Agenda item

To consider the annual report of the Haringey Safeguarding Adults Board for 2023/24.

Dr Adi Cooper, Independent Chair of the Haringey Safeguarding Adults Board (HSAB), presented the Board’s annual report for 2023/24, explaining that this set out the statutory duties of the Board and the work of the Board and its partners over the past year. Further key points in the report that she highlighted were:

• Details of the two Safeguarding Adults Reviews that were published last year, one of which highlighted issues around self-neglect, housing provision and multi-agency working and the other which focused on commissioned care in a care home and multiple areas of physical and mental health needs. The reviews included recommendations which were responded to.
• Details of the recent work with colleagues in the Joint Partnership Board to update, revise and co-produce the five-year strategy based on the concerns and interests of residents in Haringey.
• The Board’s subgroups had changed slightly with two new subgroups to help clarify and focus on two major areas of focus for the Board:

o   Under the Safeguarding Adult Review subgroup there was now a subgroup looking at the implementation of recommendations emerging from Safeguarding Adult Reviews. She noted that there was a particular challenge, not just in learning from the Reviews but also in maintaining ongoing improvement with the churn in staffing and organisational structures and the pressures on the public sector. It was therefore necessary for the sub-group to go back to look at earlier Reviews carried out some years previously.

o   There was now a Practice & Improvement subgroup. There had previously been a Prevention & Training subgroup but these had now been split into two with an Engagement & Prevention subgroup focusing more on working with the voluntary sector, planning events for safeguarding adults and enhancing understanding of safeguarding across communities in Haringey. The new Practice & Improvement subgroup was focused more on practitioners engaged in safeguarding practices.

• Case studies gave examples of some difficult situations that practitioners were engaged with and delivering the outcomes that people want.
• A range of initiatives from partners around improvements in training, process and practice to support ongoing improvements in safeguarding.

Dr Cooper also informed the Panel that the Board received reports on a Quarterly basis where issues were raised which could lead to deep dives to check whether there was something more significant ongoing that was indicated by the data. She noted that data on safeguarding was not there as performance data but to prompt questions about issues that may be happening beneath the surface.

Dr Cooper then responded to questions from the Panel:

• Cllr Connor referred to Recommendation 8 of the ‘Paulette’ Safeguarding Adult Review, which said that the Board should consider conducting an audit of commissioned placements and care packages to ensure that social, cultural and emotional needs were recognised. She also referred to the ‘Steve’ Safeguarding Adult Review, noting the detailed aspects of multi-agency communication and co-ordination in Recommendation 1. She asked how the Board would be able to keep abreast of important but detailed recommendations such as this. In relation to the recommendation on the ‘Steve’ Review, Dr Cooper explained that the multi-agency panel would be reporting to the Board on an annual basis about progress so the way that this recommendation was being implemented was by doing so on a routine basis rather than having to follow it up periodically. Similarly, the audit of cases within adult safeguarding was coming to the Board in a routine way. However, she acknowledged that the volume of recommendations was quite challenging and so when looking at these it was important to ensure that there was no duplication in the actions taken as some of the recommendations tended to cluster within Reviews as well as across Reviews. The new subgroup was trying to manage that process as the previous subgroup had found the volume of recommendations very high. This was not an issue unique to Haringey as the number of Reviews gradually increased following the introduction of the Care Act. She also commended the support provided by Council officers in managing this work. She noted that that the subgroup looking at historic Reviews was medium to long-term work, with a deep dive into one Review at a time, and identifying key themes that required focus on an ongoing basis. Some issues may become more or less important over time or may rely on changes to national guidance or legislation to be fully implemented.
• Asked by Cllr Connor about the joined-up approach through the Multi-Agency Solutions Panel, Vicky Murphy, Service Director for Adults Social Services, responded that the Panel was well known across all partners and internally as well as being promoted within the Safeguarding Adults Board and its subgroups. To get a referral through to the Panel, someone would need to be known to a provider and there would need to be consent under the Mental Capacity Act, so it wasn’t always straightforward, but the ability to draw on expertise across partners was there.
• Helena Kania noted the high level of Violence Against Women & Girls (VAWG) referred to in the report and queried what more could be done. Dr Cooper explained that it was routine for the partners to speak to the Board on an annual basis to explain what they were doing in this area and to examine the crossover with the safeguarding adults work. She acknowledged that this was a particularly challenging area and that this was not just an issue in intimate relationships but also in wider family relationships so there needed to be the right training available so that this could be properly identified. Asked by Helena Kania about the unreported aspects of VAWG, Dr Cooper observed that pain and shame were issues connected to safeguarding which people were reluctant to talk about and this also applied to VAWG and domestic abuse making it difficult to disclose. She agreed that there was a lot of hidden abuse, coercion and control and that what was seen in safeguarding adults data was only the tip of the iceberg. This was why the work of the Engagement and Prevention subgroup was so important as this involved a focus on raising awareness in the community, including on how to report VAWG. Cllr Connor noted that VAWG was referred to on page 57 of the agenda pack but that it wasn’t clear where this was being addressed in terms of the Board and subgroups so recommended that this be clarified in future reports. (ACTION)
• Cllr Brennan queried why VAWG and domestic abuse did not appear to be sufficiently prioritised and why statistics were not properly publicised, for example through police ward meetings. Dr Cooper clarified that Adult Safeguarding was primarily about people with care and support needs and so VAWG was an area that overlapped with the Board’s responsibilities but was a broader agenda. In relation to prosecutions, Dr Cooper said that an ongoing challenge was that victims with care and support needs were not always seen as credible witnesses or there was not enough evidence to prosecute. That wasn’t to say that the Police weren’t trying hard to build these cases, but it was a very challenging area.
• A member of the public asked a question about members of the community raising safeguarding issues with the Council but finding it difficult to receive a response. Beverley Tarka said that there were channels to report directly to safeguarding teams if there was a safeguarding concern relating to someone who was in receipt of care and support through the adult social care team and this would be prioritised. However, if this related to someone in the general population then this would not be something to be sent to the adult social care team. Asked by Cllr Connor about communications on these issues more generally, Will Maimaris said that there was an issue to consider on coordination and channels of communication when issues were raised around service provision or how a resident was being supported. Vicky Murphy said that she was happy to have a conversation after the meeting to understand the issues relating to the specific case referred to and taking this to the right team. (ACTION) In relation to the wider point about communications, she said that the methodology about locality working was strengthening the way that safeguarding worked to ensure that the team was in a position to respond quickly and in person.
• Cllr O’Donovan asked if there were specific safeguarding contacts at Alexandra Palace and Tottenham Hotspur Football Club as they hosted events with large numbers of people. Dr Cooper said that she wasn’t aware of any specific contact with Alexandra Palace, but that Tottenham Hotspur had given a good presentation to the Board some years ago about raising awareness around safeguarding which had led to some follow up work.
• Noting the references to gambling harms and adult safeguarding in the report, Cllr O’Donovan queried whether the sponsorship of Tottenham Hotspur by gambling organisations sat well with their wider safeguarding policies. Dr Cooper responded that the Council’s Public Health team, which worked specifically on gambling harms, was likely to be better placed to engage with Tottenham Hotspur on this type of issue as this did not fit with the Board’s duties and responsibilities.
• Cllr Iyngkaran observed that Haringey had one of the highest proportions of gambling premises in London and, while acknowledging that national policy/legislation was relevant to this, asked what more could be done locally. Dr Cooper explained that the outcome of the Board’s conversation on gambling was to raise awareness with partner agencies in the context of adult safeguarding, including in relation to financial abuse. Will Maimaris acknowledged that gambling was a significant public health issue and that the Council had a gambling harms programme that was supported by the Cabinet Member for Health, Social Care and Wellbeing. The Council was limited on what it could do on the activities of gambling organisations, but he was happy to share information about the Council’s work in this area at a future meeting. (ACTION)
• Cllr Iyngkaran referred to a case study in the report of physical abuse from a carer and queried why there were still difficulties in bringing this to prosecution despite the incident being captured by CCTV. While Dr Cooper was not able to elaborate further on the details of the specific case, she explained that there were a number of parallel processes alongside the safeguarding inquiry relating to cases such as this and that this related to the difficulties that the Police experienced in bringing prosecutions, as discussed earlier in the meeting. She emphasised that these case studies provided some insight into the sort of issues that practitioners deal with in relation to safeguarding adult issues.
• Referring to page 75 of the agenda pack, Cllr Connor noted that the number of safeguarding concerns had decreased by 38% in 2023/24 compared to the previous year, while the number of Section 42 enquiries had increased by 29% and the proportion of concerns leading to Section 42 enquiries had also increased. Dr Cooper commented that the data suggested that people were getting better at referring concerns through more appropriate pathways so this should not be seen as performance data but rather as an illustration about how something was changing. Vicky Murphy concurred with this and said that teams were getting better at managing concerns and partners had an improved understanding of what safeguarding was and the most appropriate way to manage concerns. Additionally, the safeguarding team had been brought back in-person 18 months previously following the pandemic and were better able to review initial concerns and ensure that a Section 42 process was followed.
• Referring to page 84 of the agenda pack, Cllr Connor noted that the NCL ICB was developing a Safeguarding Case Review Tracker and asked whether the Board had something similar. Dr Cooper explained that the ICB’s tracker was to record roles and responsibilities across the local NHS organisations in relation to Safeguarding Adults Reviews which was welcome. The Board tracked the implementation of recommendations from Safeguarding Adults Reviews as previously described in relation to the work of the Implementation subgroup.
• In relation to the Board’s priorities and objectives, under Section 8 of the report, Cllr Connor commented that, while she had understood the work of the subgroups and of ensuring that processes were in place, she hadn’t understood as clearly from the report about the impact made for residents. Dr Cooper acknowledged that this was tricky because of the complexities relating to safeguarding and also because the role of the Board was to seek assurance that certain things were happening and that practice was being maintained at the right level. However, it was possible to assess impact and improvements in practice through case file audits. Referral analysis was also relevant as, when referrals of concerns from members of the public increased for example, this could be an indication of greater awareness of safeguarding in the community. While the Board looked at various indicators of impact, it could be quite difficult to demonstrate directly. In addition, wider societal factors that impacted on safeguarding were beyond the control of the Board, for example the cost-of-living increases driving increases in financial abuse.

Cllr Connor then summarised the discussion and described the creation of the two new subgroups as a particularly significant development. She noted that the Panel would welcome further detail on progress with their work in the following year’s report, including on the implementation of Safeguarding Adults Review recommendations and on how changes in practice were impacting on the lives of residents. With regards to the Practice & Improvement subgroup, it would be useful to understand the mechanisms to support practice improvement and safeguarding across the partnership. (ACTION)