Lewisham Safeguarding Adults Board

What is Safeguarding

Corona Virus Disease (COVID-19)

Healthy Behaviours Gov.uk

This page provides residents, carers and professionals with accurate information sources so that everyone in Lewisham can help themselves to keep safe and well.

It is important to continue to receive and share accurate information, so that you can take the necessary steps to keep yourself, your family and those you care for safe.

It remains important for everyone, including those who are fully vaccinated, to follow behaviours and actions that reduce transmission and help to keep people safe. Following the recommended actions will also help limit the spread of seasonal illnesses, including flu.

It is vital we all keep up our efforts to protect everyone in our community. The risks of close contact may be greater for some people than others.

The best way to protect yourself and others from COVID-19 is to get fully vaccinated. People that are fully vaccinated should continue to follow behaviours and actions set out in the guidance on how to help limit the spread of COVID-19.

Find out how how to stay safe and help prevent the spread of coronavirus.

Ensure you keep up to date with what you need to do to protect yourself and others by reading the latest advice from the Government UK.

If you develop COVID-19 symptoms, self-isolate immediately and get a PCR test, even if your symptoms are mild. You should self-isolate at home while you book the test and wait for the results. You must self-isolate if you test positive. Your isolation period includes the day your symptoms started (or the day your test was taken if you do not have symptoms), and the next 10 full days. This is the law.

Safeguarding Adults

Safeguarding adults remains a statutory duty of local authorities to keep everyone safe from abuse or neglect.

Please don’t forget "Safeguarding is everyone’s business" so it is important that we all remain alert to possible abuse or neglect concerns.

To refresh your knowledge read our webpage on the forms and signs of abuse.

If you are concerned about yourself or anyone that you care about may be at risk of abuse or neglect please call Lewisham Gateway Team on 020 8314 7777 alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police in an emergency on 999 or non-emergency 101.

If you would like to make a referral to the Safeguarding Adults Board for their consideration of a Section 44 Care Act 2014 Safeguarding Adult Review please use our dedicated referral platform.

Domestic Abuse - Safeguarding is Everyone's Business Leaflet - gov.uk

No child or adult should be made to feel unsafe. Everyone has a right to be safe from harm and abuse. All of us have a role to play in safeguarding, never more so than now. The UK Government has published a leaflet which gives updated and specific safeguarding information and advice.

Download the Domestic Abuse - Safeguarding is Everyone's Business Leaflet - gov.uk

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Domestic Abuse Services in Lewisham that offer help, advice and support

Despite Covid restrictions having been lifted there are still times when adults are required to Self-isolate which may pose a risk to those at risk of domestic abuse.

The Athena service, run by Refuge, provides confidential, non-judgmental support to those living in Lewisham who are experiencing or at risk of gender-based violence.

Telephone 0800 112 4052  

Email Lewisham VAWG @ Refuge

Athena Service

Lewisham Council has dedicated information including links to further help and advice for people experiencing abuse.

If you are worried about a loved one, or about self-isolating with a perpetrator, please call the National Domestic Abuse Helpline on 0808 2000 247 or contact the Helpline via Refuge’s contact form at www.nationaldahelpline.org.uk. 

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Counter Terrorism Policing have launched a new safeguarding website www.actearly.uk. The website aims to increase awareness with concerned family and friends of where to go for further information and support. The site will also raise awareness and understanding of the signs of radicalisation, increase understanding and confidence of the referral process, and develop trust and confidence in the safeguarding role of the police.

In addition to the launch of the website, a new national Prevent advice helpline is also being set-up and operated by specially trained Prevent Officers whose focus will be on providing reassurance and practical advice, in confidence, to concerned friends and families. The helpline is now live on 0800 011 3764.

Lewisham and Greenwich NHS Trust logo

Lewisham & Greenwich NHS Trust - University Hospital Lewisham

If you have an urgent but not life-threatening medical need, make sure you contact NHS 111 first rather than going straight to A&E. Follow the guidance on the Trusts Webpage

Some patients are understandably anxious about going into hospitals and health centres in the community. In order to reassure patients, Lewisham and Greenwich NHS Trust has produced a short film, Local resident praises NHS and urges others not to delay getting vital treatment in which the resident explains the steps that are being taken by the staff at Lewisham Hospital to keep patients safe from Covid-19 and encouraging all residents not to put off healthcare that they need. 

The Chief Nurse at Lewisham Hospital has also produced a short film Caring for you Safely explaining the steps they have taken to keep all of their patients safe during the pandemic.

These include: requiring patients to wear face coverings and staff to wear masks, and restricting the use of some hospital entrances. Watch the film produced by Lewisham and Greenwich NHS Trust

The NHS has dedicated, accurate and up to date health Corona Virus COVID-19 information available on their website.

It is important that we all follow the advice from the Government and the NHS and do not attend your GP surgery or A&E if you have the symptoms of Corona virus, please follow the advice given on their websites and call 111 first for advice. 

Lewisham Council logo

Lewisham Council has a dedicated Coronavirus COVID – 19 webpage where you can find accurate, up to date advice and information including:

Subscribe to the Council's YouTube Channel where you can find lots of video's on keeping safe in Lewisham during the Covid-19 pandemic including information from our board member for Public Health Dr Catherine Mbema.

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Community Connections Lewisham

Community Connections Lewisham connect you to your local community and services that can help with health and wellbeing – bringing Lewisham to you.

Community Connections Lewisham supports anyone in the borough (aged 18+) looking for help with their health and wellbeing.

This could be as simple as directing you towards nearby social activities or classes, or exploring challenges with transport, health conditions, caring needs, mental health and more. They will help you to find solutions that work for you.

They are a social prescribing service, which just means we work with the local community to help people. We make sure you get the right service at the right time.

It all starts with a chat, and there’s multiple ways to get in touch with them.

You can call them on 0330 058 3464, Monday-Friday, 9:30am-4pm. Or you can fill out one of their referral forms, after which they will give you a call.

Lewisham Foodbank Logo

Lewisham Foodbank continue to provide emergency support to residents who find themselves in financial crisis and unable to afford food.

To get a referral to the foodbank, please contact an organisation that you are in contact with like a school, housing association, Citizens Advice, GP or faith organisation.

If you do not have a support organisation, you can call the Citizens Advice Helpline for free on 0808 208 2138.

Scams and Fraud

Covid-19 Scams poster Gov.uk

Metropolitan Police Service has produced a helpful guide to Covid and Vaccine scams. The information in the Little Leaflet of Covid Scams includes examples of the most common types of Covid and Vaccine scams, tips on how to protect yourself and how to report scams.

Metropolitan Police Service created the Little series of books and videos to explain some of the most common scams and give advice on how to avoid falling victim to them. 

The Little Guide to... preventing fraud and cyber crime | Metropolitan Police

Staying alert to scammers

Fraudsters continue to take advantage of the COVID-19 pandemic through scams online, by phone and on the doorstep. At particular risk are people who are isolated from their family and friends. Please be alert to scams and help protect those most at risk by reporting any suspicious activity.

COVID-19 related scams and price increases

Beware of scammers who are trying to take advantage of the coronavirus pandemic. Lewisham Council has information on COVID-19 related scams and price increases

Keep up to date with the latest advice on personal fraud from Metropolitan Police Service.

Keep up to date with the latest scams relating to the Coronavirus from Action Fraud.

Keep up to date with the latest Scams and find out how to become a Scams Champion with Friends Against Scams

Friends against scam logo image

National Trading Standards (NTS) Scams Team Practitioner E-Learning.

This resource has been designed to assist professionals and practitioners who will be interacting with victims of scams, this includes but is not limited to; social workers, community nurses, volunteers and befrienders.

This e-learning will give you:

  • An understanding of the scale of the problem of scams
  • Insights into the behaviour of the criminals behind scams
  • Practical advice on how best to support a victim of scams
  • An understanding of the legislation that can be used to support scam victims and to prosecute the criminals behind scams

National Trading Standards (NTS) Scams Team Practitioner E-Learning for professionals who will be interacting with victims of scams (friendsagainstscams.org.uk)

NHS – HEALTH EDUCATION ENGLAND Coronavirus - e-Learning for Healthcare

The programme is freely available to all colleagues working in the NHS, independent sector and social care.

The programme contains e-learning courses relating to the prevention and treatment relating to the Coronavirus pandemic. In addition, useful links are included to other sources of information from the NHS and the UK Government.

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Support and Guidance for the Adult Social Care Sector

Skills for Care has dedicated COVID-19 Support and guidance for the adult social care sector.

Information available includes:

  • COVID-19 Essential Training
  • Support for Regulated Professionals
  • Support for Registered Managers
  • Support for Individual Employers

Skills for Health - Coronavirus (COVID-19) Awareness course

This free COVID-19 resource is delivered by Skills for Health, the UK’s leading provider of online learning for healthcare.

The resource is approximately 2 hours in duration and includes information such as infection prevention, PPE, hand and respiratory hygiene, management and assessment, sampling and testing, patient transfers/managing patients and much more, to support you in your role.

Safeguarding adults during COVID-19

COVID19 Legal guidance for Mental Health, Learning Disability and Autism, and Specialised Commissioning Services

This guidance concerns the impact of COVID-19 on the use of the Mental Health Act and supporting systems to safeguard the legal rights of people receiving mental health, learning disabilities and specialised commissioned mental health services.

The Royal Society of Medicine - E-Learning Hub

The COVID-19 learning hub has been created to support healthcare professionals with access to education and learning resources during the COVID-19 outbreak. Resources include links to access past COVID-19 Series webinars, recommended guidance, specialty training, a round-up of current clinical trials and references from the RSM Library.

COVID-19 Webinar Series - For health professionals, by health professionals.

This webinar series from the Royal Society of Medicine is dedicated to give healthcare workers on the frontline, regular and easy-to-access updates from healthcare leaders on COVID-19.

Chaired by leading experts, these webinars will discuss different topics and challenges that healthcare workers, leaders and the public are facing, and how we are responding.

All COVID-19 Series webinars are free to watch on Zoom.

Coronavirus (COVID-19)

Latest updates, advice and information for pharmacy.

Royal College of General Practitioners - COVID-19 Resource Hub

The COVID-19 Resource Hub has been created to support GPs in understanding and managing this pandemic, with topics ranging from diagnosis to keeping your practice safe. The hub is updated daily with the latest developments and guidance.

Safeguarding Adults

Every adult has the right to be treated with dignity, respect and live a life free of fear. We call this process safeguarding adults.

If you suspect that you or an adult you care about may be at risk of abuse or neglect please complete the Adult Safeguarding Concern form and return to the Lewisham Adult Gateway as instructed in the form. Alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999.

Every adult has a right to make their own decisions and take risks, however, some adults are at greater risk of being abused because they rely on another person to manage day to day living.

We use the term "adult at risk" to describe people that need this support. Not all adults who need care and support are considered at risk, we assess each person according to their own abilities. Many adults with care and support needs manage their lives very well.

Social Care and Health have produced a video on Safeguarding Adults in British Sign Language.

 

 

Forms and Signs of Abuse

People with care and support needs, such as older people or people living with a disability, are more likely to be abused or neglected. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it. People with communication difficulties can be particularly at risk because they may not be able to alert others. Sometimes people may not even be aware that they are being abused, and this is especially likely if they have a cognitive impairment. Abusers may try to prevent access to the person they abuse.

Whilst these particular adults are the specific focus of ‘Safeguarding Adults’ policy and procedures, this does not negate the public duty of those carrying out this work to protect the human rights of all citizens, including those who are the subject of concern but are not covered by these procedures, or those who are not the subject of the initial concern.

Such work is the responsibility of all agencies and cannot exist in isolation. It must be effectively linked to other initiatives, as part of a network of measures aimed at enabling all citizens to live lives that are free from violence, harassment, humiliation and degradation.

Signs of abuse

Signs of abuse can often be difficult to detect. The information below aims to help people who come into contact with people with care and support needs to identify abuse and recognise possible indicators. Many types of abuse are also criminal offences and should be treated as such.

Types of abuse:

  • Discriminatory abuse
  • Domestic abuse
  • Financial or material abuse
  • Modern slavery
  • Neglect or acts of omission
  • Organisational or institutional abuse
  • Physical abuse
  • Psychological or emotional abuse
  • Radicalisation
  • Self-neglect
  • Sexual abuse
  • Sexual exploitation

Evidence of any one indicator from the following lists should not be taken on its own as proof that abuse is occurring. However, it should alert practitioners to make further assessments and to consider other associated factors. The lists of possible indicators and examples of behaviour are not exhaustive and people may be subject to a number of abuse types at the same time.

Discriminatory abuse

Types of discriminatory abuse

  • Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as protected characteristics’ under the Equality Act 2010)
  • Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
  • Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
  • Harassment or deliberate exclusion on the grounds of a protected characteristic
  • Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
  • Substandard service provision relating to a protected characteristic

Possible indicators of discriminatory abuse

  • The person appears withdrawn and isolated
  • Expressions of anger, frustration, fear or anxiety
  • The support on offer does not take account of the person’s individual needs in terms of a protected characteristic

Hate Crime

Hate crime is the targeting of individuals, groups and communities because of who they are.

It is any incident which is a criminal offence and which is thought, by you or someone else, to be motivated by a hostility or prejudice based on race, ethnicity, religious beliefs, gender, gender identity, disability, age, sexual orientation or any other actual or seeming difference.

This can include:

  • Threats, bullying or intimidation
  • Threatening or offensive mail, texts or emails
  • Verbal abuse
  • Damage to property
  • Physical assaults

It is important to report all hate incidents, even if you think nothing can be done as it helps the police and other agencies identify areas of concern, patterns of behaviour and what is happening in our communities. Hate crimes are not only crimes against the targeted victim, but also against a particular group as a whole. Firm action will be taken against people who commit any acts of hatred.

We know that some victims may not wish to be identified, so we encourage victims to report crime anonymously to a third party reporting site to ensure that the police can do all they can to tackle hate crime in the community.

The police and the council will:

  • Investigate all reported incidents of hate crime
  • Take legal action if there is sufficient evidence to enable us to do this
  • Keep in contact with you and let you know of our progress
  • Support you during this process

Here is a list of groups and local venues where you can make an anonymous report of hate crime. Some organisations can offer support to help you decide if you want to make an official report or complaint. If you do, this will be forwarded to the police and the council to note or take action and for monitoring the numbers of incidents reported.

Lewisham Irish Community Centre
2a Davenport Road, Lewisham, SE6 2AZ.
Email Lewisham Irish Community Centre
020 8695 9608

Traveller’s Outreach
Email Travellers Outreach
07931 638775

2000 Community Action Centre
199 Grove Street, Deptford, SE8 3PG.
Email 2000 Community Action Centre
020 8692 2760

Baseline drop-in service
39 Lewis Grove, Lewisham SE13 6BG
020 8314 7549
020 8314 4835

Catford Citizens Advice Bureau
120 Rushey Green, Catford SE6 4HQ
0844 826 9691

Goldsmiths, University of London
Lewisham Way, New Cross SE14 6NW
Email Goldsmiths, University of London
020 7919 7171

Lewisham Southwark College
Lewisham Way, SE4 1UT

Email Lewisham Southwark College
020 8694 3233

Lewisham Disabilities Coalition
111 Randlesdown Road, Catford SE6 3PH
020 8697 0100
Email Lewisham Disabilities Coalition

Lewisham Islamic Centre
363-365 Lewisham High Street, Lewisham SE13 6NZ
Email Lewisham Islamic Centre
020 8690 5090

Lewisham Speaking Up
The Albany, Douglas Way, Deptford, SE8 4AG
Email Lewisham Speaking Up
020 8691 7198

Lewisham Victim Support
300 Sangley Road, Catford SE6 2JT
Email Lewisham Victim Support
020 8698 4583

London Sivan Temple
4A Clarendon Rise, London SE13 5ES
Email London Sivan Temple
020 8318 9844
07836 347748

Millwall Football Club
The Den, Zampa Road, New cross SE16 3LN
Email Millwall Football Club
020 7232 1222

Second Wave
1 Creek Road, Deptford SE8 3BT
Email Second Wave
020 8694 2444

Sydenham Citizens Advice Bureau
299 Kirkdale, Sydenham SE26 4QD
Email Sydenham Citizens Advice Bureau
0844 826 9691

Metro Greenwich
141 Greenwich High Road, London SE10 8JA

Email Metro Greenwich
020 8305 5000

More information on Hate Crime can be found on the Lewisham Council Website

Domestic abuse

Types of domestic abuse

Domestic abuse can be characterised by any of the indicators of abuse relating to:

  • Psychological
  • Physical
  • Sexual
  • Financial or economic
  • Emotional

Domestic abuse includes any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called 'honour’ based violence, female genital mutilation and forced marriage. (This definition will change once the Domestic Abuse Act 2021 comes into force).

Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:

  • Acts of assault, threats, humiliation and intimidation
  • Harming, punishing, or frightening the person
  • Isolating the person from sources of support
  • Exploitation of resources or money
  • Preventing the person from escaping abuse
  • Regulating everyday behaviour

Possible indicators of domestic abuse

  • Low self-esteem
  • Feeling that the abuse is their fault when it is not
  • Physical evidence of violence such as bruising, cuts, broken bones
  • Verbal abuse and humiliation in front of others
  • Fear of outside intervention
  • Damage to home or property
  • Isolation – not seeing friends and family
  • Limited access to money

Financial or material abuse

Types of financial or material abuse

  • Theft of money or possessions
  • Fraud, scamming
  • Preventing a person from accessing their own money, benefits or assets
  • Employees taking a loan from a person using the service
  • Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions
  • Arranging less care than is needed to save money to maximise inheritance
  • Denying assistance to manage/monitor financial affairs
  • Denying assistance to access benefits
  • Misuse of personal allowance in a care home
  • Misuse of benefits or direct payments  in a family home
  • Someone moving into a person’s home and living rent free without agreement or under duress
  • False representation, using another person's bank account, cards or documents
  • Exploitation of a person’s money or assets, e.g. unauthorised use of a car
  • Misuse of a power of attorney, deputy, appointeeship or other legal authority
  • Rogue trading – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

Possible indicators of financial or material abuse

  • Missing personal possessions
  • Unexplained lack of money or inability to maintain lifestyle
  • Unexplained withdrawal of funds from accounts
  • Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
  • Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
  • The person allocated to manage financial affairs is evasive or uncooperative
  • The family or others show unusual interest in the assets of the person
  • Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
  • Recent changes in deeds or title to property
  • Rent arrears and eviction notices
  • A lack of clear financial accounts held by a care home or service
  • Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person
  • Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house
  • Unnecessary property repairs

            Modern slavery

            Types of modern slavery

            • Human trafficking
            • Forced labour
            • Domestic servitude
            • Sexual exploitation, such as escort work, prostitution and pornography
            • Debt bondage – being forced to work to pay off debts that realistically they never will be able to

            Possible indicators of modern slavery

            • Signs of physical or emotional abuse
            • Appearing to be malnourished, unkempt or withdrawn
            • Isolation from the community, seeming under the control or influence of others
            • Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
            • Lack of personal effects or identification documents
            • Always wearing the same clothes
            • Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
            • Fear of law enforcers

            Further Home Office information on identifying and reporting modern slavery

            Neglect and acts of omission

            Types of neglect and acts of omission

            • Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
            • Providing care in a way that the person dislikes
            • Failure to administer medication as prescribed
            • Refusal of access to visitors
            • Not taking account of individuals’ cultural, religious or ethnic needs
            • Not taking account of educational, social and recreational needs
            • Ignoring or isolating the person
            • Preventing the person from making their own decisions
            • Preventing access to glasses, hearing aids, dentures, etc.
            • Failure to ensure privacy and dignity

            Possible indicators of neglect and acts of omission

            • Poor environment – dirty or unhygienic
            • Poor physical condition and/or personal hygiene
            • Pressure sores or ulcers
            • Malnutrition or unexplained weight loss
            • Untreated injuries and medical problems
            • Inconsistent or reluctant contact with medical and social care organisations
            • Accumulation of untaken medication
            • Uncharacteristic failure to engage in social interaction
            • Inappropriate or inadequate clothing

              Organisational or institutional abuse

              Types of organisational or institutional abuse

              • Discouraging visits or the involvement of relatives or friends
              • Run-down or overcrowded establishment
              • Authoritarian management or rigid regimes
              • Lack of leadership and supervision
              • Insufficient staff or high turnover resulting in poor quality care
              • Abusive and disrespectful attitudes towards people using the service
              • Inappropriate use of restraints
              • Lack of respect for dignity and privacy
              • Failure to manage residents with abusive behaviour
              • Not providing adequate food and drink, or assistance with eating
              • Not offering choice or promoting independence
              • Misuse of medication
              • Failure to provide care with dentures, spectacles or hearing aids
              • Not taking account of individuals’ cultural, religious or ethnic needs
              • Failure to respond to abuse appropriately
              • Interference with personal correspondence or communication
              • Failure to respond to complaints

              Possible indicators of organisational or institutional abuse

              • Lack of flexibility and choice for people using the service
              • Inadequate staffing levels
              • People being hungry or dehydrated
              • Poor standards of care
              • Lack of personal clothing and possessions and communal use of personal items
              • Lack of adequate procedures
              • Poor record-keeping and missing documents
              • Absence of visitors
              • Few social, recreational and educational activities
              • Public discussion of personal matters
              • Unnecessary exposure during bathing or using the toilet
              • Absence of individual care plans
              • Lack of management overview and support

              Physical abuse

              Types of physical abuse

              • Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing
              • Rough handling
              • Scalding and burning
              • Physical punishments
              • Inappropriate or unlawful use of restraint
              • Making someone purposefully uncomfortable (e.g. opening a window and removing blankets)
              • Involuntary isolation or confinement
              • Misuse of medication (e.g. over-sedation)
              • Forcible feeding or withholding food
              • Unauthorised restraint, restricting movement (e.g. tying someone to a chair)

              Possible indicators of physical abuse

              • No explanation for injuries or inconsistency with the account of what happened
              • Injuries are inconsistent with the person’s lifestyle
              • Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps
              • Frequent injuries
              • Unexplained falls
              • Subdued or changed behaviour in the presence of a particular person
              • Signs of malnutrition
              • Failure to seek medical treatment or frequent changes of GP

              Psychological or emotional abuse

              Types of psychological or emotional abuse

              • Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
              • Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
              • Preventing someone from meeting their religious and cultural needs
              • Preventing the expression of choice and opinion
              • Failure to respect privacy
              • Preventing stimulation, meaningful occupation or activities
              • Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
              • Addressing a person in a patronising or infantilising way
              • Threats of harm or abandonment
              • Cyber bullying

              Possible indicators of psychological or emotional abuse

              • An air of silence when a particular person is present
              • Withdrawal or change in the psychological state of the person
              • Insomnia
              • Low self-esteem
              • Uncooperative and aggressive behaviour
              • A change of appetite, weight loss/gain
              • Signs of distress: tearfulness, anger
              • Apparent false claims, by someone involved with the person, to attract unnecessary treatment

                Self-neglect

                Types of self-neglect

                • Lack of self-care to an extent that it threatens personal health and safety
                • Neglecting to care for one’s personal hygiene, health or surroundings
                • Inability to avoid self-harm
                • Failure to seek help or access services to meet health and social care needs
                • Inability or unwillingness to manage one’s personal affairs

                Indicators of self-neglect

                • Very poor personal hygiene
                • Unkempt appearance
                • Lack of essential food, clothing or shelter
                • Malnutrition and/or dehydration
                • Living in squalid or unsanitary conditions
                • Neglecting household maintenance
                • Hoarding
                • Collecting a large number of animals in inappropriate conditions
                • Non-compliance with health or care services
                • Inability or unwillingness to take medication or treat illness or injury

                Sexual abuse

                Types of sexual abuse

                • Rape, attempted rape or sexual assault
                • Inappropriate touch anywhere
                • Non- consensual masturbation of either or both persons
                • Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth
                • Any sexual activity that the person lacks the capacity to consent to
                • Inappropriate looking, sexual teasing or innuendo or sexual harassment
                • Sexual photography or forced use of pornography or witnessing of sexual acts
                • Indecent exposure

                Possible indicators of sexual abuse

                • Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
                • Torn, stained or bloody underclothing
                • Bleeding, pain or itching in the genital area
                • Unusual difficulty in walking or sitting
                • Foreign bodies in genital or rectal openings
                • Infections, unexplained genital discharge, or sexually transmitted diseases
                • Pregnancy in a woman who is unable to consent to sexual intercourse
                • The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
                • Incontinence not related to any medical diagnosis
                • Self-harming
                • Poor concentration, withdrawal, sleep disturbance
                • Excessive fear/apprehension of, or withdrawal from, relationships
                • Fear of receiving help with personal care
                • Reluctance to be alone with a particular person

                Who is an adult at risk?

                An “Adult at Risk” is defined as any person aged 18 years and over who is or may be in need of community care services by reason of mental health issues, learning or physical disability, sensory impairment, age or illness and who is or may be unable to take care of him/herself or unable to protect him/herself against significant harm or serious exploitation.

                Since the publication of ADASS Best Practice Document: ‘Safeguarding Adults’ (2005), the range of people considered to be vulnerable has been widened to include, people encountering domestic abuse, substance misusers and asylum seekers.

                When a young person reaches the age of 18 the responsibility for their well being may transfer to adult service providers.

                Perpetrators of Abuse

                The person alleged to have caused harm

                Abuse can occur anywhere and be perpetrated by anyone. Adults at risk are sometimes abused by strangers, but more often, they are abused by someone known to them or in a position of trust. This may include:

                • A partner, relative, friend or child
                • A neighbour or someone from the community network
                • A paid carer or volunteer
                • A health, social care worker or other professional
                • Another vulnerable adult
                • A non-carer or stranger

                Abuse can occur in any relationship. It often occurs where the person who is abusing is in a more powerful position than the person who is being abused.

                Abuse occurs when the abuser misuses such power either intentionally, or unintentionally or for their own benefit or gain.

                The person who is abusing may have more power because they are more able than the person they are abusing.

                They may also have more power because the adult at risk may be dependent on them in some way.

                In some instances the abuser themselves may also be an adult at risk, for example another service user, or an adult with learning disabilities caring for a frail older parent.

                In any formal caring situation, the person providing the care is held in a position of trust.

                There can often be a power imbalance between a member of staff, paid carer or a volunteer and an adult at risk.

                It must be noted that some abusers deliberately seek out adults who appear to be vulnerable, with the intention of abusing, harming, exploiting or manipulating that person.

                How to report your concerns

                If you suspect that you or an adult you care about may be at risk of abuse or neglect please complete the Adult Safeguarding Concern form and return to the Lewisham Adult Gateway as instructed in the form. Alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999. 

                If you are a member of the public we recommend you make contact with the Lewisham Adult Gateway via telephone.

                There are a number of other ways you can contact the Lewisham Adult Gateway

                The team can be contacted Monday - Friday 9am - 5pm

                Tel: 020 8314 7777 (select option 1) Tel: 020 8314 7766 (outside of office hours)

                Fax: 020 8314 3014

                Email Lewisham Adult Gateway

                Contact details for the deaf / impaired hearing community

                Minicom: 020 8314 3309

                Text Message: 07730 637 194

                Glide: LEWISHAM Adult Social Care / 07730 637 194

                Please note – Glide is a free app which allows video messaging (for sign language).

                It can be downloaded free of charge from the following sources:

                Apple itunes

                Google play

                Microsoft app store

                More information on the Lewisham Adult Gateway 

                If you believe that a criminal offence may have been committed and you would prefer to report your concerns anonymously please report them to Crimestoppers UK

                What happens after you report your concerns

                Once a report of suspected adult abuse or neglect is made, the organisation you reported your concerns to will take steps to ensure the immediate safety of the person and anyone else who may be affected. You can be assured that all reports of suspected abuse or neglect are taken seriously and are confidential.

                Collecting information

                When a report of suspected adult abuse is received further information will be gathered. If the adult at risk is unable to speak for themselves they can choose someone to act on their behalf such as a friend or family member. If this isn’t possible Adult Social Care can arrange for an independent person to do this, they are known as an Advocate.

                They will talk to the person, or a suitable representative on their behalf, to find out what is happening and then work together to plan what can be done to help keep them safe and as independent as possible.

                People involved

                Where necessary Adult Social Care will investigate allegations of abuse with partner organisations and take appropriate action.

                Meetings

                Sometimes a meeting is needed. The individual, or the person who acts on their behalf, may be invited to a meeting called a safeguarding planning meeting. During this meeting concerns will be discussed and the Chairperson will ensure that everybody has their say.

                The Chairperson will ensure that everything that was agreed to be done is being done, and decide if any further action is needed. A safeguarding plan may be agreed to continue to keep the person safe.

                Sometimes they will need to arrange further meetings to review the safeguarding plan and make changes if necessary to ensure the person continues to remain safe.

                What if you don’t want anything to happen?

                If the abuse is happening to you, you have a right to say what you want to be done about it. You will always be asked what you want and who you want to be involved.

                Sometimes there are other people who may also be in danger and the abuse is too serious for people to do nothing. Professionals have a duty of care to you and other people and may have to act against your wishes. If this has to happen you will always be told why.

                What if you’re not happy?

                If you’re not happy about the safeguarding adults process Lewisham Adult Social Care would like to know why. You can speak to the Chairperson who was involved in your meetings, or you can contact the Lewisham Safeguarding Adults Manager.

                Positive Outcomes

                This video Safeguarding Adults- An Independent Life After Abuse produced by the Social Care Institute for Excellence shows the positive outcomes the safeguarding process can have on a person who has been abused.

                Six Safeguarding Principles

                There are six safeguarding principles that underpin all safeguarding work:

                white background

                Mental Capacity, DoLS and Advocacy

                Mental Capacity Act Deprivation of Liberty Safeguards

                The Mental Capacity Act (MCA) 2005 came into force during 2007. A number of government departments sponsored its implementation. The MCA is designed to protect and restore power to those vulnerable people who lack capacity. The MCA also supports those, over the age of 18, who have capacity and choose to plan for their future. It applies to everyone working in health and social care who is involved in the care, treatment and support of people aged 16.

                At the heart of the MCA in terms of concepts and values are the five ‘statutory principles’. Consider the five principles as the benchmark. They should be used to underpin all acts done and decisions taken in relation to those who lack capacity.

                Using the Mental Capacity Act

                This new film below from Social Care Institute for Excellence explains the MCA and how it can protect the right to make choices. It's an introduction to the Act for people who need it, staff, carers and others.

                SCIE free online Mental Capacity Act e-learning

                This course explores the Mental Capacity Act 2005, including best interests decision-making,and how to support people to make their own decisions.

                The course is for everyone who looks after or cares for someone, for example, doctors, nurses, care assistants, social workers, and family members.

                Deprivation of Liberty Safeguards

                The Deprivation of Liberty Safeguards (DoLS) provide additional protection for the most vulnerable people living in residential homes, nursing homes, hospital environments and supported housing through the use of a rigorous, standardised assessment and authorisation process. They aim to protect those who lack capacity to consent to arrangements made in relation to their care and/or treatment, but who need to be deprived of their liberty in their own best interest to protect them from harm. They also offer the person concerned the rights:

                • To challenge the decision to deprive them of their liberty;
                • For a representative to act for them and protect their interests; and
                • The right to have their status reviewed and monitored on a regular basis.

                DoLS help ensure that an institution only restricts liberty safely and correctly and only when all other less restrictive options have been explored. The Local Authority manages this process and reports to the local Safeguarding Adults Board. In March 2014 the Supreme Court judgement in the case of “P v Cheshire West and Chester Council and another and “P and Q v Surrey County Council” lowered the threshold for a deprivation and significantly widened the scope of the Mental Capacity Act Deprivation of Liberty Safeguards themselves.

                Lewisham Council's Adult Social Care has a dedicated Deprivation of Liberty Safeguards web page that provides general information, links to other sources of information and contact details for the Deprivation of Liberty Safeguards Team.

                Independent advocacy under the Care Act 2014

                Advocacy and the duty to involve

                Local authorities must involve people in decisions made about them and their care and support. No matter how complex a person’s needs, local authorities are required to help people express their wishes and feelings, support them in weighing up their options, and assist them in making their own decisions.

                When does the advocacy duty apply?

                The advocacy duty will apply from the point of first contact with the local authority and at any subsequent stage of the assessment, planning, care review, safeguarding enquiry or safeguarding adult review. If it appears to the authority that a person has care and support needs, then a judgement must be made as to whether that person has substantial difficulty in being involved and if there is an appropriate individual to support them. An independent advocate must be appointed to support and represent the person for the purpose of assisting their involvement if these two conditions are met and if the individual is required to take part in one or more of the following processes described in the Care Act:

                • A needs assessment
                • A carer’s assessment
                • The preparation of a care and support or support plan
                • A review of a care and support or support plan
                • A child’s needs assessment
                • A child’s carer’s assessment
                • A young carer’s assessment
                • A safeguarding enquiry
                • A safeguarding adult review
                • An appeal against a local authority decision under Part 1 of the Care Act (subject to further consultation)

                Judging ‘substantial difficulty’

                Local authorities must consider, for each person, whether they are likely to have substantial difficulty in engaging with the care and support process. The Care Act defines four areas where people may experience substantial difficulty. These are:

                • Understanding relevant information
                • Retaining information
                • Using or weighing information
                • Communicating views, wishes and feelings

                Who is an ‘appropriate individual’ to assist a person’s involvement?

                If the person being supported doesn’t want that person to support them, that’s not an appropriate adult. You can’t force an advocate on someone.

                Co-production workshop participant

                Local authorities must consider whether there is an appropriate individual who can facilitate a person’s involvement in the assessment, planning or review process, and this includes four specific considerations. The appropriate individual cannot be:

                • Already providing care or treatment to the person in a professional capacity or on a paid basis
                • Someone the person does not want to support them
                • Someone who is unlikely to be able to, or available to, adequately support the person’s involvement
                • Someone implicated in an enquiry into abuse or neglect or who has been judged by a safeguarding adult review to have failed to prevent abuse or neglect

                The role of an ‘appropriate individual’ under the Care Act is potentially fuller and more demanding than that of an individual with whom it is ‘appropriate to consult’ under the Mental Capacity Act (MCA). Under the Care Act the appropriate individual’s role is to facilitate the person’s involvement, not merely to consult them and make decisions on their behalf.

                Information and advice

                The Care Act places a duty on local authorities to ensure that all adults in their area have access to information and advice on care and support, and to keep them safe from abuse and neglect. Prior to making contact with the local authority, there may be some people who require independent advocacy to access information and advice.

                Continuing health care

                The advocacy duty in the Care Act applies equally to those people whose needs are being jointly accessed by the NHS and the local authority, or where a package of support is planned, commissioned or funded by both a local authority and a clinical commissioning group (CCG), known as a ‘joint package’ of care.

                Independence

                The independence of the service is an important consideration for all commissioners.  For services to be meaningful and acceptable to those they are designed to support they must have the confidence of individuals, carers and the public.

                Prisoners

                From April 2015 local authorities will also be responsible for assessing and meeting the social care needs of adult prisoners (not just on discharge from prison but also while in custody). All prisoners will be treated as if they are resident in that area for the purposes of the Care Act and for as long as they reside in that prison. Prisoners will be entitled to the support of an independent advocate in the same circumstances as people in the community.

                Social Care and Health have produced this video in British Sign Language on the provision of Independent Advocacy under the Care Act 2014.

                Prevention

                This video Safeguarding Adults - Helping People To Protect Themselves From Crime which has been produced by the Social Care Institute for Excellence, shows what care workers and others who are in contact with a vulnerable adult can do to help them protect themselves from crime.

                This video Safeguarding Adults - Looking Out For Each Other To Prevent Abuse which has been produced by the Social Care Institute for Excellence, can be helpful to highlight what the local community can do to protect themselves and those they care about.

                Feeling lonely or isolated? - Age UK telephone friendship

                As we get older, we may find we spend more time on our own. This can sometimes feel lonely, boring or make us miss friends or family.

                If you or someone you know is missing the joy of regular conversation, Age UK and our partner charity The Silver Line can help. Age UK offer free telephone friendship services so you can enjoy chatting with someone over the phone, all from the comfort of your own home. 

                Whether you’d like to speak to someone every week, or just want to talk when the need strikes, we’re here to help.

                image of london fire brigade logo

                London Fire Brigade -  Home fire safety Visits

                The London Fire Brigade’s Lewisham Borough Officers can visit you, a loved one, or someone you care for at home to provide personalised advice about fire safety. It's totally free, available 24/7, and they will even fit free smoke alarms during the visit if you need them.

                Free home fire safety visits from London Fire Brigade | London Fire Brigade (london-fire.gov.uk)

                London Fire Brigade - Fire Risk Checklist

                The London Fire Brigade has created a checklist to help you identify fire risks for the people you work with or care for. 

                This form has been designed for carers, support workers, housing officers and social workers, but if you care for a family member or friend you can also use it.

                Home Fire Safety Risk Checklist

                Metropolitan Police- Lewisham - Cash Point Safety Advice

                Cash point safety

                Independent Age - Advice and support for older age

                Independent Age have some great advice on what can cause falls, what you can do if you do fall and where to find out further information.

                Staying steady on your feet

                Lewisham and Greenwich NHS Trust offer a falls rehabilitation service which you can access via referral from your GP.

                Identity Fraud

                How much do you really know about identity fraud? Action Fraud has produced the infographic below which gives tips on how to keep your identity safe.

                Identity Fraud_Do you really know_Infographic.jpg 

                About Us

                About Us and How To Contact Us

                The overarching purpose of the Lewisham Safeguarding Adults Board (LSAB) is to help and safeguard adults with care and support needs by:

                • Assuring itself that local safeguarding arrangements are in place as defined by the Care Act 2014 and statutory guidance;
                • Assuring itself that safeguarding practice is person-centred and outcome-focused;
                • Working collaboratively to prevent abuse and neglect where possible;
                • Ensuring agencies and individuals give timely and proportionate responses when abuse or neglect have occurred; and
                • Assuring itself that safeguarding practice is continuously improving and enhancing the quality of life of adults in its area.

                The Board meets four times a year and has an Independent Chair.

                In Lewisham the Board believes that "Safeguarding is Everyone's Business". Its pledge to the people in Lewisham is that by working together and in partnership the risk of abuse or harm can be reduced by raising awareness of safeguarding of adults. As intelligence is gathered from across the partnership activity trends can be analysed and areas of concern identified so that preventative measures can be applied to keep people safe.

                **Do not contact the Independent Safeguarding Adults Board to report Safeguarding Concerns. You need to contact Adult Social Care Gateway at Lewisham Council. Please see "How to Report a Safeguarding Adult Concern" section below. Please also consider the transmission of personal information when making a referral to the Council. **

                There are two ways that you can get in contact with us, by email or letter. 

                Email Us

                Postal Address: Lewisham Safeguarding Adults Board, C/o London Borough of Lewisham, 3rd Floor, Laurence House, Catford, London, SE6 4RU.

                How to Report a Safeguarding Adult Concern

                If you suspect that you or an adult you care about may be at risk of abuse or neglect call Lewisham Adult Gateway on 020 8314 7777 alternatively if you have concerns about the immediate safety of an adult at risk then please contact the Police on 999.

                There are a number of ways you can contact Gateway

                The Gateway can be contacted Monday - Friday 9am - 5pm

                Tel: 020 8314 7777 (select option 1)

                Fax: 020 8314 3014

                Email Gateway

                Twitter blue bird logo

                You can also follow us on Twitter @lewisham_sab

                Safeguarding Adult Reviews & How to Make a Referral

                Lewisham Safeguarding Adults Board (LSAB) will arrange a Safeguarding Adult Review (SAR) when an adult in Lewisham dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult.

                We will also arrange a SAR if an adult in Lewisham has not died, but the LSAB knows or suspects that the adult has experienced serious abuse or neglect.

                We are also free to arrange for a SAR in any other situations involving an adult in Lewisham with needs for care and support.

                The Department of Health's Safeguarding Care and Support Statutory Guidance guides the reviews we carry out.

                Should the LSAB carry out a review we have a LSAB SAR Policy & Procedures Oct 2021 that we work to, which explains in detail what you can expect us to undertake for the Lewisham Community.

                Read our published Safeguarding Adult Reviews.

                Make a referral to the Board for a Safeguarding Adult Review

                If you would like to refer a case to us for the boards consideration for a Safeguarding Adult Review to be commissioned please use our dedicated referral platform.

                LSAB Structure and Members

                The current membership of the LSAB:

                Governance and operational structure

                The LSAB is a self-governing independent body with a set of legal responsibilities and duties which came into force on the 1st April 2015. The Board’s work is supported through the activities of four sub-groups which focus on key work streams to enhance the effectiveness of the Board. The membership of these sub-groups includes representatives from local organisations as well as the organisations represented on the LSAB itself.

                The governance of the Board and sub-groups is supported by Chief Officers from the following organisations: Lewisham Council, Metropolitan Police Service, NHS Lewisham Clinical Commissioning Group, South London and Maudsley NHS Foundation Trust, Lewisham & Greenwich NHS Trust, Joint Commissioning for Lewisham, Public Health for Lewisham and the Chair of the Board.

                The LSAB currently provides the Annual Report to the Healthier Communities Select Committee of the Council in order to provide assurance of how well safeguarding adults is progressing in Lewisham and to identify any areas of concern or challenge. In addition, the Annual Report is shared with the Lewisham Health and Wellbeing Board, which is a multi-agency group with statutory responsibilities.

                Lewisham Safeguarding Adults Board Structure

                Image of LSAB Structure 2021-2022

                The LSAB Compact and Strategic Business Plan 2021-2022 describes how these organisations and their representatives on the Lewisham Safeguarding Adults Board (LSAB) will work together in partnership to safeguard the residents of Lewisham in 2021-22. It is based on the statutory functions of Safeguarding Adults Boards as set out in the Care and Support Statutory Guidance, issued and updated from time to time by the Department of Health and Social Care.

                Publications

                Adult Safeguarding Leaflets and Posters

                Adult Safeguarding Posters - See it, Report it!

                Adult Safeguarding Leaflet:

                Safeguarding Adult Reviews

                Read and download all of the published Safeguarding Adult Reviews Commissioned by Lewisham Safeguarding Adults Board.

                New! 29 September 2021

                Lewisham Safeguarding Adults Board has today published the Safeguarding Adult Review for Mia.

                Lewisham Safeguarding Adults Board has also produced a LSAB 7 Minute Briefing - Mia - for Professionals.


                19 July 2021 Safeguarding Adults Review – Adult Z

                Lewisham Safeguarding Adults Board has today published the Safeguarding Adults Review for Adult Z.

                Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Adult Z - for Professionals.

                The key learning points from this Safeguarding Adults Review were mental ill health, the complexities of mental capacity assessment and providing emergency care in the community for adults with complex needs.


                Friday 26 June 2020 - Safeguarding Adult Review – Mrs A & Miss G

                Lewisham Safeguarding Adults Board has today published the Safeguarding Adult Review for Mrs A & Miss G.

                Lewisham Safeguarding Adults Board has also produced a LSAB 7 Minute Briefing - Mrs A & Miss G - for Professionals.


                Friday 12 June 2020 - Safeguarding Adult Review – Mr Tyrone Goodyear

                Lewisham Safeguarding Adults Board has today published the Safeguarding Adult Review for Mr Tyrone Goodyear.

                Accompanying this report is a statement from the family of Tyrone.

                Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing - Tyrone Goodyear - for Professionals.

                Zero Suicide Alliance provide a range of awareness training options, which provide a better understanding of the signs to look out for and the skills required to approach someone who is struggling, whether that be through social isolation or suicidal thoughts. 


                Friday 5 June 2020 - Safeguarding Adult Review - Executive Summary - Lee

                Lewisham Safeguarding Adults Board has today published the Safeguarding Adult Review Executive Summary - Lee.

                Lewisham Safeguarding Adults Board has also produced a 7 Minute Briefing – Lee - for Professionals.


                During 2018 Lewisham Safeguarding Adults Board published two safeguarding adult reviews. The full reports and accompanying documents are available to read and download below.

                Mr Michael Thompson - Safeguarding Adult Review - Full Report

                Statement of the board in relation to the Safeguarding Adult Review - Mr Michael Thompson

                Safeguarding Adult Review, Reflection and Development Briefing - Personalising Care and Improving Outcomes


                Mr CS - Safeguarding Adult Review - Full Report (Includes board statement)

                Mr CS - Safeguarding Adult Review - Practice Briefing

                Guidelines On Risk Assessment for Smoking in Care Homes

                Find out more about Safeguarding Adult Reviews and How to Make a Referral to the LSAB.


                National SAR Analysis – 7 minute briefings

                The LGA have produced a series of 7 minute briefings for different audiences regarding the findings of the national SAR analysis:

                Annual Reports

                LSAB Annual Report 2020-2021LSAB Annual Report 2021-21 image

                Message from the Independent Chair

                I want to pay tribute to all those who

                have contributed to

                safeguarding adults at risk of,

                or experiencing abuse and neglect.

                You have shown real leadership

                We have all had to adjust our lives this year due to the Covid -19 pandemic. Our patterns of daily life have been significantly disrupted; our liberties curtailed by the Coronavirus Act 2020.

                Throughout this period, however, the adult safeguarding duties within the Care Act 2014 have remained in place. Consequently the Lewisham Safeguarding Adults Board has continued to seek assurance that adult safeguarding has remained “everyone’s business” and that statutory, voluntary and community services have worked together effectively to prevent and/or protect individuals from abuse and neglect.

                The Board has also continued to deliver its Business Plan and to commission and complete Safeguarding Adult Reviews, as required by the Care Act 2014. This Annual Report summarises what the Board has achieved during the year.

                Throughout the pandemic the Board has sought assurance that services have worked effectively together when responding to this unprecedented situation. The response of local services has been commendable, with enhanced levels of collaboration to ensure the resilience of health and social care provision for people at risk.

                Going forward the Board will be concerned to ensure that this degree of cooperation and collaboration, working together, is maintained. We already have seen increased demand for care and support, and rising referrals of adult safeguarding concerns, whether occasioned by mental distress and social isolation, domestic abuse or self-neglect.

                As the country emerges from lockdown, we expect to see a rising number of concerns, as families, friends and practitioners begin to meet adults who may be at risk in person again. The resilience of all our services will be needed as never before.

                As the Board’s Independent Chair, I am especially proud of the web pages that carry important information for practitioners and for Lewisham’s residents and communities.

                I am especially proud of the outreach into Lewisham’s local neighbourhoods, community and faith groups. The Board has made good progress with its data collection and analysis, an essential part of gaining assurance about the effectiveness of adult safeguarding provision and of setting new priorities.

                We are learning and disseminating lessons too from the Safeguarding Adult Reviews that have been completed, and from other reviews already underway, ensuring service improvement and enhancement where necessary. This report shines a light on that work.

                Finally, I want to pay tribute to all those who have contributed to safeguarding adults at risk of, or experiencing abuse and neglect. You have shown real leadership.

                I want to thank Martin Crow, Vicki Williams and Tiana Mathurine, the Board’s business team, without whom we would not have made the progress summarised in this annual report.

                Photograph of Professor Michael Preston-Shoot

                Professor Michael Preston-Shoot

                Independent Chair

                Image of gov.uk campaign hands face space poster Key Outcomes in 2020-21

                1. Covid 19 - Pandemic Response:

                In addition to the Board’s normal schedule of meetings partners met more regularly  to discuss the response  to the pandemic and local risk factors. Focus was given to: 

                • Domestic Abuse and the delivery of local services
                • Adult mental health services
                • The voice of the adult - the Board worked with and supported Lewisham Speaking Up to stay engaged with adults living with a learning disability who have been disproportionately affected by Covid-19
                • Rough sleepers
                • Hospital discharges
                • Out of borough placements.

                The Board also supported the work on the ‘shielding’ programme, and with the development of a national data set analysing safeguarding trends, as well as publishing monthly e-Bulletins and a dedicated webpage. See Covid - 19 Pandemic Response: Highlighting Inequalities for further information in relation to the impact of the pandemic.

                2. Self-Neglect & Hoarding Multi-Agency Policy, Practice Guidance and Toolkit:

                This was revised based on consultation with key practitioners and clinicians working in the borough, taking into account training that had been delivered on this subject and the feedback from delegates that had been received on the previous policy. Read the policy, guidance and toolkit

                3. Launch of the Lewisham Adult Safeguarding Pathway:

                This included the publication of a revised Single Agency Adult Safeguarding Policy and Procedures Template, and the launch of a series of new leaflets and posters (see the back cover).

                4. Communication and Engagement Work

                5. Learning, Training and Development Programme: 

                6. Publication of three Safeguarding Adult Reviews: 

                7. Supported the launch of the Lewisham Modern Slavery and Human Trafficking Network:

                8. Review of Statutory Advocacy Services:

                This review commenced in March 2021 and will be completed in September.  

                From the Board’s nine Strategic Objectives eight were either fully completed or are ongoing as outlined above, with the training programme and leadership project linked to adopting a ‘Trauma Informed Approach’ delayed due to the pandemic.

                Covid - 19 Pandemic Response: Highlighting Inequalities

                Nationally

                Public Health England (PHE) described health inequalities in the following way:

                Some groups have an increased risk of adverse outcomes from COVID-19 including some ethnic groups, males, those with certain pre-existing conditions such as obesity, those in deprived communities, older people, some occupations, people living in care homes, and other vulnerable groups.

                (PHE Beyond the Data: Understanding the Impact of COVID-19 on BAME Groups  - June 2020)

                • People aged 80+ are seventy times more likely to die than those under 40
                • Mortality rates are double in the most deprived areas compared to the least
                • Rates are also Higher for Black, Asian and Minority Ethnic (BAME) groups
                • Death rates in London are 3+ times higher than in the South West (lowest area).

                 Image of PHE Inequalities Table

                 “As well as the tragic toll of the disease, the lockdown has affected both mental health and wider determinants of health and wellbeing, including access to vital services, our local economy, and the education of our children and young people.

                The full extent of this impact and the inequalities that are created or exacerbated will only begin to emerge over the coming months and years”.

                • Lewisham residents born in the Americas, the Caribbean, Middle East or Asia have a significantly higher death rate than people born in either the UK or Europe
                • 22% of deaths from COVID-19 were residents who normally lived in care homes.
                • The analysis shows no significant difference in the rate of death between those living in the most and least deprived areas of Lewisham
                • Almost 10,000 people were shielding in Lewisham, and a wider cohort of approx. 3,000 vulnerable people (not known to services) were identified, and prioritised for a welfare call/ referral to other support if required.
                • Birmingham City and Lewisham Councils are launching ground-breaking work into the health inequalities of African and Caribbean communities. The aim is to find approaches to break decades of inequality that will lead to better futures for citizens.

                (COVID-19: Lewisham System Recovery Plan - September 2020)

                Case Studies

                The following case studies provide an insight into the pressures and challenges that were faced by professionals in relation to safeguarding adults across Lewisham.


                An 81year old man lived in a residential care home due to a Image of man looking happy in care homeprogressive dementia diagnosis and his inability to remain safely in his own home. At this time the care home was closed to all visitors, and outside professionals where communicating virtually with the care home staff. The residents were being encouraged to remain in their own rooms to reduce the risk of transmission of infection, and staffing were also affected due to positive COVID tests, which all contributed to increasing the carers workload.

                Although appropriate care was being provided, due to the pressures across the system, there was a delay in a pressure relieving mattress being provided and the man developed an unstageable pressure ulcer. The case was investigated by the Community Pressure Ulcer Panel and an action plan was jointly developed.

                This was an unprecedented time for all of the services involved, but lessons were still identified and systems improved. The pressure ulcer is now completely healed and the gentleman remains happy living in the care home.


                Local police worked with a man living with a learning disability who was a victim of several robberies, assaults and anti-social behaviour. He also felt intimidated going out in his local community because of these incidents, as well other problems, some of which extended from Adverse Childhood Experiences (ACE’s).   

                His basic living conditions were very poor including mould and mildew on the walls, bare and rotting floorboards, no fridge and no lock on his front door. Police instigated a multi-agency meeting bringing together his sister, a new social worker and the relevant housing association’s property manager. 

                Following on from this the property was cleaned, painted, repaired and updated, and carers are now giving the man appropriate support. Despite having felt let down by services previously, this man is feeling a lot more positive and now starting to interact more in his local community. (Case refers to periods in between lockdown periods).


                Image of man looking out of the window Staff managing mental ill-health related safeguarding enquiries faced a number of challenges because of Covid-19, including an increase in the severity of symptoms being experienced in the community, and a shift to remote working, which was not always conducive to engaging the adult at risk.

                A positive example was the case of an adult who was initially identified by the London Ambulance Service as suffering from acute self-neglect, having attended their home due to the distressed state of the person. The Safeguarding Enquiry Officer worked with the Care Co-ordinator online, who then co-produced a care plan with the adult (Making Safeguarding Personal). Supportive outcomes and actions were generated in a very prompt manner as part of a wider harm minimisation plan.    

                Lewisham Safeguarding Adults Pathway (March 2021)

                What is this?

                Comprehensive set of web pages providing local guidance, tools, forms and resources to support the London Multi-Agency Adult Safeguarding Policy and Procedures, as well as a platform to share good practice and build a local network of connected agencies all working to help prevent abuse and neglect.

                Why do we need it?

                To make it easier for professionals to understand and digest the pan London Policy and Procedures, and to create a step by step guide (Stages 1-4) which is embedded into local agencies ways of working (practice) and systems.

                Who is it for?

                All professionals working with adults at risk of abuse and neglect in Lewisham, as well as members of the public, including carers.

                Who developed this Pathway?

                A range of professionals from across partner agencies were involved in developing the work, as well as the public who helped to co-produce the leaflets and posters.

                Arrow Image Read more about the Pathway

                New

                Adult Safeguarding Concern Form for use by all professionals.

                Guide on what is a Concern and how to respond to this, and Making Safeguarding Personal (MSP).

                New

                Guidance on conducting enquiries, contextual factors, professional curiosity & cultural competence.

                New

                Forms to help improve the consistency of approach. 

                New

                Guidance and Forms for planning meetings and conferences.

                Shift towards a neighbourhood approach in conducting Safeguarding Conferences.

                New

                Resources:

                Single Agency Policy and Procedures Template.

                Leaflets and Posters.

                What do I need to do?

                1. Use the New Adult Safeguarding Concern Form if you make a referral to the Local Authority.
                2. Read and use all of the guidance throughout the four stages as outlined, and as applicable.
                3. Embed this Pathway into your agency’s way of working and systems if you are the lead professional responsible for safeguarding.
                4. Use the template Policy and Procedures if you work in a non-statutory agency.
                5. Use the leaflets and posters.

                Contact us: when you have completed number three above.

                Communication and Engagement Work

                evidence of community awareness of adult abuse and neglect and how to respond

                (Care Act Statutory Guidance 14.157)

                Fig 1:Annual Survey 2020-21: What should the Board’s priorities be in 2021-22?

                Fig 1:Annual Survey 2020-21: What should the Board’s priorities be in 2021-22? 

                Over 200 professionals and members of the public engaged with the survey, which helped to inform the development of the Board’s strategic objectives.

                Fig 2: I think LSAB is effective?

                70% Strongly Agree/ Agree
                23% Couldn’t answer the question/ Don’t know
                7% Disagree

                I feel that we are further down the road in terms of achieving this (vision)

                than we have ever been”

                image showing 75,000+ page views on the Board’s website - up 40%  Over 45,000 impressions  on Social Media image showing 505 delegates attended training June 20 to  March 21image showing Over 6,000 reads of e-Bulletins

                Learning, Training and Development Delivery

                10 Learning and training events were cancelled/postponed between March - June 2020 due to Covid -19.

                A transition to entirely online delivery was then made after this which wasn’t easy, although targets were still achieved within a condensed six month period. This demonstrates the positive effect that online delivery can have in increasing the numbers who can engage with learning interventions (annual average has been 320 places since 2018).

                Safeguarding Information 2020-21

                increase the SAB’s understanding of prevalence of abuse and neglect locally

                that builds up a picture over time

                (Care Act Statutory Guidance 14.139)

                Table 1: Safeguarding Concerns and Concluded Section 42 Enquiries          

                 Image showing numbers safeguarding concerns and concluded section 42 enquiries

                Table 2: Types of Abuse: Concluded Section 42 Enquiries                    

                 image of Table 2: Types of Abuse: Concluded Section 42 Enquiries

                Table 3: Concluded Section 42 Enquiries By Ethnic Code Group

                 Image showing Table 3: Concluded Section 42 Enquiries By Ethnic Code Group

                Table 4: Source of Concern Leading to Section 42 Enquiry (Who reported the abuse)

                 Image showing Table 3: Concluded Section 42 Enquiries By Ethnic Code Group

                Safeguarding Adult Reviews

                Safeguarding Adults Boards must arrange a Safeguarding Adult Review (SAR) when an adult dies either as a result of abuse or neglect, known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult.

                (Care Act Statutory Guidance 14.162)

                The Case Review Sub-Group

                In total 11 cases were considered and or monitored by the Sub-Group, which is made up from the Board’s statutory partners, throughout the year.

                A National Analysis of SARs was also published in October 2020: Read the National Analysis


                SAR Demographics and Themes (11 cases considered)

                 image of SAR Demographics and Themes (11 cases considered)


                SAR Lee (5 June 2020)                                     Read the 7 Minute Briefing

                Background

                On 11 January 2016 Lee walked out of a hospital where he had been an in-patient, and was found dead in the street eight miles away three days later. Lee was 46 years old and had a history of alcohol related illnesses, depression and anxiety.

                Key Learning Points

                1. No formal assessment of risk was completed when Lee left the hospital that drew on previous knowledge of him. It took three days before Lee was formally recorded as missing by police. NHS Procedures should have been used to conclude that Lee was high risk of going missing from hospital.
                2. There was miscommunication involving the police, family and hospital with respect to whether Lee was missing, and then whether a missing person enquiry should be raised.
                3. No formal Mental Capacity Act assessment was ever conducted.

                SAR Tyrone Goodyear (12 June 2020)          Read the 7 Minute Briefing   

                Background

                Mr Goodyear had been in irregular contact with mental health services since he was 15 years old and had been assessed to have Autism Spectrum Disorder (ASD), learning difficulties and Obsessive-Compulsive Disorder.

                Tyrone lived with his mother and five of his siblings in four-bedroom temporary accommodation. This was causing friction between the family members. Tyrone left home after trying to secure alternative accommodation and his mother reported him missing. He was later found dead in a hotel room on 21 February 2019 having taken his own life via an overdose. He was 24 years old.

                Key Learning Points

                1. People with ASD are more likely to commit suicide than the general population, and the factors that predict this can also be different from the wider general public.
                2. People with ASD may ‘camouflage’ their needs in order to fit in. They may not be accessing any services but this does not mean that they do not have unmet needs.
                3. Services need to be made more accessible for people living with ASD.

                Extract: Statement from the family of Tyrone to accompany the SAR

                We hope that the changes recommended in this report can be put into place as soon as possible, to ensure that when someone with Autism Spectrum, learning and communications difficulties, and suspected mental health issues, will be treated with the correct priority that they need and deserve”.


                SAR Mrs A and Miss G (26 June 2020)                  Read the 7 Minute Briefing   

                Background

                Mrs A (102 years old) and Miss G (73 years old) both lived on their own at home and were receiving Homecare Services linked to mobility and other health conditions. They both also had periods where they were admitted to hospital and discharged, which led to complications in relation to the care they subsequently then received.  

                Key Learning Points

                1. Problems arose in the reassessment of needs during admission to hospital.
                2. After mobility had decreased this should have informed a full reassessment.
                3. Discharge from hospital resulted in the ‘restart’ of previous levels of care which were no longer appropriate to meet an increase in care needs.
                4. Discharge planning was not undertaken in line with the good practice standards.
                5. Carers continued to attempt to meet clients’ needs rather than escalate either difficulties with the delivery of effective care, or the impact on the clients’ health where needs were not met.
                6. Community Nursing did not always respond appropriately or in a timely manner to referrals made by hospital or community services.
                7. Equipment that was required at home was not ordered, delivered or set up.
                8. Other delays in practical aspects of setting up changes to care caused needs to remain unmet, which led to serious health consequences for the adults.
                9. Decision making was not assessed even though poor physical health can lead to a deterioration in mental capacity linked to associated risks in the community.

                Work of the Sub-Groups

                Case Review Sub-Group                         

                The Sub-Group oversees Safeguarding Adult Reviews (SAR) processes locally, and is led by the Board’s Independent Chair Professor Michael Preston-Shoot.

                The group met 7 times and considered 3 new SAR Notifications during 2020-21.4 SARs commenced during the year (which includes 2 that were pending from 2019-20), with a further 2 on hold due to ‘parallel processes’. 

                Lewisham Modern Slavery and Human

                Trafficking Network

                This group was newly launched and involves a range of Board partners across all age domains, but has been initially guided by the Board’s business team, supported by the Human Trafficking Foundation. 

                The Network is developing a new local strategy and guidance for, and with practitioners, which will include a Victim Care Pathway. This subject does not have a high profile in relation to adult safeguarding locally, and is evolving all of the time with new approaches and guidance being created nationally.

                Mission Statement

                “We will robustly tackle all forms of modern slavery and human trafficking in Lewisham through effective and collaborative partnership working, and by identifying, protecting and supporting potential victims of modern slavery and human trafficking.

                We will empower people to move on safely and successfully from exploitation, and   proactively target and pursue criminals”.

                The Governance for the Network has not been decided yet, but this is likely to come from the Safer Lewisham Partnership Board.

                Performance, Audit and Quality Sub-Group

                This group continued to meet quarterly throughout the year to monitor the Performance Indicators below:

                 image of Performance, Audit and Quality Sub-Group This group continued to meet quarterly throughout the year to monitor the Performance Indicators below:

                Risks have increased since the end of 2019-20 due to the pressures and challenges the Council and the NHS have faced during the last 12 months. 

                The group also monitors other pieces of relevant data some of which is outlined in Safeguarding Information 2020-21. This informs the groups work programme of audits and reviews, and has played a significant part in informing the development of the Board’s current strategic objectives (page 12).

                SAR Mrs A and Miss G Task and Finish Group

                This group was established to support and track the delivery of the Action Plan linked to this SAR. This was paused to allow Lewisham & Greenwich NHS Trust to focus on the pandemic response, but has now re-commenced.

                Lewisham Safeguarding Housing Forum

                The group continued to meet quarterly throughout the year, bringing a wider range of agencies and providers together. The Forum has now been stood down having achieved its stated objectives.

                Business Plan 2021-22 on a Page

                 Business Plan 2021-22 on a Page

                 See it Report it Poster image

                Download a copy of the LSAB Annual Report 2020-2021

                Download a copy of the LSAB Annual Report 2019-2020

                Download a copy of LSAB Annual Report 2018-2019


                Annual Reports

                The Care Act 2014 requires each Safeguarding Adults Board (SAB) to publish an annual report. 

                The Care Act (Schedule 2.4 (1) a–g) defines the minimum content of an annual report:

                As soon as is feasible after the end of each financial year, a SAB must publish a report on:

                What it has done during that year to achieve its objective,

                What it has done during that year to implement its strategy,

                What each member has done during that year to implement the strategy,

                The findings of the reviews arranged by it under section 44 (safeguarding adults reviews) which have concluded in that year (whether or not they began in that year),

                The reviews arranged by it under that section which are ongoing at the end of that year (whether or not they began in that year),

                What it has done during that year to implement the findings of reviews arranged by it under that section, and

                Where it decides during that year not to implement a finding of a review arranged by it under that section, the reasons for its decision.

                The performance of member agencies and how effectively, or otherwise, they are working together should be included in the report.

                The annual report must be sent to:

                The Chief Executive and leader of the local authority which established the SAB,

                Any local policing body that is required to sit on the SAB,

                The local Healthwatch organisation,

                The chair of the local health and wellbeing board.

                Annual reports should form the basis for the consultation on the strategic plan for the coming year.

                A SAB should seek assurance from its members that the annual report has been considered within their internal governance processes.

                Partnership Compact and Strategic Business Plan 2020-2021

                Introduction

                The compact and business plan describes how organisations and their representatives on the Lewisham Safeguarding Adults Board (LSAB) will work together in partnership to safeguard the residents of Lewisham in 2020-21. It is based on the statutory functions of Safeguarding Adults Boards as set out in the Care and Support Statutory Guidance, issued and updated from time to time by the Department of Health and Social Care.

                Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action.

                The aims of adult safeguarding:

                stop abuse or neglect wherever possible;

                • prevent harm and reduce the risk of abuse or neglect to adults with care and support needs;
                • safeguard adults in a way that supports them in making choices and having control about how they want to live;
                • promote an approach that concentrates on improving life for the adults concerned;
                • raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect;
                • provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult; and
                • then address what has caused the abuse or neglect.

                Six key principles underpin all adult safeguarding work:

                • Empowerment – people being supported and encouraged to make their own decisions and informed consent.
                • Prevention – it is better to take action before harm occurs.
                • Proportionality – the least intrusive response appropriate to the risk presented.
                • Protection – support and representation for those in greatest need.
                • Partnership – local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect & abuse.
                • Accountability – accountability and transparency in delivering safeguarding.

                Safeguarding duty: (this applies to an adult who)

                has needs for care and support (whether or not the local authority is meeting any of those needs) and;

                is experiencing, or at risk of, abuse or neglect; and

                as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

                What is abuse and / or neglect?

                The criteria set out above need to be met before the issue is considered as a concern under the statutory safeguarding duty. Exploitation is a common theme in the following list of the types of abuse and neglect.

                Physical abuse: including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

                Domestic violence: including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence.

                Sexual abuse: including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

                Psychological abuse: including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.

                Financial or material abuse: including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

                Modern slavery: encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

                Discriminatory abuse: including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion (including Hate Crimes).

                Organisational abuse: including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

                Neglect and acts of omission: including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

                Self-neglect: this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

                The statutory functions of Safeguarding Adults Boards

                As set out in Care and Support Statutory Guidance, issued by the Department of Health and Social Care, each Safeguarding Adults Board should:

                • identify the role, responsibility, authority and accountability with regard to the action each agency and professional group should take to ensure the protection of adults;
                • establish ways of analysing and interrogating data on safeguarding notifications that increase the SAB’s understanding of prevalence of abuse and neglect locally that builds up a picture over time;
                • establish how it will hold partners to account and gain assurance of the effectiveness of its arrangements;
                • determine its arrangements for peer review and self-audit;
                • establish mechanisms for developing policies and strategies for protecting adults which should be formulated, not only in collaboration and consultation with all relevant agencies but also take account of the views of adults who have needs for care and support, their families, advocates and carer representatives;
                • develop preventative strategies that aim to reduce instances of abuse and neglect in its area;
                • identify types of circumstances giving grounds for concern and when they should be considered as a referral to the local authority as an enquiry;
                • formulate guidance about the arrangements for managing adult safeguarding, and dealing with complaints, grievances and professional and administrative malpractice in relation to safeguarding adults (which includes whistleblowing: see 5.4.3 to 5.4.7 of the London Multi-Agency Adult Safeguarding Policy and Procedures);
                • develop strategies to deal with the impact of issues of race, ethnicity, religion, gender and gender orientation, sexual orientation, age, disadvantage and disability on abuse and neglect;
                • balance the requirements of confidentiality with the consideration that, to protect adults, it may be necessary to share information on a ‘need-to-know basis’;
                • identify mechanisms for monitoring and reviewing the implementation and impact of policy and training;
                • carry out Safeguarding Adult Reviews;
                • produce a Strategic Plan and an Annual Report;
                • evidence how SAB members have challenged one another and held other boards to account; and,
                • promote multi-agency training and consider any specialist training that may be required; including considering any scope to jointly commission some training with other partnerships, such as the Lewisham Safeguarding Children’s Partnership Board.

                The Strategic Business Plan for 2020-21 sets out how the LSAB partner agencies will collectively prioritise and deliver these functions over the next 12 months.

                Lewisham Safeguarding Adults Board (LSAB) Terms of Reference

                The LSAB works to prevent harm or neglect and to help those harmed by leading on and facilitating the following safeguarding adult activities for the borough:

                Strategic planning: activities such as consultation, setting goals and objectives, action planning and prioritisation, securing resources, tracking and review of implementation and goal achievement for safeguarding strategy. In addition the LSAB will influence and link to strategic planning and commissioning across the partnership to advise and scrutinise in relation to safeguarding adults.

                Setting standards and guidance: activities such as setting standards to be achieved, developing policies and procedural guidance to guide practice towards those standards. Monitoring and auditing the implementation of these policies and procedures.

                Quality assurance: lead and ensure activities such as monitoring, audit and review of practice, review of serious cases, incorporation of research and national guidance are undertaken as required. Conducting audits to ensure the effectiveness of what is done by agencies individually and collectively to safeguard and promote the welfare of adults at risk. Commissioning Safeguarding Adult Reviews and / or other reviews of incidents or organisations when an adult dies or is seriously harmed and abuse or neglect is suspected or proven.

                Promoting participation: by people who use services and carers in safeguarding practice. Promoting awareness and action in the wider community.

                Awareness raising & publicity: activities such as public awareness campaigns, targeted publicity and educational strategies, raising awareness within services.

                Capacity building and training: activities such as training and workforce development.

                Relationship management: activities such as the negotiation and clarification of interagency roles and contributions, member agency compliance, troubleshooting and resolution of difficulties, liaison with wider partnerships and related areas of practice. In addition, undertake work as appropriate with the Lewisham Safeguarding Children’s Partnership Board, Safer Lewisham Partnership and Lewisham Health and Wellbeing Board to ensure that policy and procedures, training and all other activities are co-ordinated and coherent.

                Care and Support Statutory Guidance

                Members of a SAB are expected to consider what assistance they can provide in supporting the Board in its work. This might be through payment to the local authority or to a joint fund established by the local authority to provide, for example, secretariat functions for the Board. Members might also support the work of the SAB by providing administrative help, premises for meetings or holding training sessions. It is in all core partners’ interests to have an effective SAB that is resourced adequately to carry out its functions.

                Members who attend in a professional and managerial capacity should be:

                •  able to present issues clearly in writing and in person;
                •  experienced in the work of their organisation;
                •  knowledgeable about the local area and population;
                •  have a thorough understanding of abuse and neglect and its impact;
                •  understand the pressures facing front line practitioners;
                •  able to explain their organisation’s priorities;
                •  able to promote the aims of the SAB; and,
                •  able to commit their organisation to agreed actions*.

                * While board members representing their organisations are expected to have the authority to commit their organisation to agreed actions, those board members representing Sub-Groups or non-service provider organisations may not have the relevant authority. In their case their role is to liaise between the Board and the Sub-Group and take back to their own organisations any proposals or recommendations for action.

                Each member of SAB must co-operate and contribute to the carrying out of a Safeguarding Adults Review (SAR) with a view to:

                a) identifying lessons to be learnt from the adult’s case, and

                b) applying those lessons to future cases.

                The responsibilities of members of the LSAB

                The Lewisham Safeguarding Adults Board has an Independent Chair and Deputy Chair from one of the Board’s partner agencies.

                The LSAB expects board members to:

                • develop and maintain effective working arrangements based on trust and mutual understanding;

                • be an active partner in safeguarding and promoting the welfare of adults at risk of harm or neglect;

                • contribute to the LSAB financially or by providing staff for particular tasks;

                • collate and provide management information as required by the LSAB and contribute to quality assurance arrangements;

                • share information to safeguard adults in line with agreed information sharing arrangements;

                • commit to the work of the Board by undertaking allocated tasks or sourcing the appropriate support from within their agency to undertake the work and contributing to discussions;

                • identify and support staff to participate in the interagency activities of the LSAB through their active membership of the Sub-Groups and / or Task & Finish Groups, and to progress of the work of the Board between meetings;

                • ensure that the policies, procedures and guidance from the LSAB are disseminated and acted upon in an effective way within their own organisations;

                • ensure that communications are cascaded through organisations, services and to front-line staff as appropriate;

                • represent the LSAB and its activities within their own organisation and within any groups they represent on the Board;

                • report difficulties with own organisation and between organisations to the LSAB and work with partners to find effective solutions.

                Organisations represented on the LSAB

                • Healthwatch Lewisham

                • Lewisham & Greenwich NHS Trust

                • Lewisham Adult Social Care

                • Lewisham Children & Young People’s services

                • Lewisham Safeguarding Children’s Partnership Board

                • Lewisham Homes

                • Lewisham Joint Commissioning Group

                • Lewisham Public Health

                • Lewisham Public Protection and Safety

                • Lewisham Strategic Housing Services

                • London Ambulance Services

                • London Community Rehabilitation Company

                • London Fire Brigade

                • Metropolitan Police Lewisham

                • National Probation Service, Lewisham and Southwark

                • NHS Lewisham Clinical Commissioning Group

                • South London & Maudsley NHS Foundation trust

                • Department for Work and Pensions

                There will also be representatives from partner agencies on Sub-Groups.

                Governance and accountability

                The LSAB is responsible for ensuring organisations are meeting their safeguarding obligations effectively, and will hold them to account if they are not.

                As individuals, Board members are accountable to their own agencies but the Board as a whole will be accountable to the Department of Health and Social Care, and provides reports locally to the Health and Wellbeing Board and the Healthier Communities Select Committee. Its work may be scrutinised periodically by the Overview and Scrutiny Committee and is liable to be inspected at any time by the Care Quality Commission (CQC).

                The Board, through the independent chair, is accountable to the Chief Executive of the Local Authority, the Chief Executive of the CCG and the Borough Commander of Police.

                These Executive Group of agencies may periodically meet to discuss the strategic direction of the Board, and additionally invite the London Fire Brigade Borough Commander, Chief Executive of Lewisham & Greenwich NHS Trust, and Chief Executive of the South London & Maudsley NHS Foundation Trust to join this group.

                Equality and fairness

                The LSAB operates on the basis of principles which actively value the benefits of diversity and which ensure fair treatment in service delivery. This will include both equal access to and outcomes from local service delivery.

                The LSAB will seek, so far as it is practicable, to ensure equality of representation and participation in the local democratic process of which it is a part.

                The LSAB will, through its composition and ways of working, seek to inform, support, involve and give a voice to all sections of the local communities it serves, with particular emphasis on the inclusion of black, Asian and minority ethnic groups, faith communities and those living with a disability. It will seek to ensure an appropriate gender balance in its membership, so far as this is practicable.

                Dispute resolution between LSAB Members – escalation policy

                As far as possible any disagreements or breaches should be resolved by negotiation and discussion between those involved.

                In circumstances where the matters cannot be resolved directly between agencies, the issue should be referred to the Executive Group in writing via the Chair of the LSAB. The group will consider whether it is necessary to establish a panel consisting of no less than three members from constituent organisations, who have no direct involvement in the matter. Appropriate representation from LSAB member(s) of the agencies involved in the dispute will then be invited to attend a resolution meeting. A formal agreement to resolve the dispute will be recorded and sent to the organisations involved for reference.

                Conflicts of interest

                Whenever a representative has a conflict of interest in a matter to be decided upon, the representative concerned shall declare such interest at or before discussions begin on the matter. The Chair shall record the interest in the minutes of the meeting and that representative shall take no part in the decision making process.

                5. The operational structure of the Lewisham Safeguarding Adults Board

                The frequency of LSAB meetings

                The Board meets four times a year. Board meeting dates will be set as far in advance as possible to ensure availability of all board members.

                LSAB Sub-Groups

                LSAB work activities are designed to achieve results in the most effective and efficient ways. This may include formal Sub-Groups meeting on a planned regular basis or through smaller specific Task and Finish Groups, workshops or other consultative events. This may include electronic consultation methods.

                Each Sub-Group have their own Terms of Reference, are responsible for delivering specific LSAB Strategic Objectives, and may commission Task and Finish Groups to deliver specific pieces of work linked to these objectives. Members of these groups must understand the remit of the LSAB; that they are assisting the LSAB to meet its objectives; and have the capacity to undertake work for the Board.

                Membership of these groups will reflect a range of agencies across Lewisham. They may also include individuals with specialist knowledge or the ability to add value to achieving and implementing planned objectives.

                Members are expected to attend meetings; contribute to discussions and activities of the Sub-Group. They may be required to undertake agreed specific tasks, delivering these in a timely way, alerting the Sub-Group Chair or other identified lead officer in advance of any deadlines being missed.

                The Safeguarding Housing Forum has recently been reconstituted and is now jointly delivered and supported alongside the Lewisham Safeguarding Children’s Partnership (LSCP).

                Attendance

                Individuals identified as Board, Sub-Group and / or Task and Finish Group members are expected to regularly attend meetings. Where there is unavoidable absence, all organisations should ensure that there is a suitable substitute representative from their agency.

                Attendance records of the Board and any Sub-Groups will be reported to the Board annually.

                Administrative arrangements for the LSAB

                The draft agenda will be sent to Board Members for approval/late item requests 15 working days before the meeting. Board members will have five working days to respond. Requests to alter the agenda after this deadline will not be accepted.

                The agenda and associated papers for each Board meeting are issued no later than five working days before the meeting by the LSAB Administrator.

                Papers for the next meeting must be submitted to the LSAB Administrator at least 10 working days before the meeting. Only papers submitted before this deadline will be dealt with by the LSAB Administrator and included in the documents circulated with the agenda. Any documents missing the deadline must be circulated by the author/organisation and printed copies brought to the Board Meeting.

                Minutes of LSAB Board meetings are taken by the LSAB Administrator and circulated within 15 working days of the meeting.

                Review

                These terms of reference will be reviewed as required in response to significant change in guidance, legislation or member organisations.

                Strategic Business Plan 2020-21

                Image of LSAB vision

                Image of LSAB priorities

                Prevention Aim shape

                Objectives:

                1. Further improve public and professional awareness:

                        - review the Board’s Communication and Engagement Strategy.

                    2. Expand the Board’s Learning, Training and Development Strategy:

                        - develop Foundation Level learning.

                        - use the findings from SARs published in Lewisham to inform delivery.

                    3. Deliver the findings from the Prevention Audit, including a full review of Advocacy Services.

                Accountability aim shape

                Objectives:

                1. Implement a refreshed Adult Safeguarding Pathway including links to the delivery of an adult Multi-Agency Safeguarding Hub (MaSH), improving consistency of approach and helping remove barriers to reporting abuse.
                2. Expand data analysis to closely examine ethnicity related information.
                3. Use the information from the National SAR Analysis (August 2020) to inform audit and review processes, leading to sector led improvements.
                Partnership Aim shape

                Objectives:

                1. Develop ‘Trauma Informed’ leadership and practice.                                                                          
                2. Work towards reducing racial disparity and disproportionality: - delivering effective whole community engagement.
                3. Further embed the ‘Think Family’ approach to safeguarding, working effectively with the Local safeguarding Children Partnership, Health and Wellbeing Board and Safer Lewisham Partnership.

                Board Meeting Minutes

                On this page you can find minutes of the Lewisham Safeguarding Adults Board meetings.

                Policy and Procedures

                The introduction of the Care Act 2014 put adult safeguarding on a statutory footing for the first time, embracing the principle that the ‘person knows best’. It laid the foundation for change in the way that care and support is provided to adults, encouraging greater self-determination, so people maintain independence and have real choice.

                There is an emphasis on working with adults at risk of abuse and neglect to have greater control in their lives to both prevent abuse and neglect from happening, and to give meaningful options for dealing with it should it occur.

                For professionals who work in Care & Support settings the Care Act provides clearer guidance, and supports pathways to working in an integrated way, breaking down barriers between organisations.

                The Association of Directors of Adult Social Services (ADASS), NHS London, the Metropolitan Police, and the London Clinical Commissioning Council have produced London Multi-Agency Adult Safeguarding Policy & Procedures Lewisham Safeguarding Adults Board follows these procedures.

                New! LSAB Adult Safeguarding Single Agency Policy and Procedure Template

                This good practice template can be used and modified by any agency. The template outlines the sections that need to be inserted by the agency to include their individual procedures, details and arrangements.

                Download Single Agency Policy and Procedures Template (for use by any agency) March 2021

                Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Toolkit from the LSAB

                Read our policy and practice guidance on self-neglect and hoarding.

                Lewisham Modern Day Slavery Protocol

                London Borough of Lewisham Modern Slavery Statement 2019

                Lewisham Modern Day Slavery Protocol 2019

                Information Sharing

                Adult Safeguarding: Sharing Information

                Sharing the right information, at the right time, with the right people, is fundamental to good practice in safeguarding adults.

                Frontline professionals and volunteers should always report safeguarding concerns in line with their organisation’s policy. Policies should be clear about how confidential information should be shared between departments in the same organisation.

                For Safeguarding purposes sensitive or personal information sometimes needs to be shared between the Local Authority and its safeguarding partners (including GP’s, health, the police, service providers, housing, regulators and the Office of the Public Guardian). This may include information about individuals who are at risk, service providers or those who may pose a risk to others. It aims to enable partners to share information appropriately and lawfully in order to improve the speed and quality of safeguarding responses.

                The Care Act emphasises the need to empower people, to balance choice and control for individuals against preventing harm and reducing risk, and to respond proportionately to safeguarding concerns. The Act deals with the role of the safeguarding adults board’s (SAB’s) in sharing strategic information to improve local safeguarding practice. Section 45 ‘the supply of information’ covers the responsibilities of others to comply with requests for information from the safeguarding adults board.

                Sharing information between organisations as part of day-to-day safeguarding practice is already covered in the common law duty of confidentiality, The EU General Data Protection Regulation (GDPR) the Data Protection Act, the Human Rights Act and the Crime and Disorder Act. The Mental Capacity Act is also relevant as all those coming into contact with adults with care and support needs should be able to assess whether someone has the mental capacity to make a decision concerning risk, safety or sharing information.

                It remains the responsibility of organisations and the professionals they employ to ensure that they have a basis for processing that meets common law requirements and the requirements of the GDPR; and for public bodies that they are acting within their powers.

                 

                Download the 7 Golden Rules Poster

                  Why do we need to share adult safeguarding information?

                  Organisations need to share safeguarding information with the right people at the right time to:

                  • Prevent death or serious harm,
                  • Co-ordinate effective and efficient responses,
                  • Enable early interventions to prevent the escalation of risk,
                  • Prevent abuse and harm that may increase the need for care and support,
                  • Maintain and improve good practice in safeguarding adults,
                  • Reveal patterns of abuse that were previously undetected and that could identify others at risk of abuse,
                  • Identify low-level concerns that may reveal people at risk of abuse,
                  • Help people to access the right kind of support to reduce risk and promote wellbeing,
                  • Help identify people who may pose a risk to others and, where possible, work to reduce offending behaviour,
                  • Reduce organisational risk and protect reputation.

                  False perceptions about needing consent to share safeguarding information

                  Some frontline professionals and their managers can be over-cautious about sharing personal information, particularly if it is against the wishes of the individual concerned. They may also be mistaken about needing consent to share safeguarding information. The risk of sharing information is often perceived as higher than it actually is. It is important that professionals consider the risks of not sharing safeguarding information when making decisions and that these decisions are recorded.

                  How to address false perceptions

                  • Raise awareness about responsibilities to share information (profession or work role-specific guidance may help),
                  • Encourage consideration of the risks of not sharing information,
                  • Brief staff and volunteers on the basic principles of confidentiality the EU General Data Protection Regulation and data protection,
                  • Improve understanding of the Mental Capacity Act,
                  • Provide a contact number for staff and volunteers to raise concerns,
                  • Be clear in procedures about when to raise a safeguarding concern,
                  • Assure staff and volunteers that they do not necessarily need to have evidence to raise a concern.

                  Complex networks between safeguarding partner agencies

                  The local authority has the lead responsibility for safeguarding adults with care and support needs, and the police and the NHS also have clear safeguarding duties under the Care Act 2014. Clinical commissioning groups and the police will often have different geographical boundaries and different IT systems. Housing and social care providers will also provide services across boundaries.

                  The Care Act 2014 (Section 6 [7]) places duties on the local authority and its partners to cooperate in the exercise of their functions relevant to care and support including those to protect adults. The safeguarding adults board should ensure that it ‘has the involvement of all partners necessary to effectively carry out its duties’.

                  Below is a simple flowchart of the key principles for information sharing. You can also download this flowchart.

                    Sharing information to prevent abuse and neglect

                    Sharing information between organisations about known or suspected risks may help to prevent abuse taking place. The safeguarding adults board has a key role to play in sharing information and intelligence on both local and national threats and risks. The board’s annual report must provide information about any safeguarding adults reviews. This can include learning to inform future prevention strategies. Designated adult safeguarding managers ‘should also have a role in highlighting the extent to which their own organisation prevents abuse and neglect taking place’.

                    What if a person does not want you to share their information?

                    Frontline workers and volunteers should always share safeguarding concerns in line with their organisation’s policy, usually with their line manager or safeguarding lead in the first instance, except in emergency situations. As long as it does not increase the risk to the individual, the member of staff should explain to them that it is their duty to share their concern with their manager. The safeguarding principle of proportionality should underpin decisions about sharing information without consent, and decisions should be on a case-by-case basis.

                    Individuals may not give their consent to the sharing of safeguarding information for a number of reasons. For example, they may be frightened of reprisals, they may fear losing control, they may not trust social services or other partners or they may fear that their relationship with the abuser will be damaged.

                    If a person refuses intervention to support them with a safeguarding concern, or requests that information about them is not shared with other safeguarding partners, their wishes should be respected. However, there are a number of circumstances where the practitioner can reasonably override such a decision, including:

                    • You have a lawful basis for sharing without consent under the GDPR & Data Protection Act 2018,
                    • The individual lacks the mental capacity to make that decision – this must be properly explored and recorded in line with the Mental Capacity Act,
                    • Other people are, or may be, at risk, including children sharing the information could prevent a crime,
                    • The alleged abuser has care and support needs and may also be at risk,
                    • A serious crime has been committed staff are implicated,
                    • The person has the mental capacity to make that decision but they may be under duress or being coerced,
                    • The risk is unreasonably high and meets the criteria for a multi-agency risk assessment conference referral,
                    • You have a legal obligation.

                    If none of the above apply and the decision is not to share safeguarding information with other safeguarding partners, or not to intervene to safeguard the person:

                    • Support the person to weigh up the risks and benefits of different options,
                    • Ensure they are aware of the level of risk and possible outcomes,
                    • Agree on and record the level of risk the person is taking,
                    • Offer to arrange for them to have an advocate or peer supporter,
                    • Offer support for them to build confidence and self-esteem if necessary,
                    • Record the reasons for not intervening or sharing information,
                    • Regularly review the situation,
                    • Try to build trust and use gentle persuasion to enable the person to better protect themselves.

                    If it is necessary to share information outside the organisation:

                    • Explore the reasons for the person’s objections – what are they worried about?
                    • Explain the concern and why you think it is important to share the information,
                    • Tell the person who you would like to share the information with and why,
                    • Explain the benefits, to them or others, of sharing information – could they access better help and support?
                    • Discuss the consequences of not sharing the information – could someone come to harm?
                    • Reassure them that the information will not be shared with anyone who does not need to know,
                    • Reassure them that they are not alone and that support is available to them.

                    If the person cannot be persuaded to give their consent then, unless it is considered dangerous to do so, it should be explained to them that the information will be shared without consent. The reasons should be given and recorded.

                    It is very important that the risk of sharing information is also considered. In some cases, such as domestic violence or hate crime, it is possible that sharing information could increase the risk to the individual. Safeguarding partners need to work jointly to provide advice, support and protection to the individual in order to minimise the possibility of worsening the relationship or triggering retribution from the abuser.

                    What if a safeguarding partner is reluctant to share information?

                    There are only a limited number of circumstances where it would be acceptable not to share information pertinent to safeguarding with relevant safeguarding partners. Safeguarding adults boards set clear policies for dealing with conflict on information sharing. If there is continued reluctance from one partner to share information on a safeguarding concern the matter would be referred to the board. It can then consider whether the concern warrants a request, under Clause 45 of the Care Act, for the ‘supply of information. Then the reluctant party would only have grounds for refusal if it would be ‘incompatible with their own duties or have an adverse effect on the exercise of their functions’.

                    Useful Links

                    On this page we have listed links to organisations that we think you will find helpful

                    Age UK Lewisham & Southwark

                    British Medical Association

                    Care Act Factsheets from GOV.UK

                    Care Quality Commission Safeguarding People

                    Carers Trust

                    Community Connections

                    Crimestoppers UK

                    Department of Health and Social Care

                    Disclosure and Barring Service

                    Gangmasters and Labour Abuse Authority

                    General Medical Council

                    Get Safe Online

                    Health & Care Professionals Council

                    Hourglass - Safer Ageing

                    Housing and Safeguarding Adults Alliance

                    IAPT (Improving Access to Psychological Therapies) - NHS

                    Independent Age - Advice and support for older age

                    Iranian and Kurdish Women’s Rights Organisation

                    Jargon Buster

                    Lewisham Council - Adult Social Care

                    Lewisham Council Public Safety

                    Lewisham Wellbeing Map

                    Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) Safeguarding Network

                    Mayors Office for Policing and Crime

                    Metropolitan Police Lewisham Central

                    Ministry of Justice

                    Neighbourhood and Home Watch Network

                    NHS Digital

                    No Recourse to Public Funds Network

                    Office of the Public Guardian

                    Patient - Safeguarding Information

                    Revenge p*rn helpline

                    Safety Net

                    Skills for Care

                    Social Care Institute for Excellence

                    Social Care Institute for Excellence - Safeguarding

                    Survivors UK - Male Rape & Sexual Abuse

                    Victims Choice

                    Victim Support

                    The LGA and the Association of Directors of Adult Social Services (ADASS) Safeguarding Network have worked with key partners to bring together a consolidated list of key safeguarding resources for council, care provider and wider partners' staff.

                    Training

                    Safeguarding Adults Training

                    All of our Safeguarding Adults Courses are available to Private, Voluntary and Independent organisations and commissioned care providers in Lewisham.

                    Subscribe to our E-Bulletin to be among the first to find out about the Adult Safeguarding Training we offer. 

                    Online Adult Safeguarding Foundation Level Training Sessions

                    The aim of these online sessions is to provide an introduction to adult safeguarding by outlining the legal framework, definitions and principles that are used, and by explaining the content of the Lewisham Adult Safeguarding Pathway which includes key local and national resources. This is for new staff or volunteers, or for those needing a refresher on this subject. This is led by Martin Crow LSAB Business Manager.

                    17 November 2021 - 12.45-16.00 - Book Your Place

                    Image of Online Adult Safeguarding Foundation Level Training Sessions Poster

                    13 December 2021 - 12.45-16.00 - Book Your Place

                    Image of Online Adult Safeguarding Foundation Level Training Sessions Poster

                    26 January 2022 - 12.45-16.00 - Book Your Place

                    Image of Online Adult Safeguarding Foundation Level Training Sessions Poster

                    16 March 2022 - 12.45-16.00 - Book Your Place

                    Image of Online Adult Safeguarding Foundation Level Training Sessions Poster

                    National Adult Safeguarding Awareness Week – 15 to 19 November 2021

                    Lewisham Safeguarding Adults Week 2021

                    Lewisham Training Programme

                    15 November Learning from local and national Safeguarding Adult Reviews - Webinar

                    16 November Sexual Abuse – Awareness and development session in conjunction with Lewisham Violence Against Women & Girls Forum - Webinar

                    17 November Adult Safeguarding Foundation Level Training Session - Webinar

                    18 November Networking and Safeguarding Champions Event - Islamic Centre Lewisham

                    19 November Financial Abuse – Awareness of local issues and Achieving Best Evidence for Enquiry Officers - Webinar

                    All of these sessions will be delivered between 12.30pm and 4.30pm.

                    A Week of Safeguarding Adults Awareness Raising Sessions Across Southeast London

                    Programme of Events

                    Please note: All of our online training is held on the Microsoft Teams platform.

                    Lewisham Domestic Abuse and Violence Online Summit

                    Lewisham Domestic Abuse and Violence Online "Summit"

                    Thursday 9 December 10am - 2pm

                    The Lewisham Safeguarding Adults Board, Lewisham Safeguarding Children Partnership and the Safer Lewisham Partnership Board, in consultation with the Lewisham Violence Against Women and Girls (VAWG) Forum would like to invite all professionals working in Lewisham with children, young adults and adults to attend the Lewisham Domestic Abuse and Violence Summit.

                    Aim of the Summit

                    The overall aims of the event are to assess how well agencies are responding to the significant challenges posed in the Borough linked to this subject, formally launch the new Lewisham Domestic Abuse and Violence against Women and Girls Strategy 2021-26, and in doing so, help professionals to prevent domestic abuse and violence.

                    Summary

                    A common thread throughout the event will be to reflect on the impact of COVID-19, and how this public health crisis has further highlighted the risks being faced by domestic abuse and violence victims/ survivors.

                    The Summit has been planned to coincide with the 16 days of Activism Against Gender Based Violence which is a campaign that commences on the 25 November each year (the International Day for the Elimination of Violence against Women – also known as White Ribbon Day).

                    Objectives

                    • By the end of the event delegates will have fully completed a self-assessment (sent pre-event) of their team/function or agencies effectiveness in responding effectively to VAWG, reducing harm, and preventing domestic abuse and violence.
                    • By the end of the event delegates will have completed an initial action plan to address any gaps that have been identified, and establish ways in which they can help to more broadly address the strategic issues in the Borough.
                    • By the end of the event delegates will also better understand and feel informed to help ‘change the narrative’ in Lewisham, so that all relevant agencies and professionals take a trauma informed approach and focus equally on:

                         The Child - The Victim & The Perpetrator.

                    If you wish to register for this event please cut and paste this link into Google: Register

                     

                    e-learning

                    There are lots of benefits to e-learning including personalised learning and you are not bound by geography or time.

                    NHS – HEALTH EDUCATION ENGLAND

                    Coronavirus - e-Learning for Healthcare

                    The programme is freely available to all colleagues working in the NHS, independent sector and social care.

                    The programme contains e-learning courses relating to the prevention and treatment relating to the Coronavirus pandemic. In addition, useful links are included to other sources of information from the NHS and the UK Government.

                    https://www.e-lfh.org.uk/programmes/coronavirus/

                    Skills for Health

                    Coronavirus (COVID-19) Awareness course

                    This free COVID-19 resource is delivered by Skills for Health, the UK’s leading provider of online learning for healthcare.

                    The resource is approximately 2 hours in duration and includes information such as infection prevention, PPE, hand and respiratory hygiene, management and assessment, sampling and testing, patient transfers/managing patients and much more, to support you in your role.

                    The resource is designed to support our public sector workforce to continue delivering the best possible service during these unprecedented times.

                    https://www.skillsforhealth.org.uk/covid-19-coursehttps://www.skillsforhealth.org.uk/covid-19-course

                    The Royal Society of Medicine

                    E-Learning Hub

                    The COVID-19 learning hub has been created to support healthcare professionals with access to education and learning resources during the COVID-19 outbreak. Resources include links to access past COVID-19 Series webinars, recommended guidance, specialty training, a round-up of current clinical trials and references from the RSM Library.

                    https://www.rsm.ac.uk/resources/covid-19-learning-hub/

                    COVID-19 Webinar Series - For health professionals, by health professionals.

                    This webinar series is dedicated to give healthcare workers on the frontlines, regular and easy-to-access updates from healthcare leaders on COVID-19.

                    Chaired by leading experts, these webinars will discuss different topics and challenges that healthcare workers, leaders and the public are facing, and how we are responding.

                    All COVID-19 Series webinars are free to watch on Zoom.

                    https://www.rsm.ac.uk/resources/rsm-live/

                     

                    Coronavirus (COVID-19)

                    Latest updates, advice and information for pharmacy

                    https://www.rpharms.com/coronavirus

                    Royal College of General Practitioners

                    COVID-19 Resource Hub

                    The COVID-19 Resource Hub has been created to support GPs in understanding and managing this pandemic, with topics ranging from diagnosis to keeping your practice safe. The hub is updated daily with the latest developments and guidance.

                    https://elearning.rcgp.org.uk/course/view.php?id=373#

                    Prevent Home Office awareness E-Learning

                    The Prevent awareness eLearning has recently been refreshed. This includes updates to reflect the recommendations from the Parsons Green review, updated information following the change in threat and recent attacks, and new case studies. A link to the training is below. 

                    http://www.elearning.prevent.homeoffice.gov.uk

                    Prevent Referrals E-Learning

                    https://www.elearning.prevent.homeoffice.gov.uk/preventreferrals

                    National Trading Standards

                    This resource has been designed to assist professionals and practitioners who will be interacting with victims of scams, this includes but is not limited to; social workers, community nurses, volunteers and befrienders. The E-Learning will give you an understanding of the scale of the problem of scams, an insight into the behaviour of the criminals behind scams, an understanding of the legislation that can be used to support scam victims and to prosecute criminals behind scams, and practical advice on how best to support a victim of scams.

                    Practitioner E-Learning Course

                    SCIE Courses

                    Adult safeguarding is about looking out for the people around us and protecting them from harm. Anyone can find themselves in a difficult situation where there is a possibility that they might be harmed, but when the situation involves someone who needs extra support – known as 'an adult with safeguarding needs’ – the situation becomes critical.

                    The resource explores the following questions:

                    • What is 'adult safeguarding’ and how does it affect each and every one of us?
                    • How do I recognise the signs and symptoms of abuse?
                    • What can I do if I suspect that someone is being harmed?
                    • What should I do if I believe someone is being harmed but the person asks me to keep the information confidential and take no action?
                    • What can I do to make it much less likely that a person might be harmed?
                    • How do I ensure that adult safeguarding is managed correctly in the context of the Mental Capacity Act 2005

                    www.scie.org.uk

                    Better Care Fund guidance - SCIE

                    Better Care Fund - Delivering integrated care webinars and resources

                    A series of webinars from Social Care Institute of Excellence were held in April and May 2017. These were based on the Delivering integrated care masterclasses they held across England in February and March 2017.

                    Each webinar included:

                    • a short presentation by a subject expert

                    • examples and case studies from across the country

                    • Q&A session where you can post your own questions and comments to the speakers, and to other participants.

                    If you missed the opportunity to join the webinars and masterclasses you still have the opportunity to access recordings of the webinars.

                    Zero Suicide Alliance

                    Zero Suicide Alliance provide a range of awareness training options, which provide a better understanding of the signs to look out for and the skills required to approach someone who is struggling, whether that be through social isolation or suicidal thoughts. 

                    Carers UK Professionals e-learning

                    www.carersuk.org

                    Home Office PREVENT e-learning

                    The Home Office have produced introductory e-learning training on PREVENT.

                    The training offers an introduction to the Prevent duty, and explains how it aims to safeguard vulnerable people from being radicalised to supporting terrorism or becoming terrorists themselves.

                    The training provides an important foundation on which to develop further knowledge around the risks of radicalisation and the role that you can play in supporting those at risk.

                    This training addresses all forms of terrorism and non-violent extremism, including far right wing and Islamist extremism threatening the UK.

                    This learning package uses an interactive mix of video, paper, and screen based exercises.

                    Workshop to Raise Awareness of Prevent (WRAP)

                    In addition to the e-leaning provided by the Home Office above Lewisham Safeguarding Adults Board offers a joint workshop with Lewisham Safeguarding Children Board to raise awareness of prevent.

                    Find out more about this workshop and book your place.

                    Channel General Awareness

                    Channel General Awareness e-learning provides information on Channel and what your duties and responsibilities are.

                    Who Cares UK

                    Everyone who commissions or provides regulated health and social care services that are publicly arranged and/or funded is legally bound to comply with the Human Rights Act 1998. This means that these organisations must act in ways which respect and protect the human rights of service users, such as the right to life or the right to private and family life.
                     
                    Video-based training modules have been developed by Who Cares UK with funding from the Equality and Human Rights Commission to create a better understanding among those working in health and social care of the human rights of people with various disabilities.
                     
                    The modules are aimed at frontline health and social care staff but may also benefit anyone working with disabled people in a paid or unpaid capacity.
                     

                     

                    Training and Media Resources

                    Here you will find Training and Media Resources.

                    Katie Scott (Barrister, 39 Essex Chambers) - Fluctuating Capacity         

                    Presentation Slides

                     

                    Lynne Phair (Lynne Phair Consultants) – Rights Based Risk Assessment                       

                    Presentation Slides

                     

                    Geeta Subramaniam (London Borough of Lewisham) – Unconscious Bias          

                    Presentation Slides

                     

                    Louisa Snow (999 Club) – Safeguarding Homeless People       

                     Presentation slides

                     

                    Workshop Facilitators  

                    Katie London (Refuge Lewisham) – Domestic Abuse and Safeguarding

                     Presentation slides

                    Sherrie Hoare and Indra McFarlane(Change, Grow, Live) – Drug and Alcohol Awareness

                     Presentation slides

                        

                    The Conference was an invaluable opportunity to continue our journey, cementing our partnership networks and developing our understanding of how to prevent and respond to abuse.

                    LSAB would like to thank everyone who attended and contributed to the conference.

                    Networking & Safeguarding Champions Events: Resources

                    Please find below the resources from the Networking and Safeguarding Champions Events held by LSAB.

                    Guide to common safeguarding words and phrases

                    Sometimes the language used regarding safeguarding can be confusing and difficult to understand. Here we have given you simple explanations to common safeguarding words and phrases.

                    Abuse

                    Abuse is the breaching of someone’s human and civil rights by another person or people. It may be a repeated or single act; it can be unintentional or deliberate and can take place in any relationship or setting. It includes: physical harm, sexual abuse, emotional and psychological harm, neglect, financial or material abuse, and harm caused by poor care or practice or both in institutions such as care homes. It may result in significant harm to, or exploitation of, the person being abused.

                    Adult at risk

                    Anyone aged 18 years or over who may be unable to take care of themselves due to age-related frailty, visual or hearing impairment, severe physical disability, learning disability, mental health problem, substance misuse or because they are providing care for someone else and therefore may be at risk of harm and serious exploitation.

                    Concern (safeguarding adult)

                    A concern is when the local authority is first told that an adult at risk may have been abused, is being abused, or might become a victim of abuse. Anyone can raise an alert: professionals, family members, adults at risk and members of the public. Often an alert is raised because of a feeling of anxiety or worry for an adult at risk. This feeling can arise because the adult at risk has told you what they are experiencing, you have seen abuse or something risky happening, or you have seen other signs and symptoms such as bruises.

                    Alleged perpetrator(s) or Person/ organisation alleged to have caused harm or risk

                    Anyone who has been accused of abusing or neglecting an adult at risk, where this has not yet been proved.

                    Alleged victim(s)

                    Adult at risk, who may have been abused, harmed or neglected by someone else, where it has not yet been proved that they are a victim.

                    Clinical Commissioning Group (CCG)

                    A governing body of local GPs who plan and buy local health and care services that local communities need, including: urgent and emergency care; most community health services; and mental health and learning disability services.

                    Commissioners

                    People who purchase services, often from voluntary and independent sector organisations, to provide health and care services.

                    Care Quality Commission (CQC)

                    Independent regulator of health and care services in England. CQC inspects providers such as hospitals, dentists and care homes to ensure the care they provide meets government quality and safety standards.

                    Deprivation of Liberty Safeguards (DoLS)

                    Rules that ensure special protection is given to people who cannot make a decision (‘lack capacity’) to consent to care or treatment (or both) that will be given in a care home or hospital and stops them doing what they want to do (‘deprives them of their liberty’). The hospital or care home has to get special permission to give the care or treatment and must make decisions that are in the person’s ‘best interests’.

                    Health and Wellbeing Board

                    Forums that bring together key health and social care leaders to work in a more joined-up way to reduce health inequality and improve local wellbeing. They will listen to local community needs, agree priorities and encourage health and social care commissioners to work better together to meet local needs.

                    Healthwatch

                    Healthwatch is the independent consumer champion created to gather and represent the views of the public. Healthwatch plays a role at both national and local level and makes sure that the views of the public and people who use services are taken into account.

                    Mental Capacity Act (MCA 2005)

                    A law that supports and protects people who may be unable to make some decisions for themselves (people who ‘lack capacity’) because of a physical or mental disability or ill-health. It includes a test professionals can perform to tell whether someone can make decisions or not. It covers how to act and make decisions on behalf of people who ‘lack capacity’. It is often used for decisions about health care, where to live and what to do with money.

                    Partner agencies

                    Organisations that are members of the Safeguarding Adults Board.

                    Safeguarding adults

                    All work that enables adults at risk to retain independence, wellbeing, choice and to stay safe from abuse and neglect.

                    Safeguarding Adults Review

                    An SAB must arrange a Safeguarding Adults Review (SAR) when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult. SABs must also arrange an SAR if an adult has not died but the SAB knows or suspects that the adult has experienced serious abuse or neglect.

                    Safeguarding Enquiry

                    An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place.

                    Service providers

                    Organisations that deliver health and/or social care services.

                    Service user

                    A person who is a customer or user of a service particularly used in relation to those using social care services.

                    Unpaid carer

                    Family, friends or neighbours who provide unpaid support and care to another person. This does not include those providing care and support as a paid member of staff or as a volunteer.

                    Friends Against Scams - National Trading Standards

                    Scams affect the lives of millions of people across the UK. People who are scammed often experience shame and social isolation as a result.

                    Friends Against Scams is a National Trading Standards (NTS) Scams Team initiative, which aims to protect and prevent people from becoming victims of scams by empowering communities to "Take a Stand Against Scams".

                    Friends Against Scams has been created to tackle the lack of scams awareness by providing information about scams and those who fall victim to them. This information enables communities and organisations to understand scams, talk about scams and cascade messages throughout communities about scams prevention and protection.

                    Friends Against Scams encourages communities and organisations to take the knowledge learnt and turn it into action.

                    Anybody can join Friends Against Scams and make a difference in their own way.

                    Become a friend

                    If you would like to be a Friend Against Scams you can attend a short awareness session in person or complete the online training.

                    After this session you will be asked to start taking action to "Take a Stand Against Scams". 

                    Click here for more information.

                     

                    Other useful Information

                    Presentation on Door Stop Crime.

                    Self Neglect & Hoarding Resources

                    Here you will find the resources from the Self-neglect and Hoarding Training held by the LSAB

                    Read the LSAB Self-neglect and Hoarding Policy and Procedures.

                    Social Housing Providers

                    Social housing and safeguarding

                    All social housing providers must have appropriate safeguarding arrangements in place for tenants who have care and support needs. The Care Act 2014 requires you to support and train your staff.

                    The Social Care Centre for Excellence (SCIE) can provide tailored training on issues such as safeguarding, self-neglect and hoarding. SCIE can also update your safeguarding policies and procedures. Or you can book a place at one of their open courses.

                    Safeguarding and housing: course outline

                    Self-neglect: course outline

                    Contact SCIE

                    See our Training section for information on free e-learning, courses available in Lewisham and other learning opportunities.

                    Adult Safeguarding for Housing Staff

                    SCIE has produced an introductory video on Adult Safeguarding for housing staff.

                    A guide for staff on promoting sexuality, relationships and consent in housing with care services

                    Written by Dr Adi Cooper – City & Hackney Safeguarding Adults Board

                    This guide focuses on older people, sexuality, intimacy and relationships in housing with care. It looks at non-sexual and sexual relationships and individual sexual behaviour. This is not an easy subject and each case is unique, but this guide aims to steer you through how to respond and think about situations of this nature. Just because a person is old, it does not diminish their desire for companionship, intimacy and love and yet often this basic right may be denied, ignored or stigmatised. Older people in housing with care who wish to and are capable of expressing choice, should be supported to develop or maintain any relationship of their choosing.

                    Professionals

                    Information for Professionals

                    Information for Professionals

                    The information in this section is for all staff engaged in safeguarding adults at risk. It gives practical pointers to help people assess the risk of abuse, recognise it when it does occur and respond to it appropriately. It will also help put front line safeguarding in a context of multi-agency, cross-borough work to prevent and investigate abuse across London.

                    While there are similarities between practice with children and adults at risk, there are significant differences and, to a large extent this is reflected in the definition of adults at risk which contributes to that complexity.

                    Services have a duty to safeguard all of their service users but provide additional measures for service users who are less able to protect themselves from harm or abuse.

                    ‘Safeguarding adults’ covers a spectrum of activity from prevention through to multi agency responses where harm and abuse occurs.

                    Safeguarding Resources

                    Skills for Care have collated practical and useful safeguarding resources for the Private Voluntary and Independent Sector. The information available includes recommendations, standards, guides and links to a whole host of related resources.

                    Jargon Buster

                    Think Local Act Personal have a useful Jargon Buster that can help professionals from fields other than social work understand the language that is commonly used in care and support work.

                    SLaM Crisis Assessment Team

                    Here you will find information on the SLaM Crisis Assessment Team

                    Disclosure and Barring Service

                    The Disclosure and Barring Service have produced guidance on 'Making Recruitment Easier'. 

                    Safeguarding in Care Homes Guidelines and Tools

                    NICE guideline on Safeguarding adults in care homes

                    The final guideline has now been published on the NICE website. You can also find the supporting evidence, tools and resources as well as all the stakeholder comments that were received during consultation and the responses to these comments. The comments were invaluable in helping NICE to develop and refine the guideline. They have also produced an equality impact assessment to support the guideline.

                    The recommendations from this guideline have been included in the NICE Pathway on safeguarding adults in care homes, which brings together everything which was said on safeguarding adults in care homes in an interactive flowchart. There is brief information about the guideline for people using services, carers and the public at Information for the public’.

                    If you have any further queries, please contact SafeguardingAdults@nice  

                    Modern Slavery and Human Trafficking

                    Hope for Justice - Year in Review

                    The latest worldwide estimate of the prevalence of modern slavery, according to UN agencies, respected NGOs and academics is that there are 24.9 million victims of forced labour, sexual exploitation and domestic servitude.

                    These crimes know no borders nor boundaries: modern slavery happens in the poorest parts of the world and also the richest.

                    Hope for Justice has a ‘home and abroad’ strategy, and are determined to stamp out modern slavery and human trafficking absolutely everywhere they find it.

                    Hope for Justice have now released their Year in Review 2017 - 2018.

                    Modern Slavery: Duty to notify

                    Do you know that you have a duty to notify the Home Office of potential victims of modern slavery?

                    The Modern Slavery Fact-sheet can tell you more on your duty to notify.

                    The Home Office has published new modern slavery it's closer than you think campaign resources which brings together documents and promotional material related to the awareness campaign on modern slavery which you can use in your local campaigns.

                    Identification of victims

                    The Home Office has produced Modern Slavery Victims - Guidance, Referral and Assessment Forms which gives information on how to identify and refer potential victims of modern slavery/human trafficking to the national referral mechanism.

                    What is the National Referral Mechanism?

                    The national referral mechanism (NRM) is a victim identification and support process. The NRM is designed to make it easier for all agencies that could be involved in a trafficking case (eg the police, UK Visas and Immigration, local authorities, non-governmental organisations) to share information about potential victims and facilitate their access to advice, accommodation and support.

                    The guidance document gives information including:

                    • What the NRM is
                    • The referral process
                    • How to complete the referral forms

                    Slavery and human trafficking in supply chains: guidance for businesses

                    The Home Office provides Statutory guidance for organisations on how to ensure that slavery and human trafficking is not taking place in their business or supply chains.

                    Links to further information and resources

                    Hope for Justice.org exist to bring an end to modern slavery by rescuing victims, restoring lives, and reforming society.

                    Hope for Justice have published a new Spotting the Signs of Modern Slavery poster for you to display in your organisation.

                    Hope for Justice also have comprehensive briefing documents that define human trafficking, outline the UK and global markets for the exploitation of human beings and analyse the current mechanisms for addressing this complex crime.

                    Human Trafficking Foundation (HTF) is a UK-based charity which grew out of the work of the All Party Parliamentary Group on Human Trafficking. HTF was created in order to support and add value to the work of the many charities and agencies operating to combat human trafficking in the UK.

                    Hoarding & Self-neglect

                    What is Hoarding?

                    • The acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value. (Frost and Gross, 1993)

                    And/or

                    • Living spaces are cluttered enough that they can't be used for the activities for which they were designed.  (Frost and Hartl, 1996)

                    And

                    • Where significant distress or impairment in functioning is caused by the hoarding.

                    Hoarding has been recognised as a metal health issue since Community Care published ‘Hoarding and self-neglect – what social workers need to know

                    Learning from London Safeguarding Adult Reviews

                    London SAR Task and Finish Group recently commissioned an analysis of the nature and content of 27 Safeguarding Adults reviews commissioned and completed by London Safeguarding Adults Boards since the implementation of the Care Act 2014 on 1st April 2015 up to 30th April 2017. 17 reviews were submitted to the project for analysis.

                    The purpose of the project was to consider the establishment of a repository of London SAR's. The is would allow for the development of quality markers, disseminate relevant lessons and methods to measure the impact of learning from SAR's. The repository would also hold information on reviewers and methodologies.

                    Read the report to see the results of the analysis project.

                    Hoarding and Self-Neglect Briefing from the LSAB

                    Read our briefing on hoarding and self-neglect.

                    LSAB Self-Neglect Learning Seminar

                    Thanks to all those that attended our learning seminar. As promised to you at the event here is the presentation for you. 

                    Here are links to some good background documents & briefings on hoarding and self-neglect.

                    In particular:

                    SCIE Self Neglect Managers Briefing March 2015 by Suzy Braye, David Orr and Michael Preston-Shoot

                    British Psychological Society Hoarding 2015 - A Psychological Perspective on Hoarding

                    The clutter image rating clearly illustrates the wide range of clutter in different rooms from clear to extreme.

                     

                    Self- Help to De-Hoard Your Home

                    If you feel you are hoarding in your home and would like to help yourself de-hoard below are links to advice, information and top tips on how you can achieve this.

                    http://www.helpforhoarders.co.uk/self-help/

                    http://www.helpforhoarders.co.uk/

                    New Training Resource from Safeguarding Adults in Gloucestershire

                    “Am I YOUR Job?” is a brand new trainer resource (training session plan and video) on Self-Neglect from Safeguarding Adults in Gloucestershire.

                     

                    Criminal Exploitation of vulnerable adults: County Lines & Cuckooing

                    What is cuckooing?

                    Criminal gangs target the homes of vulnerable people to be used for drug dealing – a process known as “cuckooing” after the “Cuckoo” bird that invades other bird’s nests. Victims are often left with little choice but to co-operate.

                    Drug dealers will often approach the vulnerable person offering money or free drugs to use their home for dealing. In some instances after providing free drugs, the dealers will then force the person to sell drugs for them in order to    ‘re-pay’ their drug debts.

                    These criminals are selective about who they target, a lot of the time victims are lonely, isolated, frequently drug users themselves and can already be known to the police.

                    “Cuckooing” means the drug dealers can operate from a property rather than the street, which is out of sight from the police making it a very attractive option. They can then use the premises to deal drugs from, which is difficult for the police to monitor.  

                    What to do if you suspect a property is being ‘cuckooed’?

                    Call Metropolitan Police Service on 101 or 999 in an emergency to report drug-related information.

                    If you don’t want to speak to the police directly, you can call Crimestoppers anonymously on 0800 555 111.

                    Criminal Exploitation of children and vulnerable adults: Updated County Lines Guidance

                    The government has published refreshed County Lines Guidance. The guidance is primarily aimed at frontline staff who work with children, young people and potentially vulnerable adults.

                    If you’re a professional working in social care, education, health, housing, benefits, law enforcement (police) and related partner organisations this guidance is for you.

                    Criminal exploitation of children and vulnerable adults is a geographically widespread form of harm that is a typical feature of county lines activity. It is a harm which is relatively little known about or recognised by those best placed to spot its potential victims.

                    The guidance is intended to explain the nature of this harm to enable you, the professional, to recognise its signs and respond appropriately so that potential victims get the support and help they need.

                    Like other forms of abuse and exploitation, county lines exploitation:

                    • Can affect any vulnerable adult over the age of 18 years;
                    • Can still be exploitation even if the activity appears consensual;
                    • Can involve force and/or enticement-based methods of compliance and is often accompanied by violence or threats of violence;
                    • Can be perpetrated by individuals or groups, males or females, and young people or adults; and
                    • Is typified by some form of power imbalance in favour of those perpetrating the exploitation. Whilst age may be the most obvious, this power imbalance can also be due to a range of other factors including gender, cognitive ability, physical strength, status, and access to economic or other resources.

                    As so little is known about this type of abuse the national picture on county lines continues to develop but there are recorded cases of:

                    • Both males and females being exploited;
                    • White British children and young people being targeted because gangs perceive they are more likely to evade police detection but a person of any ethnicity or nationality may be exploited;
                    • The use of social media to make initial contact with children and young people;
                    • Class A drug users being targeted so that gangs can takeover their homes (known as ‘cuckooing’).

                      What to do if you are a professional who is concerned

                      Any practitioner working with a vulnerable person who they think may be at risk of county lines exploitation should follow their local safeguarding guidance and share this information with Lewisham Council’s social care services. If you believe a person is in immediate risk of harm, you should contact the police.

                      Read the full Guidance for more detailed information on County Lines exploitation.

                      Promotional and digital resources to support your work on addressing County Lines in Lewisham.

                      For additional information on cuckooing, please see the 'Introduction to Cuckooing' presentation

                      CONTEST and the Prevent Strategy

                      What is CONTEST and the Prevent Strategy?

                      The Prevent Strategy is one of the key elements of CONTEST, the Government's counter- terrorism strategy and it aims to stop people from being drawn into terrorist-related activity. Prevent has strong links to safeguarding because vulnerable adults and children can be susceptible to radicalisation and recruitment into violent extremist and terrorist organisations.

                      CONTEST has four strands:

                      • Protect: Strengthen our protection against terrorist attack.
                      • Prepare: Mitigate the impact of an attack.
                      • Pursue: Stop a terrorist attack.
                      • Prevent: Stop people from becoming terrorists or supporting terrorism by:
                        • responding to the ideological challenge of terrorism and the threat we face from those who promote it,
                        • preventing people from being drawn into terrorism and ensuring that they are given appropriate advice and support,
                        • working with sectors and institutions where there are risks of radicalisation that we need to address.

                      What does the Prevent Duty mean for Statutory Organisations in Lewisham?

                      Since 2015, statutory agencies have a duty under the Counter Terrorism & Security Act "to have due regard to the need to prevent people from being drawn into terrorism". This means that local authorities should:

                      • Establish strategic and operational links with other specified authorities,
                      • Facilitate the assessment of risk for specified authorities, including providing advice and sharing threat assessments based on the Counter Terrorism Local Profiles (CTLP),
                      • Provide a range of training products (including but not limited to Workshops to Raise Awareness of Prevent - WRAP) to all specified authorities,
                      • Understand the full range of bodies affected by the new duties, and ensure they understand their responsibilities,
                      • Embed Prevent into commissioning, procurement, and grant funding processes,
                      • Embed Prevent into Safeguarding Policies and ensure all providers are signed up to local Safeguarding arrangements. In Lewisham, work has been taking place to ensure that all relevant agencies are complying with their obligations under the 2015 Counter Terrorism & Security Act. This includes delivering briefings, training and advice.

                      Image of London Brough of Lewisham logo

                      Lewisham Prevent Service

                      London Borough of Lewisham Prevent are available to assist agencies in complying with their Counter Terrorism Act duties. The support offer includes: 

                      • Prevent in Lewisham operates a Strategic Board
                      • Prevent Delivery Group 
                      • Multi-Agency Safeguarding Panel – Channel

                      Compliance in Lewisham

                      • The provision of Workshops to Raise Awareness of Prevent (WRAP training for frontline staff),
                      • Management briefings regarding Prevent Duty compliance,
                      • Coordination of strategic and operational groups,
                      • The provision of Prevent-related resources and dissemination of relevant information.

                      Safeguarding vulnerable people against radicalisation and extremism

                      There have been several cases where extremist groups have attempted to radicalise vulnerable adults. This can include justifying political, religious, sexist, or racist violence, or to steer individuals towards an ideology of extremism and intolerance. A vulnerable adult might be groomed and radicalised into carrying out acts of violence and cause significant harm to others.

                      There are several ways in which vulnerable adults can be at risk of radicalisation.

                      • They can be groomed either online or in person by people seeking to draw them into extremist activity.
                      • Vulnerable adults can be radicalised online via networks or online chat platforms.
                      • Grooming can also be carried out by those who hold harmful, extremist beliefs, including peer or family members who have an influence over the person's life.
                      • People can be exposed to violent, anti-social, extremist imagery and narratives which can lead to normalising intolerance of others and extremist ideology.

                      All agencies play a vital role in ensuring vulnerable adults and our communities are safe from the threat of radicalisation, extremist ideologies and terrorism.

                      If you are concerned that a vulnerable adult or other family members may hold extremist views or are at risk of being radicalised, it is important to ensure that they receive support to protect them from being drawn into terrorism.

                      Making a Referral

                      If you are are a professional or work in the voluntary sector and are worried about a vulnerable person you should follow your own organisation’s safeguarding procedures.

                      If you are a member of the public your concerns should be reported to:

                      London Borough of Lewisham Gateway
                      020 8314 7777 (Lines are open Monday to Friday from 9am to 5pm)
                      Email

                      In an emergency always dial 999.

                      If you have any questions regarding Prevent in Lewisham contact the Prevent Manager by email

                      Channel Awareness

                      This training package is for anyone who may be asked to contribute to, sit on, or even run a Channel Panel. It is aimed at all levels, from a professional required to input and attend a Channel Panel meeting for the first time, to a member of staff new to their role and organising a panel meeting. It covers an introduction to what Channel is, how it operates in the local area, and how to organise a Channel Panel for the first time. It also covers information sharing, including how, when and with whom to share information of a Channel case.

                      Public Advice

                      • If you see or hear anything that could be terrorist-related, trust your instincts and call the Anti-Terrorist Hotline on 0800 789 321.
                      • If you think you have seen a person acting suspiciously, or if you see a vehicle, unattended package or bag which might be an immediate threat, move away and call 999.
                      • If you are involved in an incident follow police advice to: 'RUN, HIDE AND TELL 
                      • Download the citizenAID App , which provides safety and medical advice from Google Play, Apple App or the Windows Store, for free.  

                      Prevent Support and Advice

                      You can contact the Prevent team directly and we will be more than happy to provide training, advice and support. However all referrals this should be done in addition to your usual safeguarding referral pathway.

                      Contact the Lewisham Prevent Team for support and information on fulfilling the duty.  

                      Lewisham Prevent Service Training

                      Prevent Referrals

                      Workshop to Raise Awareness of Prevent (WRAP)

                      Target Group:  All professionals working with vulnerable adults in the Borough of Lewisham.

                      The session is intended to:

                      • Develop an understanding of the Prevent Strategy & roles within it.
                      • Develop existing expertise and professional judgement in relation to extremism and radicalisation or recruitment to extremist groups.
                      • Increase awareness of the national / international picture of extremism and terrorism.
                      • Raise awareness of the links between online risks and radicalisation.
                      • Improve confidence to raise concerns.
                      • Raise awareness of the Channel interventions, safeguarding the individual.
                      • Increase the whole organisations capacity to prevent extremism and safeguard vulnerable people.

                      The webinars will include a presentation and Q&A session.

                      Hosted by Lewisham Prevent Team

                      The training is for anyone who has been through the Prevent awareness eLearning or a Workshop to Raise Awareness of Prevent (WRAP), and so already understands Prevent and of their role in safeguarding vulnerable people. 

                      The package shares best practice on how to articulate concerns about an individual and ensure that they are robust and considered.

                      It is aimed at anyone who may be able to notice signs of vulnerability to radicalisation and seeks to give them confidence in referring on for help if appropriate. It is also designed for those (for example line managers) who may receive referrals and need to consider how to respond, whether that be establishing more context, or reaching out to partner agencies for support.

                      The Lewisham Prevent Service offer bespoke training packages designed to meet the needs of the audience. Contact the Lewisham Prevent Service to find out more and book your training event.

                      E-Learning

                      Prevent Home Office awareness eLearning

                      The Prevent awareness eLearning has recently been refreshed. This includes updates to reflect the recommendations from the Parsons Green review, updated information following the change in threat and recent attacks, and new case studies. A link to the training is below. 

                      http://www.elearning.prevent.homeoffice.gov.uk

                      Prevent Referrals E-Learning

                      https://www.elearning.prevent.homeoffice.gov.uk/preventreferrals

                      Guidance and Further Reading

                      The Prevent Duty guidance for partners and Local Authorities

                      Information on Channel

                      Home Office guide for schools about social media and radicalisation

                      How people become radicalised

                      Carers

                      Safeguarding Information for Carers

                      Spotting signs of abuse: Information for carers

                      It's not always easy to spot the symptoms of abuse. Someone being abused may make excuses for why they're bruised, they don't want to go out or talk to people, or they're short of money.

                      It's important to know the signs of abuse and, where they are identified, gently share your concerns with the person being abused. If you wait, hoping the person will tell you what's been happening to them, you could delay matters and allow the abuse to continue. 

                      The lists of possible indicators and examples of behaviour are not exhaustive and people may be subject to a number of abuse types at the same time.

                      Physical abuse

                      Types of physical abuse

                      • Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing
                      • Rough handling
                      • Scalding and burning
                      • Physical punishments
                      • Inappropriate or unlawful use of restraint
                      • Making someone purposefully uncomfortable (e.g. opening a window and removing blankets)
                      • Involuntary isolation or confinement
                      • Misuse of medication (e.g. over-sedation)
                      • Forcible feeding or withholding food
                      • Unauthorised restraint, restricting movement (e.g. tying someone to a chair)

                      Possible indicators of physical abuse

                      • No explanation for injuries or inconsistency with the account of what happened
                      • Injuries are inconsistent with the person’s lifestyle
                      • Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps
                      • Frequent injuries
                      • Unexplained falls
                      • Subdued or changed behaviour in the presence of a particular person
                      • Signs of malnutrition
                      • Failure to seek medical treatment or frequent changes of GP

                      Domestic violence or abuse

                      Types of domestic violence or abuse

                      Domestic violence or abuse can be characterised by any of the indicators of abuse outlined relating to:

                      • Psychological
                      • Physical
                      • Sexual
                      • Financial
                      • Emotional.

                      Domestic violence and abuse includes any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called 'honour’ -based violence, female genital mutilation and forced marriage.

                      Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:

                      • Acts of assault, threats, humiliation and intimidation
                      • Harming, punishing, or frightening the person
                      • Isolating the person from sources of support
                      • Exploitation of resources or money
                      • Preventing the person from escaping abuse
                      • Regulating everyday behaviour

                      Possible indicators of domestic violence or abuse

                      • Low self-esteem
                      • Feeling that the abuse is their fault when it is not
                      • Physical evidence of violence such as bruising, cuts, broken bones
                      • Verbal abuse and humiliation in front of others
                      • Fear of outside intervention
                      • Damage to home or property
                      • Isolation – not seeing friends and family
                      • Limited access to money

                      Sexual abuse

                      Types of sexual abuse

                      • Rape, attempted rape or sexual assault
                      • Inappropriate touch anywhere
                      • Non- consensual masturbation of either or both persons
                      • Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth
                      • Any sexual activity that the person lacks the capacity to consent to
                      • Inappropriate looking, sexual teasing or innuendo or sexual harassment
                      • Sexual photography or forced use of pornography or witnessing of sexual acts
                      • Indecent exposure

                      Possible indicators of sexual abuse

                      • Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
                      • Torn, stained or bloody underclothing
                      • Bleeding, pain or itching in the genital area
                      • Unusual difficulty in walking or sitting
                      • Foreign bodies in genital or rectal openings
                      • Infections, unexplained genital discharge, or sexually transmitted diseases
                      • Pregnancy in a woman who is unable to consent to sexual intercourse
                      • The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
                      • Incontinence not related to any medical diagnosis
                      • Self-harming
                      • Poor concentration, withdrawal, sleep disturbance
                      • Excessive fear/apprehension of, or withdrawal from, relationships
                      • Fear of receiving help with personal care
                      • Reluctance to be alone with a particular person

                      Psychological or emotional abuse

                      Types of psychological or emotional abuse

                      • Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
                      • Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
                      • Preventing someone from meeting their religious and cultural needs
                      • Preventing the expression of choice and opinion
                      • Failure to respect privacy
                      • Preventing stimulation, meaningful occupation or activities
                      • Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
                      • Addressing a person in a patronising or infantilising way
                      • Threats of harm or abandonment
                      • Cyber bullying

                      Possible indicators of psychological or emotional abuse

                      • An air of silence when a particular person is present
                      • Withdrawal or change in the psychological state of the person
                      • Insomnia
                      • Low self-esteem
                      • Uncooperative and aggressive behaviour
                      • A change of appetite, weight loss/gain
                      • Signs of distress: tearfulness, anger
                      • Apparent false claims, by someone involved with the person, to attract unnecessary treatment

                      Financial or material abuse

                      Types of financial or material abuse

                      • Theft of money or possessions
                      • Fraud, scamming
                      • Preventing a person from accessing their own money, benefits or assets
                      • Employees taking a loan from a person using the service
                      • Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions
                      • Arranging less care than is needed to save money to maximise inheritance
                      • Denying assistance to manage/monitor financial affairs
                      • Denying assistance to access benefits
                      • Misuse of personal allowance in a care home
                      • Misuse of benefits or direct payments  in a family home
                      • Someone moving into a person’s home and living rent free without agreement or under duress
                      • False representation, using another person's bank account, cards or documents
                      • Exploitation of a person’s money or assets, e.g. unauthorised use of a car
                      • Misuse of a power of attorney, deputy, appointeeship or other legal authority
                      • Rogue trading – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

                      Possible indicators of financial or material abuse

                      • Missing personal possessions
                      • Unexplained lack of money or inability to maintain lifestyle
                      • Unexplained withdrawal of funds from accounts
                      • Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
                      • Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
                      • The person allocated to manage financial affairs is evasive or uncooperative
                      • The family or others show unusual interest in the assets of the person
                      • Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
                      • Recent changes in deeds or title to property
                      • Rent arrears and eviction notices
                      • A lack of clear financial accounts held by a care home or service
                      • Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person
                      • Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house
                      • Unnecessary property repairs

                      Modern slavery

                      Types of modern slavery

                      • Human trafficking
                      • Forced labour
                      • Domestic servitude
                      • Sexual exploitation, such as escort work, prostitution and pornography
                      • Debt bondage – being forced to work to pay off debts that realistically they never will be able to

                      Possible indicators of modern slavery

                      • Signs of physical or emotional abuse
                      • Appearing to be malnourished, unkempt or withdrawn
                      • Isolation from the community, seeming under the control or influence of others
                      • Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
                      • Lack of personal effects or identification documents
                      • Always wearing the same clothes
                      • Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
                      • Fear of law enforcers

                      Further Home Office information on identifying and reporting modern slavery

                      Discriminatory abuse

                      Types of discriminatory abuse

                      Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as protected characteristics’ under the Equality Act 2010)

                      • Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
                      • Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
                      • Harassment or deliberate exclusion on the grounds of a protected characteristic
                      • Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
                      • Substandard service provision relating to a protected characteristic

                      Possible indicators of discriminatory abuse

                      • The person appears withdrawn and isolated
                      • Expressions of anger, frustration, fear or anxiety
                      • The support on offer does not take account of the person’s individual needs in terms of a protected characteristic

                      Organisational or institutional abuse

                      Types of organisational or institutional abuse

                      • Discouraging visits or the involvement of relatives or friends
                      • Run-down or overcrowded establishment
                      • Authoritarian management or rigid regimes
                      • Lack of leadership and supervision
                      • Insufficient staff or high turnover resulting in poor quality care
                      • Abusive and disrespectful attitudes towards people using the service
                      • Inappropriate use of restraints
                      • Lack of respect for dignity and privacy
                      • Failure to manage residents with abusive behaviour
                      • Not providing adequate food and drink, or assistance with eating
                      • Not offering choice or promoting independence
                      • Misuse of medication
                      • Failure to provide care with dentures, spectacles or hearing aids
                      • Not taking account of individuals’ cultural, religious or ethnic needs
                      • Failure to respond to abuse appropriately
                      • Interference with personal correspondence or communication
                      • Failure to respond to complaints

                      Possible indicators of organisational or institutional abuse

                      • Lack of flexibility and choice for people using the service
                      • Inadequate staffing levels
                      • People being hungry or dehydrated
                      • Poor standards of care
                      • Lack of personal clothing and possessions and communal use of personal items
                      • Lack of adequate procedures
                      • Poor record-keeping and missing documents
                      • Absence of visitors
                      • Few social, recreational and educational activities
                      • Public discussion of personal matters
                      • Unnecessary exposure during bathing or using the toilet
                      • Absence of individual care plans
                      • Lack of management overview and support

                      Neglect and acts of omission

                      Types of neglect and acts of omission

                      • Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
                      • Providing care in a way that the person dislikes
                      • Failure to administer medication as prescribed
                      • Refusal of access to visitors
                      • Not taking account of individuals’ cultural, religious or ethnic needs
                      • Not taking account of educational, social and recreational needs
                      • Ignoring or isolating the person
                      • Preventing the person from making their own decisions
                      • Preventing access to glasses, hearing aids, dentures, etc.
                      • Failure to ensure privacy and dignity

                      Possible indicators of neglect and acts of omission

                      • Poor environment – dirty or unhygienic
                      • Poor physical condition and/or personal hygiene
                      • Pressure sores or ulcers
                      • Malnutrition or unexplained weight loss
                      • Untreated injuries and medical problems
                      • Inconsistent or reluctant contact with medical and social care organisations
                      • Accumulation of untaken medication
                      • Uncharacteristic failure to engage in social interaction
                      • Inappropriate or inadequate clothing

                      Self-neglect

                      Types of self-neglect

                      • Lack of self-care to an extent that it threatens personal health and safety
                      • Neglecting to care for one’s personal hygiene, health or surroundings
                      • Inability to avoid self-harm
                      • Failure to seek help or access services to meet health and social care needs
                      • Inability or unwillingness to manage one’s personal affairs

                      Indicators of self-neglect

                      • Very poor personal hygiene
                      • Unkempt appearance
                      • Lack of essential food, clothing or shelter
                      • Malnutrition and/or dehydration
                      • Living in squalid or unsanitary conditions
                      • Neglecting household maintenance
                      • Hoarding
                      • Collecting a large number of animals in inappropriate conditions
                      • Non-compliance with health or care services
                      • Inability or unwillingness to take medication or treat illness or injury

                      Please don't ignore your concerns, that could allow any abuse to carry on or escalate.

                      Carers who are at risk of harm/or who harm

                      The Care Act defines a carer as someone who ‘provides or intends to provide care for another adult’ (but not as a volunteer or contracted worker).

                      There are three main considerations in relation to safeguarding, domestic abuse and carers.

                      Carers may cause harm, through abuse or neglect of the person they care for, they may be caused harm by the person they care for, or they may be important observers and reporters of harm by others. Some people with care and support needs are intentionally abusive to their carers. However, others may not have capacity to choose not to be abusive; their disability may cause abusive behaviour, as in some cases involving people with dementia, support to address domestic abuse should be offered if abuse is causing a carer’s physical or mental health to deteriorate, or preventing them from caring for another adult. The carer may feel unable to leave or seek help for themselves due to fear of leaving the person they care for with the perpetrator, or fear of being unable to care for them on their own. The Local Authority has a duty to assess a carers needs for support to maintain their well-being – including protection from abuse.

                      If you are a Carer and live in Lewisham and think that you need an assessment of your needs please contact

                      Gateway

                      Tel: 020 8314 7777

                      Email:Gateway@lewisham.gov.uk

                      Opening hours:

                      Monday - Friday 9am - 5pm

                      Carers - Information and Support

                      If you help another person who needs support to live in their home then you may be a Carer. The person you care for could be mentally or physically disabled, ill or elderly and frail. They could be your parent, child, partner, relative or friend

                      Other Useful Links for Carers

                      Contacts

                      Tel: 020 8314 7777

                      Email: Gateway@lewisham.gov.uk

                      Opening hours: Monday - Friday 9am - 5pm

                      Tel: 020 8699 8686

                      Email: info@carerslewisham.org.uk

                      Professionals using too much jargon?

                      If you're finding it difficult to navigate the mind field of jargon that can often be used by professionals in the care and support occupations Think Local Act Personal have a useful Jargon Buster that can help carers understand the language that is commonly used in care and support work.

                      Carer's Briefing Paper

                      The House of Commons Library briefing paper - Carers was published on Carers Rights Day 2016, Friday 25 November 2016. It provides information about the number of carers in the UK and the issues they face. The report also explains the rights, benefits and support available to carers and Government policy on caring.

                      Lewisham Adult Safeguarding Pathway

                      Lewisham Adult Safeguarding Pathway

                      Lewisham Adult Safeguarding Pathway

                      Arrow Image

                      I welcome wholeheartedly the introduction of the Adult Safeguarding Pathway in Lewisham. Safeguarding Adult Reviews in Lewisham and nationally regularly highlight missed opportunities to refer adult Safeguarding Concerns and to conduct adult Safeguarding Enquiries. The Lewisham Pathway provides comprehensive guidance for all those working in and around adult safeguarding. It offers a framework for the prevention of abuse and neglect, including self-neglect, and for protecting individuals who have experienced and or are at risk of abuse and neglect.

                      The Pathway has been informed by, and indeed references good practice guidance that has been published by the Local Government Association in partnership with the Association of Directors of Social Services. The Lewisham Pathway therefore encapsulates the best evidence available for effective adult safeguarding. Accordingly, I hope that every agency in Lewisham will disseminate the pathway documentation as widely as possible, and add their details to the register so that the Lewisham Safeguarding Adults Board can begin to track implementation.

                      I would like to thank everyone who has contributed to the development of the Pathway. It forms such an important component of the jigsaw of policies, procedures, practice and services that are designed to keep people safe.

                      Professor Michael Preston-Shoot                                                                                                                               

                      Independent Chair                                                                                                                                                                 

                      Lewisham Safeguarding Adults Board 

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                      In this section of the website you will find all the local guidance, tools and forms you need to raise an Adult Safeguarding Concern, and for relevant practitioners to conduct an Adult Safeguarding Enquiry.

                      This supports each of the four stages outlined in the London Multi-Agency Adult Safeguarding Policy and Procedures.

                      Concerns Stage 1: Advice for Submitting an Adult Safeguarding Concern 

                      1. You need to recognise if what you are seeing or hearing is potential abuse or neglect

                      There are many forms and ways that adult abuse and neglect can occur, so we should not be constrained by definitions and terminologies. Adult abuse is also often complex involving more than one type of abuse occurring at any one time.

                      However, the most common forms of abuse are:    

                      Physical Abuse – including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

                      Domestic Abuse – including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence (the definition for Domestic Abuse will change once the Domestic Abuse Act 2021 is implemented). Domestic Abuse and Older People – Information from Safe Lives

                      Also see this free online training for Female Genital Mutilation and Forced Marriage: Virtual College

                      Sexual Abuse – including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography.

                      Psychological Abuse – including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation or blaming.

                      Financial or Material Abuse – including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements.

                      Modern Slavery – encompasses slavery, human trafficking, forced labour and domestic servitude. (A new Lewisham Modern Slavery Protocol will be published in the early summer of 2021).

                      Discriminatory Abuse – including forms of harassment, slurs or similar treatment because of race, gender and gender identity, age, disability, sexual orientation or religion.

                      Organisational Abuse – including neglect and poor care practice within and institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home.

                      Neglect and Acts of Omission – including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

                      Refer to:

                      Pressure Ulcers: Safeguarding Adults Protocol

                      Stop the Pressure: NHS Improvement

                      SEL CCG Guidance on Pressure Ulcer Management

                      Self-Neglect – this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. See: LSAB Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Hoarding Toolkit (April 2021)

                      More detailed information on this subject can be found here: Forms and Signs of Abuse

                      Please see the London Fire Brigade: Help for Hoarders - Fire Safety Tips

                      2. Talk to the adult (unless it is not safe to do so)

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                      Safeguarding Principle - Protection

                      What does this means for the professionals: Adults are offered ways to protect themselves, and there is a co-ordinated response to adult safeguarding.

                      What does this means for the adult: "I am provided with help and support to report abuse. I am supported to take part in the safeguarding process to the extent to which I want and which I am able".

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                      2.1 If the adult does not wish to report the abuse: Are they in immediate danger or risk of serious harm?

                      Has a crime been committed? If so, and the adult is in immediate danger or risk of serious harm, then this should be reported to the Police immediately. Help to keep the adult safe until the Police respond. The adult does not need to give their consent under these circumstances due to ‘vital interest’ considerations (immediate danger or risk of serious harm).

                      How to Report Your Concerns About an Adult

                      Are others, including children in immediate danger or risk of serious harm? If so, then this should be reported to Police immediately, and consideration also give to reporting this to Children’s Services. Help to keep the child safe until the Police respond. The adult(s) does not need to give their consent under these circumstances due to ‘public interest’ considerations (others, including children are in immediate danger or risk of serious harm). 

                      How to Report Your Concerns About a Child

                      Safeguarding and promoting the welfare of children and adults most at risk of abuse and neglect is a shared responsibility. The ‘Think Family’ approach should be used by all practitioners who should consider the needs of the whole family, including young carers, taking into account family circumstances and responsibilities. Existing professional relationships should be viewed as a chance to identify risk, refer to colleagues in other services, and to use targeted support to help prevent problems from escalating and therefore potentially limiting harm. Refer to the: Lewisham Think Family Protocol

                      2.2 Consider if this matter meets the Section 42 (1) criteria within the Care Act 2014 as a Safeguarding Concern: 

                      a. do I have reasonable cause to suspect that the adult has needs for care and support; and

                      b.do I have reasonable cause to suspect that the adult is at risk, or, experiencing abuse or neglect. 

                      It must be noted that the third criteria (c) under the legal duty for a Section 42 Enquiry (1) is not relevant at the Concern stage: 

                      c. as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it. 

                      SCIE: Assessment and Eligibility Outcomes (Care & Support Needs)

                      LGA/ADASS Guidance on What Constitutes a Safeguarding Concern - Sept 2020

                      If this is not a crime and these criteria appear to have been met, then speak to the adult to get their views on the Safeguarding Concern or the incident. It is always best to support the adult in reporting abuse themselves. Find out what they want to happen next. 

                      If a decision is made not to refer to the Local Authority the individual agency must make a record of the concern and any action taken. Concerns should be recorded in such a way that repeated, low level harm incidents are easily identified and subsequently referred. 

                      Not referring under safeguarding adults’ procedures does not negate the need to report internally or to regulators/commissioners as required, and if care providers are using this guidance, it is important to note that all Safeguarding Concerns must be notified to the Local Authority. 

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                      Safeguarding Principle - Empowerment

                      What does this mean for the professionals: Adults are encouraged to make their own decisions and are provided with information and support.

                      What does this mean for the adult: "I am consulted about the outcomes I want from the safeguarding process and these directly inform what happens".…………………………………………………………………………………………………………………………...............................

                      If this criteria does not appear to have been met, but you are unsure, then you must seek further advice including from the Local Authority. How to Report Your Concerns About an Adult

                      If you are certain that this criteria has not been met, then consider what other pathways, options or services could be used to help support this adult, including providing relevant information? Record your decision-making in relation to this subject in an appropriate manner.

                      3. Seek the adult’s consent to submit a Safeguarding Concern to the Local Authority

                      Seek the adult’s consent to submit the Safeguarding Concern and explain this may mean that several agencies may gain access to their personal details:     

                      • Read the The Eight Caldicott Principles (updated from seven in December 2020).
                      • Does the adult have the mental capacity to consent to the Safeguarding Concern being submitted now?
                      • Is there any possibility that the adult has/ is suffering from any type of coercion, control, threat, duress or pressure from another person(s) which may mean they refuse consent?
                      • Does mental capacity (including executive capacity) need to be assessed or reviewed? For more information read: Decision Making and Mental Capacity (NICE Guidelines)
                      • Give due regard to the adult’s views and wishes, including their desired outcomes, even if Best Interest Decisions have been made linked to the Mental Capacity Act. For more information read: Local Government Association - Making Safeguarding Personal Toolkit including on the six Safeguarding Principles.
                      • If the adult does have the mental capacity to consent to the Safeguarding Concern being submitted, but refuses, professionals must be careful that they consider how to keep the adult safe if they continue to submit the concern. This may be particularly relevant in domestic abuse cases. The adult must be informed that a Safeguarding Concern has been submitted, unless it is unsafe or impractical to do so.
                      • A Safeguarding Concern can still be submitted without the adult’s consent if ‘vital’ or ‘public’ interest considerations apply (see 2.1 above). For more information read: LGA/ADASS Guidance on What Constitutes a Safeguarding Concern - Sept 2020

                      4. Gather as much information as possible

                      Having spoken to the adult (as above) and determined their views, wishes and desired outcomes. Also gather as much information as possible from other relevant sources and documentation:

                      • Does anyone else need to be informed or involved, including the nominated safeguarding lead in your agency, before progressing to submitting a Safeguarding Concern?
                      • Are there any other internal policy or procedural requirements within your agency?
                      • If you unhappy about how your organisation is dealing with a Safeguarding Concern do you know how to escalate this, which could include the use of a Whistleblowing Policy?

                      Help to keep the adult safe until the Local Authority respond.

                      Professionals should read the London Multi-Agency Safeguarding Policy and Procedures (pages 61-66) for further information on this subject, using the checklists and good practice guidance that is provided.

                      5. Submit the Adult Safeguarding Concern 

                      • Ensure all of the relevant fields in the Safeguarding Concern Form are fully completed with as much detail as possible, and submitted correctly using the contact details outlined in the link below. The Safeguarding Concern Form is also included on the weblink below.
                      • You should receive receipt of this and be kept informed of progress.
                      • If you do not receive any feedback on progress you should follow this up with the Local Authority involving your organisational lead if required, and in exceptional circumstances this can also be escalated to the Lewisham Safeguarding Adults Board to consider.

                      How to Report Your Concerns About an Adult

                      Concerns Stage 1: Guidance for Making Decisions on Adult Safeguarding Enquiries

                      1. Purpose of this guidance

                      This guidance has been developed to assist practitioners in assessing the context, seriousness and level of risk associated with an adult Safeguarding Concern, and in doing so, help with the consistency of decision making used to cause a Safeguarding Enquiry to be conducted. It is primarily for use by lead professionals working in the Local Authority at the point of receiving an adult Safeguarding Concern; although others may also find it helpful to refer to this guidance when responding to a concern of abuse or neglect, and deciding if this should be referred to, the Local Authority. If care providers are using this guidance, it is important to note that all Safeguarding Concerns must be notified to the Local Authority.

                      The guidance is not intended to replace, but support professional judgement, and links to the section in the London Multi-Agency Safeguarding Policy and Procedures which provides the procedural detail in relation to Safeguarding Enquiries (pages 66-78).

                      2. Legal definitions

                      The Care Act 2014 statutory guidance and Section 42 (1) criteria states that the Local Authority must make enquiries, or cause others to do so, if they reasonably have cause to suspect an adult:

                      a. Has needs for care and support (whether or not the local authority is meeting any of those needs) and;

                      b. Is experiencing, or at risk of, abuse and neglect; and

                      c. As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

                      Referring agencies need to use their professional judgement, consider the views of the adult at risk, and where appropriate seek consent for sharing information on a multi-agency basis.

                      See: Advice for Submitting an Adult Safeguarding Concern.

                      3. Managing the different levels of harm

                      In order to manage the large volume of adult Safeguarding Concerns which come under safeguarding adults’ policy and procedures, there is a need to differentiate between those concerns relating to low level harm/risk, and those that are more serious. Whilst it is likely that concerns relating to low level harm/risk will not progress beyond an Initial Enquiry Stage, the concern will be recorded by the Local Authority and proportionate action taken to manage the risks that have been identified. This may include: provision of information or advice; referral to another agency or professional; assessment of care and support needs.

                      The sharing of low level concerns helps the Local Authority to understand any emerging patterns or trends that may need to be taken into consideration when deciding whether safeguarding adults procedures need to continue.

                      Local Government Association - Making Safeguarding Personal Toolkit

                      LGA/ADASS Guidance on What Constitutes a Safeguarding Concern - Sept 2020

                      4. Using this guidance

                      The guidance is not designed in a way in which further actions are determined by achieving a score, it is there to provide guidance and key considerations for practitioners who are assessing the context, circumstances, seriousness and impact of the abuse that is occurring, as well as the risk of it recurring.

                      5. Other Safeguarding Enquiry

                      Other Safeguarding Enquiries can be used when all of the Section 42 (1) criteria have not been met (see section 2), but the Local Authority still considers it "necessary and proportionate" to conduct a safeguarding enquiry. This could be linked to promoting an individual’s well-being as outlined in Section 1 of the Care Act, or for carers who do not qualify under Section 42. More detail on this subject is provided here (Page 7): ADASS Advice Note   

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                      Safeguarding Principle - Proportionality

                      What does this mean for the professionals: A proportionate and least intrusive response is made balanced with the level of risk.

                      What does this for the Adult: "I am confident the professionals will work in my interest and only get involved as much as needed".

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                      6. The interface between Section 42 Enquiries and Safeguarding Adults Reviews (SAR)

                      As a matter of law an enquiry under Section 42 cannot be initiated in relation to an adult who is deceased. However, if the circumstances of the death mean that there are reasons to be concerned about risks to other adults, Section 42 Enquiries may need to be made to decide whether action needs to be taken to protect them. For example, this will often be necessary following a death in an organisational setting where other adults are continuing to receive a service.

                      Where a Section 42 Enquiry has already commenced and the adult subsequently passes away, then as outlined above, the enquiry may need to be concluded if there are potential ongoing risk to other adults. Otherwise a multi-agency decision involving “interested others”, which could include family members, should be made regarding the enquiry potentially being suspended.

                      Where a death is suspected to be the result of abuse or neglect and the other SAR criteria are met, a SAR notification should be submitted to enable the Lewisham Safeguarding Adults Board (LSAB) to consider this under Section 44 of the Care Act.

                      See: How to make a SAR Referral to the Lewisham Safeguarding Adults Board

                      SAR Notifications must be submitted as soon as possible after the adult’s death. It should be noted that a brief investigation may be necessary to assemble the required information for the LSAB's Case Review Sub-Group to make a recommendation as to whether a SAR should take place. This investigation should aim only to gather sufficient information for that purpose, and should not aim to reach firm conclusions about what happened. This investigation should be recorded as an Other Enquiry.

                      The Care Act statutory guidance also gives examples of serious abuse or neglect cases where an adult “would have been likely to have died but for an intervention, or has suffered permanent harm or has reduced capacity or quality of life (whether because of physical or psychological effects) as a result of the abuse or neglect”. Under these circumstances, Section 42 Enquiries into what happened to that adult will still need to take place in parallel, to ensure the adult’s immediate safety and the safety of any others who may be at risk, but should be limited to those purposes rather than duplicating more thorough investigations into the history which may take place through a SAR.

                      The Local Authority (or delegated agency) may need to make initial enquiries to consider whether the conditions for a SAR are met, but should not describe these as Section 42 Enquiries. In these circumstances the meeting should be a Safeguarding Information Sharing meeting and logged onto the case management system as an Other Enquiry. Where the suspected abuse or neglect has taken place in an organisational setting, and there may be potential risks to others, the meeting should be an 'Organisational Safeguarding meeting' and consideration should be given to invoking the Provider Concerns Process.

                      7. Factors to be considered

                      Contextual Factors

                      The following table should be used to consider the context of the Safeguarding Concern alongside the broader issues such as: mental capacity; mental health; physical disability; learning disability; communication issues; possible coercive control and the relationship between the victim and any alleged perpetrator; where the victim lives; who do they rely upon for their care; what is the extent of their circle or network of supportive relationships. 

                      Table 1: Contextual Factors

                      1.

                      The Abusive Act

                      Less Serious                                           More Serious

                      Less serious concerns are likely to be dealt with at initial enquiry stage only, whilst the more serious concerns will progress to further stages in the safeguarding adults’ procedures.

                      2.

                      Seriousness of Abuse

                      Less Serious                                           More Serious

                      Refer to table 2. Look at the relevant categories of abuse and use your knowledge of the case and your professional judgement to gauge the seriousness of the concern.

                      3.

                      Pattern of Abuse

                      Isolated incident

                      Recent abuse in an ongoing relationship

                      Repeated abuse

                      The volume of incidents, Safeguarding Concerns and or Quality Alerts about an individual adult, provider or locality should be carefully considered as part of the wider context of potential abuse, but no benchmark number set to automatically trigger an enquiry.

                      4.

                      Impact of Abuse on Victims

                      No impact

                      Some impact but not long-lasting

                      Serious long-lasting impact

                      Impact of abuse does not necessarily correspond to the extent of the abuse –different people will be affected in different ways. Views of the adult at risk will be important in determining the impact of abuse. Protected Characteristics such as disability should be considered as well as disproportionality.

                      5.

                      Impact on Others

                       

                      No one else affected

                      Others indirectly affected

                      Others directly affected

                      Other people may be affected by the abuse of another adult. Are relatives, children or other adults distressed or affected by the abuse?

                      Are other people intimidated and/or their environment affected?

                      6.

                      Intent of Alleged Perpetrator(s)

                      Unintended/ill-informed

                      Opportunistic

                      Deliberate/targeted

                      Is the act/omission a violent/serious unprofessional response to difficulties in providing care? Is the act/omission planned and deliberately malicious? Is the act a breach of a professional code of conduct?

                      7.

                      Illegality of Actions

                      Bad practice/Not illegal

                      Criminal act

                      Serious criminal act

                      Seek advice from the Police if you are unsure if a crime has been committed. Is the act/omission poor or bad practice (but not illegal) or is it clearly a crime? (* See below)

                      8.

                      Risk of Repeated Abuse on the Victim

                      Unlikely to recur

                      Possible to recur

                      Likely to recur

                      Is the abuse less likely to recur with significant changes e.g. training, supervision, respite, support or very likely even if changes are made and/or more support provided?

                      9.

                      Risk of Repeated Abuse on Others

                      Others not at risk

                      Possibly at risk

                      Others at serious risk

                      Are others (adults and/or children) at risk of being abused: Very unlikely? Less likely if significant changes are made? This perpetrator/setting represents a risk/threat to other adults or children?

                      *See: London Multi-Agency Safeguarding Policy and Procedures (pages 67-68)

                      7.2 Types and Level of Abuse

                      The second table should also be used in conjunction with Table 1. The issues described within the ‘Less Serious’ sections may be notified to the Local Authority, but these are likely to be managed at the Initial Enquiry Stage only, and may not progress to a Safeguarding Enquiry. 

                      Concerns of a more serious nature should be referred to the Local Authority.

                      See: Advice for Submitting an Adult Safeguarding Concern

                      These concerns will receive additional scrutiny and progress further under Safeguarding Adults’ procedures. Where a criminal offence is thought or alleged to have been committed the Police will be contacted. Other emergency services should be contacted as required. 

                      Table 2: Types and Level of Abuse

                       

                                    Less Serious

                      More Serious

                      Discriminatory Abuse

                      • Isolated incident of teasing motivated by prejudicial attitudes.
                      • Isolated incident of care planning that fails to address an adult’s specific diversity/equality associated needs for a short period.
                      • Inequitable access to service provision as a result of a diversity or equality issue. The Protected Characteristics are:

                      1.      Age

                      2.      Disability (inc. learning disability)

                      3.      Gender Reassignment

                      4.      Marriage and Civil Partnership

                      5.      Pregnancy and Maternity

                      6.      Race

                      7.      Religion or Belief

                      8.      Sex

                      9.      Sexual Orientation

                      • Recurring failure to meet specific care/support needs associated with diversity or equality.
                      • Being refused access to essential services.
                      • Denial of civil liberties e.g. voting, making a complaint.
                      • Humiliation or threats on a regular basis, recurring taunts.
                      • Hate crime which may result in injury/emergency medical treatment/fear for life/attempted murder/honour-based violence.

                      Domestic Abuse

                       

                      • Isolated incident of abusive nature.
                      • Occasional taunts or verbal outbursts

                       

                       

                      • Inexplicable marking or lesions, cuts or grip marks on a number of occasions.
                      • Alleged perpetrator exhibits controlling or coercive behaviour.
                      • Limited access to medical and dental care.
                      • Accumulations of minor incidents.
                      • Frequent verbal/physical outbursts.
                      • No access/control over finances.
                      • Stalking.
                      • Relationship characterised by imbalance of power.
                      • Threats to kill, attempts to strangle choke or suffocate.

                      Also see:

                      Financial Abuse.

                      Physical Abuse.

                      Psychological Abuse. 

                      Sexual Abuse.

                      The ‘SafeLives’ Domestic Abuse, Stalking and Honour Based Violence (DASH) Risk Identification Checklist should be used to determine the level of risk in domestic abuse cases and a referral made into MARAC where appropriate.

                      SafeLives Risk Identification Checklist

                      Financial or Material Abuse

                      If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.  

                      • Staff personally benefit from the adult’s funds e.g. accrue ‘reward’ points on their own store loyalty cards when shopping.
                      • Money not recorded safely and properly.
                      • Adult not routinely involved in decisions about how their money is spent or kept safe – capacity in this respect is not properly considered.
                      • Non-payment of care fees not impacting on care.
                      • Adult’s monies kept in a joint bank account – unclear arrangements for equitable sharing of interest.
                      • Adult denied access to his/her own funds or possessions.
                      • Misuse/misappropriation of property or possessions of benefits by a person in a position of trust or control.
                      • Personal finance removed from the adult’s control.
                      • Ongoing non-payment of care fees putting an adult’s care at risk.
                      • Fraud/exploitation relating to benefits, income, property or will.
                      • Theft (this may include household items such as food).

                      Modern Slavery

                      • All Safeguarding Concerns about Modern Slavery are deemed to be more serious. (A new Lewisham Modern Slavery Protocol will be published in the early summer of 2021).
                      • Limited freedom of movement.
                      • Being forced to work for little or no payment.
                      • Limited or no access to medical and dental care.
                      • Forced marriage.
                      • Limited access to food or shelter.
                      • Be regularly moved (trafficked) to avoid detection or linked to drug dealing - ‘County Lines’.
                      • Removal of passport or ID documents.
                      • Sexual exploitation.
                      • Starvation.
                      • Organ harvesting.
                      • No control over movement/imprisonment.
                      • No access to appropriate benefits.

                      Neglect & Acts Of Omission

                      • Isolated missed home care visit where no harm occurs.
                      • Adult is not assisted with a meal/drink on one occasion and no harm occurs.
                      • Adult not bathed as often as would like – possible complaint.
                      • Not having access to aids to independence.
                      • Inadequacies in care provision that lead to discomfort or inconvenience- no harm occurs e.g. being left wet occasionally.  
                      • Recurring missed medication or administration errors that cause no harm.
                      • Adult does not receive prescribed medication (missed/wrong dose) on one occasion – no harm occurs.
                      • Recurrent missed home care visits where risk of harm escalates, or one missed visit where harm occurs.
                      • Hospital discharge without adequate planning and harm occurs.
                      • Ongoing lack of care to the extent that health and wellbeing deteriorate significantly e.g. pressure wounds, dehydration, malnutrition, loss of independence/confidence.
                      • Failure to arrange access to lifesaving services or medical care.
                      • Failure to intervene in dangerous situations where the adult lacks the capacity to assess risk.

                      Pressure Ulcers: Safeguarding Adults Protocol

                      Stop the Pressure: NHS Improvement

                      SEL CCG Guidance on Pressure Ulcer Management

                      Organisational Abuse

                      • Lack of stimulation/ opportunities for adults to engage in social and leisure activities.
                      • Adults not given sufficient voice or involvement in the running of the service.
                      • Denial of individuality and opportunities for adults to make informed choice and take responsible risks.
                      • Care-planning documentation not person-centred.
                      • Rigid/inflexible routines.
                      • Adult’s dignity is undermined e.g. lack of privacy during support with intimate care needs, sharing under-clothing.
                      • Inadequate risk assessment resulting in multiple adult on adult incidents within care setting.
                      • Bad/poor practice not being reported and going unchecked.
                      • Unsafe and unhygienic living environments.
                      • Missed medication round resulting in more than one person not receiving their prescribed medication.
                      • Staff misusing their position of power over adults in their care.
                      • Over-medication and/or inappropriate restraint used to manage behaviour.
                      • Widespread consistent ill-treatment.

                      Physical Abuse

                      If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.  

                      • Staff error causing little or no harm e.g. friction mark on skin due to ill-fitting hoist sling.
                      • Minor events that still meet criteria
                      • for ‘incident reporting’ accidents.
                      • Single incident - adult on adult in care setting causing little or no harm.
                      • Inexplicable marking found on one occasion.
                      • Minor event where adult lacks capacity in keeping themselves safe
                      • Recurring missed medication or errors that affect more than one adult and/or result in harm.
                      • Incident involving adult on adult in care setting where injury occurs.
                      • Deliberate maladministration of medications.
                      • Covert administration without proper medical authorisation.
                      • Inappropriate restraint.
                      • Withholding of food, drinks or aids to independence.
                      • Inexplicable fractures/injuries.
                      • Multiple (more then 2) adult on adult incidents involving the same adult/s in care setting.
                      • Accumulations of minor incidents.
                      • Inexplicable marking or lesions, cuts or grip marks on a number of occasions.
                      • Assault.
                      • Grievous bodily harm/assault with a weapon leading to irreversible damage or death.
                      • Pattern of recurring medication errors or an incident of deliberate maladministration that results in ill-health or death.

                      Psychological Abuse

                      If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.  

                      • Isolated incident where adult is spoken to in a rude or inappropriate way – respect is undermined but no/little distress caused.
                      • Occasional taunts or verbal outburst.
                      • Withholding of information to disempower.
                      • Treatment or behaviour that undermines dignity and esteem.
                      • Denying or failing to recognise adult’s choice or opinion.
                      • Coercive or controlling behaviour.
                      • Humiliation.
                      • Emotional blackmail e.g. threats or abandonment/harm.
                      • Frequent and frightening verbal outbursts or harassment.
                      • Basic human rights/civil liberties, over-riding advance directive.
                      • Prolonged intimidation.
                      • Vicious/personalised verbal attacks.

                      Self-Neglect

                      • Hoarding behaviour which doesn’t impact on the health and well-being of the adult or others.
                      • Isolated/occasional reports about unkempt personal appearance or property which is out of character or unusual for the adult.
                      • Incontinence leading to health concerns.

                       

                      • Multiple reports of concerns from multiple agencies.
                      • Ongoing lack of care or behaviour to the extent that health and wellbeing deteriorate significantly e.g. pressure sores, wounds, dehydration, malnutrition.
                      • Behaviour which poses a fire risk to the adult and others.
                      • Poor management of finances leading to risks to health, wellbeing or property.
                      • Hoarding behaviour impacting on the health and well-being of the individual and/or others.
                      • Life in danger if intervention is not made in order to protect the adult.
                      • Failure to seek lifesaving services or medical care where required.

                      LSAB Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Hoarding Toolkit (April 2021)

                      Sexual Abuse (including sexual exploitation)

                      If any of these elements occur within the context of a family or intimate relationship, then this should be dealt with as Domestic Abuse.  

                      • Isolated incident of teasing or low-level unwanted sexualised attention (verbal) directed at one adult by another whether or not capacity exists.

                       

                      • Any sexualised touching or isolated or recurring masturbation without consent.
                      • Voyeurism without consent
                      • Being subject to indecent exposure.
                      • Grooming including via the internet and social media.
                      • Attempted penetration by any means (whether or not it occurs within a relationship) without consent.
                      • Being made to look at pornographic material against will/where consent cannot be given.
                      • Female Genital mutilation.
                      • Sex in a relationship characterised by authority inequality or exploitation e.g. receiving something in return for carrying out a sexual act.
                      • Sex without consent (rape).

                      Enquiry Stage 2: Advice for Conducting an Adult Safeguarding Enquiry

                      1. The decision-making process

                      The Multi-Agency Adult Safeguarding Concern Form has been designed to provide all of the detailed and necessary information to allow colleagues in the Local Authority to effectively make a decision on if a Safeguarding Concern needs to progress to a Section 42 (or Other Enquiry) under the Local Authorities duty to do so within the Care Act 2014.

                      Please also refer to: Guidance for Making Decisions on Adult Safeguarding Enquiries

                      All of this Safeguarding data will be collated within the Local Authorities case management system (as the lead agency in the Borough) so that there is a central source of information and intelligence, which will allow this to be carefully monitored and assessed.         

                      2. Enquiry routes

                      Once a decision is made that a Safeguarding Enquiry must be conducted under the Section 42 duty, the relevant team within the Local Authority will decide who is best placed to conduct this, directing it through one of the four strands (2.1 to 2.4) outlined below. When this is delegated outside of the Local Authority they will still retain the overall responsibility to co-ordinate the enquiry as the lead agency, and as such they will provide the quality assurance and oversight in relation to all Safeguarding Enquiries.

                      See: S42 Enquiry Report Template (Pdf)    S42 Enquiry Report Template (Word Version)

                      Professionals should also read the London Multi-Agency Safeguarding Policy and Procedures (pages 66-78) for further information on conducting Adult Safeguarding Enquiries, using the checklists and detailed good practice guidance (target timescales are the bottom of this page). 

                      2.1 Police investigation

                      If a Safeguarding Concern has been submitted to the Local Authority and it is identified that an element, or all of this Concern may be linked to criminal activity, then the early involvement of police is essential. Police investigations should be coordinated by the local police MaSH team who may also support other parallel actions or enquiry options, but this should always be police led.   

                      See pages 67-68 of the London Multi-Agency Safeguarding Policy and Procedures for more information.

                      2.2 Standard delegation within the London Borough of Lewisham (LBL) Council

                      All social work staff within LBL can have Safeguarding Enquiries delegated to them, normally through one of the following four main strands:

                      1. Neighbourhood Teams 1-4.
                      2. Safeguarding and Quality Assurance Team.
                      3. Hospital Social Work Team (University Hospital of Lewisham).
                      4. Mental Health Social Work Team within South London and Maudsley (SLaM) NHS Trust.

                      There is a need for supervision and co-ordination of enquiries by Safeguarding Adults Managers (SAMs). 

                      See pages 57-58 of the London Multi-Agency Safeguarding Policy and Procedures for more information.

                      2.3 External delegation

                      Safeguarding Enquiries or elements of them may also be routinely delegated outside of LBL to the following partners:

                      1. Lewisham and Greenwich NHS Trust (LGT) Safeguarding Team, who may then sub-delegate across their internal divisions, including to the District Nursing Service.
                      2. South London and Maudsley NHS Foundation Trust (SLaM).
                      3. South East London (SEL) Clinical Commissioning Group (CCG). 
                      4. Care and Nursing Homes.
                      5. Home Care Providers.
                      6. GP Practices.
                      7. Other Service Providers.

                      See: Causing S.42 Enquiries Letter Template (Word)

                      SAMs will also need to supervise and co-ordination these enquiries.

                      2.4 Referrals to Pressure Ulcer Panels (PUPs)

                      Potential Safeguarding Concerns linked to pressure ulcers can be challenging as it needs to be determined if this has been caused by poor quality care or evidence of neglect or omissions in care provision. This can occur due to other associated factors and may require input from a professional for clinical judgements to be considered:

                       The person’s physical and mental health.

                      • Multiple co-morbidities.
                      • State of overall skin condition of the person.
                      • Indicators of neglect of care provision in relation to hygiene and/or repositioning.
                      • Evidence of ineffective continence management.
                      • Evidence of ineffective nutritional and fluid management.
                      • Ineffective Pain management.
                      • Evidence of completed and accurate proactive risk and wound assessments and subsequent care planning.
                      • Accurate monitoring and recording in all documentation.
                      • The views of the service user, family and friends on treatment and care are recorded.
                      • Capacity and level of engagement of service users and others.
                      • Evidence of appropriate and timely referrals to members of multidisciplinary team
                      • Views of others including professionals.

                      See: SEL CCG Guidance on Pressure Ulcer Management 

                      While Pressure Ulcers are a risk for people who are frail and not able to move easily, with good management and care these can be prevented. If an adult at risk has a pressure ulcer this should not been as a reason to automatically suspect abuse or neglect, although this should be carefully considered, and a Safeguarding Concern must always be submitted for a stage 3, 4, Unstageable, Deep Tissue Injury and Medical Device pressure ulcers.

                      If a Safeguarding Concern has been submitted for a pressure ulcer related matter the Local Authority  will pass this case onto the relevant Pressure Ulcer Panel (PUP) to oversee the initial investigation:

                      • The Community PUP - overseen by the South East London Clinical Commissioning Group. (Care Home Only)
                      • The Acute Trust’s PUP - overseen by Lewisham and Greenwich NHS Trust. (Trust Acute and Community Service)

                      Health professionals will then inform the safeguarding process by conducting a Pressure Ulcer Synopsis and Root Cause Analysis (RCA) and submit the relevant reports to the appropriate PUP.

                      If the pressure ulcer amounts to the wilful neglect of an individual who lacks mental capacity, a crime under section 44 of the Mental Capacity Act 2005 may have occurred, and in these instances the police will be informed.

                      SAM’s should engage with the PUP’s to gain understanding of process and decision making of PUP professionals, alongside assisting to co-ordinate any other elements of the safeguarding enquiry if there is another aspect to this.

                      The PUP’s will attempt to conclude their investigation within 28 days, but this may not always be possible. Once the PUP’s have decided no further investigation by panel is required, the enquiry is closed to the panel and an action plan process is implemented. The SAM should then co-ordinate any further actions up to the point of the enquiry being closed overall.

                      3. Professional Curiosity and Critical Evaluation

                      Professional Curiosity is the capacity and communication skill to explore and understand what is happening within a family (or an organisational setting) rather than making assumptions, accepting things at face value, or allowing your personal values or possible unconscious bias to influence the way that that you see and interpret risk. 

                      This has been described as the need for practitioners to practice ‘respectful uncertainty’ in applying Critical Evaluation to any information they receive, or ‘thinking the unthinkable’.

                      Watch this YouTube Video: The journey from reflection towards reflexivity (relevant for all practitioners)

                      The following factors highlight the need to improve professional curiosity:

                      • The views and feelings of some adults can be very difficult to ascertain.
                      • Practitioners do not always listen to adults who try to speak on behalf of another adult and who may have important information to contribute.
                      • Carers can prevent practitioners from seeing and listening to an adult.
                      • Practitioners can be misinformed with stories they want to believe are true.
                      • Effective multi-agency work needs to be coordinated.
                      • Challenging carers and other professionals requires expertise, confidence, time and a considerable amount of emotional energy.

                       The key to effective safeguarding practice is to ask the right questions, including: 

                      1. Would I live here, and if not, why not?
                      2. Would I be happy with this standard of care for a member of my family?
                      3. What does good look like?
                      4. Is there anything else going on in this person’s life which might be causing harm, or the potential for adult abuse or neglect?

                      3.1 Barriers to professional curiosity

                      It is important to note that when a lack of professional curiosity is cited as a factor in any safeguarding enquiry or review that  this does not automatically mean that blame should be apportioned. It is widely recognised that there are many barriers to being professionally curious, some of which are set out below:

                      The ‘rule of optimism’.
                      Risk enablement is about a strengths-based approach, but this does not mean that new or escalating risks should not be treated seriously. The ‘rule of optimism’ is a well-known dynamic in which professionals can tend to rationalise away new or escalating risks despite clear evidence to the contrary.

                      Accumulating risk – seeing the whole picture.
                      Reviews repeatedly demonstrate that professionals tend to respond to each situation or new risk discretely, rather than assessing the new information within the context of the whole person, or looking at the cumulative effect of a series of incidents and information.

                      Normalisation.
                      This refers to social processes through which ideas and actions come to be seen as 'normal' and become taken-for-granted or 'natural' in everyday life. Because they are seen as ‘normal’ they cease to be questioned and are therefore not recognised as potential risks or assessed as such.

                      Professional deference.
                      Workers who have most contact with the individual are in a good position to recognise when the risks to the person are escalating. However, there can be a tendency to defer to the opinion of a ‘higher status’ professional who has limited contact with the person but who views the risk as less significant. Be confident in your own judgement and always outline your observations and concerns to other professionals, be courageous and challenge their opinion of risk if it varies from your own. Escalate ongoing concerns through your manager and by using more formal procedures if necessary.

                      Confirmation bias.
                      This is when we look for evidence that supports or confirms our pre-held view, and ignores contrary information that refutes them. It occurs when we filter out potentially useful facts and opinions that don't coincide with our preconceived ideas.

                      ‘Knowing but not knowing’.
                      This is about having a sense that something is not right but not knowing exactly what, so it is difficult to grasp the problem and take action.

                      Confidence in managing tension.
                      Disagreement, disruption and aggression from families or others, can undermine confidence and divert meetings away from topics the practitioner wants to explore and back to the family’s own agenda.

                      Dealing with uncertainty.
                      Contested accounts, vague or retracted disclosures, deception and inconclusive medical evidence are common in safeguarding practice. Practitioners are often presented with concerns which are impossible to substantiate. In such situations, ‘there is a temptation to discount concerns that cannot be proved’. A person-centred approach requires practitioners to remain mindful of the original concern and be professionally curious:

                      • ‘Unsubstantiated’ concerns and inconclusive medical evidence should not lead to case closure without further assessment.
                      • Retracted allegations still need to be investigated wherever possible.
                      • The use of risk assessment tools can reduce uncertainty, but they are not a substitute for professional judgement, and results need to be collated with observations and other sources of information.
                      • Social care practitioners are responsible for triangulating information such as, seeking independent confirmation of information, and weighing up information from a range of practitioners, particularly when there are differing accounts, and considering different theories/ research to understand the situation.

                      Other barriers to professional curiosity.
                      Poor supervision, complexity and pressure of work, changes of case worker leading to repeatedly ‘starting again’ in casework, closing cases too quickly, fixed thinking/preconceived ideas and values, and a lack of openness to new knowledge are also barriers to a professionally curious approach.

                      3.2 Disguised Compliance

                      Disguised Compliance involves carers giving the appearance of co-operating with agencies to avoid raising suspicions and allay concerns.

                      There is a continuum of behaviours from carers on a sliding scale, with full co-operation at one end of the scale, and planned and effective resistance at the other. Showing your best side or ‘saving face’ may be viewed as ‘normal’ behaviour and therefore we can expect a degree of Disguised Compliance in all families; but at its worst superficial cooperation may be to conceal deliberate abuse, and professionals can sometimes delay or avoid interventions due to Disguised Compliance.

                      The following principles will help front line practitioner’s deal with Disguised Compliance more effectively:

                      • Focus on the needs, voice and lived experience of the adult.
                      • Avoid being encouraged to focus too extensively on the needs and presentation of the carers, whether aggressive, argumentative or apparently compliant.
                      • Think carefully about the engagement of the carers and the impact of this behaviour on the practitioner’s view of risk.
                      • Focus on change in the family dynamic and the impact this will have on the life and well-being of the adult. This is a more reliable measure than the agreement of carers in the professionals plan.
                      • There is some evidence that an empathetic approach by professionals may result in an increased level of trust and a more open family response leading to greater disclosure by adults.
                      • Practitioners need to build close partnership style relationships with families whilst being constantly aware of the adult’s needs and the degree to which they are met.
                      • There is no magic way of spotting Disguised Compliance other than the discrepancy between a carer’s account and observations of the needs and account of the adult. The latter must always take precedent.
                      • Practitioners should aim to ‘triangulate’ and cross-reference the information they have received to confirm or refute the facts that have been presented.

                      3.3 Professional Challenge - having different perspectives

                      Having different professional perspectives within safeguarding practice is a sign of healthy and well-functioning inter-agency partnerships. These differences of opinion are usually resolved by discussion and negotiation between the practitioners concerned, but it is essential that they do not adversely affect outcomes for adults and are resolved in a constructive manner.

                      If you have a difference of opinion with another practitioner, remember:

                      • Professional differences and disagreements can help find better ways to improve outcomes for adults and families.
                      • All professionals are responsible for their own actions in relation to case work.
                      • Differences and disagreements should be resolved as simply and quickly as possible, in the first instance by individual practitioners and /or their line managers.
                      • All practitioners should respect the views of others whatever the level of experience – remember that challenging more senior or experienced practitioners can be hard.
                      • Expect to be challenged; working together effectively depends on an open approach and honest relationships between agencies and professionals.
                      • Differences are reduced by clarity about roles and responsibilities, the ability to discuss and share problems, and by effectively networking.

                      3.4 Cultural Competence

                      Culturally competent safeguarding practice is essential in achieving the right outcomes, and for improving the well-being of adults from Black, Asian and Minority Ethnic (BAME) communities.

                      Lack of cultural awareness among practitioners can impact on their ability to effectively work with and support adults, and therefore deal with abuse and neglect appropriately. This can also result in poor practice or interventions, which in turn can reduce trust in statutory agencies and create barriers for engagement with and from minority ethnic communities.   

                      It is important therefore that practitioners are sensitive to differing family patterns and lifestyles that vary across different racial, ethnic and cultural groups. At the same time they must be clear that abuse or neglect cannot be condoned for religious or cultural reasons.

                      All practitioners working with adults at risk and their carers whose faith, culture, nationality and recent history differs significantly from that of the majority culture, must be professionally curious and take personal responsibility for informing their work with sufficient knowledge (or seeking advice) on the particular culture and/or faith by which the adult and their family or carers live their daily lives.

                      Practitioners should be curious about situations or information arising in the course of their work, allowing the family to give their account as well as researching such things by discussion with other practitioners, or by researching the evidence base. Examples of this might be around attitudes towards, and acceptance of, services e.g. health and dietary choices.

                      In some instances reluctance to access support stems from a desire to keep family life private. In many communities there is a prevalent fear that social work practitioners will negatively interfere, and there may be a poor view of support services arising from initial contact through the immigration system, and, for some communities – particularly those with insecure immigration status – an instinctive distrust of the state arising from experiences in their country of origin.

                      Practitioners must take personal responsibility for utilising specialist services. Knowing about and using services available locally to provide relevant cultural and faith-related input to prevention, support and rehabilitation services for adults (and their family) will help support practice.

                      This includes:

                      • Knowing which agencies are available to access locally (and nationally).
                      • Having contact details to hand.
                      • Timing requests for expert support and information appropriately to ensure that assessments, care planning and review are sound and holistic.

                      Often for BAME communities, accessing appropriate services is a consistent barrier to them fully participating in society, increasing their exclusion and potential for victimisation.

                      4. The Challenge of Engagement and Self-Neglect

                      Only 5% of Section 42 Enquiries are related to Self-Neglect in Lewisham, but professionals must understand the significance of these complex cases as almost half of all Safeguarding Adults Reviews, and therefore some of the most serious cases of abuse nationally, are related to this subject.

                      When an adult is self-neglecting, relationship based work becomes crucial and having one worker as a single point of contact may be beneficial.

                      Using the label “hard to engage” is damaging and may result in other professionals believing there is little point in attempting to do so, and therefore should be avoided (“seldom heard” may be a more appropriate term).

                      Practitioners should work together if one is struggling to achieve meaningful engagement with the adult, as another may still be able to take the lead on behalf of an Enquiry Officer in managing and monitoring risk.

                      Practitioners should also consider the following in helping to improve engagement with adults:

                      1. Creative, flexible and imaginative ways to communicate with adults, including working with faith, community leaders and non-safeguarding practitioners to achieve the best outcomes.
                      2. Producing information in a number of ways to meet individual needs.
                      3. Involving family members appropriately to help support adults.
                      4. The use of advocacy to engage with adults.
                      5. Training staff to enable and improve engagement with adults.

                      See: LSAB Self-Neglect and Hoarding Multi-Agency Policy, Practice Guidance and Hoarding Toolkit

                      5. Making Safeguarding Personal during a Safeguarding Enquiry

                      Making Safeguarding Personal (MSP) is an initiative which aims to develop a person centred and outcomes focus to safeguarding work in supporting people to improve or resolve their circumstances.

                       What MSP Seeks to achieve: 

                      1. A personalised approach enabling safeguarding to be done with and not to people, using practical methods defined by the adults individual needs rather than those of the organisation.
                      2. The outcomes an adult wants, by determining these at the beginning of working with them, and ascertaining if those outcomes were realised at the end.
                      3. Improvement to people’s circumstances rather than on ‘investigation and conclusion’.
                      4. Utilisation of person-centred practice rather than ‘putting people through a process’.
                      5. Good outcomes for people by working with them in a timely way, rather than one constrained by timescales.
                      6. Improved practice by supporting a range of methods for staff learning and development.
                      7. Learning through sharing good practice.
                      8. Further development of recording systems in order to understand what works well.
                      9. Broader cultural change and commitment within organisations, to enable practitioners, families, teams and the Lewisham Safeguarding Adults Board to know what difference has been made. 

                      Also see: Supporting people living with Dementia to be involved in adult Safeguarding Enquiries (March 2021)

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                      Safeguarding Principle - Empowerment

                      What does this mean for the professionals: Adults are encouraged to make their own decisions and are provided with support and information.

                      What does this mean for the adult: "I am consulted about the outcomes I want from the safeguarding process and these directly inform what happens". ……………………………………………………………………………………………………………………………………………

                      Local Government Association - Making Safeguarding Personal Toolkit

                      Plan & Review Stage 3: Multi-Agency Adult Safeguarding Planning Meeting Guidance

                      1. What is the purpose of a Multi-Agency Adult Safeguarding Planning Meeting?

                      The overarching purpose of a Multi-Agency Adult Safeguarding Planning Meeting is to bring together all of the relevant stakeholders, so that information and intelligence can be shared to determine what the appropriate actions should be to “sufficiently reduce, or remove the risk to the adult” (although it may also be appropriate for this to 'remain' in some circumstances).

                      This is a shift in terminology and emphasis away from trying to 'substantiate' reports of abuse, which can become combative between professionals and agencies, detracting from the efforts to improve the adult's wellbeing and safety.  

                      See: Multi-Agency Adult Safeguarding Planning Meeting Form (Word)   Multi-Agency Adult Safeguarding Planning Meeting Form (Pdf)

                      2. When might a Multi-Agency Adult Safeguarding Planning Meeting be needed?

                      A Planning Meeting may not be necessary in relation to all Section 42 Safeguarding Enquiries, but the following points should be used to help determine if one is required:

                      1. Where the health and safety of the adult is, or maybe compromised, and a detailed (or initial) safeguarding plan is required.
                      2. Where there have been previous Safeguarding Concerns and the issues have been repeated, and or, the risks are more acute than previously thought.
                      3. Where multiple agencies (including providers) are needed in providing support and or protection, and there is a need to co-ordinate actions.
                      4. In organisational or institutional cases where other adults are at risk of abuse or neglect. This may include where issues have affected residents of other Local Authorities.
                      5. Where the abuse involved a member of staff/volunteer (position of trust), and this brings into question the safety of other adults, and or the service.
                      6. Where there is the potential for parallel or overlapping criminal investigations by Police. In some instances a Planning Meeting may be required at short notice (1 day) following on from the initial Safeguarding Enquiries, if the issues identified place the adult at significant risk of harm, otherwise this should be arranged within 5 working days of a decision being made that one is necessary. With this in mind the following points made under each of the six Safeguarding Principles should be followed to ensure that Planning Meetings are utilised effectively and consistently. The objectives of a Safeguarding Enquiry are laid out on page 70 of the London Multi-Agency Safeguarding Policy and Procedures 

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                      Safeguarding Principle - Empowerment

                      What does this mean for the professionals: Adults are encouraged to make their own decisions and are provided with support and information.

                      What does this mean for the adult: "I am consulted about the outcomes I want from the safeguarding process and these directly inform what happens".……………………………………………………………………………………………………………………………………………

                      The practitioner who is setting up and chairing a Planning Meeting (see section 3) must ensure that the adult’s views, wishes and opinions are effectively represented, and conduct the meeting in an appropriate manner, using appropriate adaptations if required, allowing for the full participation of the adult and or their representative(s).    

                      2.1 If the adult does wish to attend the following points must be born in mind:

                      • The adult can bring someone to support them at the meeting. This might be a family member, friend or an Advocate (see section 3.2 of the London Multi-Agency Safeguarding Policy and Procedures), and or a legal representative.
                      • The meeting is about the adult and their views and wishes. The Chair of the meeting must ensure these are heard and listened to by everyone else.
                      • The meeting may need to decide what actions need to be taken, and by who, to make the adult safer and improve their wellbeing. This will be a group decision and the adult’s views will form part of this decision.
                      • A Safeguarding Plan may be agreed - this is about how the adult wants to be supported to be safe. Decisions about the adult’s welfare or care will need to be agreed with them.
                      • If the adult has been assessed as not having mental capacity to make a particular decision at that time, then it will need to be made in their ‘best interests’, and their views, wishes, feelings and beliefs must still be taken into account. Such decisions must be made in line with the Mental Capacity Act 2005 (Mental capacity should be carefully considered during every safeguarding enquiry- see section 3.1 of the London Multi-Agency Safeguarding Policy and Procedures).

                       2.2 If the adult does not wish to attend they may:

                      • Give their views in writing, or
                      • Ask someone to attend on their behalf, for example an advocate, friend or family member, or
                      • Ask the Safeguarding worker or Safeguarding Adults Manager to pass on their views.

                       Local Government Association - Making Safeguarding Personal Toolkit  ………………………………………………………………………………………………………………………………………….

                      Safeguarding Principle - Prevention 

                      What does this mean for the professionals: Strategies are developed to prevent abuse and neglect that promotes resilience and self-determination.

                      What does this mean for the adult: "I am provided with easily understood information about what abuse is, how to recognise the signs and what I can do to seek help". ……………………………………………………………………………………………………………………………………………

                      2.3 The Planning Meeting should consider:

                      • The longer-term ongoing support the adult will need.
                      • What learning can be shared across agencies to help prevent further re-occurrences. This is also linked to Section 44 of the Care Act 2014 - if the criteria for a Safeguarding Adults Review (SAR) is met.
                      • If a referral to the Provider Concerns Process should be made (see sections 5.7 & 5.8 of the London Multi-Agency Safeguarding Policy and Procedures)
                      • What training or education is needed to help prevent further re-occurrences of abuse.
                      • How information should be recorded and shared in line with the data protection legislation to help prevent further instances of abuse (see section 2.39 of the London Multi-Agency Safeguarding Policy and Procedures

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                      Safeguarding Principle - Proportionality

                      What does this mean for the professionals: A proportionate and least intrusive response is made balanced with the level of risk.

                      What does this mean for the adult: "I am confident professionals will work in my interest and only get involved as much as needed".

                      ……………………………………………………………………………………………………………………………………………

                      • If the abuse or neglect is unintentional and has arisen because an informal carer is struggling to care for another person. An assessment of both the carer and the adult must be considered in relation to wellbeing principles and duties. 

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                      Safeguarding Principle - Protection 

                      What does this mean for the professionals: Adults are offered ways to protect themselves, and there is a co-ordinated response to safeguarding.

                      What does this mean for the adult: "I am provided with help and support to report abuse. I am supported to take part to the extent to which I want and to which I am able". ……………………………………………………………………………………………………………………………………………

                      • The details of the Safeguarding Concern and how this places the adult at risk of abuse or neglect.
                      • That there is clarity about the type of abuse that has occurred and that this is recorded effectively, considering types of abuse that are particularly under-recorded:
                        • Organisational Abuse
                        • Discriminatory Abuse
                        • Modern Slavery
                        • Domestic Abuse.
                      • If an enquiry does take place, that an appropriate risk assessment of the available information is conducted that informs decisions regarding how the investigation will be undertaken, by whom, and by when.
                      • How a Safeguarding Plan will be delivered to reduce or remove the risk of harm to the adult, and or others.
                      • Any potential risks to children and young people (or other adults at risk) and agreement on who will arrange a Child Protection referral, where necessary. Refer to the: Lewisham Think Family Protocol
                      • The link with other key processes and procedures e.g. personnel issues (including referrals to the Disclosure and Barring Service or a professional or regulatory body); Police investigations; other regulatory processes such as a NHS Serious Incident, and the link to Pressure Ulcer Panels (see section 6).

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                      Safeguarding Principle - Partnerships 

                      What does this mean for the professionals: Local solutions through services working together within their communities.

                      What does this mean for the adult: "I am confident that information will be appropriately shared in a way that takes into account its personal and sensitive nature. I am confident that agencies will work together to find the most effective responses for my own situation".

                      ……………………………………………………………………………………………………………………...……………………

                      • How everyone involved in the enquiry will deliver the actions that are agreed as a result of the investigation in a manner consistent with Making Safeguarding Personal principles (MSP) and that the adult’s views and wishes are achieved as agreed. 

                      Local Government Association - Making Safeguarding Personal Toolkit

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                      Safeguarding Principle - Accountability

                      What does this mean for the professionals: Accountability and transparency in delivering a safeguarding response.

                      What does this mean for the adult: "I am clear about the roles and responsibilities of all those involved in the solution to the problem".

                      ………………………………………………………………………………………………………………………………………………….

                      • That arrangements are in place to give feedback to the person raising the Safeguarding Concern if they are not in attendance at the Planning Meeting.
                      • How partners are going to monitor and measure the delivery of the agreed actions with MSP in mind.
                      • Issues relating to inequalities and or potential discrimination are identified and taken account of.

                      3. Who can convene a Multi-Agency Adult Safeguarding Planning Meeting?

                      An Enquiry Officer or a Safeguarding Adults Manager from the London Borough of Lewisham (LBL) can convene a Multi-Agency Adult Safeguarding Planning Meeting.   

                      4. Who should attend a Multi-Agency Adult Safeguarding Planning Meeting?

                      There are a wide range of people who may be required to attend a Planning Meeting, including, but not limited to:

                      1. The adult and or their representative (see 2.1).
                      2. The Safeguarding Adults Manager or their equivalent.
                      3. The Safeguarding Enquiry Officer.
                      4. The person who raised the Safeguarding Concern (if they are a professional).
                      5. Police manager.
                      6. Other criminal justice agencies.
                      7. NHS Trust manager and or relevant specialist.
                      8. GP
                      9. Care Quality Commission.
                      10. Care Provider agency manager.
                      11. Relevant LBL and or South East London (SEL) Clinical Commissioning Group (CCG) Commissioner.
                      12. Quality Assurance or Contracts Officer from LBL and or SEL CCG.
                      13. The person/agency alleged to have caused the harm should have been given the opportunity to submit their representations. If this an agency, then a manager not directly involved in providing care in the case may be invited to attend.
                      14. Any other relevant agency/service representative as deemed appropriate by the person chairing the meeting.

                      Whoever attends a Planning Meeting should be of sufficient seniority to make decisions within the meeting concerning the organisation’s role and the resources they may contribute to the agreed Safeguarding Plan.

                      Planning Meetings should be formally recorded and minutes taken, which should be shared with those attending. This should be completed within 5 working days of the Meeting.

                      5. Practical arrangements 

                      Whilst there is a need to formally record the minutes from Planning Meetings, these should be set up as informally and flexibly as possible to meet the requirements of the adult and or their representative(s), whilst also helping ensure that professionals can contribute when these meetings are being set up at relatively short-notice. 

                      It may be suitable and appropriate to set these meetings up online using video methods, or via telephone, or by being flexible in utilising meeting rooms that are accessible for those involved. Otherwise the chair of the Planning Meeting should consider:   

                      1. How to create a comfortable and welcoming environment.
                      2. Whether the adult wishes to have a representative(s) with them and whether they will or should have an active or silent role (legal representative). This should be agreed with the adult, their legal representative and the chair ahead of the Planning Meeting.
                      3. Any communication requirements or other accessibility issues.
                      4. Location of facilities such as refreshments and toilets.
                      5. How breaks will be agreed, if needed.
                      6. Arrangements should the adult require a break or wish to clarify any points covered in the meeting.
                      7. The adult and their representative(s) should not be required to join a room where other attendees have previously gathered, and where possible they should be in the room before other attendees join, having met and had a chance to talk with the chair ahead of the meeting.
                      8. Meetings can also be in multiple parts to make them less intimidating (smaller groups) and more manageable for the adult, and include a separate and wider ‘professionals’ meeting.
                      9. Where the venue is the adult’s own home, consideration should be given to how their home will be treated with respect, and how to maintain confidentiality if others not attending the meeting may also be present in the home.

                      See: Multi-Agency Adult Safeguarding Planning Meeting Form (Word)   Multi-Agency Adult Safeguarding Planning Meeting Form (Pdf)

                      6. How do Planning Meetings link to Pressure Ulcer Panels and the Provider Concerns process?

                      6.1 Pressure Ulcer Panels 

                      Any Section 42 Safeguarding Enquiry which has commenced as a result of a pressure ulcer related issue will normally be conducted via one of the two Pressure Ulcer Panels in the Borough of Lewisham, which are both overseen by a senior social work practitioner from within LBL. 

                      If these are routine cases, then a separate Planning Meeting will not be required, unless one or more of the issues listed in section 2 of this guidance are also present in the case. 

                      If a Planning Meeting is deemed to be necessary in relation to a pressure ulcer related case, then one should be convened within 5 working days of a decision being made that one is necessary, even if the case has not been brought to a conclusion by the relevant Pressure Ulcer Panel. 

                      6.2 Provider Concerns 

                      As described in section 2.3, one outcome from a Planning Meeting might be to make a referral to the Provider Concerns process if the criteria for this has been reached. The Planning Meeting may help to identify signs linked to provider concerns, allowing for early supportive actions to be taken by commissioning authorities in supporting social care providers. A referral for the Provider Concerns Process should be made through the applicable Contracts Officer from LBL and or SEL CCG. 

                      7. Monitoring and review of Planning Meetings 

                      The Operational Lead from LBL will provide operational oversight and monitor all activity linked to the Section 42 Enquiry process, including Planning Meetings, in conjunction with the Service Manager with overall responsibility for adult safeguarding within LBL.

                      The Service Manager within LBL will provide oversight of Planning Meetings, providing quality assurance to the Lewisham Safeguarding Adults Board through ongoing audit and reporting processes.

                      Plan & Review Stage 3: Multi-Agency Adult Safeguarding Case Conference (MASCC) Guidance

                      1. What is the purpose of a Multi-Agency Adult Safeguarding Case Conference?

                      The overarching purpose of a Multi-Agency Adult Safeguarding Case Conference (MASCC) is to bring together all of the relevant stakeholders, so that the Safeguarding Enquiry process can be reviewed, to ensure that the "risk to the adult has been sufficiently reduced, or removed" (although it may also be appropriate for this to 'remain' in some circumstances), before being closed.

                      This is a shift in terminology and emphasis away from trying to 'substantiate' reports of abuse, which can become combative between professionals and agencies, detracting from the efforts to improve the adult's wellbeing and safety.

                      See: Multi-Agency Adult Safeguarding Case Conference Meeting Record (Pdf)

                      Multi-Agency Adult Safeguarding Case Conference Meeting Record (Word)

                      2. When might a MASCC be needed?

                      A MASCC will not be necessary in relation to many Section 42 Safeguarding Enquiries, but the following points should be used to help determine if one is required: 

                      1. To ensure that in the most complex cases the risk management arrangements that have been put in place are being effective.
                      2. Where multiple agencies (including providers) have been involved in offering support and or protection, and ongoing co-ordination is required.
                      3. In organisational or institutional cases where other adults may also have also been at risk of abuse or neglect. This may include where issues have affected residents of other Local Authorities.
                      4. Where the abuse involved a member of staff/volunteer (position of trust), and this brought into question the safety of other adults, and or the service.
                      5. Where there may have been multiple ongoing enquiries by different organisations or other processes, including by Police and the Pressure Ulcer Panels (see section 6).
                      6. To consider if other legal or statutory actions or redress are needed. This may include a referral for a Safeguarding Adults Review (SAR - s.44 Care Act 2014).                                                  

                      How to make a SAR Referral to the Lewisham Safeguarding Adults Board

                      In some instances a MASCC may be required at short notice following on from an initial Safeguarding Planning Meeting, if the issues identified place the adult at significant risk of harm, otherwise this should be arranged within 10 working days of a decision being made that one is necessary.

                      See: Multi-Agency Adult Safeguarding Planning Meeting Guidance

                      With this in mind the following points made under each of the six Safeguarding Principles should be followed to ensure that MASCC’s are utilised effectively and consistently.

                      ...................................................................................................................................................................………………

                      Safeguarding Principle - Empowerment 

                      What does this mean for the professionals: Adults are encouraged to make their own decisions and are provided with support and information.

                      What does this means for the adult: "I am consulted about the outcomes I want from the safeguarding process and these directly inform what happens".

                      ...................................................................................................................................................................………………

                      The practitioner who is setting up and chairing a MASCC (see section 3) must ensure that the adult’s views, wishes and opinions are effectively represented, and conduct the meeting in an appropriate manner, using appropriate adaptations if required, allowing for the full participation of the adult and or their representative(s).     

                      2.1 If the adult does wish to attend the following points must be born in mind:

                      • The adult can bring someone to support them at the meeting. This might be a family member, friend or an Advocate (see section 3.2 of the London Multi-Agency Safeguarding Policy and Procedures), and or a legal representative.
                      • The meeting is about the adult and their views and wishes. The Chair of the meeting must ensure these are heard and listened to by everyone else.
                      • The meeting may need to decide if any additional actions need to take place, and by who, to make the adult safer and improve their wellbeing. This will be a group decision and the adult’s views will form part of this decision.
                      • A new Safeguarding Plan may be agreed - this is about how the adult wants to be supported to be safe. Decisions about the adult’s welfare or care will need to be agreed with them.
                      • If the adult has been assessed as not having mental capacity to make a particular decision at that time, then it will need to be made in their ‘best interests’, and their views, wishes, feelings and beliefs must still be taken into account. Such decisions must be made in line with the Mental Capacity Act 2005 (Mental capacity should be carefully considered during every safeguarding enquiry- see section 3.1 of the London Multi-Agency Safeguarding Policy and Procedures).

                      2.2 If the adult does not wish to attend they may:

                      • Give their views in writing, or;
                      • Ask someone to attend on their behalf, for example an advocate, friend or family member, or;
                      • Ask the Safeguarding worker or Safeguarding Adults Manager to pass on their views.

                      See: Local Government Association - Making Safeguarding Personal Toolkit

                      ...................................................................................................................................................................………………

                      Safeguarding Principle - Prevention 

                      What does this mean for the professionals: Strategies are developed to prevent abuse and neglect that promotes resilience and self-determination.

                      What does this mean for the adult: "I am provided with easily understood information about what abuse is, how to recognise the signs and what I can do to seek help".

                      ...................................................................................................................................................................………………

                      2.3 The MASCC should consider:

                      • The longer-term health, social care, communication, cultural or other specific needs of the adult at risk.
                      • The ongoing support the adult will need.
                      • What learning can be shared across agencies to help prevent further re-occurrences (this is also linked to Section 44 of the Care Act 2014 - if the criteria is met).
                      • What training or education is also needed to help prevent further re-occurrences of abuse.
                      • How information should be recorded and shared in line with the data protection legislation to help prevent further instances of abuse (see section 2.39 of the London Multi-Agency Safeguarding Policy and Procedures).

                      ...................................................................................................................................................................………………

                      Safeguarding Principle - Proportionality  

                      What does this mean for professionals: A proportionate and least intrusive response is made balanced with the level of risk.

                      What does this mean for the adult: "I am confident that the professionals will work in my interest and only get involved as much as needed".

                      ...................................................................................................................................................................………………

                      ..................................................................................................................................................................………………

                      Safeguarding Principle - Protection

                      What does this mean for the professionals: Adults are offered ways to protect themselves, and there is a co-ordinated response to adult safeguarding.  

                      What does this mean for the adult: "I am provided with help and support to report abuse. I am supported to take part in the safeguarding process to the extent to which I want and to which I am able".

                      ...................................................................................................................................................................………………

                      • Any potential risks to children and young people (or other adults at risk) and agreement on who will arrange a Child Protection referral, where necessary (if this hasn’t already been actioned and is applicable).
                      • How actions that may be needed to further reduce the future risk of harm to the adult, and or others, will be delivered.
                      • Ensure there is clarity about the type of abuse that has occurred and that this is recorded effectively, considering types of abuse that are particularly under-recorded:
                        • Organisational Abuse
                        • Discriminatory Abuse
                        • Modern Slavery
                        • Domestic Abuse.
                      • The link with other key processes and procedures e.g. personnel issues (including referrals to the Disclosure and Barring Service or a professional or regulatory body); Police investigations; other regulatory processes such as a NHS Serious Incident, and the link to Pressure Ulcer Panels (see section 6).

                      ...................................................................................................................................................................………………

                      Safeguarding Principle - Partnerships 

                      What does this mean for the professionals: Local Solutions through services working together within their communities.

                      What does this mean for the adult: "I am confident that information will be appropriately shared in a way that takes into account its personal and sensitive nature. I am confident that agencies will work together to find the most effective responses for my own situation".

                      ...................................................................................................................................................................………………

                      ...................................................................................................................................................................………………

                      Safeguarding Principle - Accountability

                      What does this means for the professionals: Accountability and transparency in delivering a safeguarding response.

                      What does this mean for the adult: "I am clear about the roles and responsibilities in all those involved in the solution to the problem".

                      ...................................................................................................................................................................………………

                      • That arrangements are in place to feedback the conclusion of the Case Conference and any other relevant information to those who need to be advised and are not in attendance.
                      • Where other processes, such as a complaints procedures have been suspended pending the outcome of the enquiry, that these are subsequently resumed.

                      3. Who can convene a MASCC?

                        An Operational Lead/Manager within the London Borough of Lewisham (LBL) can convene a MASCC, or a Service Manager within LBL for more complex or serious cases.  

                        Operational leads should seek advice from their senior colleagues if they are in doubt about convening a MASCC.

                        4. Who should attend a MASCC?

                        There are a wide range of people who may be required to attend a MASCC, including, but not limited to:

                        1. The adult and or their representative (see 2.1).
                        2. The Safeguarding Adults Manager (SAM) or their equivalent.
                        3. The Safeguarding Enquiry Officer.
                        4. Police manager.
                        5. Other criminal justice agencies.
                        6. NHS Trust manager and or relevant specialist.
                        7. GP
                        8. Care Quality Commission.
                        9. Care Provider agency manager.
                        10. Relevant LBL and or South East London (SEL) Clinical Commissioning Group (CCG) Commissioner.
                        11. Quality Assurance or Contracts Officer from LBL and or SEL CCG.
                        12. The person/agency alleged to have caused the harm should have been given the opportunity to submit their representations. If this is an agency, then a manager not directly involved in providing care in the case may be invited to attend.

                        MASCC’s should be formally recorded and minutes taken, which should be shared with those attending. This should be completed within 10 working days of the Case Conference.

                        5. Practical arrangements

                        Whilst there is a need to formally record the minutes from MASCC’s, these Case Conferences should be set up as informally and flexibly as possible to meet the requirements of the adult and or their representative(s), whilst also helping ensure that professionals can contribute when these meetings are being set up at relatively short-notice.

                        It may be suitable and appropriate to set these Case Conferences up online using video methods, or via telephone, or by being flexible in utilising meeting rooms that are accessible for those involved.

                        Otherwise the chair of the MASCC should consider:   

                        1. How to create a comfortable and welcoming environment.
                        2. Whether the adult wishes to have a representative(s) with them and whether they will or should have an active or silent role (legal representative). This should be agreed with the adult, their legal representative and the chair ahead of the Conference.
                        3. Any communication requirements or other accessibility issues.
                        4. Location of facilities such as refreshments and toilets.
                        5. How breaks will be agreed, if needed.
                        6. Arrangements should the adult require a break or wish to clarify any points covered in the Case Conference.
                        7. The adult and their representative(s) should not be required to join a room where other attendees have previously gathered, and where possible they should be in the room before other attendees join, having met and had a chance to talk with the chair ahead of the meeting.
                        8. Meetings can also be in multiple parts to make them less intimidating (smaller groups) and more manageable for the adult, and include a separate and wider ‘professionals’ meeting.
                        9. Where the venue is the adult’s own home, consideration should be given to how their home will be treated with respect, and how to maintain confidentiality if others not attending the Conference may also be present in the home.

                        See: Multi-Agency Adult Safeguarding Case Conference Meeting Record (Pdf)

                        Multi-Agency Adult Safeguarding Case Conference Meeting Record (Word)

                        6. How do MASCC’s link to Pressure Ulcer Panels and the Provider Concerns process?

                            6.1 Pressure Ulcer Panels

                            Any Section 42 Safeguarding Enquiry which has commenced as a result of a pressure ulcer related issue will normally be conducted via one of the two Pressure Ulcer Panels in the Borough of Lewisham, which are both overseen by a senior social work practitioner from within LBL.

                            If these are routine cases, then a MASCC will not be required, unless one or more of the issues listed in section 2 of this guidance are present in the case.

                            If a MASCC is deemed to be necessary in relation to a pressure ulcer related case, then a MASCC should be convened within 10 working days of a decision being made that one is necessary, even if the case has not been brought to a conclusion by the relevant Pressure Ulcer Panel.

                            6.2 Provider Concerns   

                            As described in section 2, one outcome from a MASCC might be to make a referral to the Provider Concerns process if the criteria for this has been reached (see sections 5.7 & 5.8 of the London Multi-Agency Safeguarding Policy and Procedures). The MASCC may help to identify signs linked to provider concerns, allowing for early supportive actions to be taken by commissioning authorities in supporting social care providers. A referral for the Provider Concerns Process should be made through the applicable Contracts Officer from LBL and or SEL CCG.

                            7. Monitoring and review of MASSC’s

                            The Operational Lead for LBL will provide operational oversight and monitor all activity linked to the Section 42 Enquiry process, including MASCC’s, in conjunction with the Service Manager with overall responsibility for adult safeguarding within LBL.

                            The Service Manager within LBL will provide oversight of MASCC’s (including chairing more complex Case Conferences as required), providing quality assurance to the Lewisham Safeguarding Adults Board through ongoing audit and reporting processes.

                            Closing the Enquiry Stage 4

                            A Safeguarding Concern/Enquiry can be closed at any of the previous three stages of the procedure.

                            However, the following points should be used as a checklist to ensure the procedure has been closed effectively and appropriately:

                            • Anyone involved in the Safeguarding Concern/Enquiry should be advised on how and who to contact if there are further concerns about the adult at risk.
                            • There should be agreement on how any further concerns will be followed up.
                            • It is good practice where a care management assessment, Care Programme Approach (CPA), reassessment of care and support, health review, placement review or any other pre-booked review is due to take place following the safeguarding enquiry, for a standard check to be made that there has been no reoccurrence of concerns.
                            • Closure records should note the reason for this decision and the views of the adult at risk to the proposed closure. The SAM responsible should ensure that all actions have been taken, building in any personalised actions:
                              • Agreements with the adult at risk to closure.
                              • Referral for assessment and support.
                              • Advice and information provided.
                              • All organisations involved in the enquiry updated and informed.
                              • Feedback has been provided to the referrer (this is very important).
                              • Action taken with the person alleged to have caused harm.
                              • Action taken to support other service users.
                              • Referral to children and young people made (if necessary).
                              • Outcomes noted and evaluated by adult at risk.
                              • Consideration for a Safeguarding Adults Review (SAR).
                              • Any lessons to be learnt.

                            The adult safeguarding process may be closed but other processes may continue, for example, a disciplinary or professional body investigation. These processes may take some time. Consideration may need to be given to the impact of these on the adult and how this will be monitored. Where there are outstanding criminal investigations and pending court actions, the adult safeguarding process can also be closed providing that the adult is safeguarded.

                            All closures no matter at what stage are subject to an evaluation of outcomes by the adult at risk. If the adult at risk disagrees with the decision to close safeguarding down their reasons should be fully explored and alternatives offered.

                            At the close of each enquiry there should be evidence of:

                            1. Enhanced safeguarding practice ensuring that people have an opportunity to discuss the outcomes they wanted at the start of safeguarding activity.
                            2. Follow-up discussions with adults at risk at the end of safeguarding activity to see to what extent their desired outcomes have been met.
                            3. Recording the results in an anonymised way by fully completing all data recording requirements so this can be used to inform practice, and provide the necessary performance monitoring information for the Lewisham Safeguarding Adults Board.

                            Adult Safeguarding Pathway Resources

                            Adult Safeguarding Posters - See it, Report it!

                            Adult Safeguarding Leaflet:

                            Single Agency Policy and Procedures Template (for use by any agency)

                            Adult Safeguarding Pathway Forms and Templates

                            London Fire Brigade: Help for Hoarders - Fire Safety Tips

                            London Fire Brigade: Help for Hoarders - Fire Safety Tips

                            Prevention

                            We can all help to prevent adult abuse and neglect by supporting the delivery of these key objectives:

                            1. Improve Public Awareness

                            This can be achieved by helping to support awareness building campaigns and by signposting adults to appropriate sources of information. One easy way to do this is by following @lewisham_sab on Twitter and supporting the campaigns we deliver.

                            2. Identify Adults who May be at Increased Risk

                            There are many factors which might increase the risks of adult abuse and neglect including: older age; physical, mental, sensory, learning or cognitive illness or disability; and having to rely on others for health and social care support.

                            3. Identifying & Responding Effectively to Abuse

                            Organisations and individuals working to improve their understanding and early identification of the different types of adult abuse, so that an effective response can be achieved in conjunction with the adults views and wishes.

                            4. Consistent & Widespread Application of Policies & Procedures

                            It is important for organisations delivering services to adults to have appropriate policies and procedures which are developed in line with guidance from the Lewisham Safeguarding Adults Board, and embedded into the practice of all professionals. See: Pathway Resources

                            5. Focus on Equality & Narrowing Inequality

                            Adults from financially deprived backgrounds are more likely to become an identifiedvictim of adult abuse and neglect, and  it is less likely that an adult from some ethnic minority communities will be engaged with statutory services in Lewisham. All professionals can help to improve reporting and equal access to protective services.

                            This Government Guidance provides some excellent information and resources to help reduce inequality: Inclusion Health: Applying All Our Health (May 2021)

                            6. Help Adults to Protect Themselves

                            Every organisation delivering services to adults at risk of abuse and neglect can identify ways in which they can help to inform, and support adults in protecting themselves from abuse.

                            7. Provide Information, Advice & Advocacy

                            Individual organisations will know the communication needs of their client groups, and as such are best placed to provide bespoke adult safeguarding information in the most appropriate formats, methods and languages. See: Pathway Resources

                            8. Provide Access to Training & Education

                            Organisations have a responsibility to provide access to up to date and relevant adult safeguarding training for their staff and volunteers, and additional support for the person (s) responsible for leading on this subject within that agency.

                            9. Support Broader Wellbeing Strategies

                            There is a clearly established link between the prevention of adult abuse and broader health and wellbeing strategies, including the reduction of social isolation and loneliness. Organisations can help to engage adults in these type of strategies, which will also indirectly help to prevent adult abuse.

                            Please let us know if you have any thoughts or ideas in relation to prevention.

                            Adult Safeguarding Network: Register of Agencies - Your Feedback - Good Practice Library

                            Please get in touch and let us know if your agency has connected to this Pathway through your agencies policy and procedures, and by signposting staff/volunteers to these webpages.

                            If you also have any feedback on the Pathway, or want to generally share good practice including anonymised case examples of how you have helped to support adults in achieving positive outcomes, then please let us know and we will share and promote this via this webpage if this is suitable: LSAB@lewisham.gov.uk

                            Agencies connected to this Pathway

                            1. London Borough of Lewisham

                             

                             

                             

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