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									                                      Notice Board
Dear colleague

This is our second safeguarding newsletter to all GPs in SoTW. Whilst we would like to
focus your attention this month on Safeguarding Adults we have included some issues
around children and would like to take this opportunity to welcome Dr Sian Firth to her
new role as Named GP Safeguarding Children for Sunderland.

Sian is a salaried GP who has worked at Dr Cloak and partners practice in Southwick for
9 years, after studying and qualifying in Newcastle. She has a keen interest in Child
Health, (she has worked in paediatrics in Sunderland and completed her DcH). She is
enthusiastic about her new role and the challenges she faces as Named GP. Should any
GP in Sunderland wish to contact Sian regarding a safeguarding issue she can be
contacted on 07919540082/sian.firth@nhs.net.

If any GP reading this newsletter is interested in taking on a similar role in South Tyneside
please contact Carol Drummond (2831379 ) or in Gateshead Maggie Lilburn (4971571 )

You will find useful information in this edition on:

      The BMA Safeguarding Adults Toolkit
      The Mental Capacity Act and Deprivation of Liberty Safeguards
      Specific learning for GPs from local and national Serious Case Reviews around
       Adults
      Training opportunities
      Multi-Agency Public Protection Arrangements (MAPPA)
      Multi-Agency Risk Assessment Conferences (MARAC)
      PREVENT
      Reviewing your Practice’s Safeguarding Arrangements
      Local Updates


Regards

Maggie, Carol and Deanna (Designated Nurses Safeguarding Adults & Children)




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  Did you know the BMA has released guidance this month to support
                   doctors in safeguarding adults?


Doctors have an obligation to take action if they believe vulnerable adults are
    being badly treated in care homes, according to the British Medical
                                 Association
Whilst this guidance is principally aimed at GPs, any professional working in care settings
with vulnerable adults will find it useful.

Recent shocking events at some Castlebeck homes show how care can sometimes be far
from the high standard it should be. This guidance sets out how GPs can help avoid that
happening, as well as looking at ways in which GPs can improve and protect wellbeing
more generally.

The Department of Health commissioned the BMA to produce ‘Safeguarding vulnerable
adults – a toolkit for general practitioners’ because of a lack of clarity in this
increasingly complex area.

The guidance highlights the obligation doctors have to protect vulnerable adults and that
legislation is in place to protect doctors who wish to speak out. This includes identifying
abusers, identifying systemic healthcare failures and reporting poor performance by
health professionals.

According to the BMA guidance, it is essential that doctors support the independence and
the quality of life of vulnerable adults. Doctors should also involve this group of individuals
in decisions about their treatment and care as far as possible.

Chairman of the BMA’s Medical Ethics Committee (MEC), Dr Tony Calland, said: “The
way doctors deal with these possible situations demonstrates how complex caring for
vulnerable adults can be. There is no ‘one size fits all’ solution and each case needs to be
judged individually. This toolkit will help to guide and support doctors in their decision-
making. Our guidance also helps doctors identify which adults have the capacity to
protect and promote their own interests, and which adults may need decisions made on
their behalf.”


    http://www.bma.org.uk/ethics/doctor_relationships/safeguardvulnerableadults.jsp



                                        Safeguarding Adults
                                              Toolkit




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        Mental Capacity Act 2005 and Deprivation of Liberty Safeguards

   The MCA was fully implemented in 2007 and the DOL Safeguards since April 2009

All Health and Social Care professionals must comply with the Act and the Codes of
Practice when working with adults who lack capacity to make particular decisions for
themselves.
The MCA        introduced a Statutory Right to Advocacy for patients if they were
 'unbefriended' and incapacitated and the decision maker was considering providing,
withholding or withdrawing serious medical treatment, or they were to be in hospital for
more than 28 days

The Act enshrines 5 principles in legislation :

       It should be assumed that adults over 16 have full capacity to make decisions for
        themselves unless it can be shown that they lack capacity to make a specific
        decision for themselves at the time the decision needs to be made
       A person must not be treated as unable to make a decision unless all practicable
        steps to help them do so have been taken without success
       A person must not be treated as unable to make a decision merely because they
        make an unwise decision
       An act done, or decision made, under this Act for or on behalf of a person lacking
        capacity must be done, or made, in their best interests
       Before the act is done or the decision made, regard must be had to whether the
        purpose for which it is needed can be as effectively achieved in a way that is less
        restrictive of the person’s rights and freedom of action

The Act allows restrictions / restraints in relation to an incapacitated person as long as it is
necessary to protect the person from harm and is proportionate to the risk of harm.
However if these restrictions would cumulatively amount to a deprivation of liberty then
the MCA DOLS Safeguards or an order from the Court of Protection must be used.

Advice on individual situations can be The MCA and DOLS Codes of Practice are
                                        available from www.publicguardian.gov.uk
 obtained from your Local Authority
                                                     then click justice
Safeguarding Adults Team or on your
  Local Safeguarding Adult Board
              website:                 Claud Regnard, Consultant in Palliative
Sunderland              0191 566 1736             Care and a working group have produced
www.alertabuse.org.uk                             an excellent document relevant to all Health
                                                  professionals entitled Deciding Right. An
                                                  integrated approach to Making Care
South Tyneside 0191 424 4049                      Decisions in Advance with children, young
www.southtyneside.info/safeguardingadults
                                                  people and adults.
                                                  http://durhamdalesgpcommissioning.org.uk/
Gateshead               0191 433 2362             wp-content/uploads/2011/08/Deciding-
www.gateshead.gov.uk/Care%20and%20Health/
CommunityCare/VulnerableAdults/FAQ.aspx           Right-full-document-v10-min-size.pdf



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                What is MARAC?                           What is MAPPA?
Multi-agency     Risk        Assessment      The Multi-Agency Public Protection
Conferences (MARACs) are held for            Arrangements (MAPPA) is a statutory
victims of HIGH risk domestic abuse –        system set up nationally to assess and
those who are at risk of serious harm or     manage the risks posed by sexual and
death.                                       violent offenders, to reduce serious
                                             offending, minimise serious harm to the
MARACs are led by the police and although public and assist in the early detection of
not statutory, seen as “best practice” in repeat offenders.
supporting victims; both adult and child and
all genders.                                 The Police, Prison and Probation Services
                                             are charged with the duty and responsibility
Within a MARAC, relevant agencies are to ensure that MAPPA is established in
able to share up to date risk information their area and for the assessment and
and decide upon the most appropriate way management of risk of all identified MAPPA
to reduce or manage the identified risks     offenders.

                                             PCTs, other NHS Trusts and SHAs have
                                             a duty to co-operate with the RA under
    MARAC risk                               section 325(3) of the Criminal Justice
assessment checklist
                                             Act (2003)
                          How do MAPPA & MARAC interact?
MARAC is not a formal part of the MAPPA although it should be complementary to and
have links with the local MAPPA. The MARAC runs parallel with Level 2 MAPPA and
ensures identified High Risk Domestic Abuse cases are dealt with in a public protection
framework. Some offenders will meet the criteria for both MAPPA and MARAC and in
some cases the risk of re-offending by these offenders maybe managed simultaneously
by MAPPA and MARAC decisions.

If a named person is the subject of both the MARAC and MAPPA, then it will be the
responsibility of the MAPPA Coordinator and the referring agency manager or their
representatives to determine whether it should be brought to one forum or if the case
should run concurrent at both the MARAC and MAPPA.

Further information can be found at:
http://www.acpo.police.uk/documents/crime/2010/20110301%20CBA%20ACPO%20(201
0)%20Guidance%20on%20Protecting%20the%20Public%20v2%20main%20version.pdf

                       How are GPs involved in these processes?

 NHS SoTW Community Health Services currently co-ordinate health information from
GPs for both processes. If a patient of your practice is being managed as a victim under
MARAC or as a risk under MAPPA you may be contacted for information from the team or
 be asked to support either process. You are reminded of your responsibilities regarding
                         information sharing for both processes -
  https://www.education.gov.uk/publications/eOrderingDownload/00807-2008BKT-EN-
                                       March09.pdf



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                                     Did You Know?

The Police Public Protection Unit (PPU) has changed how it works. It is now known as
the Protection of Vulnerable People Unit and now covers Sunderland, South Tyneside
and Gateshead; and is based at Southwick Police Station.

The Unit will cover 3 main areas:

DV and Rape – Detective Inspector Denise Clarke
Child Abuse and Vulnerable Adults - Detective Inspector Ron Cruikshank
MAPPA – Detective Inspector Phil Bond

They are awaiting telephone numbers etc but in the interim can be contacted on the
Police number of 454 7555; then asking for the named person at Southwick Police
Station.


 Just a reminder: you may recall                            Sunderland
 some workshops that were held                            Wearmouth Room
   over the summer regarding                              Pemberton House
           PREVENT?                                 19th January 2012 9.30 -11.00 am
                                                    1st February 2012 9.30 -11.00 am
PREVENT is the strategy which aims                 29th March 2012 9.30am - 11.00 am
to stop people becoming terrorists or
  supporting extremism. Health has                             Gateshead
                                                              Board Room
  been identified as a key partner in
                                                              Team View
   supporting the strategy as many
                                                 15th February 2012 9.30am – 11.00am
frontline staff can identify and/or play          1st March 2012 9.30am – 11.00 am
     a role in supporting vulnerable
   individuals who may be at risk of                        South Tyneside
being recruited by violent extremists.                       Board Room
   All health staff need therefore to                         Clarendon
have an understanding of PREVENT                  8th March between 9.30am – 11.00am
and what to do if they have concerns
       about a vulnerable person.
                                                 These are awareness raising workshops
Sessions are being held on the dates/times      and will equip you with an understanding of
opposite and are open to GPs and Practice        when to share concerns about potentially
         Staff from the 3 localities                     vulnerable patients/clients

  Come along and share the learning with         To book a place please contact,
 other health staff in a workshop facilitated   Eleanor Hardy, Admin Team Lead
          by a Designated Nurse                     on 5297222 or by email to
                                                   Eleanor.hardy@sotw.nhs.uk


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When is a Serious Case Review                  What’s the local situation?
(SCR) undertaken in Adult cases?
                                               South Tyneside has undertaken 2
When a vulnerable adult dies, and abuse or        SCRs in adult cases; one in 2009,
neglect are known or suspected in the             another in 2010. There is one
death, local agencies need to consider            pending on completion of criminal
immediately whether there are any other           proceedings.
vulnerable adults at risk of harm who may
need safeguarding. Thereafter, agencies        There is currently a SCR ongoing in
need to consider whether there are any            Sunderland following the murder of
lessons to be learned from the                    a woman living in warden controlled
circumstances of the case about the ways          accommodation
in which they work together to safeguard
adults. When a vulnerable adult dies in    The Designated Nurses monitor SCRs from
such circumstances, the Local              other areas to ensure NHS SoTW learns
Safeguarding Adults Board should always    from them too.
conduct a Serious Case Review into the
involvement of agencies and professionals.
The Board should also consider whether a
SCR should be conducted where a             Watch this space for dates for “lessons
vulnerable adult sustains a potentially                 learned” sessions
life-threatening injury or serious or
permanent damage to their health or well
being.
    Specific Learning for GPs from Adult Safeguarding Serious Case
                                Reviews

       The importance of sharing information across the health economy if concerns are
        identified about a vulnerable adult

       Staff in GP practices to undertake training regarding recognising and supporting
        vulnerable adults

       All practices to have a Safeguarding Adults Policy which includes guidance on
        actions to be taken following DNA of a vulnerable adult

       All GP records to clearly document safeguarding adult concerns and actions taken

       All practices to identify a Safeguarding Lead for Adults

       GPs/Practice staff to make safeguarding “alerts” in a timely manner in accordance
        with MA policy and procedures

Please remember to discuss any concerns you may have around any nursing or care
homes you visit and report them appropriately. Concerns may be around weight loss,
dehydration, bruising, pressure sores but may also be due to observation of bruising or
comments made by your patient – Safeguarding is everybody’s responsibility




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                              Safeguarding Children
                                     News

Children’s Minister responds to major        Full day Level 3 Safeguarding Children
report on Child Sexual Exploitation                     Training for GPs

Tim Loughton has responded to a major                  South Tyneside GPs
report on Child Sexual Exploitation in
Gangs and Groups published by the                          2nd Nov 2011
University of Bedfordshire. The Office of               Cleadon Park PCC
the Children’s Commissioner is
launching a 2 year inquiry.                 Jan 18th 2012, Primrose CA Children’s Centre

Tim Loughton said:                            March 7th 2012, Primrose CA Children’s
This report is an important contribution                      Centre
to our understanding of the terrible
problem of CSE. CSE is an appalling
form of child abuse and we are                           Gateshead GPs
determined to do everything possible to
stamp it out. I will carefully consider     14th Dec 2011 Council Offices Prince Consort
these findings as we develop our action                    Road (Rm 6)
plan to safeguard children and young
people from sexual exploitation.            9th Feb 2012 Council Offices Prince Consort
                                                           Road (Rm 6)
The action plan, to be published later
this Autumn, will draw on work around          23rd March 2012 Council Offices Prince
the country to prevent sexual                          Consort Road (Rm 6)
exploitation, identify those at risk and
support victims. It will address the                     Sunderland GPs
challenge of securing prosecutions and
the need for robust action against          2nd Nov 2011 Penshaw 60 Pemberton House
perpetrators.
                                            11th Jan 2012 Penshaw 60 Pemberton House
All LSCBs will be looking to raise
awareness of CSE and ensure local             14th March 2012 Penshaw 40 Pemberton
strategies to address this form of abuse.                     House

http://www.education.gov.uk/inthenews/i       To reserve a place on a course please
nthenews/a00199248/tim-loughton-               contact Eleanor.Hardy@sotw.nhs.uk
responds-to-major-report-on-child-
sexual-exploitation




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                                  South Tyneside update
Safer Families

Are you aware of the Think Family approach to service planning and delivery? It is an
approach backed by considerable research and evidence of impact. The approach is
based on the importance of the family in caring for and supporting children and vulnerable
adults. It seeks to strengthen the development and co-ordination of services typically
delivered to children OR adults, to ensure a more seamless and robust service for
families. The research shows that this pays off in terms of the outcomes achieved.

The approach requires some changes to our working culture and arrangements. That will
take time, but we are keen to support that process by providing some staff development
sessions that will ensure staff and managers:
     are aware of the direction of travel set out within our Safer Families Strategy
     the values and principles of the Think Family approach and
     have an understanding of the progress already made, including some tools that will
        help practitioners to adopt a Think Family approach to their practice

On the following dates; venue to follow

                            Session 1 – 18th January 2012 - 9am-12pm
                          Session 2 – 25th January 2012 - 1.00pm to 4pm
                         Session 3 – 10th February 2012 - 1.00pm to 4pm
                         Session 4 – 14th February 2012 - 1.00pm to 4pm

                        Please contact Lynn.hodson@southtyneside.gov.uk
                                 if you would like to reserve a place



       Gateshead update                                Sunderland update

   In November Gateshead          Sunderland has 447 Children that are subject to a CP
    Local Safeguarding             Plan, 365 of which are in the category of neglect.
    Children Board are to          Sunderland Safeguarding Children Board have
    launch their new inter –       endorsed a multi-agency approach to enable
    agency safeguarding            practitioners to identify neglect and work with families to
    procedures.                    improve their outcomes.           The GRADED CARE
  These can be found at:           PROFILE is a practical tool to give an objective
 www.gateshead.goc.uk/lscb         measure of the care of children across all areas of
                                   need. It draws on the concept of a continuum &
      Our SCR into the tragic     identifies strengths and weaknesses and identifies
       death of a baby is still    priorities for intervention
       ongoing; further details
       will be provided in the     A randomised controlled trial is due to commence in the
       Winter Edition              near future on 25 families (subject to CPP or
                                   CIN)…watch this space




                                                                                      8
 How good do you think your Practices Systems and Processes are for
                          Safeguarding?

The Designated Nurses have developed a Safeguarding Commissioning
Policy which is currently being consulted upon. Part of this document is a
self-assessment tool for all providers of care to use to review their
safeguarding arrangements (for adults and children). This will be a useful
opportunity for GPs and their Practice Managers to prepare themselves for
CQC registration and for future audits resulting from SCRs


self assessment tool


                       Have a look and let us know what you think!




                                 Tell Us……………….

     E-mail any suggestions for future newsletters or any comments to improve
                 further newsletters to Deanna.Lagun@sotw.nhs.uk




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