This page includes the content of the NSAB Annual Report 2022-23. You can download the full report below.
Introductions from our Chair and Cabinet Member
“Welcome to the Newcastle Safeguarding Adults Board’s (NSAB) Annual Report for 2022-23. This report demonstrates a continuing trend in increased safeguarding adults activity in Newcastle and most importantly the significant commitment to this critical agenda from all partner agencies.
Below you can find a summary of key local data related to safeguarding adults. There have been increases in safeguarding adults’ referrals, concerns, and enquiries. A key focus for the NSAB in 2023-24 is to try and address the large number of referrals that are made which do not meet the criteria for action under safeguarding adults’ procedures and to ensure there are appropriate resources to meet the increased demand.
Last year, the Adult N Safeguarding Adults Review (SAR) was published. This review acknowledged the persistence and flexible efforts of professionals working with Adult N. Recommendations based on the learning from this case were identified which informed how the Board and member agencies could make improvements for the future. The NSAB is closely monitoring an action plan which responds to the recommendations from the SAR and much progress has already been made.
The Annual Report places a “spotlight” on three areas: Carers, Domestic Abuse and Older People, and the Mental Capacity Act. These sections share more detail about the work that has been undertaken by the Board and member agencies in response to learning from reviews that have been recently published.
An increase in self-neglect concerns can be seen in the local performance data, its complexity has also been evident in some cases that have been referred through to the SAR Committee. In September 2023, a Thematic Review was published in relation to self-neglect which highlighted ‘learning themes’ from several cases and feedback from practitioners on their experiences.
We have also been involved in the development of some key regional resources around self-neglect: a series of 7-minute guides on different topics linked to self-neglect and an animation aimed at raising awareness with the public. Working regionally means working more efficiently and effectively. I was honoured to host the regional webinar launching the self-neglect animation which was attended by 700 professionals.
The publication of the Whorlton Hall SAR by Durham Safeguarding Adults Partnership led us to seek assurance from members on the key findings that were made. This SAR has local, regional, and national implications, with all of the recommendations being made at a national level. The Board was assured by what was already in place locally, however, we anticipate a need to consider the Newcastle position once there has been a national response.
The four Board sub-committees continue to be the key pillars of the NSAB, leading on delivery of most actions from the strategic annual plan and taking these forward diligently and collaboratively. To support this important work, I had the pleasure of attending each of the sub-committees in 2022-23 to personally thank them for their ongoing, positive contributions.
The Board’s Strategic Annual Plan for 2023-24 details the proposed priorities to be achieved in the coming year. There are some ambitious targets, if the aim is to be progressed, in ensuring that Newcastle is an increasingly safer city for adults at risk of abuse and neglect.
The 2023-2024 plan details actions to:
- Explore different methods for people to give feedback on their experiences of the safeguarding adults process.
- Introduce a framework for the management of allegations against a Person in a Position of Trust.
- Ensure referrers are supported to make good safeguarding adults’ referrals.
- Understand the new Serious Violence Duty and implications for the NSAB.
- Prevent fire fatalities.
I would like to offer my sincere thanks and appreciation to everyone who contributes to safeguarding adults work in Newcastle. This annual report provides evidence as to how everyone supporting adults at risk of abuse and neglect, works with a high degree of commitment, creatively and tenaciously to ensure adults with care and support needs are protected from harm. I am grateful for the ongoing support to this agenda.
I commend this Annual Report to you and encourage you to share it within your organisations and via your networks, particularly noting the positive difference being made in Newcastle”.
NSAB Independent Chair
“This annual report demonstrates that Newcastle is a responsive and supportive City, particularly for those who are most vulnerable and in need of help. The number of safeguarding adults concerns raised tells me that people want to take action when they are worried someone is at risk of harm. Despite the limited resources across the public and community and voluntary sectors, there is a commitment and willingness to ensure Newcastle is a safe place to live.
The last year has been challenging for our residents. Newcastle has areas of significant deprivation and the cost-of-living crisis gives further cause for concern, given the link between poverty and abuse and neglect. I welcome the work that the NSAB continues to do in this area. It is important that whatever role someone has, whether that be a nurse, a social worker or a volunteer, that they feel confident to discuss a person’s financial situation and know where to seek specialist support if this is needed. This might be the only opportunity there is to get the person the help they need, to maximise their income and prevent the need for support or protection in the future.
Effective safeguarding arrangements are achieved only via collaboration between partners and agencies and the NSAB’s annual report is testament to the joint working that takes place. It is vital that we continue to work together to ensure that Newcastle is a healthy, caring City.
Councillor Karen Kilgour
Deputy Leader, Newcastle City Council and Cabinet Member for Healthy, Caring City
Who we are and what we do
The Newcastle Safeguarding Adults Board (NSAB) is a statutory multi-agency partnership responsible for safeguarding adults from abuse and neglect. There are a number of agencies represented on the Board, including the Council, Health Services and the Police. Our NSAB roles and responsibilities page has more information about the Board and it’s work.
|NSAB Strategic Annual Plan for 2022-23 agreed.
Regional 7-minute guides on self-neglect published.
|MCA Task and Finish Group established.
Carers and adult safeguarding work commenced.
|Adult N Safeguarding Adult Review and Self-Neglect Thematic Review published.
|Safeguarding Adults Week webinars and events.
Self-Neglect animation launched.
|Assurance sought on Whorlton Hall Safeguarding Adults Review recommendations.
|Consideration of local Drug Market Profile.
Development of 2023-24 Strategic Annual Plan.
Strategic Annual Plan
The Board starts each year by agreeing it’s strategic annual plan for the 12 months ahead. Work begins on the plan in late December going into early January, with the plan agreed at the NSAB meeting in May of each year.
The plan is informed by our local data, learning from audits and reviews, consultation activity, agency self-assessments and any changes in national policy, guidance or legislation. Some priorities are carried over from our 2022-23 plan.
Our plan is shaped around the key principles of safeguarding adults work: Empowerment, Prevention, Protection, Proportionality, Partnership and Accountability.
Our Strategic Annual Plan 2022-23 includes the following action areas:
- Continuation of the MCA Task and Finish Group
- Implementation of our communication strategy
- Understand the implications of the new Serious Violence Duty on safeguarding adults
- Explore different methods for people to provide feedback on their experiences of the safeguarding adults process
- Continuation of our Making Safeguarding Personal Scorecard
- Improve the quality of safeguarding adults referrals
- Agree a process for the management of allegations against a Person in a Position of Trust
- Review Multi-Agency Safeguarding Hub (MASH) arrangements to respond to increased demand
- Co-ordination of actions from statutory reviews linked to drugs and alcohol
- Contribute to work on reducing fire fatalities
- Receive assurance on the current process when an adult with care and support needs presents with an unexplained injury
Carers and adult safeguarding
The NSAB had a focus on carers in 2022-23. This was as a result of learning from the Adult L Safeguarding Adults Review (published in 2021-22) and the revision of the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) guidance in this area: Carers and safeguarding: a briefing for people who work with carers. There are estimated to be at least 26,000 carers in Newcastle.
A carer is….Anyone who provides unpaid care and support to someone who couldn’t manage without their help because of disability, frailty, mental illness, drug or alcohol dependency. This includes those in receipt of Carers Allowance.
The majority of carers strive to act in the best interests of the person they care for and support. However, there are times, when those carers experience harm from the person they are offering care and support to, or from the communities in which they live. Risk of harm to the person being cared for may also arise because of carer stress, tiredness, lack of information, skills or support or a combination of these factors.
Work began with the revision of the local Carers Risk Assessment Tool. This had been introduced a number of years ago and was updated in 2022-23 to reflect updated national guidance and learning from local and national reviews. The tool can be used by any professional and aims to help identify key factors which might place the carer or cared for person at increased risk of harm. Completion of the tool can provide additional evidence to support referrals into safeguarding adults procedures or to other services.
The tool has been relaunched with associated guidance and the offer of some one-hour briefings. These are regularly available as part of the multi-agency safeguarding adults training programme. Carer risks also feature significantly in a new training package covering domestic abuse and older people.
There are also an estimated 27,000 individuals affected by a loved ones alcohol or drug use, and a further 5,000 family members affected by problematic gambling. A training plan has been put in place to support identification of drug and alcohol issues, and arrangements between drug and alcohol services and carers services for referrals for families affected.
For further information on carers in Newcastle, please visit Looking After Someone on the InformationNOW website.
Our local safeguarding adults data
The local authority makes a statutory data return each year to NHS Digital on key safeguarding adults measures. The Safeguarding Adults Collection is focussed on data related to safeguarding adults concerns and Section 42 enquires. However, a local count is still undertaken on the volume of safeguarding adults referrals made. The table below demonstrates that over 50% of the referrals made to Adult Social Care do not meet the criteria for a safeguarding adults concern. There was a 36% increase on the number of referrals received in 2022-23, compared to 2023-24. Responding to the increased and sustained safeguarding adults activity continues to be a key priority for the NSAB.
|Safeguarding adults referrals
A referral made to Adult Social Care identified as requiring safeguarding intervention
|Safeguarding adult concerns
Referrals which met the safeguarding adult concern criteria
|Section 42 enquiries
Safeguarding adults concerns which met all three parts of the Section 42 (Care Act) enquiry criteria
Safeguarding adults concerns which did not meet all three parts of the Section 42 (Care Act) enquiry criteria but it was deemed necessary to carry out enquiries/take action
Working age adults continue to account for the highest number of safeguarding adults concerns received. However, when the volume of concerns is compared to overall population totals, the prevalence of abuse and neglect increases with age.
|Percentage of safeguarding concerns received
Where known, the most common primary support reason for adults at risk subject to safeguarding adults concerns was physical support. This was followed by mental health support and learning disability support.
|Primary support reason
|Percentage of safeguarding concerns received
|Mental health support
|Learning disability support
|Support with memory and cognition
Ensuring the safeguarding adults process is person-centred is an important priority for the NSAB. Two years ago, the Board introduced a dedicated performance scorecard for Making Safeguarding Personal. The close scrutiny of data in this area has led to year-on-year improvements in key performance indicators.
- In 74% of Section 42 enquiries, the adult at risk/representation was asked their desired outcomes.
- In 88% of Section 42 enquiries, risk was either reduced or removed.
- When an adult at risk expresses their desired outcomes these are fully or partially met in 92% of cases.
The table below shows the types of abuse recorded against Section 42 enquiries. Multiple abuse types can be recorded for each enquiry. The top three recorded abuse types were neglect, self-neglect and physical abuse.
|Type of abuse
|Number of Section 42 enquiries where this type of abuse was recorded
Domestic abuse and older people
A national analysis of Domestic Homicide Reviews (DHRs) between 2018-2020 identified that one in five homicide victims were aged over 70. Those in this age bracket were at much greater risk of death as a result of domestic abuse than younger people. Despite this, it can be a very hidden issue and one which is complex for practitioners to identify and respond to. The NSAB has worked with Safe Newcastle in 2022-23 to launch some specialist training in this area.
The Adult L SAR highlighted that more could be done by the NSAB to highlight domestic abuse risks in older couples and nationally it is highlighted that there is a systematic invisibility to the issue. A general presumption that domestic abuse doesn’t happen to older people can be exacerbated by publicity campaigns which often focus on younger women with children and that it is only recently that the National Crime Survey for England and Wales started collecting data on domestic abuse victims aged over 74.
Older people are less likely to self-report domestic abuse which means that professionals need to be professionally curious and create opportunities to speak to the person experiencing the abuse alone. The World Health Organisation highlights that the consequences of abuse can be especially serious for older people. Abuse can lead to long-term emotional problems; recovery is likely to take longer; and even minor injuries can cause permanent damage or death.
The new half-day training was launched during Safeguarding Adults Week 2022 as a pilot and is co-delivered by the NSAB Coordinator, the Violence Against Women and Girls Workforce Development and Training Officer, Newcastle City Council’s Carers Lead and an Independent Sexual Violence Advisor (ISVA) from Changing Lives. The session draws on learning from SARs and DHRs and resources from the Centre for Age, Gender and Social Justice (Dewis Choice). It highlights some the key risk factors, including a particular focus on risks within carer and cared-for relationships. The training is now offered on an ongoing basis as part of the multi-agency training programme.
|There were 135 safeguarding adults concerns raised about domestic abuse for people aged over 65 in Newcastle last year. The oldest was 93 years old.
Safeguarding Adults Review Committee
Adult N SAR
In 2022-23, the Safeguarding Adults Review (SAR) Committee finalised and published a SAR in relation to Adult N. Adult N was 58 years old when she died in 2020. Whilst Adult N’s death was not attributed to abuse or neglect, she was known to have been in an abusive relationship with her partner. Over a number of years, she experienced physical, emotional and financial abuse from her partner and others, including in the days prior to her death. Protecting Adult N from harm was complex for the practitioners who worked with her.
The report highlights that the response to Adult N from local agencies was very good. The work with Adult N was characterised by positive, assertive, supportive and multi-agency approaches. The author stated that “local services deserve praise for the response to Adult N”. The central question posed by Adult N’s case and care was “what else could the multi-agency system have done to protect her from an ongoing risk of harm?”. The Safeguarding Adults Review recommended a number of areas where practice might be strengthened:
- Addressing drug use disorders via detoxification and residential rehabilitation.
- Using the Mental Capacity Act and other legal frameworks.
- Diagnosing cognitive impairment.
- Alcohol screening and understanding referral pathways.
- Fire and smoking risks to people with substance misuse disorders.
- Working with pharmacies to safeguard adults.
All of the recommendations made in the SAR have been accepted by the NSAB and an action plan has been developed in response. The SAR Committee will oversee progress against the action plan and report progress to the NSAB.
The NSAB have published the full report and a practitioner briefing about the case. These can all be downloaded from the SAR pages of the Newcastle Safeguarding website.
Self-Neglect Thematic Review
A Self-Neglect Thematic Review was published in September 2022 as a result of an increasing number of complex cases in this area, as well as a number of referrals to the Committee for consideration of a SAR. There was a desire to further understand practitioner experiences of self-neglect in order to make improvements to policy, guidance and training in this area. Views were sought via an online survey and a Practitioner Workshop using an Appreciative Inquiry methodology.
The key points from the review were:
- Practitioners report a relatively high degree of confidence in responding to self-neglect cases.
- Positive, person-centred engagement with the person at risk of, or experiencing, self-neglect is crucial.
- Trying to understand the cause of self-neglect is an important part of being able to deal with the symptoms.
- Self-neglect cases will require long-term, consistent, multi-agency involvement.
- Understanding and applying the Mental Capacity Act is fundamental to self-neglect cases but this can be complex and challenging.
- Early identification, intervention and prevention are desired but sometimes the reality is that cases are only picked up and dealt with at crisis point.
- There was limited awareness and familiarity with local self-neglect practice guidance.
- Very few practitioners had received recent self-neglect training that met their needs.
The review made the following recommendations:
- The findings from the review should be used in the review of self-neglect practice guidance and single and multi-agency training.
- Regional self-neglect 7-minute guides should be widely shared across practitioner groups and networks.
- All agencies should include or disseminate key messages and links to resources about self-neglect on their intranet sites or via internal communication methods.
- Consider establishing a self-neglect practitioner forum.
- Increase practitioner confidence in application of the Mental Capacity Act.
- Explore self-neglect risks/prompts being added to core assessment forms/documentation.
SAR Committee priorities for 2022-23
The SAR Committee will continue to oversee the action plans in response to the recommendations made in recent SARs and other reviews. The Committee continues to progress one SAR (which is being jointly undertaken as a Domestic Homicide Review). The Committee have a Development Session planned for the Autumn which will be focussed on other review processes and their interface with Safeguarding Adults Reviews.
Improving Practice Committee
Despite service pressures across the NSAB partnership, the attendance, commitment and involvement of Improving Practice Committee (IPC) members has been excellent during 2022/23, with meetings continuing online. Important outputs include: a Making Safeguarding Personal audit, a programme of seminars for Safeguarding Adults Week and updated policies and procedures. The contribution of individual members has added value to the wide-ranging discussions at meetings, this influencing the quality of work by the committee.
Complex discussions, such as how to respond to referrers who fail to seek the views or consent of the adult at risk, ways to improve communication with practitioners about the importance and application of the Mental Capacity Act and how to respond to abuse by a person in a position of trust, have mostly preceded the development of guidance for front line staff. Work to develop a protocol on responding to abuse by a person in a position of trust will continue in 2023-24.
A highlight of our work was the very successful programme of seminars delivered during Safeguarding Adults Week, 21st-27th November 2022. This was the most comprehensive programme to date, with contributions and participation from many organisations and sectors. The week makes a big difference to the NSAB’s commitment to increasing safeguarding adults awareness.
Safeguarding Adults Week stats
- 1,000+ people attended our webinars and events during the week
- 10,000+ tweet impressions from our @newcastle_sab account
- 3,000+ hits on our website during the week.
A full round-up of the week was published on the NSAB website.
Involvement in the city-wide task and finish group on the Mental Capacity Act led by Vida Morris, Chair of the NSAB, has been another focus for work during 2022/23. The IPC was asked to make recommendations to improve communication with practitioners about the MCA, its importance and application in practice.
Suggestions have been put forward which include using newsletters, posters and/or social media to share important messages.
Contributing ideas and suggestions to local safeguarding adults’ developments is a key role of the committee. Fiona Richardson, Carers Lead Newcastle City Council provided a briefing on developments to the carers risk assessment in June 2022 and committee members had the opportunity to contribute suggestions. Summaries of two Safeguarding Adults Reviews (Adult L and Adult N ) were shared with the committee to facilitate wider sharing across partner organisations.
During the year the committee has heard from several organisations whose services and staff have made a real difference to the lives of adults at risk. These include the Tyne and Wear Fire and Rescue Service (TWFRS), Connected Voice Advocacy and the Newcastle Active Inclusion Service. The positive partnership approach underpinning the ‘safe and well’ visits provided by the TWFRS provide an opportunity to reduce not only fire-related risks but other factors that might increase the risk of abuse or neglect. A case discussion led by Connected Voice Advocacy gave evidence of the vital role of advocacy in supporting people to have a voice in the safeguarding adults process. The Newcastle Active Inclusion Service contributed to the committee’s discussions on the best way to have routine conversations about finances with those at risk. They shared their Trigger Point Conversation Guides and gave details of their training offer. All this is available to support and guide practice across the city, embodying accessibility and a spirit of preventative and partnership working: Financial inclusion information for professionals and volunteers.
Laura case study
This case study has been provided by Newcastle Hospitals. Names have been anonymised and some details changed.
|Laura is young woman living at home, where there are substantial concerns regarding impaired skin integrity, home environment, physical disability, and isolation. Laura only has contact with community-based health services who continue to maintain visits and gently promote referrals to social prescribers, Tyne and Wear Fire and Rescue Service for Safe and Well checks, and for GP reviews. There are concerns about mood and depression but Laura has been assessed as having mental capacity regarding care and treatment. Laura has been very clear that she does not want involvement of social care and that she will address her home circumstances in her own time.
Services have respected and worked with Laura’s views and flexibly adapted visits, persistently worked to introduce possible support, and raised safeguarding referrals where indicated. Laura’s case demonstrates that Making Safeguarding Personal is fundamental to the safeguarding process, and that we are required to balance safety and autonomy constantly. The case also reveals that concerns can evolve over many months and that what we would hope for individuals to live free from harm, abuse, neglect and self-neglect is not a straightforward path.
Learning and Development Sub-Committee
The work of the Learning & Development Committee (L&DC) continues to be busy and dynamic. It maintains a clear focus on keeping the multi-agency workforce up to date with current issues and processes that impact on their role protecting adults at risk in our community.
The Committee has drawn on a range of expertise to inform reviews and updates of the training on offer for safeguarding and mental capacity. Areas highlighted this year have been a refocus on the The Risk Assessment Management Plan ( a useful tool for workers use to help evidence and manage risks when a Safeguarding Adults Enquiry is being completed) and The Carers Risk Assessment Tool (used to help evidence risks related to unpaid carers or the people they care for).
The Committee have worked alongside Public Health to commission training on the Mental Capacity Act and Vulnerable Dependent Drinkers, directly responding to recommendations from the two Safeguarding Adults Reviews published in 2022. The Committee have also reviewed information on the Government’s updated Prevent Strategy and considered its implications for training.
As we move forward from the Covid pandemic, the Committee have considered the benefits and disadvantages of maintaining an online-only training offer. It is planned that more training sessions will be available in-person, whilst retaining a significant online offer. .
With the short-term impact of Covid subsiding the Committee has rapidly redirected its attention to the present crises around the cost of living. Safeguarding practice cannot ignore the struggles people in our community are facing. Multi-agency safeguarding training has been adjusted to include information for professionals about where they can direct people for help.
Key Learning and Development Committee stats:
- 4,216 participants on our multi-agency training programme
- 96% of participants on NSAB training rate it as good or excellent.
- 93% of learners felt that training would influence their practice.
- “Clear and well organised. Break out rooms gave space for small group discussion and sharing of best practice which was very helpful”
- “I will have greater confidence in taking steps to raise an enquiry and fill in the necessary paperwork”
- “Very well delivered, kept engaged throughout and interactive exercises were excellent in keeping motivation for the course”
- “Online learning is not my learning style usually. I found the session engaging with the right amount, of interactive sessions and slides”
This year the Committee has undertaken a survey with agencies about how they provide training about the Mental Capacity Act (MCA). The survey results were fed into the Mental Capacity Act Task and Finish group set up by the Board which resulted in a letter being sent to all partner agencies about MCA training with the following recommendations:
- Consider Mental Capacity Act training as being a mandatory requirement for relevant staff in line with the levels outlined in the National MCA Competency Framework (2017)
- Consider bespoke, accredited, MCA training at a more advanced level to reflect the needs of different workforce roles. Practitioners have fed back that they find case focussed examples relevant to their own area of work particularly helpful in aiding their understanding and application in practice.
- Separate MCA training from safeguarding training. The MCA is much broader than safeguarding and relevant to all who may make decisions for others, not just in relation to safeguarding matters. It can be helpful for the MCA to be referred to on safeguarding training, but this should not be solely relied upon as the mechanism for delivering MCA competencies.
The Committee has received presentations on the learning from local SARs and other reviews undertaken by the SAR Committee. This has resulted in updates to core safeguarding training, including highlighting professional challenges, debunking the “lifestyle choice” narrative (particularly in relation to self-neglect), escalation of complex cases and maintaining a focus on staff knowing and understanding the law and how it should be used.
Overall performance against our annual work plan has been excellent. Training evaluations continue to demonstrate a high level of satisfaction by practitioners. The Committee are confident that the quality and diversity of training has contributed significantly to the enhancement of practice by those working with adults at risk in the community.
Looking ahead to 2023-24, the Committee have a number of priorities, including:
- Continued joint working with Newcastle Safeguarding Children’s Partnership, Public Health, and Safe Newcastle.
- Delivery of training for community groups and the wider public.
- Provision of training around “making a good safeguarding adults referral”.
- Raise awareness of ‘closed cultures within organisations and the safeguarding risks that may arise from this.
Missing, Slavery, Exploited, Trafficked (M-SET) Sub-Committee
Strategic M-SET is a joint sub-committee of the NSAB and the Newcastle Safeguarding Children Partnership. It’s focus is around missing, slavery, exploitation and trafficking.
The Committee continues to achieve key actions against it’s delivery plan. A key priority is to ensure there that there are learning and development opportunities available in this key area and that public awareness is raised. Last year, Northumbria Police and Adult Social Care delivered a County Lines and Criminal Exploitation webinar for Safeguarding Adults Week and representatives at the Committee continue to report delivery of training in this area. In 2023-24 the Committee are keen to have a better coordination of exploitation training. A Task and Finish Group will be established which will seek to: agree a local competency framework; map the current training offer against these competencies; and respond to any gaps in the training available.
With regards to public awareness, local charity Edge NE (and Strategic MSET member) featured in a National BBC news report in relation to their work with children and young people at risk of county lines and criminal exploitation. This has helped to raise awareness of these important issues – Edge NE report that following the news report they received contact from dozens of families seeking support. Edge NE work with young adults up to 25 years old impacted by gangs, serious youth violence and criminal exploitation.
Presentations were received on a number of learning reviews where exploitation had been a feature – some out-of-area Safeguarding Adults Reviews and Child Safeguarding Practice Reviews and a local NSCP learning review. Discussions were held about their relevance to systems, policy and practice in Newcastle.
The Regional Missing Adults Protocol was reviewed in line with the introduction of a National Missing Adults Protocol. As a relatively new protocol, local implementation of it was evaluated. A lot of training had been provided around the protocol, particularly with supported accommodation providers. It was agreed that there would be regular information sharing between the Police and Adult Social Care around the top missing adults/locations to ensure that these are being progressed via safeguarding adults procedures where this is appropriate. A specific missing policy for hostels was introduced in 2022-23.
The Committee took an interest in the impact of the Ukrainian Resettlement Scheme and were assured of the local arrangements in place to identify and respond to any safeguarding concerns arising from this.
Exploitation Case Study
Jane first became known to me, when I was visiting another female in relation to intervention around mental health and experiences of exploitation. Jane was at her friend’s flat, and we began to talk. Initially Jane stated that she needed support around her mental health, but quickly specified that she would not want a referral to any agencies because of past perceived negative experiences. As weeks progressed, Jane would often be at her friend’s flat when I arrived and she and her friend would talk about the historical trauma. After approximately six times of meeting Jane at her friend’s house, Jane agreed to meet with me on her own. Jane was not registered with a GP, and consistently declined referral to any other agencies. Jane disclosed that she was sleeping with her dealer to pay off debts, and that sometimes she would sex work if she needed additional money. Jane was drinking frequently and using cannabis, coke and “anything I can get my hands on really” as a means to block out the pain of having children removed three years previously. Each anniversary of the children’s birthdays would understandably tilt Jane into a spiral of despair, self-loathing and pain.
Jane and I met on a regular basis – and following a lengthy period of contact, Jane agreed to register with a GP. I supported her to do so, and within this to access a Social Prescriber who supported Jane to access free gym membership. During our sessions, Jane and I would talk about harm minimisation. I would provide condoms and sexual heath advice and a gentle touch counselling approach in relation to her trauma and deeply routed pain. Information around concerns was passed onto the Police via the Partnership Intelligence Form.
Jane is now receiving treatment with drug and alcohol services, counselling from Talking Therapies and regularly attends the gym. There are, of course, still times when Jane “has a wobble” as she calls it, but she is gradually unfurling like a flower, to see herself as a strong woman who has experienced trauma and is deserving of respect, support and compassion. She will begin a college course in September, and has dreams and aspirations for the future.Case study from North East and North Cumbria ICB. Names have been anonymised and some details changed.
Jane’s story to me, is one of hope – things are not perfect, but Jane is growing more insightful and self-compassionate. Recently Jane has consented to a referral to Changing Lives, and I am confident with the support of services Jane will continue to grow stronger. With each person I work with, I learn something new, I grow wiser from learning from the experiences of others who have endured so much, and it makes me ever more determined to raise their voice and to champion victims of exploitation whoever they may be.
Partner agency perspectives
Newcastle City Council
The Adult Social Care workforce continue to be front and centre of responding to the increased safeguarding adults activity in Newcastle. The Local Authority has taken a lead role in trying to resolve the impact of the increase in the volume of safeguarding adults referrals being made through: multi-agency partnership working, exploration of alternative operating models, and a review of resource investment into the Multi-Agency Safeguarding Hub (MASH). Additional staffing resource has been provided into the MASH from Adult Social Care.
Supporting staff to be confident in MCA practice has been a key priority. Legal Services have hosted a series of MCA Forums for Social Workers covering different topics and themes including: Internet and Social Media; Fluctuating Capacity; Finance; Care Plans; and Sexual Relations. These forums have been attended by 385 participants.
The Council had a regionally supported, peer annual conversation to support preparation for the inspection of local authorities by the Care Quality Commission (CQC). It was an independent review of performance against CQC’s four assurance themes, which are: working with people, providing support, ensuring safety and leadership. The feedback viewed Newcastle as good, with many excellent examples of work. We evidenced good comparative performance in many areas including the proportion of people who use services who report they feel safe. There are areas where Newcastle can make improvements, such as, making better use of our data. The areas of improvements have led to recommendation action plans which are just the start of our assurance preparation.
A pilot project (Partnerships for People and Place) with the West End Foodbank was completed in 2022-23. The project sought to better understand and break the link between safeguarding and poverty. The initial focus was on Elswick, Benwell and Scotswood, where both wards have high levels of deprivation and safeguarding concerns, but also wards with excellent public services, vibrant voluntary and community sector organisations, and close knit and diverse communities which provided great potential. We found that when we join up better at a local and national level, we help address the serious issues of poverty and safeguarding risks, but also provide much greater opportunities for fulfilling lives for the people living here. This is currently being developed into an ongoing way of working.
The Public Health Team at Newcastle City Council have been pro-active in supporting learning from Safeguarding Adults Reviews linked to people with drug and/or alcohol issues. One example is their funding of the multi-agency training on the Mental Capacity Act and vulnerable dependent drinkers. This is a great example of workforce upskilling in response to increasingly complex cases that are seen in the safeguarding remit. This will be mandatory training for Adult Social Work staff.
2022/23 saw the refresh of the Keeping Everyone Safe (KES) training modules which brings together key messages in relation to safeguarding children, safeguarding adults, community safety, domestic abuse and Prevent under one banner. As of July 2023, 85% of colleagues who are required to undertake the refreshed training have done so.
North East and North Cumbria ICB
The Newcastle Gateshead Clinical Commissioning Group (CCG) transitioned to the North East and North Cumbria Integrated Care Board (ICB) on 1 July 2023, 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.
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.
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. A number of requests are now being received from individual GP practices for face-to-face sessions which is being reviewed in line with resource availability.
In July 2021, the Designated Nurse Safeguarding Adults developed a funding proposal for NHS England for an ICS wide pilot to develop forensic examination services for adults who present with unexplained or non-accidental injuries. Work on the pilot has progressed and achievements to date include sponsorship of a Virtual Forensic Aspects of Safeguarding Conference on in April 2022. The Conference was free to attend, and details were circulated to clinical staff across the ICS footprint. By sponsoring the event we have been able to ensure it is recorded and will subsequently be available to both clinical and non-clinical staff as a resource. The pilot study continues in Hull.
The ICB Safeguarding Team continue to provide support and work collaboratively
with multi -agency partners, including attendance at the Safeguarding Adult Board subgroups and promotion of shared learning from reviews. The Designated Nurse for Safeguarding Adults chairs the NSAB’s Safeguarding Adults Review Committee and has involvement with projects supporting asylum seekers, hate crime prevention, Prevent and Community Safety Partnerships and the Local Domestic Abuse Partnership Board.
The ICB safeguarding team continues to raise awareness and promote safeguarding information and offers of support to the staff within the organisation. Safeguarding Adults Week 2022 was promoted daily across the ICB corresponding to the local and national themes of the week.
Protecting Vulnerable People is a priority for Northumbria police. The Force Vulnerability Strategy which was launched in 2022 with four key pillars: Working Together, Our People, Leadership and Early Intervention and Prevention continues to be at the forefront of our training and service delivery. The key aim is to protect and safeguard our vulnerable people and ensure perpetrators are targeted and prevented from re-offending and causing further harm within our communities. Harm Reduction Teams are now embedded across the force area and they play a key role in tackling emerging issues identified with vulnerability, working with partners to adopt a problem solving approach. The force Harm reduction team oversee our Force Early Intervention Strategy and continues to grow.
To ensure that Protecting the Vulnerable is front and centre of our force response, force wide “Vulnerability Matters” training continues to be given to new recruits and continues CPD inputs to our frontline officers. This training supports officers to take a trauma informed approach to dealing with vulnerability and assist officers to identify vulnerable adults in the community. The training focusses on equipping officers to better understand vulnerability by looking for clues, applying curiosity and ensuring our communications are in a supportive and empathetic way. This includes a Our Sergeants and Inspectors in force are given regular inputs on the Care Act and the categories of abuse so they can apply this learning in their team supervisions.
To further embed the learning around vulnerability our street triage team and missing from home coordinators have spent time within our communications centre assisting and advising our call handlers on live time cases. This ensures that we are linking with our partners at the earliest opportunity. This links to the implementation of the Right Care, Right Person protocol where we are assessing at first contact what the most proportionate response is and who the right agency is to respond. As a result we have seen a large reduction in the number of deployments to missing episodes, meaning we have more officers free to attend those incidents for those in greatest need.
Search has continued to have a regular presence representing the voluntary sector on the Newcastle Safeguarding Adults Board and Improving Practice Committee this year. We are passionate about supporting the work of the Board and ensuring the voice of the Voluntary Sector gets represented.
Search has introduced two new mandatory training sessions to our staff induction over the past year, Making Safeguarding Personal, and Making Every Contact Count. We have done this to strengthen our approach to safeguarding ensuring that we do “Make Safeguarding Personal” as well as supporting the NSAB priorities. We are shaping our volunteer induction training to include a greater focus on Making Safeguarding Personal too.
Search has supported other small voluntary organisations by providing an information session on Safeguarding for their volunteers over the past year.
Your Homes Newcastle
YHN, in collaboration with Newcastle City Council’s (NCC’s) Active Inclusion Unit, set up the Sustaining Tenancies at Risk panel, in May 2022. It is a multi-agency response putting into practice the policy aim of no evictions into homelessness for YHN tenants. By taking action to support those at high risk of eviction as early as possible rather than at the point of crisis, it works to protect individuals from harm. YHN front line officers refer tenants who are close to eviction to the panel. The panel reviews the effectiveness of any existing support and puts in place targeted multi-agency interventions to enhance existing support or as part of a new offer to the tenant. This partnership approach involves a wide range of YHN, NCC housing, welfare advice, children’s and adult social care services, health and third sector services. It includes taking steps to stabilise the tenant’s financial and housing situation. It also refers households to the Complex Case Panel to find alternative accommodation when it has been identified that the tenant is currently in unsuitable or unaffordable accommodation. The panel will only agree collectively to an eviction when there is a consensus that all possible steps have been taken to support the resident to sustain their tenancy. 215 households were supported by the panel in 2022/23 and £60,000 of rent arrears recovered, helping sustain customer tenancies.
At YHN, we believe that one of the ways that we can best contribute to safeguarding priorities is by enabling our customers to sustain successful independent living and prevent homelessness by securing the foundations for a stable “L.I.F.E.”.
This includes supporting people to have somewhere to live, an income, be free from unmanageable debt and access to employment opportunities. We do this by providing a range of support and housing directly to customers and also working closely with multi-agency partners. To improve the outcomes of our most vulnerable customers and to help prevent escalation of safeguarding issues, YHN has established a targeted fund which can be accessed by our officers for customers as part of a package of support. It was established as a response to the cost of living crisis and aims to support customers in emergency need of energy support and to provide customer choice in products to help them keep warm and safe at home whilst reducing the cost of energy bills. Over winter 2022/23, we supported 480 customers.
During 2022/23, YHN has further committed to its approach to being a more psychologically informed organisation. We are undertaking an in-depth training programme to increase the psychological awareness of our staff. This is further developing staff understanding of the drivers behind customers’ behaviours and better equipping staff to support customers. So far, we have enrolled 325 frontline staff and managers across YHN and NCCs Active Inclusion Unit onto the training. The first modules are designed as an introduction to some of the key concepts and ways of working in a psychologically and trauma informed way.As part of the development of our psychological approach, a group of Senior Managers completed a self-assessment tool to inform next steps and opportunities for development tailored to their individual service areas.
Terry Case Study
This case study has been provided by Your Homes Newcastle. Names have been anonymised and some details changed.
|Terry recently moved into his own YHN tenancy. He is supported by a YHN Support and Progression Worker (SPW) as part of an accommodation pathway into independent living for people who have experienced homelessness or rough sleeping. The project provides person-centred support focused on securing the foundations for a stable life over a 2-year period.
Terry has a dependency on alcohol and during his tenancy has fluctuated between periods of abstinence and periods when he feels that he is drinking too much and struggling to manage. He has been referred into Adult Social Care by YHN, particularly in relation to self-harm and self-neglect.
Terry has a really positive relationship with the SPW and the service which has built up over a period of time, which has involved engaging psychologically informed support techniques such as consistency and reliability. He has said that he has benefited from feeling like he has been heard and having someone listening to his story. He has said that this has helped him feel less isolated and it has been an opportunity to talk about his strengths and encouraged his positive activities.
Terry has a weekly appointment with his SPW who visits him in his home. During these appointments, the SPW talks to him about his drinking and talks through ways to cut down and avoid drinking, for example, talking about places that he can go that week and people that he feels he can safely associate with and people to avoid.
The SPW makes sure that he has food and encourages him to ensure that he is eating enough. When Terry has self-harmed, they talk together about ways that he can avoid this behaviour, as well as good wound care and offer to support him to access services for self-harm and mental health support. They talk about the medication he has from his GP and what medication he is buying and taking and support him to continue following his GP’s advice. When he has felt suicidal, he has often called the SPW and the SPW has alerted emergency services where required or talked to him about what help is available, encouraging him to engage with the Crisis Mental Health Team.
Newcastle upon Tyne Hospitals NHS Foundation Trust
The Newcastle Hospitals workforce continue to be fundamental in identifying and responding to increasing safeguarding activity across the Trust in both acute and community settings. We have seen a further 5% increase in activity compared to previous years. To ensure we continue to deliver high quality safeguarding practice we have invested in new posts into the team to help ensure we can respond to the increase in referrals and case complexity. We also continue to work with several Local Authorities and this partnership working throughout the region remains a fundamental principle of our safeguarding practice.
As a Trust we are continuing to see a substantial increase in the use of the Mental Capacity Act evident through case discussions and audit, number of Deprivation of Liberty Safeguards and involvement of legal services. A key area of focus for the Trust in this year has been to develop staff understanding of the Mental Capacity Act. We recently launched an eLearning package on the Mental Capacity Act for all clinical and patient facing staff with bespoke sessions for those who require enhanced training. It has been encouraging to see over 8000 staff undertake this training to date and to see this impacting competence and confidence in practice.
We have built on the NSAB priorities through the year and have worked to embed these objectives throughout the Trust. The priorities have continued to drive a wider understanding of the Mental Capacity Act, the Making Safeguarding Personal agenda and to ensure we expand expertise in responding to self-neglect.
Understanding the multiple and complex needs of individuals, we have continued to access legal literacy sessions, which has been critical in addressing multifaceted self-neglect cases. Self-neglect remains the highest category of concern and reflects the challenges for individuals and families where there can be substance use, significant environmental concerns or where services need to consider flexible and persistent ways of maintaining contact with service users. Understanding the risk and complexity of cases is a key part of analysis, which is essential when reflecting on recent and current Safeguarding Adult Reviews. This process has also resulted in swifter case escalation to Local Authorities where there are growing and significant concerns.
Addressing the priority of older people experiencing domestic abuse, we have worked with Safe Newcastle to provide a bespoke domestic abuse masterclass for staff working in the emergency department. We have also continued to host safeguarding forums throughout the year which explored older people experiencing domestic abuse.
Connected Voice Advocacy
Connected Voice Advocacy continues to play a significant role in safeguarding adults work in Newcastle. Significant developments and contributions in 2022-23 include:
- Training to the voluntary, community or social enterprise (VCSE) organisations in the role of advocacy in safeguarding (free and online throughout the year).
- Updates on NICE guidance and duties for Safeguarding Adult Boards.
- Awareness session to referral pathways for Independent Advocate and Community Advocacy roles.
- Online campaigns all year and in Safeguarding Adults Week 2022.
The service contributes to the NSAB’s priorities in the following ways:
- Increasing access to advocacy
- Person centred and preventative support to avoid Section 42 enquiries
- Making NICE guidance easy to understand for all stakeholders
- Awareness training on Mental Capacity Act and referral pathways for VCSE.
Donna Case Study
This case study has been provided by Connected Voice Advocacy. Names have been anonymised and some details changed.
|Advocates are trained by the local authority how to respond to safeguarding concerns including in specialist areas such as domestic violence and sexual exploitation. The advocates frequently use the domestic violence risk checklist with clients to ascertain the level of risk and liaise closely with the Independent Domestic Violence Advisor (IDVA) service.
Donna was referred for advocacy from medics at a neurological rehabilitation hospital. Her brain injury impairs her memory considerably and she presented with issues of substance misuse and a vulnerable housing situation.
An advocate supported Donna by building rapport and trust, explaining the confidential independent nature of advocacy and establishing communication methods and strategies to help her remember information.
The advocate took instruction from Donna and sought additional help from agencies like Shelter where her tenancy issues were addressed and her housing rights upheld. Donna worked alongside her advocate on an application for supported housing where she was able to move to her own flat with ongoing support from of a key worker. The advocate helped Donna to talk over her previous high risk relationships and together they agreed a safety plan which was documented in a way Donna could use and remember. As a result of a domestic abuse incident, a safeguarding adults referral was made. Donna felt intimidated and anxious about the safeguarding process. To ensure she could engage in the investigation process, the advocate helped her to prepare for meetings, understand the implications of the decisions made in the meetings and to consider what she wanted from the process to maintain her autonomy and safety. Donna felt reassured that she could call her advocate with questions or concerns. When Donna felt in danger the advocate liaised with Police and Local Authority to raise additional alerts and the Police responded with prompt safety checks. Due to the frequent nature of concerns a MARAC (Multi-Agency Risk Assessment Conference for high risk domestic abuse) referral was made. With Donna’s consent the advocate referred Donna to the Local Authority for a Care Act Needs Assessment and a social worker was identified.
The advocacy intervention led to Donna receiving the support she needed to maintain independent living, maintain her own safety from harm, have adaptations to improve her memory and better understand her rights under legal frameworks.
In 2023, Changing Lives and the Agenda Alliance (an alliance of member organisations who work in collaboration to influence public policy and practice to respond appropriately to women and girls with multiple, complex unmet needs) published their Dismantling Disadvantage report.
The report is the culmination of a research project which seeks to understand the ways in which socio-economic, regional, and gender disparities interact. The report highlights that pre-existing disparities in regional health and wealth have been exacerbated by the pandemic and cost-of-living crisis, with a significant impact on those at the sharpest edge of inequality, women with multiple unmet needs. These women experience a combination of systemic disadvantages, leading to overall poorer outcomes and a risk of premature death.
The report makes a number of recommendations to end the cycle of trauma and harm so that women and girls can thrive.
Mental Capacity Act
The Newcastle Safeguarding Adults Board have been looking at how Mental Capacity Act (MCA) practice can be improved due to a growing body of national, regional, and local evidence that knowledge and confidence in staff involved in making decisions on behalf of others, needs to be improved in this critical area. It is identified that there are fundamental flaws in how the Mental Capacity Act is understood and applied in practice.
The NSAB asked all member agencies to complete an MCA position statement. This outlined how well embedded organisations felt the MCA was, what training and policies were in place and how practice was audited and monitored.
All of the responses highlighted concerted efforts to support front-line practitioners around the MCA, whether that was via training opportunities, policies and procedures or advice and support. There was also a self-awareness that despite this, challenges remained – practitioner knowledge and confidence could be improved.
NSAB members acknowledged that further action was required to change practice and prevent recurring recommendations being made in Safeguarding Adult Reviews. An MCA Task and Finish Group was established to look at what actions could be taken by the NSAB to improve MCA practice locally and to explore the regional and national routes for escalation and sources of support. The issue was raised in a number of regional and national forums but there were limited examples of best or innovative practice.
The sub-committees of the NSAB were seen as pivotal in delivering change locally. The Learning and Development Committee undertook a training survey and review. This identified whilst training was being offered, this was often just at a basic awareness level (regardless of role) and sometimes was only delivered as part of safeguarding adults training (despite the MCA’s much broader application). The findings of the Learning and Development Committee’s review led to a letter being sent out to all NSAB members about MCA training, the content of the letter was also published for wider dissemination. The Improving Practice Committee have been looking at communication and marketing material – a series of posters and an MCA focussed newsletter/regular briefing. The work of the MCA Task and Finish Group continues.
|Newcastle City Council
|North East and North Cumbria Integrated Care Board
|Communications & Marketing
|Safeguarding Adult Reviews
In 2022-23, the NSAB was chaired by Vida Morris. The NSAB would like to offer thanks to James Steward, Michelle Stamp, Karen Whorton, Lynne Colledge and Julia Young for their contributions to safeguarding adults and who all stepped down as NSAB members this year.