SAFEGUARDING ADULTS FRAMEWORK Introduction Prevention and effective responses to neglect, harm and abuse is a basic requirement of modern health care services. Safeguarding adults involves a range of additional measures taken to protect patients in the most vulnerable circumstances, patients that are currently defined within No Secrets as vulnerable adults. This may be due to illness, impaired mental capacity, physical or learning disability or frailty brought about by age or other circumstance. Safeguarding adults includes: Prevention: of neglect, harm and abuse through high quality care Responses: effective responses where harm of abuse occurs Learning: to improve prevention and services to patients Purpose of this Framework This Framework sets out NHS Portsmouth Clinical Commissioning Group s arrangements for fulfilling its duty to have regard to the need to safeguard and promote the welfare of vulnerable adults. The Framework aims to: Support the commissioning of high quality care for patients in the most vulnerable circumstances and; Address failures in care with providers and ensure effective responses to allegations of harm and abuse either by CCG employees or by providers and contractor and; Ensure that these responses are in line with the Portsmouth City Council, Southampton City Council & Hampshire County Council Safeguarding Adults Policy 2010 and; Improve services to patients through learning from all case reviews or serious adverse events Improve services to patients through the involvement of vulnerable adults in the development and improvement of services In doing so, it is recognised that this Framework has been developed utilising current guidance as it applies to Primary Care Trusts, the NHS legal entity most closely aligned to the future role and function of the CCG. PCTs will end as entities by April 2013, with CCGs establishing as part of the new NHS structure from that date. Portsmouth CCG will thus review this framework in the light of any revised guidance published during 2012/13. For the purposes of this Framework, reference to PCT duties in current national guidance is taken as indication of the most likely expectations of CCGs with regard to adult s safeguarding. Page 1 of 7
Legislation, Regulations and Guidance People have fundamental rights contained within the Human Rights Act 1998. Commissioners as public bodies have statutory obligations to uphold these rights and protect patients who are unable to do this for themselves. Other legislation particularly relevant to safeguarding adults includes: Equality Act 2010 Mental Capacity Act 2005 Safeguarding Vulnerable Groups Act 2006 Mental Health Act 1983. NHS Act 2006 The No Secrets document (Dept of Health, 2000) sets out the standards for the NHS for multi-agency working to safeguard vulnerable adults. Whilst it is the Local Authority who is the lead agency, other agencies such as health, police and housing all have responsibilities with regard to safeguarding vulnerable adults. More recently, the Department of Health guidance Safeguarding Adults: The Role of NHS Commissioners (March 2011) sets the expectation that NHS commissioners must work proactively with all contractors and service providers to ensure safeguarding arrangements are in place that maintain the safety and well-being of those adults who are contractually under the care of the NHS. Safeguarding is also central to the quality of care and the NHS Outcomes Framework (Dept of Health, 2010), particularly: Domain 4: Ensuring people have a positive experience of care. Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm. The Care Quality Commission s Essential Standards for Quality and Safety (2010) sets specific outcomes for safeguarding and safety as a requirement for registration for all providers of NHS care. Commissioners have responsibilities to address failures of care in addition to the responsibilities of the CQC. Where the CQC take enforcement action, commissioners have a key role in managing the impact this has on the local health economy. Roles and Responsibilities: Local Authority (Portsmouth City Council) Portsmouth City Council has established the Portsmouth Safeguarding Adults Board (PSAB). This Board has been in operation for a number of years. Portsmouth City Primary Care Trust has been a member of the PSAB and NHS Portsmouth CCG has joined as a member during 2011, ahead of its establishment in April 2013. Portsmouth City Council, in partnership with Southampton City Council and Hampshire County Council developed the local safeguarding adults policy ( Safeguarding Adults Policy 2010: Policy and Procedures to Ensure the Prevention and Protection of Vulnerable Adults from Abuse ) which sets out the principles, standards and processes for the prevention of and response to abuse of vulnerable adults locally. NHS Portsmouth CCG will support and adhere to this policy. Page 2 of 7
NHS Portsmouth CCG CCGs need to demonstrate that they are meeting their responsibilities to safeguard and promote the welfare of vulnerable adults. In addition they need to demonstrate they are supporting and complying with the Portsmouth City Council, Southampton City Council & Hampshire County Council Safeguarding Adults Policy 2010. There are seven fundamental actions expected of NHS commissioners for safeguarding adults: 1. Safeguarding adults as a fundamental part of the commissioning strategy. 2. Systems are in place to set safeguarding adults into all contracting and procurement processes 3. Commissioners have assurance for safeguarding adults standards and processes to escalate concerns and risks 4. Commissioners report on safeguarding adults as part of assurance and accountability. 5. There are clear workforce arrangements in place for safeguarding adults. 6. There are effective working relationships and partnership working in place for safeguarding adults 7. Commissioners can demonstrate how they discharge their roles and responsibilities as a supervisory body as required by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards These responsibilities are set out in Annex A, with details of the local arrangements NHS Portsmouth CCG will put in place in order to fulfill these responsibilities. Governance Arrangements in NHS Portsmouth CCG Safeguarding arrangements are an integral part of the CCG s Quality and Integrated Risk Management Framework and, as such, will be managed in accordance with the Frameworks and their supporting policies. The CCG will be expected to have a clear line of accountability within the organisation for safeguarding adults. As such ultimate accountability for safeguarding adults will be with the CCG s Clinical Leader (the Accountable Officer ). In order to ensure the duties related to this accountability are discharged and to secure significant executive level management and leadership, the CCG s will be responsible for ensuring the CCG has the correct procedures and capacity in place and that the CCG is fulfilling in full any partnership duties. In doing so, the COO will work closely with the CCG Executive member who holds the Quality & Safeguarding role. Table 1 outlines the roles and responsibilities of these 3 key members of the CCG s Governing Body. Page 3 of 7
Table 1: CCG Governing Body: Roles Clinical Leader ( Accountable Officer ) Ultimate accountability for Responsibility for ensuring ensuring the CCG the CCG has in place discharges in full its duties procedures and capacity to in relation to Safeguarding fulfill it safeguarding duties Adults Ensures Board level scrutiny of safeguarding Ensures CCG participation in Local Safeguarding Adults Board and processes Ensures arrangements are in place to assure the CCG that all providers and contractors to the CCG are fulfilling their safeguarding duties CCG Executive (Quality & Safeguarding) Ensures clinical overview and influence over all CCG safeguarding processes Represents the CCG at Local Safeguarding Adults Board Provides very senior and clinical leadership for the CCG and acts as local champion and advocate for safeguarding adults in CCG business and, in particular, in primary care Reports to the CCG Governing Body on all aspects of safeguarding adults Portsmouth Safeguarding Adults Board The CCG will be a key member of the established Portsmouth Safeguarding Adults Board. The CCG joined the PSAB during 2011 whilst the CCG was operating in shadow running mode, recognising the importance of the PSAB to the CCG post-authorisation in April 2013. The CCG is represented on the PSAB by the CCG Executive member (a GP) who holds the Quality & Safeguarding portfolio. The CCG s will act as a deputy. NHS National Commissioning Board The CCG expects that the role of the National Commissioning Board (NCB) will include a responsibility for ensuring the health commissioning system as a whole is working effectively to safeguard and promote the welfare of vulnerable adults. As such Portsmouth CCG fully expects to be reporting to the local regional office of the NCB on local arrangements for discharging its duties regarding safeguarding. Conclusion NHS Portsmouth CCG expects and wants to fulfill the responsibilities and duties placed upon it regarding Safeguarding Adults. The CCG has set out in this Framework how it will set in place arrangements to discharge the safeguarding duties placed on NHS commissioners; the CCG will review this Framework on publication of any further national guidance. The CCG will set these arrangements in place prior to its establishment in April 2013, recognising the importance of having clear arrangements in place during this period of transition. Innes Richens (Designate) June 2012 Page 4 of 7
Appendix A: NHS Portsmouth CCG s Responsibilities and Arrangements for Safeguarding Adults Responsibility Local Arrangements Lead 1 Safeguarding adults as a fundamental part of the commissioning strategy. Joint Strategic Needs Assessment routinely focuses on vulnerable communities and adults; outputs are used to inform commissioning strategy and Joint Health & Well Being Plan Clinical Leader Quality & Safeguarding is a key portfolio/role of one of the 5 elected GP members of the CCG s Governing Body 2 Ensure a culture of listening to and engaging in dialogue with vulnerable adults, taking account of their wishes and feelings both in individual decisions and the establishment or development and improvement of services. 3 Systems are in place to set safeguarding adults into all contracting and procurement processes 4 Commissioners have assurance for safeguarding adults standards and processes to escalate concerns and risks Routine involvement of service users and their carers in commissioning plans and service reviews The CCG will continue to involve service users and their families in the review and development of its services. Multiple methods will be used dependent on the service under review including one-off consultations, ongoing user groups, gaining feedback through different digital media. The CCG expects all providers to comply with local and national Safeguarding policy and governance requirements and to demonstrate routinely to the CCG it has all the necessary arrangements in place. Safeguarding Adults is integral within standards for all contracts as a minimum Contracts specify compliance with CQC Essential Standards and related legislation (including Mental Capacity Act, Mental Health Act, Deprivation of Liberty Safeguards, Equality Act, Safeguarding Vulnerable Groups Act) Processes in place via local Protection of Vulnerable Adults (POVA) arrangements for alerts, responses and serious case reviews for all providers. Regular assurance/reporting from all providers on safeguarding to be developed as part of quality/safety reporting for all NHS providers. The CCG expects these reports to be shared between providers and the Local Authority as the Safeguarding lead agency. Page 5 of 7
Responsibility Local Arrangements Lead 5 Commissioner have processes in place to ensure they can make adult care placements (such as in care homes, nursing homes or independent hospitals) based on knowledge of standards of care and safeguarding concerns. 6 Commissioners report on safeguarding adults as part of assurance and accountability. 7 There are clear workforce arrangements in place for safeguarding adults including CCG staff training and development on safeguarding CCG involvement in local POVA arrangements results in routine information about all providers regarding standards of care or any safeguarding concerns being available to the placement team (eg Continuing HealthCare, Nursing Homes) at the time the package of care is being determined. Placements are made on the basis of individual need and quality/safety of the provider. Routine review of adult safeguarding reports from al providers as part of quality/safety reporting from all providers; information used as necessary within contract/performance reviews with providers. Regular reporting on Quality/Safety to CCG Governing Body to include focus on safeguarding. CCG Clinical Leader ( Accountable Officer ) holds ultimate responsibility for CCG s safeguarding adults duties. In addition, the CCG will identify a GP Executive on the Governing Body who will hold a Quality & Safety portfolio that includes safeguarding. The CCG s will be responsible ensuring the CCG has in place procedures and capacity to fulfill it safeguarding duties. The CCG will secure capability/capacity to provide specialist expertise for safeguarding adults (ie leading investigations, clinical leadership across the local economy) The CCG will have in place clear Safeguarding workforce/hr policies that include recruitment and staff training. Safeguarding will be included in staff induction describing how staff should exercise vigilance to help mitigate against : responsible for ensuring process in place CCG Executive (Quality & Safety): responsible for reporting at CCG Governing Body Clinical Leader CCG Executive Lead (Quality & Safety) Page 6 of 7
Responsibility Local Arrangements Lead the risk that people using CCG services might be suffering from abuse. The CCG will maintain the routine publication of a statement of CCG s responsibilities regarding Safeguarding made available to all staff via payslips. 8 There are effective working relationships and partnership working in place for safeguarding adults 9 Commissioners can demonstrate how they discharge their roles and responsibilities as a supervisory body as required by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards The CCG will be a member of the Portsmouth Safeguarding Adults Board The CCG will adhere to and endorse the local Safeguarding Adults Policy (2010). The CCG will endorse and support the inclusion of a specific Safeguarding objective within the Joint Health & Wellbeing Strategy The CCG will identify an authorising officer for Deprivation of Liberty Safeguards and have clear procedures in place. The CCG will routinely review DoLs Safeguarding procedures and policies in partnership with Portsmouth City Council. CCG Executive Lead (Quality & Safety) Page 7 of 7