Islington review

Islington CSPU will develop minimum standards around DV definition/policies that will be distributed for adoption by all partners locally, so to ensure a consistent approach and understanding of the issue.

At a strategic level, Islington Adult Social Care should review how effectively it works with domestic violence agencies and MARAC and the MARAC Steering Group. Joint working may help to raise awareness of the specific risks relating to domestic violence for adults at risk and ensure better adjustment outcomes for their family carers.

For all agencies who do not conduct periodic reviews of their processes and policies they must conduct a review of all safeguarding adult and domestic violence processes and policies and explicitly consider the overlap of the dynamic of domestic violence in its broadest sense and the response to safeguarding adults at risk. (The review process should be overseen by the Islington Safeguarding Adults Board in addition to the Safer Islington Partnership.) All agencies will be required and expected to implement policies and procedures in this area and report on their progress. These processes and policies to be reviewed annually and reported back to both strategic boards.

Organisations to consider implementing separate interview and screening procedures for carers and patients to ensure both parties have the ability to speak freely and openly about their needs and concerns. This is particularly important in case of potential abuse and domestic violence, but a relevant screening tool for all cases.

Adult Social Care to adopt an integrated whole systems infrastructure which will better facilitate and support multi-agency working. Adult Social Care to identify a lead organisation with case management responsibility and a lead local authority with co-ordination responsibility. Local authorities have the lead role in coordinating the multi-agency approach to safeguarding adults at risk. This includes the coordination of the application of this policy and procedures, coordination of activity between organisations, review of practice, facilitation of joint training, dissemination of information and monitoring and review of progress within the local authority area. This could be addressed in Islington by the launch of the 2013 Plan for Whole System Integration. The objective of this approach is to optimise multi agency expertise and resource to deliver effective seamless multi agency preventive services, treatment and care closer to home and will include other public services in addition to health and social care. Carers at Risk - Greater multi agency and think family interventions incorporated in a whole systems approach as described above in working with carers to identify risk where the carer has unmet or unrecognised low level needs, are vulnerable themselves and have little personal or private space or life outside the caring environment.

MSW and ELiPSe team to review referral pathways, especially around how information about referrals to family services is communicated to clients and how referral outcomes are fed back to them.

Organisations to review/develop their policies on non-engagement and refusal of services, with an emphasis placed on the importance of focussing on the whole family including cared for and carer in terms of refusal or non-engagement. (There may be scope for additional work looking at ways of supporting carers where the cared-for person refuses to accept care from anyone else, as this is a common tension within informal care relationships.)

District Nursing team to continue to seek consent from service users and/or have discussion with them before referring to social services. This consent needs to be documented clearly in case files as not to delay referral processes. Additionally, as it is standard procedure to share notes with clients and keep them at the client’s property, on a national level, District Nursing should develop a central electronic back-up system (attached to health records) of home notes so professionals can access these records at any time and that in the case of loss or destruction there remains a copy of all patients’ records.

Telecare Service should review their procedures relating to service users who refuse services to ensure this information is captured and systematically fed back to the referrer. To this end, the Telecare Service will work with Adult Social Care to further develop the IAS system to capture and report issues of non-engagement by service users and/or their carers. This will ensure risk assessments are based upon accurate information and processes and procedures are managed in line with the guidance published by the Islington Safeguarding Adults Unit on 'Complex Cases including persons who refuse to engage and persons who self-neglect' (November 2010).

All organisations to explore ways of implementing best practice to identify carers and their support needs and refer them at the earliest stage possible to the Islington Carers Hub for advice, support and opportunities to be with a potentially supportive peer group of other carers. The Islington Carers Hub is open to all carers, even if a formal Needs Assessment has not been completed, and referral should take place at the earliest opportunity. Carers' should be Red coded in the GP clinical computer system thus allowing easy identification of them by a simple search.

As this case has some similarities with other serious cases involving family carers, the Islington Safeguarding Adults Partnership Board should examine together all such cases in the last 24 months to identify any areas for development or concern.

To deliver training to ensure all practitioners have a good understanding of the dynamics of domestic violence and appropriate responses. This case must be used as part of the development of an enhanced training package for practitioners which addresses safeguarding issues and includes domestic violence and abuse in its broadest sense.

Islington CCG should develop a more consistent approach to domestic violence that includes training, identification and appropriate responses.

The Islington Safeguarding Adults Partnership Board to look into the issues of carer support and domestic violence and the overlap with safeguarding adults (perhaps by conducting a review with Domestic Violence agencies to raise awareness among professionals and the public about the risks and vulnerabilities). For example, no widely-used risk evaluation tool exists which reliably predicts which family carers are likely to abuse the person they look after. (The ISAPB could look to develop such a tool to facilitate weighting of various risk factors, decision-making and thresholds for intervention in this area if deemed appropriate.)

Agencies to review the use of, and triggers for, risk assessments. Appropriate training to be commissioned to support staff to use risk assessments as a robust tool to manage risk and inform actions and outcomes, particularly where carers are involved or where domestic violence is suspected.