accepted in the future. Promotion of the guidance should be undertaken on a 6 monthly basis to acknowledge changes in staff.

General practices to be cognisant of, and adhere to, NICE guidance that all patients affected by multiple sclerosis and their partner, family member, or carer should: • be referred to the specialist MS nursing service for support and regular review. • be given information about specialist voluntary sector MS services. This should be reoffered at reviews to ensure the patient/service user remain aware of the specialist support available.

The learning from this review be disseminated to GP practices to highlight the need to ensure that where a patient has caring responsibilities this is clearly visible on their patient record to enable the impact on their physical and mental health to be considered in consultations and assessments, and following recommended good practice, consider establishing a practice register of carers which could be reviewed annually to maintain its accuracy. Each carer should have an annual review as a minimum to assess their needs. (The Six 'quality markers' to Support Carers in Appendix 3 to be shared).

Hospital social work team to be compliant with Norfolk County Council (NCC) policy to hold fortnightly Reflective Practice meetings irrespective of hospital pressures. This to include a session to be held specifically in relation to Service’s IMR findings and a refresher on NCC Domestic Violence and Abuse policy.

Where appropriate, separate Carer’s Assessments should take place in the hospital particularly where higher risks of carer stress are identified and irrespective of the discharge pathway identified.

Onward referral for Carer’s Assessment post discharge should always be considered where an informal carer has been identified and their consent given. The process of onward referrals to community professionals – Health and Social Care, to be re-clarified to the Hospital Social Work Team.

Management overview of hospital discharge cases where carer’s stress is raised as a concern to be increased, including authorisation of the discharge plan.

Hospital Team Manager to ensure compliance with mandatory and enhanced Safeguarding training is monitored, and all assessing workers are compliant according to the requirements of their role.

Quality Assurance team to support with a training session on Carers for the Norfolk & Norwich University Hospital Social Work team including an understanding of legal framework and policy.

EEAST to reinstate routinely providing a copy of all social care referral to Primary Care. (Currently, due to a change in adult care pathway questions in EEAST’s single point of contact (SPOC), a copy of the adult social care referral is no longer sent to the patient’s GP).

EEAST to reinforce with all staff the criteria and processes for undertaking an appropriate referral to social care.

The GP practice should ensure that a system is put in place to identify patients who have caring responsibilities, and this is highlighted on their patient record. To support this system the practice should consider the good practice of introducing a register of carers, to enable their patients who are carers to be recognised and the impact on their health considered at appointments and assessments.

A system should be put in place to ensure that the practice record of carers is reviewed annually to maintain its accuracy.

Each patient who is a carer should have an annual review as a minimum to assess their needs, and if required be offered a referral for a Carer’s Assessment. If declined the Carer’s Assessment should be reoffered at future reviews.

Continue to circulate Norfolk Safeguarding and Adult Board’s Self Neglect & Hoarding policy across the trust and include in level 3 training, focusing on using the Clutter image rating tool to aid with assessments.

Continue to encourage staff to be more professionally curious. This is supported in training, supervision, and phone calls.

Share with clinical leadership team and continue within training and telephone support for trust staff, the need to hear the patient’s voice at all consultations, face to face and on telephone.

Continue to promote domestic abuse training and domestic abuse Champions across the trust.

Standardised annual competency checks to be put in place for staff in between safeguarding training sessions, this could be in team meetings and included as part of an appraisal as a target.

Clear standards around supervision, team meeting frequency, and standardised agendas to be established.

The Management team to devise good practice fact sheets informed by the findings from the Service’s IMR and this DHR as guidance for staff to assist their practice.

Monitor the level of carer’s assessments offered by reablement practitioners and investigate whether this could be captured by the Liquid Logic database.

Implement training plan to improve the level of recording by all staff.

An additional supervision for all staff involved in this case who did not demonstrate the required practice and/or knowledge required to be undertaken focussing on this case and the issues identified.

Include in the guidance for staff the expected actions following a service user’s fall.

Review responses to urgent situations with system partners. Review the information given by the Support Worker in this case to establish whether enough detail was provided to triage appropriately, whether staff require guidance when making referrals or whether changes are needed in the processes followed by staff triaging referrals and agreed response times.

Where a patient expresses feelings of low mood or makes comments consistent with not wishing to live any longer, professional curiosity should be used to explore the rationale and home circumstances which may be influencing these thoughts, and a referral to the Mental Health Liaison Team (MHLT) considered.