Agenda item

To consider the annual report of the Haringey Safeguarding Adults Board for 2024/25.

Natalie Cowland, Independent Chair of the Haringey Safeguarding Adults Board (HSAB), introduced the Board’s annual report for 2024/25 by highlighting some key points:

• A Person in a Position of Trust (PIPOT) framework had been introduced which had resulted in a number of cases being reported and responded to.
• The approach to Missing Persons had been reviewed.
• The Board’s strategic priorities would run until 2028 and had been developed in consultation with the Joint Partnership Board.
• Processes on safeguarding and multi-agency collaboration around homelessness had been strengthened.
• Following a review, a revised version of the Board’s Multi-Agency Escalation Protocol had been approved.
• Ongoing challenges included oversight of data which required strengthening.
• The Board was strengthening its relationship with the Joint Partnership Board because of the importance of co-production and understanding of lived experience.
• Further partnership working, including through joint meetings, would be taking place with the Community Safety Partnership and the Haringey Safeguarding Children Partnership board.
• The Board was conscious of the need to maintain the strength of safeguarding structures given the nature of the pressures and restructuring that local agencies were subject to.
• An independent review was ongoing in relation to adult social care and safeguarding, including the structure and resourcing of the HSAB.
• A review of the Board’s Delivery Plan would be carried out to ensure that resources were being focused in the right places.

Natalie Cowland then responded to questions from the Panel:

• Cllr Brennan raised concerns about the difficulties in achieving effective multi-agency communications. Natalie Cowland emphasised the importance of partnership working and building relationships to establish a shared understanding. She acknowledged that there was a risk of relying on individual relationships and so coordination needed to operate at a system level to make sure that pathways were understood with clear guidance in use.
• Asked by Cllr Connor for further details about system-based working, Natalie Cowland said that this was an area where improvement was constantly being sought and that it was working better in some areas than others. She cited the example of close working with the Police as part of their current restructuring and reconfiguration of resources to ensure that the pathways, resources and support on safeguarding issues were available in a timely way when needed. This involved a review of these processes to ensure that the framework was effective.
• Cllr Connor referred to the section of the report on the Safeguarding Adults Reviews (SARs) and the importance of embedding learning. She requested clarification on the relevance of the following points relating to the ‘Victoria’ SAR:

o   Ensuring feedback is given when safeguarding concerns are referred.

o   Ensuring concerns raised about a care provider are shared with the relevant commissioning team.

Natalie Cowland said that a common concern in safeguarding was when people raised concerns but then did not hear anything further about the action taken. Jo Baty, Director of Adult Social Services explained that these issues had previously been raised by the CQC and so a meeting with providers had been organised by the Commissioning team to understand how communications with the team could be improved. This also included collaboration such as integrated workforce development, training support and ensuring understanding of escalation protocols. She added that another issue for adult social care was having more AI to help manage the high levels of demand, including in safeguarding.

• With regard to the ‘Eleanor’ SAR, Cllr Connor noted the reference to reviewing arrangements for authorising urgent packages of social care and queried why this hadn’t been triggered in this case. Natalie Cowland said that she hadn’t been in post during this case but would obtain further details for the Panel. (ACTION) She added that work to implement the recommendations from the SARs were underway. Cllr Connor also referred to the concerns raised through the “Rosemary and Mearl” SAR and recommended that the next HSAB annual report should include details of how the processes highlighted by SAR reports were being tightened. (ACTION)
• Cllr Connor referred to the section on the SAR Implementation Subgroup on page 49 of the report which described “an improved approach to quality assurance of local care provision, guided by the Quality Assurance and Contract Management Framework”. She contrasted this with information that 68 care homes in Haringey had not been inspected by the CQC for at least five to six years raising serious concerns about oversight, risk and resident safety. Natalie Cowland said that the backlog of inspections had been brought to the attention of the Board and these concerns had been escalated to the CQC. The CQC had brought additional resourcing to support this area and had asked to work with the commissioning team on the prioritisation of inspections. Sara Sutton, Corporate Director of Adults, Housing & Health, added that the Council had its own internal quality assurance processes which it had made improvements to. However, she acknowledged that there was a linked issue within the wider quality assurance landscape. Cllr Connor noted that the CQC were due to attend the next meeting of the Panel in February and so this could be raised with them directly. (ACTION)
• Referring to the Engagement & Prevention Subgroup, Cllr O’Donovan requested further details about the prevention of financial abuse and a recent workshop on the issue. Natalie Cowland said that the workshop had taken place before her appointment but that she understood it to have been successful. She explained that issues relating to financial abuse was reported to the Board but no significant rise had been seen in this area. Cllr O’Donovan expressed concern that financial scams could be an under-reported issue and asked if national agencies reported data on this issue. Natalie Cowland said that she was not aware of such reporting but would be happy to consider what more could be done to strengthen prevention and engagement. (ACTION) Sara Sutton added that there was a role for Trading Standards on this issue and Cllr O’Donovan noted the role of the banks. Jo Baty commented that the other aspect to be aware of was transitional safeguarding as young people could be vulnerable to financial abuse when moving into independent/semi-independent living. She noted that Disability Action Haringey (DAH) was keen to do more work on this issue.
• Asked by Cllr O’Donovan about work to support people who had issues with hoarding, Natalie Cowland noted that the aim of a recent event on this topic had been to start a conversation, to build on this with the Engagement & Prevention Subgroup and bring the key agencies together on this. Cllr Brennan reported examples from casework where residents with hoarding issues would not allow access to their properties. She suggested that a gentle, supportive approach was needed to help people in such circumstances. Natalie Cowland said that there were support agencies active in this area and that she could provide details of these. (ACTION)
• Cllr das Neves commented that a session for Councillors on safeguarding, including practical information and advice on how to support residents who were experiencing some of the issues that had been discussed was planned for later in the year. Sara Sutton noted that this was relevant to different portfolio areas, including Housing and Fire Safety.
• Referring to the SARs and how risk could be managed, Cllr Iyngkaran noted that all the individuals in the cases referred to were women and typically had complex medical histories. Natalie Cowland noted that the two SARs since she had been appointed had both been related to men but that all cases were examined in detail to understand what system-wide learning was relevant. Sara Sutton added that one of the ambitions of the multi-agency care coordination team (MACCT) was to expand working with people with multiple morbidity issues, complex needs and/or frailty. Cllr Connor noted that it would be useful for the Panel to receive an update about this approach at a future meeting including the funding mechanisms for this. (ACTION) Jo Baty added that the arrangements for the Panels that supported residents with more complex needs were being reviewed. There was also a forthcoming workshop with Housing colleagues on collaboration after hospital discharge, particularly in relation to residents who live alone.
• Cllr Connor referred to recent media reports on concerns about ‘grooming gangs’ and asked about the safeguarding arrangements in place and whether it fit within the transitions work or under Objective 3.2 in the report (Working with other partnerships to address safeguarding issues). Natalie Cowland responded that this sat more within the transitions space because the focus with the grooming gangs issue was typically on young people, but that abuse did not necessarily stop after the age of 18. She had sought assurance on this issue and there was no evidence that there were currently grooming gangs active in Haringey. Safeguarding Adults Boards had all had the opportunity to feed into Baroness Casey’s work in this area through the national chairs’ network. Cllr Connor commented that the recent media reports had referred to concerns about grooming gangs in the Haringey area and queried whether cases such as this could have been misidentified. Natalie Cowland said that the categorisation of any such incidents would be a question for the Police. Sara Sutton added that there was some significant work ongoing in Haringey in relation to issues of modern day slavery, sex work and sexual exploitation of adults which was linked in with the HSAB, Community Safety Partnership and with the Council’s multi-agency work on the prevention of VAWG (Violence Against Women and Girls). Further information on this work could be brought to the relevant Scrutiny Panel if required. Cllr Connor proposed a recommendation to approach the Police to respond to further questions on this issue. (ACTION)
• Cllr Iyngkaran referred to the reported decrease of police deployments to health-related calls in Haringey on page 62 of the agenda pack. He queried what feedback there had been on this from local health services. Natalie Cowland noted that this pre-dated her appointment, but that the Board had received an update on the Right Care, Right Person (RCRP) initiative and it was on the forward plan for the joint Adults and Children’s Safeguarding Boards to seek further assurances on this and the associated pressures. Sara Sutton commented that this was an area of concern due to pressures on the capacity of health services, including the Mental Health Trust. The Mental Health Trust had introduced a community single point of access and there was also now a mental health option on the NHS 111 phone service. She added that some investment from the Integrated Care Board (ICB) on assertive outreach support was forthcoming, but that the details of the plans were being awaited. She also highlighted that the focus on community mental health support would need to be linked into the wider area of multi-agency work on neighbourhoods. Cllr das Neves also expressed her concerns about the gaps in community mental health.
• Cllr Connor referred to the performance data, noting the 78% increase in safeguarding referrals from 2023/24 to 2024/25. Natalie Cowland explained that part of the increase related to the standardised safeguarding referral templates used across agencies which were directed to a dedicated inbox. There had also been more training on the thresholds for safeguarding reporting. She also noted post-pandemic vulnerabilities and the cost of living as contributory factors to issues such as financial abuse and neglect. Jo Baty added that, with financial pressures across all public agencies, this inevitably led to a pushing of safeguarding referrals to adult social care, with significant increases in referrals from the Police and NHS. This was a huge issue for adult social care which would need to be tackled with an improved digital response, more work with SAB in what constituted safeguarding, and the establishment of an early intervention and prevention officer to signpost people to. Cllr Connor referred to a recent issue where a large number of emails to adult social care were found to be unread and queried whether adult social care had the capacity to respond to a large increase in safeguarding referrals. Natalie Cowland acknowledged that this was recognised as an area that required strengthening, including improvement to the front door and triaging. Jo Baty was reporting into the HSAB on the improvement plan in this area. 
• Given the increase in safeguarding referrals, Cllr Iyngkaran asked what proportion of these were not appropriate and how feedback on this was provided. Jo Baty explained that there were statutory definitions of what constituted safeguarding issues, but that this had become broader over time. She added that there was sometimes a perception that, by making an issue a safeguarding concern, it would be dealt with more quickly. With an increased level of referrals, it was necessary to look at each referral carefully and ensure that the team was triaging and managing risk appropriately. Sara Sutton added that a high proportion of the additional safeguarding referrals did not meet the definition of a Section 42 inquiry and may sometimes be relevant to other areas such as housing legislation. The Panel requested that the data on the number of safeguarding referrals that did not meet the necessary thresholds be provided to the Panel and also how they were triaged. (ACTION)
• Cllr Peacock raised an item of local casework and it was agreed that she would refer this to the Director of Adult Social Care. 
• Referring to the graph on the source of safeguarding referrals on page 65 of the agenda pack, Cllr Opoku asked about the sources in the ‘Other’ column. Natalie Cowland agreed to look into this and provide a written response. (ACTION)
• Referring to the graph on the age bands for referrals on page 69 of the agenda pack, Cllr Opoku asked if a more detailed breakdown was available for the 18-64 age group. Natalie Cowland agreed to look into this and provide a written response. (ACTION)
• Referring to the graph on the locations for abuse on page 67 of the agenda pack, Cllr Iyngkaran queried why the numbers had significantly reduced even though the number of safeguarding referrals had increased. Jo Baty said that it was difficult to give a definite reason but that this chart reflected only one dimension of information that was known about incidences of abuse and did not reflect the overall picture.
• Referring to page 69 of the agenda pack, Cllr Connor queried why the proportion of Section 42 safeguarding enquiries with a fully achieved outcome had declined from 82% in 2023/24 to 72% in 2024/25. Natalie Cowland cited the complexity of cases and the challenges in person-centred planning which had impacted on this. This would be monitored and reported on in the next annual report. Jo Baty added that a lot of work had been done on advocacy and that performance in this area had improved since this time. Further scrutiny of advocacy from the service was included in the work plan for next year.