Agenda item

To present the Brent Safeguarding Adults Board (SAB) annual report, covering the period from April 2021 to March 2022.

Fran Pearson (Independent Chair, Safeguarding Adults Board) introduced the report, which presented the Brent Safeguarding Adults Board (SAB) annual report covering the period from April 2021 to March 2022. She highlighted that she started in the role of Independent Chair on 1 April 2022, following the departure of Michael Preston-Shoot, and therefore would be presenting a report for a year for which she was not present. She expressed thanks for the years of service the previous Chair had provided to Brent.

In introducing the report, Fran Pearson drew the Committee’s attention to the similarities between the Adult’s and Children’s safeguarding arrangements, which involved the role, commitment and accountability of the three statutory partners to the Board – Sue Sheldon on behalf of the Integrated Care Board (ICB), Barry Loader on behalf of the Metropolitan Police, and Claudia Brown (Director Adult Social Care, Brent Council) and Phil Porter (Corporate Director Adult Social Care and Health, Brent Council) on behalf of the local authority. The principle of those three statutory partners being central and equal to each other remained the same for both the children’s and adult’s arrangements. She concluded by noting that insights and thoughts from previous Scrutiny Committee’s had helped inform, shape and make richer the Board’s annual report.

Barry Loader (Acting Borough Commander, NWL BCU – Metropolitan Police) agreed with Fran’s initial oversight of the cohesiveness of the partnership, and felt the partnership was lucky to have benefited from longstanding membership of each of the statutory partners which was rare amongst safeguarding partnerships. This allowed the partners to have challenging conversations with each other and move forward strategy plans to improve outcomes for victims and vulnerable members of the community. He added that safeguarding adults covered a large age range from 18 until death, and the partnership now saw more cases of younger vulnerable adults. This was attributed to the impact of the cost of living and people living longer. He expressed a commitment to continue identify vulnerable individuals going forward, while highlighting the high demand on the service.

Sue Sheldon (Assistant Director for Safeguarding Adults and Children, NHS NWL) echoed the previous remarks in relation to partnership working. She advised that, following the transition from the Clinical Commissioning Group (CCG) into the Integrated Care Board (ICB), there had been a concern that safeguarding would be lost, but assured the Committee that the ICB were still very committed to safeguarding both adults and children.

In concluding the introduction, Councillor Nerva (Cabinet Member for Public Health and Adult Social Care) highlighted that the report was extensive in detailing the work that the SAB had achieved over the year, and there was now a need to look at the future, ensuring adult safeguarding was not lost amongst NHS re-organisations, which he would be maintaining focus on going forward.

The Chair thanked councillors and officers for their introduction and invited the Committee to raise comments and questions, with the following issues raised:

The Committee asked Fran Pearson, upon reflecting on her first 100 days in post, what issue was most prominent that she would want to build on going forward. Fran Pearson advised that she would like to focus on the future, and ensure that the Board was agile and reflected context. The SAB had discussed cuckooing as an emerging issue, and were in the process of shaping the priorities for the upcoming year. One priority was self-neglect, including reflecting on the need to be agile, such as considering whether the character of self-neglect had changed, and there was a 2-3 year work programme being put together in relation to that priority. A second priority would be around substance misuse and housing insecurity which would be scoped in the December SAB meeting. She highlighted the importance of not duplicating work already going on, as there were a number of working parties, groups and multi-agency pieces of work being done and the SAB needed to remain high level and strategic.

The Committee asked what had been particularly surprising to Fran Pearson as she started working with the partnership, to which she responded stability. In SABs in other localities, she had experienced 50% of SAB memberships changing over the course of a year, compared to Brent where there had been longstanding membership, a strong level of consistency, and high levels of trust amongst the partners. Going forward, she would like to further understand the population in a fuller context, including hard to reach communities and issues being faced by Brent’s. For example, when looking at self-neglect and hoarding, environmental health colleagues had described them as being owner occupiers, which helped to further understand their lifestyle. In order to do that, triangulation of data from partners was needed and she would look to bring that in where possible.

Responding to the challenges that the SAB foresaw, Fran Pearson highlighted the cost-of-living crisis, which was a live situation impacting on self-neglect and different types of financial exploitation. Fran was keen to carve out time for the SAB to reflect on issues in depth and hear different perspectives on the issues. As Chair, she had introduced executive meetings with the statutory partners, giving them the opportunity to do that reflection and consider possible actions going forward.

Noting the increase in incidents of cuckooing, the Committee queried whether the 25 cases in 2022 also included the 13 cases from 2021. Carolyn Downs (Chief Executive, Brent Council) advised that she would be concerned if the 13 cases from 2021 had not been resolved. She was pleased that the SAB were taking a focus on cuckooing, as it was an extremely complex issue and it was important to take a multi-agency approach in these cases. Often, the cases related to an acute mental health issue and therefore had cross cutting implications for mental health teams, housing, police, and community safety. She hoped that, moving forward, the partnership would approach cases of cuckooing collaboratively. The Committee asked for a case study on cuckooing showing the cross-partnership approach.

In relation to the percentage figures for domestic abuse, self-harm, sexual abuse, exploitation, Female Genital Mutilation, forced marriage and modern slavery, the Committee highlighted they were very low, and asked why that was. Phil Porter (Corporate Director Adult Social Care and Health, Brent Council) advised members that the figures included in the report were in relation to only those adults who had a care and support need as defined by the Care Act, and not the general adult population. There would be higher percentages of those incidences in the adult population that would not be captured in the figures presented to the Committee. Fran Pearson added that it was a particular challenge trying to elicit from those with complex needs what was happening to them and building that relationship with individuals in order to receive that information. The report detailed the need for further communications about referrals in order to reach all sections of Brent’s communities, as anyone could refer someone, including the person themselves, and there were underrepresented communities in the figures. Officers were working with the Brent Health Matters team through their close community connections to get that message out, and councillors could also help with that message.

In response to further queries around some of the data in the report, including the pie chart, Fran Pearson advised that they could think about the narrative alongside the data for future iterations of the annual report. The difficulty was that the annual report was only a snapshot of information, with one year of data, therefore she felt it would be useful to look back at trends over a longer period of time to understand if things were going in the right direction. In comparison to other boroughs, she did not think Brent were outliers in terms of ‘self-neglect, psychological and emotional abuse’ being the largest categories of abuse. Alongside a more detailed narrative, it was agreed that future reports should have firmer details about equalities data, as well as a narrative of what ‘other’ as a category of abuse meant. In addition, members asked for the details of referrers, such as by agency.

Continuing to consider the data, the Committee queried whether it was possible that there was underreporting due to current service demands and the cost-of-living crisis. They were advised that the report reflected the previous year’s data, so any impact from current service demand and cost-of-living would be reflected in next year’s report. Barry Loader felt that, in the current context, there were challenges for all public sector services, and reminded the Committee that this data did not include the volume of referrals from outside of Adult Social Care, which was significant. The Police did a lot of training around identification of vulnerability and had a framework for reporting. Phil Porter advised that they had not seen any decline in agencies referring, so there was not evidence to suggest that services were too overwhelmed to refer. In relation to the referral rate and subsequent conversion rate into an enquiry, Brent were not outliers in the numbers, so there was some reassurance in the levels of referrals and concerns.

In relation to the increase of safeguarding concern numbers coming from extra care, the Committee were advised this was because Adult Social Care had increased the volume of individuals in extra care, meaning there would be an increase in safeguarding referrals and as a result an increase in the number of referrals leading to an enquiry.

Members asked how far the zero tolerance to behaviour policy had impacted self-referring. They were concerned that if someone wanted to refer themselves but were not able or willing to articulate their circumstances, or did not approach it with the right attitude, their issues might not be picked up. Phil Porter highlighted the need to push the message that it was safe to refer in, and any referral would be treated anonymously and confidentially.

The Committee asked whether specialists were involved in strategy meetings where agencies decided whether a referral should become an enquiry. Claudia Brown informed the Committee that the strategy meeting included reviewing whether the client was known to any other services, and there would then be a discussion about the best place to move that case forward.

The Committee queried whether the number of bed ulcers being referred as a safeguarding issue was unusual, and Claudia Brown (Director Adult Social Care, Brent Council) advised that this was not unusual. Sue Sheldon added that pressure ulcers were monitored very closely in both a hospital and community setting, and there was work being done across North West London currently looking at pressure ulcers. The increased number of referrals meant that professionals were raising the issue, but they were being screened and did not meet the safeguarding criteria for an enquiry.

In concluding the discussion, the Committee asked how each statutory partner felt the relationship was working. Claudia Brown reflected that there was a general understanding of safeguarding across the partnership, and ongoing improvement in relation to the partnership. Barry Loader felt that all partner agencies needed to be constantly horizon scanning to be aware of emerging issues and the ways vulnerable people could be exploited. Sue Sheldon agreed, highlighting that the ability to discuss and challenge understanding was important for the partnership.

The Chair thanked those present for their contributions and drew the item to a close. He invited the Committee to make recommendations, with the following RESOLVED:

To recommend the following key areas for improvement:

i)              That a narrative is further developed to compliment safeguarding data within future Safeguarding Adults Board annual reports, including additional equalities data and referrer data.

ii)             That there continues to be extensive training on adult safeguarding issues amongst partner organisations to improve standards.

iii)           That there be an outline of what successful partnership working might look like, and details on how partners work to improve safeguarding processes in individual agencies in future annual reports.

iv)           That information is shared on areas of improvement for the Brent Safeguarding Adults Board, including the action plan to address those areas.