Lincoln review

LCC ASC to review compliance with their assessment and review procedures, including some QA of OT Assessments in order to confirm that this case is an isolated incident of non- face to face practice with immediate effect.

Ensure Waterloo Housing group are complying with the housing register contract including ensuring their staff are competent to identify and report safeguarding concerns and have appropriate policies.

ULHT’s Safeguarding Adults Lead will update the Trust’s Safeguarding Adults Policy to reinforce the need for consideration to be given to referring a patient directly into drug and alcohol support services. Timescale for completion – end of March 2016.

For GPs to assess the needs of, and impact upon the adult or child carer within families that include individuals within complex health issues and record their assessment and actions.

In response to findings 3 & 4: More focused work is required to ensure clinicians are aware of and implement their responsibilities within the Trust Safeguarding Policy (Policy 11) and Multi-agency Domestic Abuse Policy to correctly identify, record and respond to disclosures of historical and domestic abuse, embedding the domestic abuse risk assessment and referral process across all areas of the Trust. The Older Adults division particularly should implement, and assure the Trust boards of the implementation, of the Safeguarding Screening tools, effective risk management and associated actions upon suspicion or disclosure of domestic abuse, with an action plan to assure this recommendation is implemented within six months.

Domestic abuse needs to have a higher profile in the Local Authority's work with Adults and their families. This needs to be supported by a dynamic approach that encapsulates good practice, excellent training and the tools to do the job effectively, e.g., a proficient system including IT and good articulation, and promotion of domestic abuse as an issue that affects all communities.

LCC ASC to review their performance or contract review methods for external providers, in particular around the quality of assessments and recording, with a key focus on their quality standards principles.

To advise and assist Waterloo with reviewing their safeguarding policy, which is due for review in January 2016. A copy of ELDC’s safeguarding policy has already been forwarded to them.

With reference to points 2 and 4, an audit of risk assessments and care planning throughout the Trust, in order to analyse the quality of record keeping upon appointment and discharge of patients and review following disclosure of a risk event. Improved record keeping in line with Trust guidelines, in particular within risk assessment, care planning and robust information-sharing with internal and external agencies, would increase the potential for decisions made being based on comprehensive knowledge of the risks, patient’s wishes and expectations and collaboratively-established unmet needs. This should be implemented within six months.

In order to ensure that practice is good, Adult Care needs to give consideration to a range of measures, checks and balances that support practitioners in delivering good quality work across a range of services.

All relevant agencies to undertake a dip audit sample of the quality of Domestic Abuse Incidents and the completion of DASH risk assessments, ensuring it captures a review of the DASH assessment being completed on the right person (victim) or both (in cases of dual reporting). The results should inform the need to issue further guidance to the relevant professionals where appropriate. Following the outcome of this audit by agencies, the Domestic Abuse Strategic Management Board to consider a review of the process around the dual reporting of domestic violence and abuse.

To review the process for assessing housing applicant’s medical need and ensure those staff making the assessments are competent. Waterloo have already been contacted about this.

During the Trust-wide audit of risk assessments and care planning as detailed above, analysis of the extent of the recording of children being a protective factor in risk assessments, as per finding 5 above.

Consideration needs to be given to strengthening the management oversight, particularly at the principal practitioner level. This could be achieved by incorporating robust risk assessment at the allocation stage of case management, in particular the use of the family histories and chronologies in identifying patterns and themes of behaviour in order to enable professional judgements about level of risk to be made confidently. In reflecting on this case, it would be timely to also consider reviewing the 'complex' case definition and deciding if a 'complex' case needs to be managed in a different way from a more straight forward request.

In line with the principles of the Care Act 2014, LCC ASC to produce a briefing note to be circulated to all agencies on the definition of carers, their roles and responsibilities and how they can access services.

Review whether the Council is doing enough to advise its residents of Domestic Abuse services for victims and perpetrators and how this information can be communicated.

In relation to finding 6, there should be an immediate Trust-wide review of patient service contracts and policies in how they engage patients who present with risks to self, to others and from others, who are unwilling or unable to attend planned appointments. An action plan in response to this review should be implemented within 6 months.

In order to support a strengthened management oversight, Adult Care may wish to consider revisiting the current Quality assurance regime, to put in quality checks of cases at points such as review and closure, or all cases open for 6 months plus, for example, which could also cross reference with practitioner supervision and development. This would support the development of high level assessment skills and start to help identify what 'good' looks like.

LPFT and CCG to review and align their practice of addressing the needs of carers, including arranging assessments for carers which address their own substance misuse or mental health needs.

Regarding point 7 above, the Trust will roll out the clinical system portal in 2 phases, commencing in June 2016. This will allow clinical staff to access records from all Trust electronic clinical systems. In order to improve access to all clinical systems and to promote staff accessing historical information held in paper form, information will be shared in the Trust’s lesson learned bulletin about administration staff having access to all systems and how to request paper records with historical information.

The practice standards need to be revisited in terms of how these are articulated to the staff and how Adult Care ensures they are adhered to. This would provide a base-line standard of practice that could be tested with a more robust approach to auditing cases.

As part of the domestic violence and abuse training, all agencies to be alerted to the particular attention to older people’s experiences and the increased risk for abuse in a caring relationship when the carer is a partner.

Adult Care and LCC needs to ensure there is a robust approach to Making Safeguarding Personal. In focusing on this developmental area, the implementation of the new Domestic Abuse protocol for the Local Authority as a whole needs to be supported in a systematic and dynamic way. This also needs to be articulated well to multi-agency partners who are also engaged in working with Adults and their families. This would ensure that all staff working with the citizens of Lincolnshire have safeguarding at the forefront of their practice, encourage relationship-based practice and so that the best person to have the 'conversation' about difficult issues would be equipped to do this and be clear about their accountabilities.

Adult Care may wish to commission a training strategy for Adult Care and those services which are commissioned by it, with strong performance measurements underpinning it, which are reported on a regular basis, and action taken if these standards are not met. This training strategy should also consider the multi-agency training that is hosted by the Adult Safeguarding Board and how this can be offered to partners in the future in order to ensure there is a suite of core training, including safeguarding issues, such as domestic abuse, drug and alcohol use and mental health.

Adult Care may need to consider changes to AIS that ask a domestic abuse question as part of all assessments as a mandatory field. This would raise awareness and at least provide a prompt to staff to ask these questions. There would need to be consideration to review what is asked in the Carer's Assessment in order to ensure an in-depth assessment is undertaken that focuses beyond the presenting issues. These changes would need to be articulated to the Mosaic team to ensure this is factored into the build of the new system.