Agenda item

RESOLVED:

·         that the report be noted, and that Michael Preston-Shoot be thanked for all his work as the Independent Chair of the Lewisham Safeguarding Adults Board.

Michael Preston-Shoot (Independent Chair of Lewisham Safeguarding Adults Board- LSAB) introduced the report. The following key points were noted:

3.1. The annual report contained details of two Safeguarding Adult Reviews (SAR)- Amanda (published on 2 November 2022) and Eileen Dean (published on 11 November 2022). Both these reviews had received significant national interest. The SAR of Eileen Dean was widely discussed, and a number of Safeguarding Adults Boards were using this review to highlight the shortage of appropriate placements for some people with enduring forms of mental illness.

3.2. Another SAR, expected to be published in the annual report 2023-24 was for ‘Joshua’, a young man who died as a result of restraint used by a number of police officers.

3.3. A lot of the SARs involved mental health issues. Therefore, facilitated by Councillor Paul Bell, the LSAB had held a number of high-level meetings with SLaM (South London and Maudsley NHS Trust) seeking assurance about the degree of support being provided to people- both to inpatients and to people with mental distress living in the community.

3.4. The annual report for 2022-23 included details of an assurance audit in relation to housing issues. This audit provided a degree of reassurance but also highlighted a number of recommendations for housing providers and for the Local Authority. The LSAB had an oversight on the implementation of these recommendations.

3.5. The next LSAB annual report for 2023-24, would include the details of an audit of the Mental Capacity Act assessments.

3.6. Several meetings of the LSAB had focused on monitoring the implementation of the Right Care Right Person (RCRP) operational model. The Independent Chair of LSAB reported that in his opinion, RCRP had been rolled out better than expected with very few cases requiring escalation. However, LSAB would continue to keep a close eye on the outcome of RCRP’s implementation.

3.7. The Council’s preparation for Care Quality Commission (CQC) assurance would also be included in the 2023-24 LSAB report. The Independent Chair of LSAB had shared with Council officers the feedback from the five pilot sites that experienced the CQC inspection towards the end of 2023. Further intelligence was expected from Hertfordshire, Hounslow and West Berkshire that were due to be inspected in early 2024.

3.8. The 2023-24 LSAB annual report would also focus on neurodiversity and the degree to which services were responding appropriately to people who experience different forms of neurodiversity.

3.9. Michael Preston-Shoot, who had been the Independent Chair of LSAB since January 2017, was stepping down from this role at the end of March 2024. He thanked all Lewisham Councillors for the support they provided to LSAB’s work.

The Committee members were invited to ask questions. The following key points were noted:

3.10. There were a total of 500 safeguarding concerns in 2022-23 with their primary support reason being physical disabilities. It was noted that this was a high number and that the LSAB was continually seeking assurance about the quality of care and support assessments undertaken by the Local Authority. It was also seeking assurance regarding the quality of Section 42 enquiries along with looking at the range of support provision for people with disabilities. Assurance was being sought through various performance reporting and audit processes.

3.11. The 2022-23 LSAB annual report highlighted that the dominant subject area that was prevalent in the SAR notifications was mental ill-health, which was a feature in 66% of the published SARs and 3 further ongoing reviews. The Independent Chair of LSAB was involved in the national analysis of SARs across England and the percentage of SARs in England across the last four financial years featuring mental health was 70%. So Lewisham’s 66% figure was in-line with the national figure of 70%. These high figures highlighted the challenges around ensuring effective primary and secondary mental health care. It was discussed that the 13 plus years of financial austerity had a major impact on mental health provision in both primary and secondary care.

3.12. The report outlined that adults from Black British, Black African, and Black Caribbean backgrounds were disproportionality more likely to be the subjects of a SAR notification linked to mental ill-health. It was discussed that much more work was needed across services to ensure reasonable adjustments were made to counteract discrimination and promote equality of opportunity across all protected groups. LSAB had sought assurance from SLaM about how they were planning to counteract discrimination and disproportionality in mental health and would continue to hold them to account.

3.13. One of the reasons why an audit on the Mental Capacity Act assessments was requested was because of the failure and shortcomings in relation to mental capacity emerging routinely in SARs across Lewisham and England. It was important to ensure that people were facilitated to make their own choices and were not subject to coercive behaviour or undue influence by others. On the basis of thorough assessments, when it was concluded that people did not have the capacity to take a particular decision, they needed to be involved as much as possible with advocate support.

3.14. The third highest number of SAR notifications between April 2018 and March 2023 were around issues of pressure area care. This had emerged as a local and national trend. The LSAB received regular reports from the pressure care panels (a community panel and a hospital panel) and the Integrated Care Board (ICB) was monitoring this closely as well.

3.15. Well-trained nursing staff was critical for patient safety. Financial austerity had a negative impact on the training of nurses, midwives, social workers and other practitioners in residential care homes and nursing homes. This needed to be raised with DHSC (Department of Health and Social Care) nationally as there was no national system for training social care staff.

3.16. The Covid-19 pandemic definitely had an impact on adult safeguarding as more adults were at risk due to lockdown. However, there was no specific impact on the number of SAR notifications.

3.17. Councillor Paul Bell, Cabinet Member for Health and Adult Social Care thanked Michael Preston-Shoot for all his work as the Independent Chair of the LSAB. Michael had been an excellent advocate for safeguarding in the borough and his role had been profoundly beneficial for the residents in Lewisham.

3.18. In the case of SAR Joshua, an inquest jury at Southwark coroner’s court found that the cause of death was Acute Behavioural Disturbance (ABD), also known as excited delirium, leading to exhaustion. Numerous campaigners had argued that this term contained racial biases and was often used to justify the use of lethal force by police disproportionately against black men. It was discussed that ABD was a problematic and potentially discriminatory term. There was a need to improve outreach for people living in communities with mental health issues and also to ensure that practitioners were trained on how to deal with people who are in acute distress.

RESOLVED:

·         that the report be noted, and that Michael Preston-Shoot be thanked for all his work as the Independent Chair of the Lewisham Safeguarding Adults Board.