Learning from Adult Serious Case Reviews in Worcestershire

1. Worcestershire Safeguarding Adults Board Welcome to Learning From our Serious Case Reviews Friday 16th April 2010

2. 9.15Introduction – Eddie Clarke 9.25 Serious Case Reviews – Karen Rees 9.35 Short Film 9.50 Adult SCRs in Worcestershire – Sue Pidduck 10.00 SCR 1 – Shane Lewis 10.15 Prevention of abuse – Sarah Pilkington 10.30 Break 10.50 SCR 2 – Sue Pidduck 11.00 Mental Capacity – Kate Towse 11.10 SCR 3 – Sue Pidduck 11.15 Safeguarding Carers - Rachel Fowler 11.30 Group Action Planning – Sarah Pilkington 12.15 Feedback 12.30 Close - Susan Fairlie

3. Introduction from Eddie Clarke Director of Adult and Community Services

4. Serious Case Reviews Adult abuse is everyone’s business

5. …but who are these?

6. Serious Case Reviews for Adults Policy • ADSS National Framework of Standards for Safeguarding Adults Oct 2005 • States that as good practice SABs should have in place a serious case review protocol • Government commitment to statutory footing for safeguarding adults boards, guidance is awaited • Review of No Secrets 2009 • WSAB Serious Case Review Policy • Available on the county council website

7. SCR link to other processes Serious Case Review Adult abuse is everyone’s business

8. SERIOUS CASE REVIEW PROCESS : VULNERABLE ADULTS DIES AND ABUSE OR NEGLECT APPEAR TO BE A FACTOR IN THE DEATH REQUEST FOR A SCR REPORT PRESENTED TO SCR SUBGROUP REPORT AND EXECUTIVE SUMMARY REPORT PUBLISHED INITIAL MEETING OF SCR SUB GROUP SCR PANEL MEETS Chair meets with family members INDEPENDENT MANAGEMENT REVIEWS BY EACH AGENCY PRODUCTION OF OVERVIEW REPORT BY SCR PANEL CHAIR REPORT PRESENTED TO WSAB (INCLUDING ACTION PLAN)

9. Why undertake a Serious Case Review ? • not to reinvestigate or to apportion blame when a vulnerable adult dies or is seriously injured • but to learn lessons about the way in which local professionals and agencies work together to safeguard Vulnerable Adults and develop best practice • the action plans from serious case reviews are monitored by Worcestershire Safeguarding Adults Board to ensure all agencies learn from the recommendations

10. Adult Serious Case Reviews in Worcestershire • One published, two awaiting publication • Common themes arising from all three • Vulnerable adults fell through the net • Agency procedures were not followed by staff and • Agencies did not share information or co-ordinate plans • We will briefly go through the reviews and pick out one learning theme from each

11. First Serious Case Review Shane Lewis Detective Inspector West Mercia Police Worcestershire Safeguarding Adults Board police representative adult abuse is everyone’s business

12. missed opportunities? Sarah Pilkington Learning and Development Coordinator for Adult Protection

13. prevention before responses! • the main purpose of Worcestershire’s adult protection policy is for the preventionof abuse • central notion of ‘vulnerability’ – a person’s inability to protect themselves against potential harm or neglect • critical factors that can increase vulnerability • need for personal care • communication difficulties • cognitive difficulties • prioritise these people for monitoring and review

14. lessons to be learnt • This adult had been involved with care services throughout his life • once he became an adult his needs became almost exclusively addressed through his mother • there was an ongoing pattern of reluctance to engage with services • missed out patient’s appointments • cancellation of day and respite care • not returning calls • not allowing professionals into the home

15. systems failures • issuing of repeat prescriptions • routine health checks not carried out • no direct assessment of James' needs • no contact with his by social workers after 2005 • annual review not carried out • no reassessment of need for continence products • no reassessment of ongoing needs for medication • no assessment of carers needs • GP approached for help in 2007 but was not identified as carer for adult with complex needs

16. missed signs • the last confirmed sighting was 5 months before his death • subsequent signs that were missed • essential medication not collected • continence products not collected • weight loss • dropping out of services after concerns were raised • various explanations were given but not followed up when he still failed to attend care services

17. high risk signs • difficulties in gaining access • signs that a carer is struggling to cope • unexplained deterioration in physical health • reluctance to engage with services • carer is focus of contact and intervention • vulnerable adult lacks an independent voice • poor interagency communication • lack of assessments and regular reviews

18. if a vulnerable adult lacks an independent voice we have to make sure we don’t lose sight of them in the process

19. Help and Advice • Adult Protection Team 01905 822613 / 01905 822614 or adultprotectionduty@worcestershire.gov.uk • http://worcestershire.whub.org.uk/home/wcc-social-abuseormistreatment.htm • Access Centre 0845 607 2000 • Domestic Abuse 24 hour helpline 0800 980 3331 • Action On Elder Abuse helpline 0808 808 8141 • Care Quality Commission 0121 600 5720 • Health Safeguarding Leads • Vicky Preece (PCT) 01905 760072 • Jane Smith (Acute) 01905 763333 • Karen Rees (MHP) 01905 733771 • Police 0300 333 3000 (including Domestic Violence Unit and Vulnerable Adults Detective Sergeant)

20. Second Review Mrs B was living at home with her husband until the age of 89 when she developed vascular dementia. She went into hospital with a fractured leg but did not receive rehab as she had dementia, and instead went straight to a nursing home. When her leg was better and she became mobile, the nursing home found they could not manage her dementia so she moved to a care home over Christmas and died after wandering out of the home overnight.

21. Key messages from the second review • Care planning needs to be proactive not crisis led • Physical health needs must be recognised as well as mental health needs in mental health care planning • The Mental Capacity Act must be followed and MCA assessments should be recorded • Carers Assessments must be offered and recorded for families • Dementia care must be person-centred • Recording systems should be integrated as far as possible

22. Assessing Mental Capacity Kate Towse Deprivation of Liberty Safeguards Team With thanks to Lorraine Currie – Shropshire County Council

23. Meet Lou and Andy Andy and his carer Lou live in Herby City. Lou selflessly dedicates his life to looking after Andy, who is a wheelchair user and Andy selfishly dedicates his life to making things as difficult as possible for Lou.

24. Can the Mental Capacity Act help Lou? Andy wants to go on holiday to Helsinki despite previously having stated that “Finland had a maudlin quality to it and it was unsuitable as a holiday destination.”

25. Lou looks back at some of Andy's past decisions • To specifically decide not to go to the toilet before getting in Lou’s van after 4 pints of beer then deciding he needed to as soon as he is in the van • To insist on a pet snake instead of a rabbit, once purchased declaring that he wants a rabbit • To buy a card “with deepest sympathy” for his brother’s birthday • To choose to take books on Chinese history out of the library then declare that he can’t read

26. Lou considers the 5 principles of the MCA • Presumption of capacity. • Unwise decisions. • Maximise capacity. • Least restrictive. • Best interests.

27. Lou assesses Andy’s capacity To lack capacity a person must have: An impairment or disturbance that affects the way their mind or brain works, Andy has a learning disability

28. Lou assesses Andy’s capacity • Lou explains about Helsinki, he shows Andy travel brochures and reminds him of past decisions he has made. He makes suggestions such as Florida as much better holiday destinations. • Lou assesses whether Andy can • Understand the information relevant to the decision. • Retain the information relevant to the decision. • Use, or weigh up the information relevant to the decision. • Communicate his decision.

29. Andy’s response remains the same I wanna go to Helsinki

30. Conclusion I wanna go to Florida As the decision maker Lou concludes Andy has capacity to choose to go to Helsinki. As the plane takes off Andy is heard to say…..

31. Third Review • Mr A, a 50 year old man with a range of physical and mental health problems, hehad been living with his 88 year old mother for nearly a year until just before his death. He had been known to the Domestic Violence Officer due to suspected verbal and physical abuse of his mother. • Mr A’s mother was admitted to hospital and, following a multi-agency adult protection meeting at this time, it was agreed that he would return to his own home before his mother’s discharge from hospital, for her protection. • Mr A was visited by the local community mental health team, but became ill and missed a number of appointments • . Neighbours became concerned and his body was discovered at home by the police having been there at least five weeks.

32. Key messages from the third review • WSAB should provide guidance to staff on facilitating family involvement • Family members and carers should be clearly identified and recorded as part of a standard mental health care plan and offered a carers assessment • Clarity about who should record on the County Council’s framework-i system should be given • A flagging system for adults at risk should be considered to be used across agencies

33. Think Family Rachel Fowler

34. How well are we supporting carers? Studies have found that a significant proportion of carers face physical and mental health problems that include stress and tension, anxiety, depression, disturbed sleep, back injuries and hypertension. Nearly half (48%) indicated that professionals do not spend sufficient time listening to the views of carers and 41% do not know where to go to get more help

35. What works well? ‘Carers who receive timely information, are in contact with professionals, feel involved, valued and respected and have their own needs assessed and met, experience fewer and less severe adverse effects to their own mental and physical health, family relationships, finances and careers and have more time for their own leisure pursuits.’ (Pinfold & Corry 2003)

36. Why the concern? The demands of caring Guilt and Resentment Stress Depression Isolation

37. The National Carers Strategy The principles and vision in the strategy. By 2018: Carers will be treated with dignity and respect as expert care partners Will have access to the services they need to support them in their caring role Carers will be able to have a life of their own

38. Summary Right to an assessment – carers who provide regular and substantial care are entitled to a carer’s assessment, which will look at their needs as a carer; Carers can also receive services in their own right under the Carers and Disabled Children Act 2000;

39. Key Message A carer’s assessment is not a process for its own sake. It should be as simple or as complex as it needs to be to deliver an outcome that makes it easier for the carer to care and to fulfil some of their own needs. It must focus on the outcomes for carers that will support them in their caring role and maintain their own health and well-being Carers assessments are not just about what is available at the end. The process of going through the assessment can be a tremendous support in its own right.

40. What Support is Available for Worcestershire's Carers?

41. Information • Telephone Helpline • (0800 652 3151 or 01905 26500) • Information Handbook • for Carers • Events • Newsletter

42. GP Registration Card • Working with GP • practices

43. Carer Groups Inkberrow

44. Advocacy Onside Advocacy : 01905 27525

45. Practical Sessions for Carers Contact Carers Unit on 0800 389 2896

46. Carer Assessment Social Care Access Centre 0845 607 2000

47. Carers’ Back Me Up Service

48. Good News! Worcestershire has a new carers strategy Worcestershire has a dedicated team for carers Worcestershire has some of the most forward thinking schemes to support carers New carers e-bulletin for staff New counselling service New flexible breaks service New information advice and support service

49. 0800 389 2896 01527 66177 0800 652 3151 or 01905 26500

50. Action Planning Facilitated Group Work