A Message from our Independent Chair
What difference is this making?
Brighton & Hove City Council Housing, Care and Wellbeing (HCW)
NHS Sussex (Integrated Care Board)
Sussex Partnership NHS Foundation Trust (SPFT)
Sussex Community NHS Foundation Trust
East Sussex Fire and Rescue Service (ESFRS)
It is a privilege to introduce the Annual Report for
the Brighton & Hove Safeguarding Adults Board 2023/24.
As the newly appointed Independent Chair, I am grateful to all partners for their contributions and ongoing support. I would like to thank Annie Callanan for her support during the transition in September 2023, when I took up the role. It was important to lead the SAB in developing the priorities as part of the continuous learning journey for all engaged in adult safeguarding and the wellbeing of residents in Brighton and Hove.
As the Report highlights all partners of the Board have continued to deliver services, provide care and support to people, and are responding to the changing safeguarding needs and risks that occur, in what can be described as challenging times for public services, and post COVID19. The sub-groups, and in particular the Chairs are owed much gratitude for their dedication and commitment to ensuring that the SAB’s priorities are delivered.
The Report details the work that has been undertaken, and outcomes that have been achieved. A major emphasis for the SAB is identifying the impact of the work undertaken for the people living in Brighton and Hove, and how we can ensure that we hear the voice of those who are requiring protection from risk and harm, and how partners work together with people to ensure they are safe to live a fulfilling life. This report provides some feedback from people linked with safeguarding adults.
The statutory partner organisations have provided details about how they are contributing to identifying and supporting people at risk, and those who may require care and support so they can live safely in our community.
The SAB has set its priorities for 2024/2025 on the basis of the information provided through reviews of practice, as part of the audit work the SAB undertakes, data collection, safeguarding adults’ reviews, and national feedback from reviews and emerging issues that have been identified e.g. self-neglect, trauma and multiple and intersectional needs. This includes the development of a data dashboard to assist each SAB meeting understand the nature of safeguarding on the patch, and to support any additional areas of development that may require attention.
Finally, I would like to appreciate the contributions of Guy Jackson the Board Manager and staff for efficiently and effectively managing the business of the Board. I would also life to acknowledge the work of staff and managers across all statutory, voluntary and community partners who are committed to working together to keep people safe in the City.
Seona Douglas
Independent Chair, Brighton and Hove Safeguarding Adults Board
I am pleased to provide commentary on this year’s Annual Report on behalf of Healthwatch Brighton and Hove. As the city’s patient watchdog, we are pleased to see that a focus of this year’s report is the difference that the Safeguarding Adults Board (SAB) and its subgroups is having to ensure “that people are able to live together in safety, in a city that does not tolerate abuse, neglect and exploitation and that works in partnership to actively prevent abuse occurring and ensuring that when it does happen everyone knows how to report it and that it is effectively responded to.” (SAB vision).
I would like to formally welcome Seona Douglas in her role as Chair of the SAB. Seona’s leadership is already bringing a fresh perspective with a renewed focus on constructively challenging ourselves. The SAB Leadership group and full SAB Board have widened their membership and broadened their reach, inviting presentations which link to safeguarding from local providers and public health and a new data dashboard is under development – all of which is helping the SAB to identify “where we can make best use of our time and efforts in achieving improved outcomes in adult safeguarding that benefit those who use services and those who care for them.” (SAB mission statement).
Healthwatch has continued to play a key role in supporting our city’s overall approach to safeguarding. As well as working closely with the SAB, over the last year, our Healthwatch representative, Brigid Day, has continued to act in the capacity of Chair of the SAR subgroup. Brigid’s role delivers independent scrutiny of the Group’s work. Recommendations from two published SARs in 2023/4 have focussed on
developments, which aim to improve professional practice and the experiences of people who use services and people with safeguarding needs. Recommendations from previous reviews are also in development. My thanks to Brigid for her continued dedication to her role as Chair of the SAR subgroup.
Healthwatch takes its role in supporting the safeguarding ambitions of the SAB and city safeguarding seriously and this year we have reviewed and updated our safeguarding policies and conducted a self-assessment of our adults safeguarding knowledge and practice as part of the board’s peer challenge process and identified opportunities for further training and clarified procedures for staff and volunteers. We continue to identify safeguarding concerns from our project work and report these.
Lastly, I would like to formally thank Annie Callanan for her hard work as the previous Chair of the SAB.
Healthwatch looks forward to our continued collaboration with the SAB.
Alan Boyd
Chief Executive Officer, Healthwatch Brighton and Hove
Our City
Population: Between the last two censuses (held in 2011 and 2021), the population of Brighton and Hove increased by 1.4%, from around 273,400 in 2011 to around 277,100 in 2021.
Ethnicity: In 2021, 85.4% of people in Brighton and Hove identified their ethnic group as "White" while 4.8% identified their ethnic group as "Mixed or Multiple".
People with a Disability: In 2021, just over one in nine people (11.5%) were identified as having a disability. The proportion of Brighton and Hove residents who were not classified as having a disability increased from 80.3% to 80.5%.
Care: In 2021, 4.4% of Brighton and Hove residents (aged five years and over) reported providing up to 19 hours of unpaid care each week. This figure decreased from 7.1% in 2011. These are age-standardised proportions.
Our Board
The Brighton and Hove Safeguarding Adults Board (SAB)
is a multi-agency statutory partnership that provides leadership and strategic
oversight of adult safeguarding work across Brighton and Hove. There are three
statutory partner organisations, a wide range of further partner organisations,
as well as other boards and partnerships we work with.
We focus on working in partnership, both locally and across Sussex where possible, to develop consistency across adult safeguarding arrangements.
Under the Care Act 2014 Safeguarding Adult Boards have three statutory duties;
· To develop and publish a Strategic Plan setting out how we will meet our objectives and how our partner agencies will contribute to this.
· To publish an annual report detailing how effective our work has been.
· To 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.
Beneath our full board we have four formal subgroups and two further groups that are affiliated to the board who drive the strategic priorities in safeguarding adults within the city.
The SAB has a current three-year Strategic Plan (2022-25) that contains four overarching strategic aims, with several objectives under each strategic aim. These four strategic aims are –
Each year the Safeguarding Adults Board partners review the
progress made in delivering the strategic priorities based on local
information, learning from SAB activities, and individual issues identified by
partners. Area of focus are identified and work plans for the board and
subgroups developed to take forward key areas for improvement. These three
areas of focus for 2023/24 were -
The work undertaken by the SAB in relation to these three areas of focus is summarised and the area indicated under the strategic priorities (in italics). Other work is also undertaken which relates to the role and responsibilities of the SAB.
A glossary is included at the end of this report to provide further detail on acronyms and terms used. A * is used to identify that further information can be found in the glossary.
As we go forward the SAB want to increasingly understand the difference being made as a result of the work undertaken both collectively as well as individually by partners. Here are examples of feedback received during 203-24.
Under section 44 of the Care Act 2014 Safeguarding Adults Boards (SABs) have a statutory duty to commission Safeguarding Adults Reviews.
Mandatory Safeguarding Adult Reviews (known as SARs) must be undertaken when an adult with care and support in its area dies, or experiences serious harm, and it is suspected this was as a result of abuse or neglect, including self-neglect and there is concern organisations could have worked together more effectively to protect the adult from harm.
Discretionary SARs can be undertaken by SABs in situations where this duty is not met, but it is considered there would be benefit in a review being undertake. This is usually because there is considered to be new learning that will reduce the likelihood of something similar occurring in the future or it is in the public interest.
The purpose of Safeguarding Adult Reviews is to identify effective multi-agency learning, which can be shared and applied in the future to prevent similar harm re-occurring. They are not about blame or apportioning any one organisation being accountable.
During 2023-24 the SAB received four SAR referrals,
with the primary issues in these referrals identified as:
In response one mandatory SAR is being commissioned and further information is being gathered in relation to two other referrals. There are also two mandatory and one discretionary SARs currently in progress, with the aim being to conclude the reviews in progress during the next year.
The SAB published two SARs during 2023-24 and the following page you can find summaries of both of these reviews on the following page.
We have also continued to develop our SAR governance arrangements over the last year. The membership of the subgroup has increased with the local acute hospital trust joining the group.
Updated versions of the groups Terms of Reference and accompanying membership pack have been developed, which will ensure the methodologies and approaches being considered in commissioning and undertaking reviews remain up-to-date and in line with national guidance.
Overview
The Housing, Care and Wellbeing (HCW) directorate, which was formerly known as Health and Adult Social Care, continues to have robust oversight of safeguarding performance across all areas of service. This is achieved through improved reporting capabilities in the Information Technology (IT) database for the teams on the front line of safeguarding practice, and via a monthly performance oversight senior management board.
Challenges
The directorate continues to receive a very high level of information submissions from partners that do not indicate a need for social care advice/information, a need for care and support assessment or review, or abuse and neglect safeguarding concerns. These predominantly include information highlighting a need for a person to access community wellbeing mental health or GP/health services. Discussions are ongoing working with partners to ensure that people are signposted to relevant services at the right time to support their needs.
Through analysis with partners, it has been identified there are a number of safeguarding enquiries outstanding where we have ‘caused’ another organisation to complete the enquiry, or an element of the safeguarding enquiry, on our behalf. A number of these have been addressed, and we are continuing to address this through the partnership on an ongoing basis.
Safeguarding performance data
Safeguarding enquiries under section 42 of the Care Act 2014 are provided by the social care assessment teams across the city. The data provided by Brighton and Hove City Council’s Housing, Care and Wellbeing (HCW) directorate identifies the statutory safeguarding activity which took place during 2023-24 and in prior financial years to assist in measuring operational effectiveness, and in identifying trends and emerging challenges.
Please note that some HCW data relating to 2022/23, and originally contained in the SAB Annual Report for 2022/23, has been updated and amended in this year’s Annual Report. Unless otherwise stated, this is because the data was provisional and had not been fully validated at the time it was originally published.
During 2023-2024, 840 safeguarding enquiries were opened which is a 3% reduction on the number of enquiries opened during 2022-23. Table 1 below shows the overall number of safeguarding enquiries over the past five years. The numbers have been broadly consistent, with a typical fluctuation of around 8-9% year on year.
Table 2 below breaks down the overall number of safeguarding enquiries opened by abuse and neglect category over the past three years. The IT database allows more than one category of abuse or neglect to be recorded for each enquiry, so the individual numbers total significantly more than the figure for the overall number of enquiries opened. This reflects that abuse or neglect often relates to more than one single concern and may encompass several issues.
Neglect and omission remain the category identified most frequently in enquiries, but the overall number of enquiries it featured in has reduced by 12% since 2022-2023. Neglect and omission was a factor in 32% of the total number of safeguarding enquiries opened over the past year.
There has been a large increase (41%) in the number of enquiries undertaken in relation to organisational abuse. The chapter on quality and safeguarding in the Sussex Safeguarding Procedures is in the process of being updated and will include an expanded section on organisational abuse and a new section on organisational risk. HCW will also be exploring the development of a provider risk framework to enable progress in this area.
Other categories of abuse and neglect which have seen a sizable increase in the past year include self-neglect (16% increase), domestic abuse (15% increase), and physical abuse (9% increase). The increase in self-neglect has also been identified nationally through the national SAR analysis and has been identified as an area of focus for the SAB in 2024/25.
Despite work undertaken by the SAB to promote awareness of modern slavery and discriminatory abuse, these continue to be the categories with the lowest number of safeguarding enquiries undertaken.
The directorate, and organisation, remain committed to identifying and responding to modern slavery and are refreshing their modern slavery corporate statement currently. Anecdotally, there has been an increase in concerns received regarding modern slavery which do not involve individuals with care and support needs, but the care staff themselves. This intelligence continues to be shared with Sussex Police and the Care Quality Commission and there are effective processes in place through our Quality Monitoring team and Service Improvement Panel where information is shared between agency partners. This ensures signposting to relevant agencies when needed.
Tables 3 and 4 below show the age range of those
who had Section 42 enquiries undertaken in 2023-2024. It can be seen that there
has been an 8% increase in the number of
enquiries undertaken in relation to those aged 85+.
Table 5 below shows the number of safeguarding enquiries opened between 2022-24 according to ethnicity, with those who identified as White British remaining most prevalent. The directorate’s recording of ethnicity continues to improve, as there has been a 14% decrease in the number of enquiries where ethnicity is not recorded or unknown. However, the directorate recognises this as an area which requires more focus, and this will be considered in a forthcoming review of safeguarding processes and documentation to ensure that accurate recordings are improved and maximised.
Please note that the data sets relating to ethnicity for the 2022/23 financial year have been updated and amended in this year’s annual report[1]. This is because an individual’s ethnicity can be amended on the HCW IT database records at any time, including once an enquiry has been closed. The changes therefore demonstrate the department’s drive to ensure improved recording of ethnicity for individuals which have previously been recorded as ‘unknown’.
Table 6 below shows the time taken to complete safeguarding enquiries during 2023-24 in comparison to 2022-23.
It can be seen in the table above that the majority of enquiries were closed within a 30-day period, and that 61% of all enquiries were closed within 90 days. There has, however, been a large increase in the number of enquiries which take over 365 days to complete. This is in part due to the number of outstanding ‘causing other’ enquiries sitting with other organisations.
Table 7 below records the proportion of safeguarding enquiries where risk was identified. From the total 836 enquiries closed during 2023-24, 98% led to risk being identified and action taken in response, which is consistent with the previous year.
Please note that two data sets relating to the outcome of enquiries closed in 2022/23 have been updated and amended from information contained in last year’s Annual Report[2]. This is owing to two different databases being used during this period but this is no longer the case so it is unlikely this issue would arise again.
Making
Safeguarding Personal is central to adult safeguarding and continues to be an
area of focus for the local authority and the SAB. It is mandatory to record
what outcomes individuals would like from a section 42 safeguarding enquiry,
and achieving these outcomes is a key element of safeguarding enquiries.
The percentage of safeguarding enquiries where
individual outcomes are fully or partially achieved is a HCW directorate-wide
key performance indicator and receives monthly oversight through our Finance
and Performance Board. Internal audits are
undertaken to ensure we understand the narrative and the recording practice,
and to consider samples of enquiries where the person felt their outcomes were
not achieved and the reasons for this. Engagement has been completed
with all assessment teams to ensure this positive practice and recording
performance is acknowledged and engaged.
Table 8 below shows that in safeguarding enquiries that were opened
where risk was identified and actions taken in response to this risk, the
number of people who felt their outcomes were fully achieved was 61%. The
number of individuals who felt their outcomes were partially achieved was 24%,
with 15% feeling their outcomes had not been achieved. This is an improvement
on the outcomes for 2022-2023, as outlined in Table 9 directly below Table
8.
|
Table 9
|
||
|
Outcome
|
2022-2023[3] |
2023-2024 |
|
Fully achieved
|
54% |
61% |
|
Partially achieved
|
27% |
24% |
|
Not achieved
|
18% |
15% |
Please note that all three data sets relating to the outcome of section 42 enquiries closed in 2022/23 have been updated and amended in this year’s annual report[4]. This was because the full data set totals were not available at the time the BHSAB’s 2022/23 annual report was published.
Conversion data
The HCW directorate have begun to measure data on the conversion rate for the number of safeguarding concerns which are raised, and which meet the statutory eligibility criteria to progress to a Section 42 safeguarding enquiry.
In 2023-24, the relevant conversion rate for safeguarding concerns sent to the various operational areas ranged between 20-30%. Engagement has been completed with all assessment teams to ensure this positive practice and recording performance is acknowledged and encouraged.
Operation Signature (known as Op Signature) ensures all vulnerable fraud victims receive a visit from a uniformed officer or Police Community Support Officer (PCSO), who provide reassurance and support, and makes referrals to or signposts to other agencies who can help.
The data used in this report is taken from the Sussex Police Fraud Power BI dashboard. SCARFs (single combined assessment of risk forms) * are used as part of Op Signature. In order to focus on vulnerable victims, this report uses Op Signature data unless stated otherwise.
As sextortion is a blackmail offence and not fraud, this has not been included within the Brighton and Hove overview demographic data. This is to give a more accurate vulnerable fraud victim profile so it would not be adversely affected due to the inclusion of non-fraud data. The data period in this report is inclusive of data between April 2023 – March 2024. There is also data from April 2022 – March 2023 included within this report, when comparing trends.
Brighton
and Hove Operation Signature Cases by Risk Level: April 2023 – March 2024 with
a Line of Comparison for April 2022 – March 2023.
There was a continual increase in the number of Operation Signature cases between April 2023 – March 2024 in Brighton and Hove. In 2023/24, cases were at the lowest in Q1 and peaked in Q4, compared to April 2022 – March 2023 data where cases peaked in Q1 and continually decreased through to Q3 where there was the fewest number of cases during this period, before a slight increase in Q4. Despite the
continual increase in cases in the last year, there was a slight increase in overall cases numbers in 2023/24 of 0.77% compared to the previous year period (increase of 3 actual).
High risk reports were at the lowest in Q2 (9 actual) and peaked in Q4 (23 actual). Medium risk reports were at the lowest in Q2 (25 actual) but peaked in Q3 (39 actual). Standard risk reports were at the lowest in Q1 (47 actual) and peaked in Q4 (58 actual).
There was a total of £3.22 million lost in Brighton and Hove between April 2022 – March 2023. Between April 2023 –March 2024 the total lost was £4.16 million.
Types
of Fraud in Brighton and Hove – April 2023 – March 2024.
Between April 2023 – March 2024 in Brighton and Hove, the top 3 fraud types were sextortion, courier fraud/impersonator, and dating and romance fraud. Compared to the previous year period of April 2022 – March 2023, the same top 3 offence types featured.
Sextortion offences accounted for almost a quarter of all fraud reports in Brighton and Hove in the last year (24.0%) and compared to the previous year the number of reports increased by 15.7% (increase of 14 actual). In the last year, 87.4% of victims were aged 0-29 years old. Males were most frequently victims of sextortion offences, accounting for 95.2% of victims; victims more frequently did not live alone (85.4%).
Sextortion is a form of blackmail where a perpetrator threatens to reveal intimate images of the victim online unless they give in to their demands – these demands are typically for money or further images. Criminals might befriend victims online by using a fake identify and then persuade them to perform sexual acts in front of their webcam. Criminals will then threaten to share the images with the victims’ friends and family which can make the victims feel embarrassed and ashamed and prevent them from coming forward to report the incident.
Courier Fraud was the second most frequent type of fraud between April 2023 – March 2024; compared to the previous year, courier fraud decreased by -10.9% (decrease of -7 actual). Victims of this type of fraud were most frequently men (52.6%). More than half of courier fraud victims in Brighton and Hove were over the age of 75 (56.1%) and 52.6% of victims lived alone.
Dating and Romance fraud was the third most frequent type of fraud between April 2023 – March 2024 – there was a 2.2% increase compared to the previous year (increase of 1 actual). There were slightly more female victims than male victims (a difference of 1 actual). Victims age groups were most frequently aged 30 – 59 (38.3%) and 60-74 years old (38.3%). It was more frequent that victims of dating and romance fraud lived alone (66.0%).
Victims of Fraud in Brighton and Hove by Age Group – April 2023 – March 2024
NOTE: As sextortion is blackmail and not fraud, this has not been included within the Brighton and Hove overview demographic data (above). This is to give a more accurate vulnerable fraud victim profile so it would not be adversely affected due to the inclusion of non-fraud data.
Between April 2023 – March 2024, there were more than a quarter of fraud victims in Brighton and Hove aged 75 and over (117 actual) – the most frequent age group of fraud victims. Combing the age groups of those aged 60 – 74 with those aged 75+, there were 189 victims of fraud, an increase of 2 actual compared to April 2022 – March 2023.
Referrals to Victim Support by Risk Rating – April 2023 –
March 2024
Between April 2023 – March 2024 the number of referrals to Victim Support decreased slightly between Q1 and Q2 – Q2 had the lowest number of referrals. However, the number of referrals increased in Q3 (by 17 actual) and remained the same in Q4.
Referrals to Victim Support by Risk Rating – Comparison.
Referrals to Victim Support by Risk Rating – April 2023 –
March 2024
Between April 2023 – March 2024 the number of referrals to Victim Support decreased slightly between Q1 and Q2 – Q2 had the lowest number of referrals. However, the number of referrals increased in Q3 (by 17 actual) and remained the same in Q4.
Referrals to Victim Support by Risk Rating – Comparison.
Medium and high-risk referrals to Victim Support increased in April 2023 – March 2024 compared to the previous year. The number of standard risk case referrals decreased. Overall, the number of referrals to Victim Support increased by 12.5% in the last year compared to the previous year. Medium risk referrals were the most frequent referral risk rating.
NHS Sussex (also known as the local Integrated Care Board, or ICB) continues to work alongside both statutory and the wider partners of the Safeguarding Adults Board to safeguard the local population.
NHS Sussex is represented on all SAB subgroups, its leadership group, and Chairs the Learning and Development Sub-Group. In addition to fulfilling its statutory obligations, as per the NHS: Safeguarding accountability and assurance framework[5], during the 2023-24 year, NHS Sussex have continued to support strengthening Health safeguarding practice and arrangements, both across Brighton & Hove and the wider Pan-Sussex Health landscape, with some notable highlights this past year including:
· In partnership with Brighton and Hove City Council, NHS Sussex have contributed to the funding a Health Independent Domestic Violence Advisor (HIDVA) and worked in collaboration with University Hospital Sussex for the HIDVA to be based at their Royal Sussex County Hospital Site, working alongside their existing safeguarding team. This additional resource allows patients and their families in receipt of care at the Trust to receive additional specialist domestic abuse support and advice on-site, this is in addition to, not in replacement of, existing domestic abuse and safeguarding arrangements. Further work is planned for the 2024-25 year to expand referrals into HIDVA from the Cities General Practitioners (GPs) and Primary Care staff with related training offered.
· Following on from the success in the previous year, during November 2023 NHS Sussex once again co-ordinated a “Safeguarding and Children in Care Fortnight” and a conference at the Amex Stadium. Across the two weeks thirteen virtual events were held, attended by over 900 multi-agency workers from a wide array of organisations. The conference focused on the links between health inequalities and safeguarding and children in care. Many of the session themes related to areas within the Brighton and Hove SABs Learning and Development Priorities and included transition (children to adults), sexual safety, exploring extreme right-wing narratives, safer sleep, self-neglect, fraud, intimate partner violence, adversity and mental health, crimes of honour and learning from the lives and deaths of people with a learning disability/autistic people.
· The SAB contributed to the fortnight by holding a session “self-neglect with a focus on responding to hoarding behaviour session” where 110 attendees joined. All attendees who completed an evaluation either agreed or strongly agreed that the content covered was useful and relevant to their work.
· Strengthening partnership working between Safeguarding Leads from NHS Provider organisations and those within the Independent Health sector (many of which who provide NHS care). As a result of feedback from members, an NHS Sussex led supportive Pan-Sussex forum (which meets quarterly) extended its membership to support increased partnership working across the Health Sector, notwithstanding recognising all are working with our communities within the city, along with the relevancy learning from SARs across the Health landscape.
· As part of its overall assurance process with its large health providers, we have worked in partnership with our Health Providers in supporting them complete the NHS Sussex Safeguarding Standards. Feedback received from Trusts is that this has been a particular helpful exercise with Designated Professionals working closed with the Named Nurses and Heads of Safeguarding, with a focus on impact on improving outcomes and patient experience as well as embedding learning from SARs across its workforce. This work continues during the 2024-25 year with progress monitored both via Trusts internal governance arrangements as well via Commissioning arrangements.
· NHS Sussex launched the Safeguarding Standards for Registered Care Home and Domiciliary Care Providers. The safeguarding standards were co-produced with providers and other key stakeholders providing them with a resource tool to evidence compliance with safeguarding legislation and statutory guidance and supporting them to demonstrate that people with care and support needs can feel safe within their care.
· Following a successful bid to NHS Health Education England, NHS Sussex co-ordinated a comprehensive Mental Capacity Act (MCA) training programme of sixteen webinars for up to 750 delegates from across Sussex Health and Social Care (through May 2023 to January 2024). Following excellent multi-agency participation and positive feedback, NHS Sussex are now supporting NHS providers with their own MCA improvement plans through supervision, audit work, exception reporting under Sussex Safeguarding Assurance Framework (SAAF) to enable embedding of MCA application in everyday clinical practice.
Adult Safeguarding Concerns Raised by SPFT with Brighton & Hove City Council
Brighton and Hove adult mental health services are provided jointly by the Local Authority and Sussex Partnership NHS Foundation Trust (SPFT) under a Section 75 (NHS Act 2000) agreement, which allows for the integration of Health and Social Care services. Safeguarding enquiries are undertaken by the social care staff who are seconded within SPFT mental health services.
SPFT records safeguarding incidents within its incident management system. This provides a central database for the storage and analysis of the Trust's safeguarding data.
Table 1 shows the number of safeguarding adult concerns that were shared by the Trust with Brighton and Hove City Council in 2022/23 and then in 2023/2024. The largest change relates to the number of recorded domestic abuse incidents. This is likely to be due to increased awareness and identification of domestic abuse rather than a proportionate increase in the levels of domestic abuse.
Table 1 - Adult Safeguarding Concern Incident Numbers 2022/23 and 2023/24
|
Categories of Abuse |
2022/23 |
2023/24
|
+/ - |
|
Physical |
98 |
91 |
-7 |
|
Sexual |
17 |
19 |
+2 |
|
Financial |
27 |
34 |
+7 |
|
Discriminatory |
5 |
2 |
-3 |
|
Domestic |
24 |
45 |
+21 |
|
Psychological/emotional |
47 |
29 |
-18 |
|
Neglect & acts of omission |
44 |
36 |
-8 |
|
Self-neglect |
27 |
32 |
+5 |
|
Organisational |
5 |
10 |
+5 |
|
Modern slavery |
0 |
0 |
N/A |
|
Total |
294 |
298 |
+4 |
Section 42 Enquiries
SPFT safeguarding enquiry information records fourteen enquiries within Brighton & Hove where the Trust was named as the cause of risk- two more than in 2022-2023. The majority of these enquiries were linked to inpatient mental health settings where patients at risk to themselves or others are together in a confined space. The integrated working of SPFT and Brighton & Hove City Council adult social care mental health teams enables close working to manage these safeguarding enquiries.
Safeguarding Adult Reviews
SPFT participates in the Safeguarding Adult Review (SAR) work of the SAB. SAR Craig was a significant review for SPFT because Craig was a mental health service user who was open to its services when he died. SPFT has addressed recommendations from the review about the supervisory support it provides to its staff. It has worked with the local authority through Section 75 integrated mental health service arrangements to respond to recommendations about the screening processes for concerns about patients in the community and how their assessment and care planning is managed. Work to address recommendations linked to ADHD assessment capacity remains ongoing.
Safeguarding Initiatives & Projects
Domestic Abuse- The Trust implemented new domestic abuse training in December 2023. The training was developed in conjunction with Safelives, a national domestic abuse charity, and addresses recommendations from SARs and domestic homicide reviews. The new training includes an increased focus on the importance of routine enquiry of domestic abuse as part of all patient assessments.
The Trust continues to provide mental health representation at Brighton & Hove Multi-agency Risk Assessment Conferences (MARACs)* and its safeguarding service participates in regular meetings to address high risk "cuckooing" cases (a practice where people take over a person’s property and then use the property to facilitate exploitation).
Information Sharing - The SAB information sharing protocol enabled the Trust's safeguarding service to gain read only access to Brighton & Hove safeguarding information held within the local authority's client database. This is improving the speed and efficiency of the Trust's safeguarding work and is in line with multi-agency safeguarding best practice.
Digital Device & Internet Access Policy for Service Users in Inpatient Settings - Safeguarding service staff with Prevent responsibilities have contributed to the development of this policy which will be published in 2024/25. The Trust has recognised the risks to patients' mental health and their susceptibility to radicalisation through the internet when acutely unwell within inpatient settings.
Quality Reviews - The Trust Safeguarding Adult Team is now an integrated member of its internal services' quality review process. In the last year it has contributed to quality reviews of community and inpatient services. These have provided opportunities to promote the pan Sussex Safeguarding Adults Thresholds: Guidance for Professionals. This SAB document is key to guiding staff about when to contact the local authority with safeguarding concerns.
Safeguarding is a fundamental part of our recruitment process, ensuring appropriate checks are in place to ensure all staff are employed within SCFT services to contribute to the delivery of excellent care within the community. All staff have access to mandatory and statutory safeguarding training for adults and children appropriate to their role and position within the Trust including higher-level training for those in specialist roles.
SCFT has a safeguarding team which provides specialist advice for both adults and children across all services and supports staff to recognise signs of abuse and how to report it. The Trust works effectively with all safeguarding partnerships to ensure a multi-disciplinary and cross agency approach.
The safeguarding team works closely with new service developments to ensure we provide high quality and effective health services. The team is part of a Quality and Safety Department, which enables close working both with specialist safety teams and clinical staff. This ensures that we focus on learning for improvement and strengthens our personalised approach to safeguarding.
Our safeguarding strategy has been produced and is underpinned by our commitment to providing excellent care at the heart of the community.
The aim of the strategy is to ensure that everything we do, wherever it takes place, ensures the safety, security, and well-being of children and adults who are involved with our services. This will be achieved through the following goals, which reflect the priorities of the Trust Strategy:
Our People - We will provide effective safeguarding advice and guidance to our staff, volunteers, and carers to enable them to support people with any safeguarding concerns.
Inclusive - We will recognise and respect diversity to meet the safeguarding needs of marginalised and seldom-heard groups, reducing inequalities and deprivation within our communities.
Learning - We will continue to promote a culture of continuous safeguarding improvement and learning in the face of economic uncertainty.
Partnerships - We will build on internal and external partnerships to strengthen our safeguarding practice.
Developed with the help of the Safeguarding Adult Board partners, the strategy sets out how we will deliver our commitment to safeguarding and our strategic priorities for the next three years.
Safeguarding adults training compliance:
|
Level |
Target Cohort |
Target Compliance |
2023-2024 Data
|
Analysis of Variance |
|
L2 |
Mandatory for all staff |
85% |
97.4% |
Compliance remained above SCFT compliance target of 95% |
|
L3 |
Mandatory for all Adult and Specialist Services registered nursing and AHP staff Band 5-8a |
85% |
92.4% |
In line with the NHS Intercollegiate Guidance the annual target is 85% |
|
L3 WRAP |
Mandatory for Adult and Specialist Services staff that require Adult Safeguarding L3, and Childrens Services.
|
85% |
97.1% |
Compliance evidences that the final stretched third year target of 85% by Q4 23-24 has been met. |
|
L3 MCA |
Mandatory training for all new starters (in L3 cohort) and is also accessible to all staff should they chose to complete it. |
Staff completion: 1341 |
ESR Module MCA: Assessing Mental Capacity. Completion will fluctuate depending on new staff flow into SCFT, and substantive staff choice to complete. |
|
Raising safeguarding concerns:
As it is not possible to predict when an adult safeguarding concern may be found at any given time it is not possible to provide a baseline of adult safeguarding concerns that may be raised by SCFT, and the below data evidences that SCFT are considering risk and escalating adult safeguarding concerns to enable support to the adults involved.
|
Adult safeguarding concerns raised by SCFT to BHCC 2023-2024 |
|
|
BHCC |
139 |
The safeguarding concern themes raised to Brighton and Hove City Council are as follows, and please note that due to a change in SCFT internal reporting systems the themes raised data period is June 2023-March 2024 therefore the below figure does not equate to the above:
The above table provides a comparison in relation to the domains captured within the safeguarding concerns raised to BHCC, and 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. 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).
SCFT internal Safeguarding Adults Advice Line
The SCFT safeguarding adults’ advice line data evidences that access to specialist advice is fundamental to good safeguarding practice; it supports better outcomes for adults who need care and support, and enables SCFT staff to improve their knowledge, confidence, and competence in safeguarding. This in turn supports the organisations culture to improve outcomes in the promotion of safeguarding adults from harm and abuse in line with the visions and values that are expected from every healthcare professional.
|
SCFT: Safeguarding Adults Advice Line |
2023-2024 |
Variance against previous year |
|
Contacts (Trust-wide): |
519 |
á7 |
The advice line contacts evidence that SCFT staff are discussing concerns directly with the patient (when it is appropriate to do so and following consideration of mental capacity), mitigating risks where able, providing safety-net advice and care-planning, and liaising directly with Adult Social Care where a more urgent approach is required. In addition, the SCFT Adult Safeguarding Team escalates potential quality issues within other provider services (care homes and care agencies) to the NHS Sussex Integrated Care Board (ICB) Safeguarding Team for consideration of wider discussion.
Table 1 below shows the number of Home Safety Visits (HSV) conducted by East Sussex Fire and Rescue Service (ESFRS) in 2023-2024 and includes the number of HSV referrals received from Brighton and Hove HASC, and Brighton and Hove Carelink.
|
Table 1:
Home Safety Visits & Referrals in Brighton & Hove;
2023-2024
|
Qtr 1 Total |
Qtr 2 Total |
Qtr 3 Total |
Qtr 4 Total |
Total |
|
Home Safety Visits Completed in B&H
|
693 |
615 |
554 |
550 |
2412 |
|
Home Safety visit Referrals from B&H Adult Social Care/Access |
41 |
14 |
30 |
19 |
104 |
|
Home Safety visit Referrals from B&H Carelink |
10 |
14 |
4 |
17 |
45 |
In addressing the higher rate of referrals made in Q1, ESFRS have previously noted that they deliver annual mandatory safeguarding training towards the end of the year and- with refreshed knowledge- staff are then more confident in identifying safeguarding concerns.
Table 2 below shows the number of CTN (Coming to Notice) Safeguarding Concerns raised by ESFRS in Brighton and Hove over the past year.
|
Table 2: Safeguarding Coming to notice forms raised to Adult Social Care
2023-2024
|
Total |
|
Hoarding |
59 |
|
Additional Support |
25 |
|
Living Conditions |
18 |
|
Welfare Concerns |
9 |
|
Mental Health |
7 |
|
Unattended Cooking |
5 |
|
Unsuitable Living accommodation |
5 |
|
Self-Neglect |
4 |
|
Alcohol |
3 |
|
Substance Misuse |
2 |
|
Bariatric |
2 |
|
Cuckooing |
1 |
|
Financial Abuse |
1 |
|
Modern Slavery |
1 |
|
Suicidal/Self Harm |
1 |
|
Threats of Harm |
1 |
|
Smoking |
1 |
|
Arson (including threats) |
0 |
|
ASB |
0 |
|
Building Concerns |
0 |
|
County lines |
0 |
|
Domestic Abuse |
0 |
|
Falls |
0 |
|
Firewise - Firesetting |
0 |
|
Hate Crime |
0 |
|
Possible Abuse |
0 |
|
Repeats Incidents |
0 |
University Hospitals Sussex NHS Foundation Trust
University Hospitals Sussex NHS
Foundation Trust (UHSussex) is one of the largest organisations in the NHS. It
employs approx. 20,000 staff and serves a population of 1.8 million people. The
Trust delivers services from 7 hospitals across Brighton and Hove, West and Mid
Sussex and part of East Sussex.
The Safeguarding Adults Team at UHSussex offers specialist leadership and
support across all hospital sites and outlying services. The team faced
challenges with reduced services, particularly at the Brighton and Haywards
Heath hospital sites during an extended period in 2023. However, they have now
resumed full capacity and are actively collaborating with colleagues in both
the ICB and SAB to enhance safeguarding practices throughout the organisation.
Fig1: Safeguarding Concerns raised by UHSussex regarding
patients
Total number of patients: 63[6]
Fig 2: Safeguarding Concerns Relating to Domestic Abuse
Figures 1 and 2 above pertain to the number of safeguarding referrals made by UHSussex on behalf of Brighton and Hove residents who have attended hospitals in Brighton and Haywards Heath, with an additional focus on safeguarding in relation to domestic abuse. The data indicates that referrals seem to have decreased. This was previously thought to potentially be a return to pre-COVID levels, but the numbers have continued to decline. UHSussex is collaborating with the Local Authority to better understand the reasons behind this trend and to consider necessary actions to address it.
Victim Support provides specialised domestic abuse services across Brighton and Hove. A Health Independent Domestic Violence Advisor (HIDVA) employed by Victim Support offers on-site support at the Royal Sussex County Hospital in Brighton. They provide specialised assistance to both patients and staff who disclose domestic abuse. The HIDVA collaborates with the Safeguarding Adults team to provide in-person training for staff on identifying and responding to signs of domestic abuse. Additionally, Victim Support has played a role in creating a 20-minute domestic abuse training video which has been included in the mandatory safeguarding adults training requirements for clinical staff.
UHSussex contributed to the Craig Safeguarding Adult Review (SAR). Following the review's findings and recommendations, the mandatory training on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) has been revised and updated. An MCA Working Group now convenes bi-weekly, and a program of MCA/DoLS audit is being prioritised for 2024-25 as a safeguarding initiative. The SAR Craig learning briefing from the SAB has been distributed to ward managers/matrons during internal Safeguarding Operational Governance meetings for further dissemination to their teams. These learning briefings, along with the SAB website, are referred to during safeguarding training as additional resources for staff. UHSussex has recently become a member of the SAB SAR subgroup, enhancing organisational learning.
UHSussex continues to make improvements to its safeguarding assurance processes. A weekly Harm Free Care panel has been established to review instances of pressure damage, patient falls and venous thromboembolism (VTE) occurring during a patient’s hospital stay. Safeguarding Adult Specialist Nurses are integral members of the panel, collaborating with Matrons and Heads of Nursing to identify learning and improvement action plans. Moving forward, Safeguarding Adults Lead Nurses will collaborate with Divisional governance teams to amalgamate learning from these incidents with insights from safeguarding inquiries, supporting the formulation of improvement plans.
Safeguarding Adults Training remains a focal point at UHSussex. All training content has been reviewed against the Intercollegiate Documents outlining competencies required for different staff groups. Level 1 training is now mandatory for all healthcare workers at UHSussex, integrated into the induction program for all staff, irrespective of their role. Enhancing Level 3 safeguarding adults training provision has been earmarked as a priority for 2024-25. A bi-weekly safeguarding training working group has been initiated to drive this agenda forward, with plans to review training content continually in response to local and national learning and enhance compliance monitoring and reporting processes within UHSussex.
The CQC conducted various service inspections across the Trust in 2022-23, including a Well Led inspection in October 2022. These inspections led to improvement actions, overseen by the Board and its Quality Committee. Progress against these improvement actions has been reported to the Integrated Care Board and the CQC. The Trust remains vigilant in monitoring performance against CQC standards through its governance mechanisms and procedures.
The work undertaken over the course of this year, both directly by the SAB and by our partners, has led to the Strategic Plan being updated for 2024-25 as we enter the last year of the current three-year plan.
Whilst embedding learning from SAB activities remains an ongoing area of focus and there is a need to ensure the progress made in respect of multiple and intersectional needs and inclusion, risk and equalities is continued new areas of focus have also been identified that the board will take forward.
These reflect priorities identified from recently published and ongoing Safeguarding Adult Reviews, other SAB activities, individual partner priorities, as well as the self-assessment and peer challenge process undertaken at the end of last year. This involved partners across Sussex being requested to assess their own performance in relation to four safeguarding-related themes (with twelve questions in total) and an in-person event then held to discuss and challenge each other on the outcomes from these.
The
new areas of focus for 2024-25 are -
Safeguarding Adult Reviews (SARs)
The SAB will continue to progress the SARs already underway and those in the process of being commissioned to ensure these are completed in a timely manner and learning is effectively shared across the partnership.
We will continue to progress SAR action plans already underway, completing the outstanding actions including the development of a multi-agency risk management (MARM) framework, and working in partnership with independent reviewers and partner agencies to develop action plans to translate recommendations made into effective improvement actions.
We will incorporate learning from the second national SAR analysis into all our review processes and develop updated guidance to support partner organisations in providing accurate and timely information to support SAR processes.
Quality Assurance
Having recruited a Board Support Officer, we will progress the previously identified aim of developing a multi-agency data dashboard. This will consist of strategic high-level data from statutory partners providing regular updates on safeguarding activity across the city throughout the year.
We will continue our SAB multi-agency quality assurance audit programme, firstly concluding the audit currently underway on adults who move between local authority areas. Audit themes are based on learning from SAB and SAR activities as well as the work of the learning and development subgroup.
We will continue to receive updates, discuss queries, and seek assurance on quality assurance issues, both through the subgroup and through the full board where necessary and appropriate.
Learning and Development
New learning and development priorities will be identified by the subgroup and taken to the full board for confirmation. These will be based on the outcomes from the Self-Assessment and Peer Challenge and other quality assurance processes, learning from local and national SARs, and adult safeguarding themes and issues identified as priorities by individual partner members.
Multi-agency learning and development resources will be developed in response to these priorities, and we will continue to look to take an innovative approach in this area and to work in partnership with our pan-Sussex colleagues where possible in ensuring that these are accessible and meet the needs of local communities.
We will continue to request updates from partner agencies in relation to the relevant learning and development activities they are undertaking internally and seek to share learning opportunities where relevant.
Communication and Engagement
We will actively seek to increase our level of engagement across local communities during 2024-25 through a range of activities.
The Practitioners Alliance for Safeguarding Adults (PASA) will become a formal subgroup of the SAB, with terms of reference and a work plan agreed by the members. We will continue to increase the membership so that professionals across the system in safeguarding roles, whether in the statutory or independent sectors, can use this to increase their knowledge and understanding of adult safeguarding.
The SAB will continue to share our learning, including published SARs, across a range of formats – attending in-person and virtual multi-agency and single agency events and meetings as well as through the SAB newsletter, website, and targeted emails that seeks to improve how learning is disseminated within partner agencies at all levels.
The Brighton & Hove SAB will continue to work with our colleagues at the East Sussex and West Sussex SABs, and our statutory partners, in relation to the pan-Sussex safeguarding procedures and shared resources that support a consistent approach to adult safeguarding across Sussex wherever possible. This includes a new website to host the pan-Sussex Safeguarding Policy and Procedures that will improve accessibility and contains several new and updated chapters reflecting learning from recently published SARs.
In continuing to focus on Making Safeguarding Personal (MSP) we will also consider how we can engage with people who use services across organisations in relation to safeguarding to shar their experiences as this is key to understanding what is done well or what needs to change.
Glossary of Terms
Changing Futures
Changing Futures Sussex is one of fifteen programmes set up across the country to improve the way local systems and services work for adults experiencing multiple disadvantage. The aim is to create an environment where individuals experiencing multiple disadvantage can receive flexible, trauma informed, person-centred support when they need it, leading to increased periods of stability and more opportunities to make positive changes in their lives.
Intersectional (Multiple and Intersectional Needs)
In this context intersectional needs is used to describe the ways that multiple needs (homelessness, mental health issues, substance use, domestic abuse and current or historical offending behaviour) interact or compound and exacerbate each other, so that a combination of increasing health and social care needs are experienced simultaneously.
LeDeR (Learning Disabilities Mortality Review Programme)
LeDeR is a service improvement programme, funded by the NHS, established to improve healthcare for people with a learning disability and autistic people. It aims to improve care for people with a learning disability and autistic people, reduce health inequalities for people with a learning disability and autistic people, and prevent people with a learning disability and autistic people from early deaths.
Mult-agency Risk Assessment Conference (MARAC)
MARAC is a domestic abuse Multi-Agency Risk Assessment Conference held on a regular basis in each area. They brings together representatives from a range of agencies to discuss the safety, health and well-being of people experiencing domestic abuse (and their children)
Practitioners Alliance for Safeguarding Adults (PASA)
This is a group that enables frontline professionals from organisations involved in adult safeguarding, including those working in the independent and voluntary sector, to come together to identify and discuss current or emerging adult safeguarding themes and issues. It provides an opportunity for these themes or issues to be communicated to the SAB and for the group to provide direct feedback on work undertaken by the board, and by individual partner organisations, and for members of PASA to contribute to the development of this work.
Prevent
Prevent is a government-led, multi-agency counter-terrorism programme that aims to stop individuals felt to be vulnerable to potential radicalisation becoming involved in or supporting terrorism. A range of partners participate in the Prevent programme, including Police, the local authority, and community organisations.
SCARF
The Single Combined Assessment of Risk Form (SCARF) is a document used by the Police in situations where they believe they have identified an adult at risk. In these situations, SCARFs are shared with statutory partners to facilitate early and effective identification of risk, joint decision making, and coordinated action.
Our Partners
In addition to the three statutory partners the further partners of the Brighton & Hove Safeguarding Adults Board are:
· 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
· Bridging Change
· Voluntary and Community Sector representation (represented by the Practitioners’ Alliance for Safeguarding Adults)
· Brighton and Hove Safeguarding Children Partnership
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
· Brighton and Hove Community Safety Partnership
· South-East Regional Safeguarding Adult Board Network
Our Budget
The Brighton and Hove Safeguarding Adults Board has a pooled budget; Partner
agencies contribute to the running of the board financially, and by chairing
and facilitating meetings, providing use of their buildings and facilities, and
contributing time and expertise to learning events.
Income for 2023 - 2024
|
Brighton & Hove City Council |
£86,000 |
|
Sussex Police |
£32,610 |
|
NHS Sussex |
£26,600 |
|
Total |
£145,210 |
The board carried forward some of the Brighton & Hove City Council and third-party income into the 2023/24 budget, with some again carried forward to 2024/25. Staffing costs and review costs were reduced this year due to a significant period with reduced staffing levels and costs for current reviews to be paid next year. With all staffing vacancies now filled expenditure in this area is expected to increase in 2024/25.
Expenditure in 2023 - 2024
|
Item |
Subtotal |
Total |
|
Staffing |
|
£115,000 |
|
Business Manager |
£69,978 |
|
|
Administrator |
£24,735 |
|
|
Board Support Officer |
£9,446 |
|
|
Independent Chair |
£9,154 |
|
|
Other |
£500 |
|
|
Safeguarding Adult Reviews |
|
£500 |
|
Thematic Learning Review |
£500 |
|
|
Website costs |
|
£1,805 |
|
BHSAB Development Day |
|
£330 |
|
Other costs |
|
£1,127 |
|
Sundry costs |
£216 |
|
|
Apprenticeship levy |
£449 |
|
|
Mobile costs |
£187 |
|
|
Learning and Development |
£275 |
|
|
Total |
|
£118,762 |
[1] Ethnicity (White). 2022/23 total as stated in last year’s
annual report: 505; now amended to 548.
Ethnicity (unknown/ refused). 2022/23 total as stated in last year’s annual
report: 243; now amended to 194.
[2] Outcome (no risk identified, and no action taken). 2022/23
total as stated in last year’s annual report: 114; now amended to 2.
Outcome (risk identified and action taken). 2022/23 total as stated in last
year’s annual report: 634; now amended to 848.
[4] Outcome (fully achieved). 2022/23 total as stated in last
year’s annual report: 358; now amended to 461.
Outcome (partially achieved). 2022/23 total as stated in last year’s annual
report: 192; now amended to 232.
Outcome (not achieved). 2202/23 total as stated in last year’s annual report: 83; now amended to 155.
[5] NHS England » Safeguarding children, young people and adults at risk in the NHS: Safeguarding accountability and assurance framework
[6] Please note that safeguarding concerns may be raised in relation to multiple categories of abuse for an individual patient, meaning that the totals in the ‘categories of concern’ chart is higher than the total number of patients referred.