LSAB Annual Report 2020-2021
Message from the Independent Chair
“I want to pay tribute to all those who
have contributed to
safeguarding adults at risk of,
or experiencing abuse and neglect.
You have shown real leadership”
We have all had to adjust our lives this year due to the Covid -19 pandemic. Our patterns of daily life have been significantly disrupted; our liberties curtailed by the Coronavirus Act 2020.
Throughout this period, however, the adult safeguarding duties within the Care Act 2014 have remained in place. Consequently the Lewisham Safeguarding Adults Board has continued to seek assurance that adult safeguarding has remained “everyone’s business” and that statutory, voluntary and community services have worked together effectively to prevent and/or protect individuals from abuse and neglect.
The Board has also continued to deliver its Business Plan and to commission and complete Safeguarding Adult Reviews, as required by the Care Act 2014. This Annual Report summarises what the Board has achieved during the year.
Throughout the pandemic the Board has sought assurance that services have worked effectively together when responding to this unprecedented situation. The response of local services has been commendable, with enhanced levels of collaboration to ensure the resilience of health and social care provision for people at risk.
Going forward the Board will be concerned to ensure that this degree of cooperation and collaboration, working together, is maintained. We already have seen increased demand for care and support, and rising referrals of adult safeguarding concerns, whether occasioned by mental distress and social isolation, domestic abuse or self-neglect.
As the country emerges from lockdown, we expect to see a rising number of concerns, as families, friends and practitioners begin to meet adults who may be at risk in person again. The resilience of all our services will be needed as never before.
As the Board’s Independent Chair, I am especially proud of the web pages that carry important information for practitioners and for Lewisham’s residents and communities.
I am especially proud of the outreach into Lewisham’s local neighbourhoods, community and faith groups. The Board has made good progress with its data collection and analysis, an essential part of gaining assurance about the effectiveness of adult safeguarding provision and of setting new priorities.
We are learning and disseminating lessons too from the Safeguarding Adult Reviews that have been completed, and from other reviews already underway, ensuring service improvement and enhancement where necessary. This report shines a light on that work.
Finally, I want to pay tribute to all those who have contributed to safeguarding adults at risk of, or experiencing abuse and neglect. You have shown real leadership.
I want to thank Martin Crow, Vicki Williams and Tiana Mathurine, the Board’s business team, without whom we would not have made the progress summarised in this annual report.
Professor Michael Preston-Shoot
Key Outcomes in 2020-21
1. Covid 19 - Pandemic Response:
In addition to the Board’s normal schedule of meetings partners met more regularly to discuss the response to the pandemic and local risk factors. Focus was given to:
- Domestic Abuse and the delivery of local services
- Adult mental health services
- The voice of the adult - the Board worked with and supported Lewisham Speaking Up to stay engaged with adults living with a learning disability who have been disproportionately affected by Covid-19
- Rough sleepers
- Hospital discharges
- Out of borough placements.
The Board also supported the work on the ‘shielding’ programme, and with the development of a national data set analysing safeguarding trends, as well as publishing monthly e-Bulletins and a dedicated webpage. See Covid - 19 Pandemic Response: Highlighting Inequalities for further information in relation to the impact of the pandemic.
2. Self-Neglect & Hoarding Multi-Agency Policy, Practice Guidance and Toolkit:
This was revised based on consultation with key practitioners and clinicians working in the borough, taking into account training that had been delivered on this subject and the feedback from delegates that had been received on the previous policy. Read the policy, guidance and toolkit
3. Launch of the Lewisham Adult Safeguarding Pathway:
This included the publication of a revised Single Agency Adult Safeguarding Policy and Procedures Template, and the launch of a series of new leaflets and posters (see the back cover).
4. Communication and Engagement Work:
5. Learning, Training and Development Programme:
6. Publication of three Safeguarding Adult Reviews:
7. Supported the launch of the Lewisham Modern Slavery and Human Trafficking Network:
8. Review of Statutory Advocacy Services:
This review commenced in March 2021 and will be completed in September.
From the Board’s nine Strategic Objectives eight were either fully completed or are ongoing as outlined above, with the training programme and leadership project linked to adopting a ‘Trauma Informed Approach’ delayed due to the pandemic.
Covid - 19 Pandemic Response: Highlighting Inequalities
Public Health England (PHE) described health inequalities in the following way:
“Some groups have an increased risk of adverse outcomes from COVID-19 including some ethnic groups, males, those with certain pre-existing conditions such as obesity, those in deprived communities, older people, some occupations, people living in care homes, and other vulnerable groups.
(PHE Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups - June 2020)
- People aged 80+ are seventy times more likely to die than those under 40
- Mortality rates are double in the most deprived areas compared to the least
- Rates are also Higher for Black, Asian and Minority Ethnic (BAME) groups
- Death rates in London are 3+ times higher than in the South West (lowest area).
“As well as the tragic toll of the disease, the lockdown has affected both mental health and wider determinants of health and wellbeing, including access to vital services, our local economy, and the education of our children and young people.
The full extent of this impact and the inequalities that are created or exacerbated will only begin to emerge over the coming months and years”.
- Lewisham residents born in the Americas, the Caribbean, Middle East or Asia have a significantly higher death rate than people born in either the UK or Europe
- 22% of deaths from COVID-19 were residents who normally lived in care homes.
- The analysis shows no significant difference in the rate of death between those living in the most and least deprived areas of Lewisham
- Almost 10,000 people were shielding in Lewisham, and a wider cohort of approx. 3,000 vulnerable people (not known to services) were identified, and prioritised for a welfare call/ referral to other support if required.
- Birmingham City and Lewisham Councils are launching ground-breaking work into the health inequalities of African and Caribbean communities. The aim is to find approaches to break decades of inequality that will lead to better futures for citizens.
(COVID-19: Lewisham System Recovery Plan - September 2020)
The following case studies provide an insight into the pressures and challenges that were faced by professionals in relation to safeguarding adults across Lewisham.
An 81year old man lived in a residential care home due to a progressive dementia diagnosis and his inability to remain safely in his own home. At this time the care home was closed to all visitors, and outside professionals where communicating virtually with the care home staff. The residents were being encouraged to remain in their own rooms to reduce the risk of transmission of infection, and staffing were also affected due to positive COVID tests, which all contributed to increasing the carers workload.
Although appropriate care was being provided, due to the pressures across the system, there was a delay in a pressure relieving mattress being provided and the man developed an unstageable pressure ulcer. The case was investigated by the Community Pressure Ulcer Panel and an action plan was jointly developed.
This was an unprecedented time for all of the services involved, but lessons were still identified and systems improved. The pressure ulcer is now completely healed and the gentleman remains happy living in the care home.
Local police worked with a man living with a learning disability who was a victim of several robberies, assaults and anti-social behaviour. He also felt intimidated going out in his local community because of these incidents, as well other problems, some of which extended from Adverse Childhood Experiences (ACE’s).
His basic living conditions were very poor including mould and mildew on the walls, bare and rotting floorboards, no fridge and no lock on his front door. Police instigated a multi-agency meeting bringing together his sister, a new social worker and the relevant housing association’s property manager.
Following on from this the property was cleaned, painted, repaired and updated, and carers are now giving the man appropriate support. Despite having felt let down by services previously, this man is feeling a lot more positive and now starting to interact more in his local community. (Case refers to periods in between lockdown periods).
Staff managing mental ill-health related safeguarding enquiries faced a number of challenges because of Covid-19, including an increase in the severity of symptoms being experienced in the community, and a shift to remote working, which was not always conducive to engaging the adult at risk.
A positive example was the case of an adult who was initially identified by the London Ambulance Service as suffering from acute self-neglect, having attended their home due to the distressed state of the person. The Safeguarding Enquiry Officer worked with the Care Co-ordinator online, who then co-produced a care plan with the adult (Making Safeguarding Personal). Supportive outcomes and actions were generated in a very prompt manner as part of a wider harm minimisation plan.
Lewisham Safeguarding Adults Pathway (March 2021)
What is this?
Comprehensive set of web pages providing local guidance, tools, forms and resources to support the London Multi-Agency Adult Safeguarding Policy and Procedures, as well as a platform to share good practice and build a local network of connected agencies all working to help prevent abuse and neglect.
Why do we need it?
To make it easier for professionals to understand and digest the pan London Policy and Procedures, and to create a step by step guide (Stages 1-4) which is embedded into local agencies ways of working (practice) and systems.
Who is it for?
All professionals working with adults at risk of abuse and neglect in Lewisham, as well as members of the public, including carers.
Who developed this Pathway?
A range of professionals from across partner agencies were involved in developing the work, as well as the public who helped to co-produce the leaflets and posters.
Read more about the Pathway
Adult Safeguarding Concern Form for use by all professionals.
Guide on what is a Concern and how to respond to this, and Making Safeguarding Personal (MSP).
Guidance on conducting enquiries, contextual factors, professional curiosity & cultural competence.
Forms to help improve the consistency of approach.
Guidance and Forms for planning meetings and conferences.
Shift towards a neighbourhood approach in conducting Safeguarding Conferences.
Single Agency Policy and Procedures Template.
Leaflets and Posters.
What do I need to do?
- Use the New Adult Safeguarding Concern Form if you make a referral to the Local Authority.
- Read and use all of the guidance throughout the four stages as outlined, and as applicable.
- Embed this Pathway into your agency’s way of working and systems if you are the lead professional responsible for safeguarding.
- Use the template Policy and Procedures if you work in a non-statutory agency.
- Use the leaflets and posters.
Contact us: when you have completed number three above.
Communication and Engagement Work
“evidence of community awareness of adult abuse and neglect and how to respond”
(Care Act Statutory Guidance 14.157)
Fig 1:Annual Survey 2020-21: What should the Board’s priorities be in 2021-22?
Over 200 professionals and members of the public engaged with the survey, which helped to inform the development of the Board’s strategic objectives.
Fig 2: I think LSAB is effective?
70% Strongly Agree/ Agree
23% Couldn’t answer the question/ Don’t know
“I feel that we are further down the road in terms of achieving this (vision)
than we have ever been”
Learning, Training and Development Delivery
10 Learning and training events were cancelled/postponed between March - June 2020 due to Covid -19.
A transition to entirely online delivery was then made after this which wasn’t easy, although targets were still achieved within a condensed six month period. This demonstrates the positive effect that online delivery can have in increasing the numbers who can engage with learning interventions (annual average has been 320 places since 2018).
Safeguarding Information 2020-21
“increase the SAB’s understanding of prevalence of abuse and neglect locally
that builds up a picture over time”
(Care Act Statutory Guidance 14.139)
Table 1: Safeguarding Concerns and Concluded Section 42 Enquiries
Table 2: Types of Abuse: Concluded Section 42 Enquiries
Table 3: Concluded Section 42 Enquiries By Ethnic Code Group
Table 4: Source of Concern Leading to Section 42 Enquiry (Who reported the abuse)
Safeguarding Adult Reviews
“Safeguarding Adults Boards must arrange a Safeguarding Adult Review (SAR) when an adult dies either as a result of abuse or neglect, known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult”.
(Care Act Statutory Guidance 14.162)
The Case Review Sub-Group
In total 11 cases were considered and or monitored by the Sub-Group, which is made up from the Board’s statutory partners, throughout the year.
A National Analysis of SARs was also published in October 2020: Read the National Analysis
SAR Demographics and Themes (11 cases considered)
SAR Lee (5 June 2020) Read the 7 Minute Briefing
On 11 January 2016 Lee walked out of a hospital where he had been an in-patient, and was found dead in the street eight miles away three days later. Lee was 46 years old and had a history of alcohol related illnesses, depression and anxiety.
Key Learning Points
- No formal assessment of risk was completed when Lee left the hospital that drew on previous knowledge of him. It took three days before Lee was formally recorded as missing by police. NHS Procedures should have been used to conclude that Lee was high risk of going missing from hospital.
- There was miscommunication involving the police, family and hospital with respect to whether Lee was missing, and then whether a missing person enquiry should be raised.
- No formal Mental Capacity Act assessment was ever conducted.
SAR Tyrone Goodyear (12 June 2020) Read the 7 Minute Briefing
Mr Goodyear had been in irregular contact with mental health services since he was 15 years old and had been assessed to have Autism Spectrum Disorder (ASD), learning difficulties and Obsessive-Compulsive Disorder.
Tyrone lived with his mother and five of his siblings in four-bedroom temporary accommodation. This was causing friction between the family members. Tyrone left home after trying to secure alternative accommodation and his mother reported him missing. He was later found dead in a hotel room on 21 February 2019 having taken his own life via an overdose. He was 24 years old.
Key Learning Points
- People with ASD are more likely to commit suicide than the general population, and the factors that predict this can also be different from the wider general public.
- People with ASD may ‘camouflage’ their needs in order to fit in. They may not be accessing any services but this does not mean that they do not have unmet needs.
- Services need to be made more accessible for people living with ASD.
Extract: Statement from the family of Tyrone to accompany the SAR
“We hope that the changes recommended in this report can be put into place as soon as possible, to ensure that when someone with Autism Spectrum, learning and communications difficulties, and suspected mental health issues, will be treated with the correct priority that they need and deserve”.
SAR Mrs A and Miss G (26 June 2020) Read the 7 Minute Briefing
Mrs A (102 years old) and Miss G (73 years old) both lived on their own at home and were receiving Homecare Services linked to mobility and other health conditions. They both also had periods where they were admitted to hospital and discharged, which led to complications in relation to the care they subsequently then received.
Key Learning Points
- Problems arose in the reassessment of needs during admission to hospital.
- After mobility had decreased this should have informed a full reassessment.
- Discharge from hospital resulted in the ‘restart’ of previous levels of care which were no longer appropriate to meet an increase in care needs.
- Discharge planning was not undertaken in line with the good practice standards.
- Carers continued to attempt to meet clients’ needs rather than escalate either difficulties with the delivery of effective care, or the impact on the clients’ health where needs were not met.
- Community Nursing did not always respond appropriately or in a timely manner to referrals made by hospital or community services.
- Equipment that was required at home was not ordered, delivered or set up.
- Other delays in practical aspects of setting up changes to care caused needs to remain unmet, which led to serious health consequences for the adults.
- Decision making was not assessed even though poor physical health can lead to a deterioration in mental capacity linked to associated risks in the community.
Work of the Sub-Groups
Case Review Sub-Group
The Sub-Group oversees Safeguarding Adult Reviews (SAR) processes locally, and is led by the Board’s Independent Chair Professor Michael Preston-Shoot.
The group met 7 times and considered 3 new SAR Notifications during 2020-21.4 SARs commenced during the year (which includes 2 that were pending from 2019-20), with a further 2 on hold due to ‘parallel processes’.
Lewisham Modern Slavery and Human
This group was newly launched and involves a range of Board partners across all age domains, but has been initially guided by the Board’s business team, supported by the Human Trafficking Foundation.
The Network is developing a new local strategy and guidance for, and with practitioners, which will include a Victim Care Pathway. This subject does not have a high profile in relation to adult safeguarding locally, and is evolving all of the time with new approaches and guidance being created nationally.
“We will robustly tackle all forms of modern slavery and human trafficking in Lewisham through effective and collaborative partnership working, and by identifying, protecting and supporting potential victims of modern slavery and human trafficking.
We will empower people to move on safely and successfully from exploitation, and proactively target and pursue criminals”.
The Governance for the Network has not been decided yet, but this is likely to come from the Safer Lewisham Partnership Board.
Performance, Audit and Quality Sub-Group
This group continued to meet quarterly throughout the year to monitor the Performance Indicators below:
Risks have increased since the end of 2019-20 due to the pressures and challenges the Council and the NHS have faced during the last 12 months.
The group also monitors other pieces of relevant data some of which is outlined in Safeguarding Information 2020-21. This informs the groups work programme of audits and reviews, and has played a significant part in informing the development of the Board’s current strategic objectives (page 12).
SAR Mrs A and Miss G Task and Finish Group
This group was established to support and track the delivery of the Action Plan linked to this SAR. This was paused to allow Lewisham & Greenwich NHS Trust to focus on the pandemic response, but has now re-commenced.
Lewisham Safeguarding Housing Forum
The group continued to meet quarterly throughout the year, bringing a wider range of agencies and providers together. The Forum has now been stood down having achieved its stated objectives.
Business Plan 2021-22 on a Page
Download a copy of the LSAB Annual Report 2020-2021
Download a copy of the LSAB Annual Report 2019-2020
Download a copy of LSAB Annual Report 2018-2019
The Care Act 2014 requires each Safeguarding Adults Board (SAB) to publish an annual report.
The Care Act (Schedule 2.4 (1) a–g) defines the minimum content of an annual report:
As soon as is feasible after the end of each financial year, a SAB must publish a report on:
What it has done during that year to achieve its objective,
What it has done during that year to implement its strategy,
What each member has done during that year to implement the strategy,
The findings of the reviews arranged by it under section 44 (safeguarding adults reviews) which have concluded in that year (whether or not they began in that year),
The reviews arranged by it under that section which are ongoing at the end of that year (whether or not they began in that year),
What it has done during that year to implement the findings of reviews arranged by it under that section, and
Where it decides during that year not to implement a finding of a review arranged by it under that section, the reasons for its decision.
The performance of member agencies and how effectively, or otherwise, they are working together should be included in the report.
The annual report must be sent to:
The Chief Executive and leader of the local authority which established the SAB,
Any local policing body that is required to sit on the SAB,
The local Healthwatch organisation,
The chair of the local health and wellbeing board.
Annual reports should form the basis for the consultation on the strategic plan for the coming year.
A SAB should seek assurance from its members that the annual report has been considered within their internal governance processes.
Partnership Compact and Strategic Business Plan 2022-2023
This document describes how organisations and their representatives on the Lewisham Safeguarding Adults Board (LSAB) will work together in partnership to safeguard the residents of Lewisham in 2022-23. It is based on the statutory functions of Safeguarding Adults Boards as set out in the Care and Support Statutory Guidance, issued and updated from time to time by the Department of Health and Social Care.
Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action.
1.1 The aims of adult safeguarding:
- stop abuse or neglect wherever possible;
- prevent harm and reduce the risk of abuse or neglect to adults with care and support needs;
- 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 as a whole, 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 what to do to raise a concern about the safety or well-being of an adult; and
- then address what has caused the abuse or neglect.
1.2 Six key principles underpin all adult safeguarding work:
- Empowerment – people being supported and encouraged to make their own decisions and informed consent.
- Prevention – it is better to take action before harm occurs.
- Proportionality – the least intrusive response appropriate to the risk presented.
- Protection – support and representation for those in greatest need.
- Partnership – local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
- Accountability – accountability and transparency in delivering safeguarding.
1.3 Safeguarding duty: (this applies to an adult who)
- has needs for care and support (whether or not the local authority is meeting any of those needs) and;
- is experiencing, or at risk of, abuse or neglect; and
- as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
2. What is abuse and / or neglect?
The criteria set out in section 1.3 above need to be met before the issue is considered as a concern under the statutory safeguarding duty. Exploitation is a common theme in the following list of the types of abuse and neglect.
- Physical abuse: including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.
- Domestic abuse: including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence. A new definition is outlined in the Domestic Abuse Act 2021 including a description of ‘personally connected’.
- Sexual abuse: including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.
- Sexual exploitation: This is when a sexual act takes place in exchange for things like food, shelter, protection, or to pay bills, and the victim may have been coerced or manipulated into this sexual act.
- Psychological abuse: including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.
- Financial or material abuse: including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.
- Modern slavery: encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.
- Discriminatory abuse: including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion (including Hate Crimes).
- Organisational abuse: including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.
- Neglect and acts of omission: including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.
- Self-neglect: this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.
3. The statutory functions of Safeguarding Adults Boards
As set out in Care and Support Statutory Guidance, issued by the Department of Health and Social Care, each Safeguarding Adults Board should:
- identify the role, responsibility, authority and accountability with regard to the action each agency and professional group should take to ensure the protection of adults;
- establish ways of analysing and interrogating data on safeguarding notifications that increase the SAB’s understanding of prevalence of abuse and neglect locally that builds up a picture over time;
- establish how it will hold partners to account and gain assurance of the effectiveness of its arrangements;
- determine its arrangements for peer review and self-audit;
- establish mechanisms for developing policies and strategies for protecting adults which should be formulated, not only in collaboration and consultation with all relevant agencies but also take account of the views of adults who have needs for care and support, their families, advocates and carer representatives;
- develop preventative strategies that aim to reduce instances of abuse and neglect in its area;
- identify types of circumstances giving grounds for concern and when they should be considered as a referral to the local authority as an enquiry;
- formulate guidance about the arrangements for managing adult safeguarding, and dealing with complaints, grievances and professional and administrative malpractice in relation to safeguarding adults (which includes whistleblowing: see 5.4.3 to 5.4.7 of the London Multi-Agency Adult Safeguarding Policy and Procedures);
- develop strategies to deal with the impact of issues of race, ethnicity, religion, gender and gender orientation, sexual orientation, age, disadvantage and disability on abuse and neglect;
- balance the requirements of confidentiality with the consideration that, to protect adults, it may be necessary to share information on a ‘need-to-know basis’;
- identify mechanisms for monitoring and reviewing the implementation and impact of policy and training;
- carry out Safeguarding Adult Reviews;
- produce a Strategic Plan and an Annual Report;
- evidence how SAB members have challenged one another and held other boards to account; and,
- promote multi-agency training and consider any specialist training that may be required; including considering any scope to jointly commission some training with other partnerships, such as the Lewisham Safeguarding Children’s Partnership Board.
The Strategic Business Plan for 2022-23 sets out how the LSAB partner agencies will collectively prioritise and deliver these functions over the next 12 months.
4. Lewisham Safeguarding Adults Board (LSAB) Terms of Reference
The LSAB works to prevent harm or neglect and to help those harmed by leading on and facilitating the following safeguarding adult activities for the borough:
- Strategic planning: activities such as consultation, setting goals and objectives, action planning and prioritisation, securing resources, tracking and review of implementation and goal achievement for safeguarding strategy. In addition the LSAB will influence and link to strategic planning and commissioning across the partnership to advise and scrutinise in relation to safeguarding adults.
- Setting standards and guidance: activities such as setting standards to be achieved, developing policies and procedural guidance to guide practice towards those standards. Monitoring and auditing the implementation of these policies and procedures.
- Quality assurance: lead and ensure activities such as monitoring, audit and review of practice, review of serious cases, incorporation of research and national guidance are undertaken as required. Conducting audits to ensure the effectiveness of what is done by agencies individually and collectively to safeguard and promote the welfare of adults at risk. Commissioning Safeguarding Adult Reviews and / or other reviews of incidents or organisations when an adult dies or is seriously harmed and abuse or neglect is suspected or proven.
- Promoting participation: by people who use services and carers in safeguarding practice. Promoting awareness and action in the wider community.
- Awareness raising & publicity: activities such as public awareness campaigns, targeted publicity and educational strategies, raising awareness within services.
- Capacity building and training: activities such as training and workforce development.
- Relationship management: activities such as the negotiation and clarification of interagency roles and contributions, member agency compliance, troubleshooting and resolution of difficulties, liaison with wider partnerships and related areas of practice. In addition, undertake work as appropriate with the Lewisham Safeguarding Children’s Partnership Board, Safer Lewisham Partnership and Lewisham Health and Wellbeing Board to ensure that policy and procedures, training and all other activities are co-ordinated and coherent.
4.1 Care and Support Statutory Guidance
Members of a SAB are expected to consider what assistance they can provide in supporting the Board in its work. This might be through payment to the local authority or to a joint fund established by the local authority to provide, for example, secretariat functions for the Board. Members might also support the work of the SAB by providing administrative help, premises for meetings or holding training sessions. It is in all core partners’ interests to have an effective SAB that is resourced adequately to carry out its functions.
Members who attend in a professional and managerial capacity should be:
- able to present issues clearly in writing and in person;
- experienced in the work of their organisation;
- knowledgeable about the local area and population;
- have a thorough understanding of abuse and neglect and its impact;
- understand the pressures facing front line practitioners;
- able to explain their organisation’s priorities;
- able to promote the aims of the SAB; and,
- able to commit their organisation to agreed actions*.
* While board members representing their organisations are expected to have the authority to commit their organisation to agreed actions, those board members representing Sub-Groups or non-service provider organisations may not have the relevant authority. In their case their role is to liaise between the Board and the Sub-Group and take back to their own organisations any proposals or recommendations for action.
Each member of SAB must co-operate and contribute to the carrying out of a Safeguarding Adults Review (SAR) with a view to:
- identifying lessons to be learnt from the adult’s case, and
- applying those lessons to future cases.
4.2 The responsibilities of members of the LSAB
The Lewisham Safeguarding Adults Board has an Independent Chair and Deputy Chair from one of the Board’s partner agencies.
The LSAB expects board members to:
- develop and maintain effective working arrangements based on trust and mutual understanding;
- be an active partner in safeguarding and promoting the welfare of adults at risk of harm or neglect;
- contribute to the LSAB financially or by providing staff for particular tasks;
- collate and provide management information as required by the LSAB and contribute to quality assurance arrangements;
- share information to safeguard adults in line with agreed information sharing arrangements;
- commit to the work of the Board by undertaking allocated tasks or sourcing the appropriate support from within their agency to undertake the work and contributing to discussions;
- identify and support staff to participate in the interagency activities of the LSAB through their active membership of the Sub-Groups and / or Task & Finish Groups, and to progress of the work of the Board between meetings;
- ensure that the policies, procedures, guidance, tools and resources in the Lewisham Adult Safeguarding Pathway are disseminated and acted upon in an effective way within their own organisations;
- ensure that communications are cascaded through organisations, services and to front-line staff as appropriate;
- represent the LSAB and its activities within their own organisation and within any groups they represent on the Board;
- report difficulties with own organisation and between organisations to the LSAB and work with partners to find effective solutions.
4.3 Organisations represented on the LSAB
- Age UK Lewisham and Southwark
- Bromley, Lewisham and Greenwich MIND
- Department for Work and Pensions – South London District
- Healthwatch Lewisham
- Lewisham & Greenwich NHS Trust
- Lewisham Adult Social Care
- Lewisham Children & Young People’s services
- Lewisham Refugee and Migrant Network
- Lewisham Safeguarding Children Partnership (LSCP)
- Lewisham Homes
- Lewisham Joint Commissioning Group
- Lewisham Public Health
- Lewisham Public Protection and Safety
- Lewisham Strategic Housing Services
- London Ambulance Service
- London Fire Brigade
- Metropolitan Police, Lewisham (South East BCU)
- National Probation Service, Lewisham and Bromley
- NHS South East London Clinical Commissioning Group
- South London & Maudsley NHS Foundation trust
There will also be representatives from partner agencies on Sub-Groups.
4.4 Governance and accountability
- The LSAB is responsible for ensuring organisations are meeting their safeguarding obligations effectively, and will hold them to account if they are not.
- As individuals, Board members are accountable to their own agencies but the Board as a whole will be accountable to the Department of Health and Social Care, and provides reports locally to the Health and Wellbeing Board and the Healthier Communities Select Committee. Its work may be scrutinised periodically by the Overview and Scrutiny Committee and is liable to be inspected at any time by the Care Quality Commission (CQC).
- The Board, through the independent chair, is accountable to the Chief Executive of the Local Authority, the Chief Executive of the CCG and the Borough Commander of Police.
- These Executive Group of agencies may periodically meet to discuss the strategic direction of the Board, and additionally invite the London Fire Brigade Borough Commander, Chief Executive of Lewisham & Greenwich NHS Trust, and Chief Executive of the South London & Maudsley NHS Foundation Trust to join this group.
4.5 Equality and fairness
- The LSAB operates on the basis of principles which actively value the benefits of diversity and which ensure fair treatment in service delivery. This will include both equal access to and outcomes from local service delivery.
- The LSAB will seek, so far as it is practicable, to ensure equality of representation and participation in the local democratic process of which it is a part.
- The LSAB will, through its composition and ways of working, seek to inform, support, involve and give a voice to all sections of the local communities it serves, with particular emphasis on the inclusion of black, Asian and minority ethnic groups, faith communities and those living with a disability. It will seek to ensure an appropriate gender balance in its membership, so far as this is practicable.
4.6 Dispute resolution between LSAB Members – escalation policy
In order for practitioners and agencies to work together effectively to safeguard adults at risk, ‘professional challenge’ should be seen as part of a healthy working relationship.
Successful partnership working is reliant upon resolving professional disagreements in a timely manner in order to avoid any potential risks to the adult(s) in question.
- As far as possible any inter-agency disputes should be resolved by negotiation and discussion between the practitioners directly involved.
- If this does not bring the matter to a satisfactory conclusion this should be escalated through the hierarchies of the agencies up to senior management level if needed.
- If this still does not lead to a constructive and positive outcome the issue should be referred to the Executive Group in writing via the Chair of the LSAB. The group will consider whether it is necessary to establish a panel consisting of no less than three members from constituent organisations, who have no direct involvement in the matter. Appropriate representation from LSAB member(s) of the agencies involved in the dispute will then be invited to attend a resolution meeting. A formal agreement to resolve the dispute will be recorded and sent to the organisations involved for reference.
4.7 Conflicts of interest
Whenever a representative has a conflict of interest in a matter to be decided upon, the representative concerned shall declare such interest at or before discussions begin on the matter. The Chair shall record the interest in the minutes of the meeting and that representative shall take no part in the decision making process.
5. The operational structure of the Lewisham Safeguarding Adults Board
5.1 The frequency of LSAB meetings
The Board meets four times a year. Board meeting dates will be set as far in advance as possible to ensure availability of all board members.
5.2 LSAB Sub-Groups
LSAB work activities are designed to achieve results in the most effective and efficient ways. This may include formal Sub-Groups meeting on a planned regular basis or through smaller specific Task and Finish Groups, workshops or other consultative events. This may include electronic consultation methods.
Each Sub-Group have their own Terms of Reference and are responsible for delivering specific LSAB Strategic Objectives, and may commission Task and Finish Groups to deliver specific pieces of work linked to these objectives. Members of these groups must understand the remit of the LSAB; that they are assisting the LSAB to meet its objectives; and have the capacity to undertake work for the Board.
Membership of these groups will reflect a range of agencies across Lewisham. They may also include individuals with specialist knowledge or the ability to add value to achieving and implementing planned objectives.
Members are expected to attend meetings; contribute to discussions and activities of the Sub-Group. They may be required to undertake agreed specific tasks, delivering these in a timely way, alerting the Sub-Group Chair or other identified lead officer in advance of any deadlines being missed.
Strategic Learning will be shared along with the Lewisham Safeguarding Children Partnership (LSCP) and Safer Lewisham Partnership (SLP) to share the learning from Safeguarding Adults Reviews, Child Safeguarding Practice Reviews and Domestic Homicide Reviews, enabling higher level strategic objectives to be developed and shared.
Individuals identified as Board, Sub-Group and / or Task and Finish Group members are expected to regularly attend meetings. Where there is unavoidable absence, all organisations should ensure that there is a suitable substitute representative from their agency.
5.4 Administrative arrangements for the LSAB
The draft agenda will be sent to Board Members for approval/late item requests 15 working days before the meeting. Board members will have five working days to respond. Requests to alter the agenda after this deadline will not be accepted.
The agenda and associated papers for each Board meeting are issued no later than five working days before the meeting by the LSAB Administrator.
Papers for the next meeting must be submitted to the LSAB Administrator at least 10 working days before the meeting. Only papers submitted before this deadline will be dealt with by the LSAB Administrator and included in the documents circulated with the agenda. Any documents missing the deadline must be circulated by the author/organisation and printed copies brought to the Board Meeting.
Minutes of LSAB Board meetings are taken by the LSAB Administrator and circulated within 15 working days of the meeting.
These terms of reference will be reviewed as required in response to significant change in guidance, legislation or member organisations.
Appendix 1: Strategic Business Plan 2022-23
Adult Safeguarding: Sharing Information
Sharing the right information, at the right time, with the right people, is fundamental to good practice in safeguarding adults.
Frontline professionals and volunteers should always report safeguarding concerns in line with their organisation’s policy. Policies should be clear about how confidential information should be shared between departments in the same organisation.
For Safeguarding purposes sensitive or personal information sometimes needs to be shared between the Local Authority and its safeguarding partners (including GP’s, health, the police, service providers, housing, regulators and the Office of the Public Guardian). This may include information about individuals who are at risk, service providers or those who may pose a risk to others. It aims to enable partners to share information appropriately and lawfully in order to improve the speed and quality of safeguarding responses.
The Care Act emphasises the need to empower people, to balance choice and control for individuals against preventing harm and reducing risk, and to respond proportionately to safeguarding concerns. The Act deals with the role of the safeguarding adults board’s (SAB’s) in sharing strategic information to improve local safeguarding practice. Section 45 ‘the supply of information’ covers the responsibilities of others to comply with requests for information from the safeguarding adults board.
Sharing information between organisations as part of day-to-day safeguarding practice is already covered in the common law duty of confidentiality, The EU General Data Protection Regulation (GDPR) the Data Protection Act, the Human Rights Act and the Crime and Disorder Act. The Mental Capacity Act is also relevant as all those coming into contact with adults with care and support needs should be able to assess whether someone has the mental capacity to make a decision concerning risk, safety or sharing information.
It remains the responsibility of organisations and the professionals they employ to ensure that they have a basis for processing that meets common law requirements and the requirements of the GDPR; and for public bodies that they are acting within their powers.
Download the 7 Golden Rules Poster
Why do we need to share adult safeguarding information?
Organisations need to share safeguarding information with the right people at the right time to:
- Prevent death or serious harm,
- Co-ordinate effective and efficient responses,
- Enable early interventions to prevent the escalation of risk,
- Prevent abuse and harm that may increase the need for care and support,
- Maintain and improve good practice in safeguarding adults,
- Reveal patterns of abuse that were previously undetected and that could identify others at risk of abuse,
- Identify low-level concerns that may reveal people at risk of abuse,
- Help people to access the right kind of support to reduce risk and promote wellbeing,
- Help identify people who may pose a risk to others and, where possible, work to reduce offending behaviour,
- Reduce organisational risk and protect reputation.
False perceptions about needing consent to share safeguarding information
Some frontline professionals and their managers can be over-cautious about sharing personal information, particularly if it is against the wishes of the individual concerned. They may also be mistaken about needing consent to share safeguarding information. The risk of sharing information is often perceived as higher than it actually is. It is important that professionals consider the risks of not sharing safeguarding information when making decisions and that these decisions are recorded.
How to address false perceptions
- Raise awareness about responsibilities to share information (profession or work role-specific guidance may help),
- Encourage consideration of the risks of not sharing information,
- Brief staff and volunteers on the basic principles of confidentiality the EU General Data Protection Regulation and data protection,
- Improve understanding of the Mental Capacity Act,
- Provide a contact number for staff and volunteers to raise concerns,
- Be clear in procedures about when to raise a safeguarding concern,
- Assure staff and volunteers that they do not necessarily need to have evidence to raise a concern.
Complex networks between safeguarding partner agencies
The local authority has the lead responsibility for safeguarding adults with care and support needs, and the police and the NHS also have clear safeguarding duties under the Care Act 2014. Clinical commissioning groups and the police will often have different geographical boundaries and different IT systems. Housing and social care providers will also provide services across boundaries.
The Care Act 2014 (Section 6 ) places duties on the local authority and its partners to cooperate in the exercise of their functions relevant to care and support including those to protect adults. The safeguarding adults board should ensure that it ‘has the involvement of all partners necessary to effectively carry out its duties’.
Below is a simple flowchart of the key principles for information sharing. You can also download this flowchart.
Sharing information to prevent abuse and neglect
Sharing information between organisations about known or suspected risks may help to prevent abuse taking place. The safeguarding adults board has a key role to play in sharing information and intelligence on both local and national threats and risks. The board’s annual report must provide information about any safeguarding adults reviews. This can include learning to inform future prevention strategies. Designated adult safeguarding managers ‘should also have a role in highlighting the extent to which their own organisation prevents abuse and neglect taking place’.
What if a person does not want you to share their information?
Frontline workers and volunteers should always share safeguarding concerns in line with their organisation’s policy, usually with their line manager or safeguarding lead in the first instance, except in emergency situations. As long as it does not increase the risk to the individual, the member of staff should explain to them that it is their duty to share their concern with their manager. The safeguarding principle of proportionality should underpin decisions about sharing information without consent, and decisions should be on a case-by-case basis.
Individuals may not give their consent to the sharing of safeguarding information for a number of reasons. For example, they may be frightened of reprisals, they may fear losing control, they may not trust social services or other partners or they may fear that their relationship with the abuser will be damaged.
If a person refuses intervention to support them with a safeguarding concern, or requests that information about them is not shared with other safeguarding partners, their wishes should be respected. However, there are a number of circumstances where the practitioner can reasonably override such a decision, including:
- You have a lawful basis for sharing without consent under the GDPR & Data Protection Act 2018,
- The individual lacks the mental capacity to make that decision – this must be properly explored and recorded in line with the Mental Capacity Act,
- Other people are, or may be, at risk, including children sharing the information could prevent a crime,
- The alleged abuser has care and support needs and may also be at risk,
- A serious crime has been committed staff are implicated,
- The person has the mental capacity to make that decision but they may be under duress or being coerced,
- The risk is unreasonably high and meets the criteria for a multi-agency risk assessment conference referral,
- You have a legal obligation.
If none of the above apply and the decision is not to share safeguarding information with other safeguarding partners, or not to intervene to safeguard the person:
- Support the person to weigh up the risks and benefits of different options,
- Ensure they are aware of the level of risk and possible outcomes,
- Agree on and record the level of risk the person is taking,
- Offer to arrange for them to have an advocate or peer supporter,
- Offer support for them to build confidence and self-esteem if necessary,
- Record the reasons for not intervening or sharing information,
- Regularly review the situation,
- Try to build trust and use gentle persuasion to enable the person to better protect themselves.
If it is necessary to share information outside the organisation:
- Explore the reasons for the person’s objections – what are they worried about?
- Explain the concern and why you think it is important to share the information,
- Tell the person who you would like to share the information with and why,
- Explain the benefits, to them or others, of sharing information – could they access better help and support?
- Discuss the consequences of not sharing the information – could someone come to harm?
- Reassure them that the information will not be shared with anyone who does not need to know,
- Reassure them that they are not alone and that support is available to them.
If the person cannot be persuaded to give their consent then, unless it is considered dangerous to do so, it should be explained to them that the information will be shared without consent. The reasons should be given and recorded.
It is very important that the risk of sharing information is also considered. In some cases, such as domestic violence or hate crime, it is possible that sharing information could increase the risk to the individual. Safeguarding partners need to work jointly to provide advice, support and protection to the individual in order to minimise the possibility of worsening the relationship or triggering retribution from the abuser.
What if a safeguarding partner is reluctant to share information?
There are only a limited number of circumstances where it would be acceptable not to share information pertinent to safeguarding with relevant safeguarding partners. Safeguarding adults boards set clear policies for dealing with conflict on information sharing. If there is continued reluctance from one partner to share information on a safeguarding concern the matter would be referred to the board. It can then consider whether the concern warrants a request, under Clause 45 of the Care Act, for the ‘supply of information’. Then the reluctant party would only have grounds for refusal if it would be ‘incompatible with their own duties or have an adverse effect on the exercise of their functions’.