A Message from our Independent Chair
Brighton and Hove City Council’s Health and Adult Social Care (HASC)
Sussex Partnership NHS Foundation Trust (SPFT)
University Hospitals Sussex NHS Foundation Trust (UHS)
Sussex Community NHS Foundation Trust (SCFT)
East Sussex Fire and Rescue Service (ESFRS)
I am very pleased to introduce this, my first Annual Report, as Independent Chair of the Brighton and Hove Safeguarding Adults Board (BHSAB), following my arrival in August 2021.
The Board is statutory and co-ordinates local partnership arrangements to safeguard adults at risk of harm. This Annual Report details the work carried out during 2021-22 across all partner organisations working together to improve services for vulnerable people in Brighton and Hove and I have been impressed by the commitment and willingness of all partners to actively engage in the business of safeguarding adults.
We have already made some changes to the arrangements in place with the meetings of the core group of statutory partners, the Police, the National Health Service, and the local authority, now including the Chairs of the Board subgroups, who are so vital to our work. In practical terms this will ensure a greater understanding of shared priorities, lessons learned across the Board, and lead to improved outcomes as a result of our actions.
We have published one Safeguarding Adults Review during 2020-21, who we have referred to as James. James was a young man with an acquired brain injury and the review identified learning in a range of areas, such as the need for specialist pathways and support for people with complex needs. The learning from this review continues to be taken forward through a comprehensive Action Plan.
The impact of Covid, which has overshadowed all our work over the last two years, continues with staff shortages and increasing demand affecting services. Staff in all agencies however continue to show commitment and a willingness to deliver services through working together and putting those who use services at the heart of practice. I know I speak for all Board member agencies when I extend our thanks for their efforts.
We will be holding our first Brighton and Hove Safeguarding Adults Board Development Event in July 2022 where we will look at our progress to date, agree priorities, and establish our strategic plan for the remainder of this year and beyond.
I was delighted to be appointed as your Independent Chair, and through this to be invited to join both the Health and Wellbeing Board and the Community Safety Partnership. I appreciate and am grateful to Board partners for their support and engagement during these continued shared challenges and look forward to us continuing that work in the coming year.
Annie Callanan
Independent Chair, Brighton and Hove Safeguarding Adults Board
Healthwatch Brighton and Hove have worked closely with the Brighton and Hove Safeguarding Adults Board over the last year. The core role of Healthwatch is to improve health and care services across our city. We have a particular focus on reaching out to vulnerable people and communities who do not have a strong voice. Last year we engaged with nearly 10,000 people, including people with disabilities, young people and the LGBTQ+ community.
Hearing from vulnerable groups is also evident from an ongoing service delivered since the Covid-19 pandemic – providing wellbeing checks for those people recently discharged from hospital. Our dedicated team of volunteers phone people usually within their first two weeks of discharge to offer support including signposting to other services. Having contacted around 2500 people, we have observed a notable increase in mental health issues and the number of safeguarding concerns escalated to Adult Social Care.
Dr Lester Coleman, our Head of Research chaired the Safeguarding Adults Review (SAR) monthly meetings. He has since been replaced by Brigid Day, our safeguarding specialist advisor who has many years of relevant experience. Brigid took over the chair role early in 2022. As a chair, Healthwatch has overseen the publication of one Safeguarding Adults Review over the last year and supported the development of one thematic learning review and a desktop review, due for publication in 2022-23.
In chairing the Safeguarding Adults Review, Healthwatch has continued to see several developments in the way reviews are assessed and undertaken. This past year has continued to benefit from learning across the across the region (primarily East Sussex, Kent and Surrey) and the appointment of a new vice-chair role.
The Brighton and Hove Safeguarding Adults Board provide excellent leadership, coordination, and a focus for partnership to promote high standards of safety and quality in health and social care in our city. We fully support the development of the new three-year Strategic Plan.
David Liley
CEO, Healthwatch Brighton & Hove
The Brighton and Hove Safeguarding Adults Board (BHSAB) is a multi-agency statutory partnership that provides leadership and strategic oversight of adult safeguarding work across Brighton and Hove. There is a strong focus on working together to protect adults with care and support needs from abuse and neglect.
Our Statutory Partners:
· Brighton and Hove City Council
· Sussex Police
· Sussex Clinical Commissioning Group
The further partners of the Board are:
· Brighton and Hove Safeguarding Children Partnership
· University Hospitals Sussex NHS Trust
· East Sussex Fire and Rescue Service
· Healthwatch Brighton and Hove
· National Probation Service
· South-East Coast Ambulance Service NHS Foundation Trust
· Sussex Community NHS Foundation Trust
· Sussex Partnership NHS Foundation Trust
· Department of Work and Pensions
· Voluntary and Community Sector representation (represented by the Practitioners Alliance for Safeguarding Adults
In addition, the Board maintains links with the following:
· East Sussex Safeguarding Adults Board
· West Sussex Safeguarding Adults Board
· The National Network of Chairs of Safeguarding Adult Boards
· The Safeguarding Adults Board Manager Network
· Safeguarding Adults National Network
· Brighton and Hove Community Safety Partnership
· South-East Regional Safeguarding Adult Board Network
Safeguarding Adults Board have three statutory duties:
· Develop and publish a Strategic Plan that sets out how we will meet our objectives and how our partner agencies will contribute to this.
· Publish an annual report detailing how effective our work has been.
· Arrange for Safeguarding Adults Reviews (SARs) to be undertaken when the criteria under section 44 of the Care Act are considered to have been met.
In line with our statutory duties the Brighton and Hove Safeguarding Adults Board previously worked with partners to develop and publish a Strategic Plan for 2019-2022, in which six priority areas were identified that are listed below.
These six priority areas have been used to develop strategic objectives for each area, which were updated on an annual basis to reflect emerging safeguarding themes and challenges, as well as learning from Safeguarding Adults Board activities undertaken. The strategic objectives inform the work plans that have been developed for each of the subgroups of the Brighton and Hove Safeguarding Adults Board to ensure that these priority areas drive the work of the subgroups.
In
the achievements section of this year’s Annual Report we
identify how we have met each of these priority areas during
2021-22.
The Brighton and Hove Safeguarding Adults Board has a pooled budget; Partner agencies contribute to the running of the board financially, and also by chairing and facilitating meetings, providing use of their buildings and facilities, and contributing time and expertise to learning events.
Income for 2021 - 2022
|
Brighton & Hove City Council |
£86,000 |
|
Sussex Police |
£22,610 |
|
Brighton & Hove Clinical Commissioning Group |
£26,600 |
|
Total |
£135,210 |
The board carried forward some of the Brighton & Hove City Council and third-party income into the 2021/22 budget, with some again carried forward to 2022/23. There are significant expenses incurred during the previous year, principally review costs, which remain outstanding at this time so the total expenditure for 2021-22 will increased once these have been paid.
Expenditure in 2021 - 2022
|
Independent Chair |
£7,000 |
|
Safeguarding Adult Reviews |
£8,500 |
|
Staffing Total |
£90,600 |
|
Business Manager |
£60,000 |
|
Administrator |
£23,000 |
|
Quality Assurance & Learning and Development Officer |
£7,000 |
|
Other Staff Costs |
£600 |
|
BHSAB Website |
£2,000 |
|
Staff Training |
£500 |
|
SAB Conference |
£0 |
|
Sundry Costs |
£70 |
|
Sussex Safeguarding Adults Policy & Procedures Website |
£700 |
|
Recruitment Costs |
£0 |
|
Total |
£109,370 |
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What we achieved in 2021-22|
· Following six years in the role the previous Independent Chair of the Brighton and Hove Safeguarding Adults Board (BHSAB) decided to stand down during 2021-22. A recruitment process was undertaken, which led to an experienced new Independent Chair being appointed. This has led to a number of developments already being made to the work of the board, which include the Strategic Leadership Group being expanded into a Leadership Group to include the Chairs of the subgroups. This ensures the awareness they have of safeguarding activities and the work of the subgroups is central in developing board meeting agendas. · A pan-Sussex Multi-Agency Self-Assessment and Peer Challenge process was undertaken. This is a biannual process with a streamlined self-assessment audit tool developed that focused on four themes; Aims & Challenges, Making Safeguarding Personal, Leadership & Governance, and Learning from Safeguarding Adults Reviews. Pan-Sussex and local peer challenge events were held with Red, Amber and Green (RAG) ratings agreed. Partners will be asked to advise of their action plans to develop improvements. · A virtual Safeguarding Conference was held with our colleagues at the East Sussex SAB. This consisted of an introductory session on legal literacy and landscape in relation to adult safeguarding followed by three workshops hosted by presenters from across the partnership and beyond. It was an inter-active event so attendees were able to engage the presenters, and each other and was very well attended, with over 180 representatives from a wide range of statutory and non-statutory organisations. |
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· In continuing to focus on a pan-Sussex approach to adult safeguarding wherever possible, and a pro-active approach to developing resources to support professionals and agencies, two further pan-Sussex protocols have been published during 2021-22. An Escalation and Resolution Protocol was developed in response to the learning from the Safeguarding Adults Review into James, which provides a process for professionals to escalate and resolve professional disagreements in a timely and person-centred manner in relation to adult safeguarding, including where mental capacity is an issue. · A pan-Sussex Safeguarding Thresholds Guidance document has also been published, which provides advice and guidance for professionals and agencies in relation to adult safeguarding thresholds. This is designed to be used in conjunction with existing policies and procedures and includes alternative actions that can be considered if the threshold for a safeguarding enquiry is unlikely to be met. · There have been several updates made to the pan-Sussex Safeguarding Policy & Procedures during 2021-22. These include new chapters on PIPOT (People in a position of trust), PREVENT, and Domestic Abuse. The website is continually updated to improve accessibility and ease of use for professional and agencies working in adult safeguarding. |
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· This has been another extremely busy year for the Brighton and Hove Safeguarding Adults Board (BHSAB) in respect of Safeguarding Adults Reviews (SARs), reflecting both continued increased pressures on agencies as well as increasing awareness of the SAR eligibility criteria locally. There is a detailed section on SARs further on in this Annual Report but in summary the BHSAB has published one SAR during 2022, James, with another desktop review in the process of being concluded that will then be published and one further review in progress. These SARs have identified a number of areas of learning and the BHSAB is focusing on working with our partner organisations to progress action plans to take forward the recommendations made. · Following the work of the Quality Assurance subgroup being paused during the pandemic this has restarted and the audit that was undertaken on the impact of the Coronavirus pandemic on our partner agencies at this point has been concluded. A review report has been produced, with recommendations that will be taken forward through a number of pathways, and that has also been shared with the National Health and Safety Executive. · A further audit is in the process of being undertaken, in response to the learning from SAR James, on the role of the lead professional in adult safeguarding. This is seeking to understand the knowledge, understanding and application of this role locally and an audit tool is being in the process of being completed by agencies. A review report and action plan will be developed and learning from this process shared with professionals and agencies across the system.
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· In addition to the pan-Sussex protocols discussed earlier the Brighton and Hove Safeguarding Adults Board (BHSAB) has also continued to develop resources to support professionals, agencies as well as the general public within Brighton and Hove. These include working with our Police partners to produce guidance around fraud and scams (in response to the growth in this area during the pandemic), learning briefings on Professional Curiosity and Making Safeguarding Personal, as well as updated guidance on the types of abuse and neglect and how to raise safeguarding concerns. · The BHSAB has continued to produce learning briefings in relation to SARs that have been published in order to effectively disseminate learning. These has been accompanied by also attending team and organisational meetings across the statutory and non-statutory sectors through the course of the year to share this learning, as well as around the work of the BHSAB more broadly. · We have continued to publish our quarterly newsletter that shares updates and learning from SAB activities across the safeguarding system. The distribution list for the newsletter has continued to increase over the course of 2021-22 as awareness of the BHSAB grows and this will continue as we move into 2022-23. |
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· The Brighton and Hove Safeguarding Adults Board (BHSAB) has continued to focus on engagement during 2021-22. In addition to attending a range of one-off team and organisational meetings and forums throughout the year we have become regular members of the Sussex Police’s Adult Safeguarding Group, the Practitioners Alliance for Safeguarding Adults (PASA) meetings and have continued to attend Exploitation and pan-Sussex Safeguarding Adults Policies and Procedures meetings. · At a national level the BHSAB has continued to attend meetings of both the Independent Chairs and Board Managers networks, as well as chairing the South-East Regional Independent Chairs meetings and the Safeguarding Adults National Network (SANN). We have provided updates and presentations on the work of the BHSAB, and our partner agencies have also shared this through forums such as the National Health and Safety Executive. ·
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· The virtual joint Safeguarding Adults Board (SAB) Conference that took place during 2021-22 primarily focused on workforce development. An introductory session on raising increasing knowledge and awareness in relation to the role of SABs, Safeguarding Adults Reviews, and safeguarding literacy and landscape more broadly, was then followed by three workshops. These were on trauma-informed practice, mental capacity and inherent jurisdiction, and professional curiosity, and were hosted by presenters from across the partnership as well as further afield. The feedback received was that attendees had found the learning from these extremely beneficial and requested additional events in the future. · The presentations and updates provided by the Brighton and Hove Safeguarding Adults Board (BHSAB) in a range of statutory and non-statutory organisations have also supported workforce development through a range of mechanisms, including the BHSAB website and social media, our newsletter and attendance at a range of organisational meetings and events. These updates have been on learning from SARs, new protocols that have been published and on briefings and resources produced. This is a contributory factor in the developing knowledge and awareness across the local system of Safeguarding Adults Reviews and the increase in referrals that has been seen over the past two years. · The BHSAB has responded to feedback from the Self-Assessment and Peer Challenge process around alternative learning resources being requested by organisations. Learning briefings have been produced around a number of topics, including Professional Curiosity and Making Safeguarding Personal, that are designed to provide ‘bite-sized’ learning opportunities for extremely busy professionals and agencies. The BHSAB have also recently produced our first accompanying ‘podcast’, audio learning that has been developed with our partner agencies, that will be expanded during 2022-23. |
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Under section 44 of the Care Act 2014 Safeguarding Adults Boards (SABs) have a statutory duty to commission a Safeguarding Adults Review (SAR) when an adult with care and support in its area dies; and the Board knows, or suspects the death was as a result of abuse or neglect and there is concern about how the SAB, its members or organisations worked together to safeguard and protect the adult.
A SAR is not undertaken to hold any organisation to account; is not a punitive process and is not to apportion blame. The purpose of a SAR is to promote effective learning and to prevent future deaths or serious harm occurring again. The aim is that it tackles barriers to good practice and lessons can be learned from the case, which can be applied in the future to prevent similar harm re-occurring.
As the Brighton and Hove Safeguarding Adults Board (BHSAB) has continued to increase knowledge and awareness of SARs locally the increased referral rate seen in 2020-21 remains similar. The BHSAB has received eight SAR referrals during 2021-22 as well as a further query made directly by the public, which is in the process of being considered whilst further information is awaited. As a result of these increasing SAR activities we have taken a number of actions over the past year that has included increasing the membership of our multi-agency SAR subgroup to bring in additional expertise and experience as well as developing several new support tools for the subgroup members (a referral tracker, SAR Action tracker, membership guidance pack and Terms of Reference).
Further areas for development in relation to the SAR subgroup processes have been identified as we move into 2022-23. We will seek to develop processes to share themes, and potentially learning activities, from SARs undertaken across Sussex. We will also continue to develop the expectations set out for Independent Reviewers to ensure that review reports are of a sufficient quality and recommendations are specific, measurable, achievable, relevant and time bound.
From the eight SAR referrals, and the query from the public, which were received by the BSAB during 2021-22 the primary issues have been in relation to;
· Cuckooing
· Self-neglect
· Organisational neglect
· Substance misuse
· Mental capacity
· Multi-agency safeguarding arrangements (between the local authority and Mental health services)
· Coronavirus
In response to this we have commissioned one SAR and are in the process of awaiting further information in relation to three other referrals. Assurance is in the process of being sought regarding single agency safeguarding arrangements in relation to two further referrals.
The
Brighton and Hove Safeguarding Adults Board has published one
Safeguarding Adults Review during 2021-22 and is in the process of
concluding two further reviews, a thematic learning review and a
desktop review, which will be published during 2022-23.
The database system used by Health and Adult Social Care (HASC) changed during the past year (November 2021), which has impacted on recording and data gathering processes for this report. HASC have advised that the system they are now using means that some of the data collection categories have changed, which will enable more accurate data to be collected going forward. An example of this is that information is now able to be recorded in multiple categories simultaneously (for example to record multiple categories of abuse of and neglect).
Health and Adult Social Care (HASC) have advised that further collaborative working with the Brighton and Hove Safeguarding Adults Board (BHSAB) will support the development of the data collected and how this is shared in future. It should be noted that the national safeguarding adults data return provided by HASC remains the same, therefore continuing to enable benchmarking across local authority area and to identify year-on-year trends.
The data provided reflects both safeguarding activity that took place during 2021-22 as well as in some other areas, demonstrating a comparison with last year and previous years to evidence emerging trends and the impact of the Coronavirus pandemic.
The first table shows the overall number of safeguarding enquiries undertaken by Health and Adult Social Care (HASC) over the past five years. HASC have advised that the significant increase in 2019 was due to shifts in recording system whilst it can be seen that over the last year the overall number of safeguarding enquiries undertaken has reduced from 875 to 802. However, it should be noted that this does reflect the exact numbers of enquires opened during 2020.
The table below breaks down the overall number of safeguarding enquiries opened by abuse and neglect category over the past year and in comparison with the previous year. HASC have advised that with the new recording system allowing more than one category of abuse or neglect to be recorded per enquiry the individual numbers no longer equal the overall total of enquiries opened.
It can be seen that neglect and omission continues to be the category where the highest number of enquiries were opened, and that this overall number has increased during 2021-22.
The number of enquiries opened relating to financial and material abuse as the second highest category, followed by physical abuse as the third highest category also remain the same. The number of enquiries opened in relation to domestic abuse has reduced during 2021-22, which may reflect the national increase in domestic abuse during the pandemic.
There continue to be a very low number of enquiries opened in relation to modern slavery and discriminatory abuse. Increasing knowledge, and the awareness and identification of modern slavery is an area of focus for the Brighton and Hove Safeguarding Adults Board (BHSAB) in the year ahead and there will also be a focus on discriminatory abuse in the longer-term.
The next table shows safeguarding enquiries opened by primary support reason during 2021-22 and in comparison with 2020-21. The highest number of enquiries continue to be undertaken with people who have physical support needs, although this number can be seen to have decreased significantly over the past year. As only one primary support reason can be recorded the overall total here reflects the overall number of enquiries opened during 2021-22.
It can be seen that whilst the overall number of enquiries relating to physical support needs as the primary support reason has reduced it is still identified in 39% of the total number of enquiries undertaken.
Memory or cognitive support needs and those with mental health needs continue to be the second and third highest categories respectively, although the numbers in each category have reduced. It is noticeable that there has been a threefold increase where the primary support reason is not known or not recorded.
In this next table the enquiries undertaken are recorded by age group over 2020-21 and 2021-22. It is evident that the significant proportion of safeguarding enquiries that were undertaken with younger adults (those aged 18-64) seen last year has continued during 2021-22.
The Brighton and Hove Safeguarding Adults Board have already identified that areas such as transitions and working with those who have complex and multiple needs, which primarily include younger adults, are priorities and we will continue to work with partners agencies to take this work forward in 2022-23.
Below are the number of safeguarding enquiries opened and closed each month during 2021-22 and in comparison with 2020-21.
This shows that in total 783 safeguarding enquiries were closed during 2021-22, which is slightly reduced from the 800 closed during 2020-21. There was a gradual increase from Q1 through to Q3 of 2021-22 in the number of enquiries closed.
This next table shows the number of enquiries opened based on ethnicity during 2021-2022 with a comparison to the previous year. The changes in recording processes in the past year means that more categories of ethnicity are now being captured so data cannot be directly compared to the previous year. However, this will enable a greater understanding of the ethnicity of those being supported through adult safeguarding processes by HASC, and as a representation of the population locally, in the future.
Whilst those who identified as white continue to represent the highest proportion of recorded ethnicity (at 73%) the high number of those where ethnicity is recorded as unknown, or no data is noticeable. HASC have advised they intend to update their recording processes to support the increased identification of ethnicity in adult safeguarding.
The chart below shows the time taken to complete safeguarding enquiries during 2021-22 and in comparison to 2020-21. This shows similar responses times over the last two years although it is evident that the number of enquiries that took a year to complete (364+ days) has significantly reduced from 120 to 70.
In this chart HASC have recorded the proportion of safeguarding enquiries where risk was identified and the outcomes from this. From the total number of enquiries closed during 2021-22 (783) it can be seen that in 78% of completed enquiries it is considered that there was risk identified and action taken in response. There was no risk identified in 13% of the enquiries that were completed.
Making Safeguarding Personal (MSP) is key in adult safeguarding and continues to be an area of focus for the BHSAB. The chart below shows the number of people who were asked about their desired outcomes from a safeguarding enquiry, with in 381 cases their outcomes identified as being fully met, outcomes being partially met in 210 cases, and in 56 cases outcomes not being achieved. HASC advise that in a further 126 cases the person, or representative, was asked but did not identify any outcomes from the safeguarding process. There were a further 10 cases where no data was recorded, which totals 783, the number of safeguarding enquiries closed during 2021-22.
The level of safeguarding activity across the Sussex Partnership NHS Foundation Trust (SPFT) remains relatively constant although there has been an increase as pandemic lockdowns have ended. The likely reason for this increase is greater hospital ward activity. During the pandemic fewer people were admitted to hospital which meant that the potential for safeguarding situations was also reduced. Hospital admission levels have now increased and with this has come an increase in other activities associated with busier ward settings and more people being supported in contained environments. Incidents of patient-on-patient altercations have increased, reflecting this change in ward activity levels.
Like most NHS organisations, the Sussex Partnership Trust does not have the level of nursing staff with which it would like to operate. This has triggered some safeguarding concerns, a significant one being an organisational abuse enquiry at an inpatient unit in East Sussex. This safeguarding enquiry has since closed but highlighted the issue of staffing level challenges and their impact on service delivery. The Trust mitigates the risks associated of operating below optimal staffing levels and acknowledges that it remains extremely challenging to recruit the required mix of professional staff to operate as it would wish.
Recruitment challenges and increasing bed occupancy levels are also impacting on the ability to admit patients. This has led to safeguarding concerns being raised in some cases due to admission delays considered to have placed patients at risk of harm, especially in relation to assessments under Section 136 of the Mental Health Act that lead to psychiatric hospital admission. The issue is being looked into and again reflects the pressures on the health and social care sector as a whole. For example, pressures on hospital admission are also affected by delays in discharge due to challenges securing other nursing and social care support in the community.
During the pandemic the safeguarding team within the Trust expanded and is now fully recruited. This is allowing better support to its frontline services to understand safeguarding, comply with Care Act requirements and protect adults at risk. The Trust's safeguarding service now also includes a Prevent Practitioner that supports Prevent work across the Trust.
Operation Signature identifies and supports victims of fraud of all types within Sussex. The Operation Signature data provided by Sussex Police identifies that the reporting of fraud continues to increase year on year, with recent data indicating that fraud now accounts for 39% of all reported crime although much of it is still going unreported.
Last year a disproportionate rise in romance fraud, false investment opportunities and doorstep criminals was attributed to the COVID-19 pandemic and these trends have continued during 2021-22. Courier fraud has since emerged as one of the most prevalent fraud types affecting vulnerable adults in Sussex.
Two specialist Operation Signature case workers have supported 1,165 victims of fraud in Sussex during 2021–22. Whilst some support has continued to be provided over the telephone, face-to-face visits have now resumed where possible.
The total loss to vulnerable victims of fraud in 2021 – 2022 is £23.05 million, with the average loss, where recorded, being £15,000 per victim, which is an increase on the previous year.
There has continued to be a wide range of scams exploiting the COVID-19 situation in 2021 – 22. The loneliness and isolation of victims, the financial worry, confusion and fear people have felt over the past year has been exploited.
Vulnerable people have been targeted with fraudulent emails and text messages relating to NHS test and trace, with vaccine and testing related frauds prevalent at certain periods.
Fraudsters targeted victims by impersonating the government to offer fake Covid-19 grants, setting up fake NHS websites to steal card details, and posing as delivery companies to target online shoppers stuck at home during national lockdowns and periods of self-isolation.
The BHSAB has responded to this increase in fraud by working with Sussex Police during 2021-22 to raise awareness of this by developing specific guidance on fraud, scams and cybercrime. This is available on the BHSAB website together with the fraud newsletter produced by the Police and this work will continue in 2022-23.
Incidents of Domestic Abuse are subject to a risk assessment using a Domestic Abuse, Stalking and Harassment (DASH) checklist. An officer, with the victim, assesses the level of risk using this checklist and will take initial steps to manage the risk identified.
Sussex Police Safeguarding Investigations Unit (SIU) refer all cases of domestic abuse involving an adult with care and support needs to Adult Social Care. This checklist provides information on whether the risk to an individual is high, medium or standard.
The table below shows the number of DASH referrals made by Sussex Police in Brighton and Hove 2021-2022 by risk level. The number of DASH referrals was highest in Q1 2021-2022.
The table below shows the comparison between 2020-21 Q1-4 to 2021-22 Q1-4. The table indicates that the amount of DASH referrals are steadily increasing and as the BHSAB develop our Strategic Plan for 2022-25 this will be an area of focus.
Vulnerable Adults at Risk (VAAR) referrals-Vulnerable Adults at Risk (VAAR) referrals are made by Sussex Police to the Local Authority when potential safeguarding issues or concerns are identified. The table below shows the number of VAAR referrals made to Brighton and Hove in 2021-2022 with a comparison line to 2020-2021.
Referrals are assessed and allocated as considered appropriate with Brighton and Hove Health and Adult Social Care (HASC). Not all VAAR referral will involve recorded crime. The number of VAAR referrals is therefore higher than the reported number of crimes involving abuse of an adult with care and support needs.
It is anticipated that the pan-Sussex SAB Safeguarding Adults Threshold Guidance that has been recently published will support partner agencies of the SAB in the accurate identification and reporting of abuse and neglect.
The table below shows the number of crimes recorded by Sussex
Police for Brighton and Hove in 2021-2022 per category of abuse
risk. This data relates to recorded crimes, acts which may result
in harm or loss, which is defined by parliamentary act as
illegal.
Sussex Police receive information about incidents not all of which will be recordable crimes. All incidents are reviewed for possible crime and intelligence and those that meet the National Crime Recording Standard are recorded as crimes too.
The three main types of abuse risk recorded are physical abuse, psychological abuse and sexual abuse which is the same result for data provided in 2019, 2020 and 2021.
NHS Brighton and Hove Clinical Commissioning Group (CCG)
Sussex CCGs (including both NHS Brighton and Hove Clinical Commissioning Group and NHS East Sussex Clinical Commissioning Group) have undertaken a range of actions in relation to adult safeguarding during 2021-22. This has included the ongoing development of an adult safeguarding data dashboard and a statutory review tracker that enables enhanced oversight of health action plans in relation to Safeguarding Adults Reviews (SARs) and Domestic Homicide Reviews (DHR’s). This extends beyond the CCG itself and incorporates health providers in progressing identified actions from reviews undertaken. The available data shows a high number of open statutory case reviews across our system that include health actions and responsibilities, with 24 current reviews across SARs and DHRs in total.
They advise that across the East Sussex area in particular, there remains a high number of Domestic Homicide Reviews (DHR’s). Despite delays in reviews being published, assurance can be provided that key learning is continuing to be identified and shared with the health partnership.
The CCG Safeguarding Team have been running Domestic Abuse half day training sessions for CCG and primary care staff which incorporate the lessons for health identified in the reviews, including; awareness of the Homicide Timeline, Multi-Agency Risk Assessment Conference (MARAC) process, coding and flagging of primary care records, health indicators of domestic abuse and the need for routine screening. Each DHR has an overarching action plan and the CCG team maintain overall oversight and responsibility for all health actions
During 2021/22, the CCGs have committed substantive funding to the MASH (Multi-Agency Safeguarding Hub (MASH) health team, which increases the health resource in both Brighton and Hove and East Sussex MASHs. From April 1st 2022, this service will be provided by the CCG safeguarding team. A key part of this development has been the implementation of a pathway to increase awareness within primary care of both children and adults referred to Multi-Agency Risk Assessment Conferences (MARAC), particularly in relation to situations where domestic abuse is occurring. This supports the ‘Think Family’ approach to safeguarding that has been adopted by the CCGs and will support risk management and safety planning.
From a staffing point of view all statutory safeguarding roles have been recruited to within the CCGs. 2 further Specialist Safeguarding Nurse roles have been agreed to – for recruitment in April 2022, to help support partnership working functions of the team as there is a transition into an Integrated Care Board, under new statutory arrangements effecting all CCGs. These roles will play a crucial part in promoting the team’s values of Think Family safeguarding and increased collaboration with provider health organisations in Sussex.
From the 1st April 2021 Brighton and Sussex University Hospitals (BSUH) merged with Western Sussex Hospitals Foundation Trust to become University Hospitals Sussex NHS Foundation Trust. Whilst this has led to changes in leadership and organisational structure; executive responsibility for safeguarding has remained with the Chief Nurse to ensure strategic oversight and feedback to the Trust Board.
Despite no longer being in national lockdown, throughout 2021 - 22 University Hospitals Sussex (UH Sussex), as with many other hospitals, has continued to be impacted by COVID; both in terms of the number of COVID positive patients in hospital beds, and the number of staff contracting COVID resulting in absence due to the isolation requirements. Maintaining safe staffing has often resulted in redeployment of staff between different areas. However, the Safeguarding Adults Team has continued to work in their usual roles, providing support to clinical areas and endeavouring to ensure that safeguarding vulnerable patients remains a priority throughout the organisation.
The data in Fig. 1 shows the number of safeguarding concerns under each category, raised by UH Sussex for 2021/22; in comparison to the previous 2020/21.
Fig. 1:
Safeguarding concerns 
The data shows a significant decrease in the majority of abuse and neglect categories reported by UH Sussex during 2021-22, in particular concerns in relation to neglect, physical abuse, psychological abuse domestic violence and sexual abuse. The recording structure within UH Sussex allows for multiple categories to be recorded in relation to one safeguarding concern e.g. a safeguarding concern reported for domestic abuse may also be recorded as physical, sexual and psychological abuse depending on the information provided by the patient and by the person raising the concern.
Fig, 2 shows the concerns raised and recorded by UH Sussex in relation to Domestic abuse for 2020 / 21 and 2021 / 22.
Fig.2 – Domestic abuse
Fig. 3 – Safeguarding concerns raised, excluding Domestic Abuse
Fig 3 shows the comparative data for safeguarding concerns raised in 2020 / 21 and 2021 / 22 excluding data relating to domestic abuse. Whilst there is still a decrease in many categories, the data shows that the more significant decrease in 2021 / 22 is in relation to the overarching area of domestic abuse. The difference may, in part, be explained by the impact of lockdown during 2020/21 and the increased risk of harm this placed on those experiencing domestic abuse, who were in many cases, living in isolation with the perpetrators of domestic abuse. Fig.2 shows that the multiple categories relate to 67 individual safeguarding referrals i.e. for 67 individual people.
This is almost double that raised in the previous year, pre-COVID and lockdown, when 36 safeguarding concerns had been raised for domestic abuse.
UH Sussex has previously been supported by a Health Independent Domestic Violence Advisor, who was employed externally but who worked on site at their Brighton hospital. This post has been vacant throughout 2021/22. UH Sussex continue to work with Victim Support to review the impact of this vacant post and how best to support staff to recognise and respond to concerns relating to domestic abuse.
The data shows a significant increase in the number of safeguarding concerns raised in relation to self-neglect. This had previously been an area of focus during safeguarding training. It also reflects some of the longer-term impacts of COVID, where people have not accessed care and support; have remained at home with an increase in alcohol /substance misuse and the potential impact of changes in their financial circumstances.
In line with the SAB objectives for 2021/22 UH Sussex completed the safeguarding self-assessment and took part in the SAB challenge event. As a result, UH Sussex rated themselves Amber overall with many actions in relation to integrating policies and establishing governance arrangements following the merger. UH Sussex also identified areas that need to improve in relation to sharing learning from SAB activity. The SAB challenge event has helped shape the safeguarding priorities for UH Sussex moving forward in 2022 – 23.
The Brighton and Hove Safeguarding Adults Board have developed a strong working relationship with University Hospitals Sussex to promote policies, procedures, protocols and guidance that has been developed in continuing to raise knowledge and awareness of adult safeguarding practice.
The data below shows concerns raised by abuse type raised by Sussex Community Foundation Trust during 21-22, and in comparison to the previous year. It should be noted that this year includes additional data on Modern Slavery, Discriminatory Abuse, Modern Slavery and Sexual Abuse so no comparison data for 2020-21 is available for this.
Sussex Community NHS Foundation Trust (SCFT) are the main providers of community NHS health and care across Brighton and Hove. SCFT provide essential medical, nursing and therapeutic care helping people to plan, manage and adapt to changes in their health to prevent avoidable admission to hospital and to minimise hospital stay.
The data shown relates to the domains captured within the safeguarding concerns raised, and as a safeguarding concern may capture more than one domain, the total amount of adult safeguarding concerns may be lower.
The key theme of neglect/acts of omission is as expected given the wide range of health and social care delivery that can be captured with the neglect domain.
Qualitative SCFT advice line data indicates that this category of abuse captures discussions on issues that included wound care, pressure area care, and visiting regimes, and it is of note that the concerns raised may be in relation to SCFT care delivery, care delivery from another health or social care provider, or unpaid carers (including family and friends).
Given the fluidity of numbers of adult concerns raised at any given time, it is not possible to provide a baseline of adult safeguarding concerns that may be raised at any given time.
The reduction in face-to-face visits completed during the COVID-19 pandemic, and government led restrictions, is likely to be a contributing factor for a potential reduction in safeguarding concerns raised with the Local Authority (HASC), especially for those types of abuse which are more easily identifiable through a face-to-face visit.
The table below shows the number of Home Safety Visits (HSV) conducted by East Sussex Fire and Rescue Service (ESFRS) in the first three quarters of 2022, including the HSV referrals received from Brighton and Hove HASC. The data for Q4 2022 was not available at the time of reporting.
There has been a significant increase in the amount of HSV completed in the last 3 quarters in particular Q2-3 whilst the number of referrals from HASC has increased slightly.
These visits are one element of the ESFRS
targeted prevention work providing support to the most vulnerable
members of the community who may be more at risk of having a fire
in their home. Home safety visits are a key element of preventative
work to help ensure that risks of neglect and self-neglect are
addressed.
The table below shows the amount of CTN (Coming to Notice) Safeguarding Concerns raised by ESFRS in Brighton and Hove.
This table shows a noticeable increase in concerns around hoarding during Q1-3 which already has 25 cases more than Q1-4 last year.
Last year there was 1 Bariatric case compared to 5 in Q1-3 in 2021-22. This is linked to requests for ESFRS Fire support to assist adults with weight issues in being able to leave their home.
The Brighton and Hove Safeguarding Adults Board (BHSAB) has identified a number of targets and goals to work towards over 2022/23 as well as in the longer-term.
Strategic Plan 2022-25 and supporting Development Event
Our current three-year Strategic Plan (2019-22) is coming to an end and in line with our statutory responsibilities under the Care Act the Brighton and Hove Safeguarding Adults Board (BHSAB) will be developing a new three-year Strategic Plan. This will set out;
1. The vision of the Board, and the outcomes we would like to achieve for people in Brighton and Hove.
2. Our aims and objectives for a three-year period.
3. How we will work towards these aims and objectives that will form the basis of the work plans developed for the subgroups of the BHSAB.
We have decided to hold a Development Event, using an external facilitator, to enable partners to come together to discuss and identify the priorities for the BHSAB that will form the basis of the new Strategic Plan for 2022-25. The Development Event will include considering the current position of the BHSAB and partner agencies and the impact of the pandemic on adult safeguarding.
We will consider individual agency priorities, which will include the implementation of the Integrated Care Systems (ICS’s) to replace clinical Commissioning Group’s, the reintroduction of the Care Quality Commission inspections of Adult Social Care departments, the work in relation to Violence against Women and Girls (VAWG) and Domestic Abuse being undertaken by the Police, as well as pan-Sussex priorities, such as the Changing Futures programme.
The development of the priorities for the new Strategic Plan will also incorporate learning from SAB activities that have been undertaken, such as the Self-Assessment and Peer Challenge Event, the 2021 SAB Conference, SARs, and audit activity. It will also include national considerations for SABs that includes the guidance published by National Institute of Clinical Excellence (NICE) in respect of Safeguarding in Care Homes and Homelessness.
Once the priorities have been agreed the new Strategic Plan for 2022-25 will be developed and published. Work plans for the BHSAB subgroups can then be developed to take forward the objectives in the Strategic Plan. These will be reviewed and updated on an annual basis in response to emerging safeguarding challenges and future learning from SAB activities.
SAB Policies, Procedures and Protocols
We will review, and update as necessary, both our own internal policies and procedures as well as the pan-Sussex SAB Protocols that have been published over the last two years. We will continue to work with our partner agencies, as well as our SAB colleagues in East and West Sussex, to identify areas where further policies, procedures and protocols are required and support the development and publication of these. This will include a pan-Sussex Hoarding Framework as well as further updates to the Sussex Safeguarding Adults Policy and Procedures.
Safeguarding Adult Reviews (SARs)
We will continue to develop our SAR processes to support the increasing number of referrals that have been received and the reviews being undertaken. This will include seeking to improve the timeliness of the various stages, assurance processes when the SAR eligibility is not considered to have been met and the development and oversight of Action Planning following the conclusion of a review.
Quality Assurance
We will continue our Quality Assurance programme, concluding an audit on the Role of the Lead Professional in Adult Safeguarding before commencing our audit programme for 2022-23. The quality assurance priorities are informed through a range of SAB activities and whilst there are several audit and review activities already provisionally identified for the year ahead these will be amended as necessary in response to emerging issues.
We are keen to develop our use of multi-agency data and increase the range of information that is received so that this can form part of assurance discussions at board meetings.
Learning and Development
The BHSAB received extremely positive feedback in respect of the joint virtual Safeguarding Conference that was held with the East Sussex SAB during 2021-22. Below are some of the comments that we received.
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We will continue to develop how we support learning and development across the partnership. This will include responding to the feedback for alternative learning resources by developing a programme of podcasts, videos and further specific guidance on a range of topics and in response to the learning that emerges from Safeguarding Adults Reviews, audits, and other Safeguarding Adults Board activities.
Engagement
The Brighton and Hove Safeguarding Adults Board (BHSAB) will continue to liaise with others at both a local and national level to ensure that we are sited on emerging and developing safeguarding issues and are able to share the work of the BHSAB and share the work of others in turn. This will include supporting the ongoing development of the Practitioners Alliance for Safeguarding Adults (PASA) so that we can reach more professionals and agencies in the community and voluntary sector locally and link them into the work of the board.
“Valley Gardens – Brighton & Hove” by Mark (CC 2.0)
https://www.flickr.com/photos/61798879@N00/51333976416/in/photostream/
"The Bandstand, Brighton" copyright Peter Tarleton (CC BY-SA 2.0)
https://www.geograph.org.uk/more.php?id=3610783
"Hove Plinth: Construction and "Constellation" - Jonathan Wright Sculpture" by Dominic Alves (CC 2.0)
https://www.flickr.com/photos/dominicspics/41603013722/in/album-72157690137911860/
"Palace Pier" by David Merrett (CC 2.0)
https://www.flickr.com/photos/davehamster/51525688230/
"Wentworth Street - Brighton" by Mark (CC 2.0)
https://www.flickr.com/photos/61798879@N00/51338254170
"Brighton train arriving at Hove" by John Sutton (CC 2.0)
https://www.geograph.org.uk/photo/7144156
