Independent Chair of the Bromley Safeguarding Adults Board

The Independent Chair of the Bromley Safeguarding Adults Board (BSAB) thanked the Chairman for providing an opportunity to give a brief summary of the work which was going on in terms of prevention, service provision and assurance for people’s safety during the current phase of the pandemic.

The Independent Chair – BSAB informed Board Members that since taking up the post at the beginning of the year, she had received a very helpful induction to understand more about local context. The BSAB was participating in a national project (Insight Project), co-sponsored by the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS), which had been established at the beginning of the pandemic to share data and provide a comparative baseline to understand the impact of the pandemic. The concerns seen in Bromley were much the same as elsewhere across the country, and included:

-  Care homes (support for homes and their staff);

-  Closed institutions (and the need to ensure good quality assurance);

-  Impact on carers (including informal, unpaid carers with more people being cared for at home, and some services being less accessible);

-  Self-neglect – hidden harm (increase in self-neglect referrals);

-  Impact on the workforce (staffing levels, and increased pressures, particularly in care homes); and

-  Domestic Abuse.

A meeting had recently taken place with the BSAB’s statutory partners to seek assurance from them, particularly in relation to the current phase of the pandemic, and responses to these areas of concern.

One of the areas which the Independent Chair – BSAB considered to be particularly impressive was the Care Home Operational Group. The group met on a daily basis, chaired by either the Director of Adult Social Care or Director of Public Health, with a membership that included representatives from across the local health and social care sector. At each meeting, members looked at the number of COVID-19 cases in care homes, which allowed them to make contact with providers and offer support as required. There was a clear escalation process in place, and the system was an example of very good practice.

With regards to Domestic Abuse, Board Members were advised that less referrals had been received during the initial phase of the pandemic than expected. However, it was noted that since the beginning of this year, referrals had started to increase. This increase was considered to be a breakthrough, and was being attributed to the large amount of work which had been undertaken to raise awareness in, for example, vaccine hubs and with front line staff across the partnership.

The Independent Chair – BSAB advised that there had been an enhancement of community outreach programmes to the most vulnerable groups – this was positive to hear as a number of the centres used by residents had closed as a result of the pandemic. There was also a multi-agency complex case pathway and guidance agreed for referrals of self-neglect. For those at risk of “falling through the gaps”, or were less likely to readily approach services, this network had been established to monitor them and ensure that interventions were put in place.

Staff resilience had been identified as an area of concern during the pandemic – staff were working extremely hard and there were increases in the  level of staff sickness due to self-isolation, some contracting COVID-19, as well as general stresses and strains on staff. There were some good examples of the support and counselling offered to staff across the partnership, and this had been identified as an item for review at the next BSAB meeting – providing the opportunity to share good practice in supporting staff of all levels during the pandemic.

The Independent Chair – BSAB noted that she had a particular interest in support for informal carers, and in one of her other roles was involved in a project to update an advice note for front line staff on support for carers during the pandemic, which was co-sponsored by the ADASS, LGA and Carers UK.

In summary, the Independent Chair – BSAB highlighted that so far, she had been very assured by the awareness and efforts being made to understand the impact of the pandemic – some really good practice was emerging, and being put in place, to address the concerns raised.

The Portfolio Holder for Adult Care and Health said that she was particularly impressed with the aspect relating to carers, as this was something very close to her heart, and that she looked forward to working with the Independent Chair – BSAB on the areas identified.

The Chairman of the Adult Care and Health Policy Development and Scrutiny Committee noted that some Members of the Committee were concerned that not enough attention had been paid in relation to Domestic Violence, so she had been comforted by the update from the Independent Chair of the BSAB. In response to a question, the Independent Chair – BSAB confirmed that she would be happy to provide a copy of her briefing note for circulation to Members of both the Health and Wellbeing Board and Adult Care and Health Policy Development and Scrutiny Committee.

Independent Chair of the Bromley Safeguarding Children Partnership

The Independent Chair of the Bromley Safeguarding Children Partnership (BSCP) highlighted that the Strategic Threat Assessment document provided to Board Members (item 16) was currently confidential. Board Members were assured that lessons had been learnt from the first lockdown, and during the early phases of the pandemic partners had considered that shorter and more frequent meetings were required. During these meetings, they had considered what were believed to be the key strategic issues:

-  The health and wellbeing of the workforce;

-  Identifying emerging safeguarding themes; and

-  Maintaining multi-agency interoperability.

In relation to the health and wellbeing of the workforce, the Independent Chair – BSCP noted that during the first phase of the pandemic, concerns relating to the pressures on staff significantly impacting on sickness, morale and resilience did not manifest as anticipated, and with a few exceptions, the workforce had remained remarkably stable and resilient. Looking at this in further detail, key issues had related to the COVID-19 vaccination roll-out for staff; COVID fatigue and associated workforce pressures. A number of staff were experiencing high levels of demand for their particular service, and in some instances, this had resulted in difficulty accessing breaks, taking annual leave or rest days. There had been some strategic and organisational difficulties, for example, Kings College Hospital NHS Foundation Trust had experienced some significant staff shortages and for a period this had an unavoidable impact on their numbers and the availability of their safeguarding team. This had been quickly resolved but was a good example of the impact on the overall safeguarding partnership when key frontline partners had to shuffle resources to meet critical needs.

The Independent Chair – BSCP noted the issues raised by the Assistant Director for Housing, and emphasised that the Housing department had been an excellent safeguarding partner. The team had provided real insight and meaningful support, and partners had come together to engage with children. In addition to frontline health and social care staff, it was recognised that teachers were doing an excellent job – schools were providing support to pupils at home; SEND provisions remained operational; and schools were open for vulnerable children and the children of key workers to attend.

With regards to the emerging issues, the Independent Chair – BSCP noted that a return to lockdown conditions had once again exacerbated difficulties in maintaining a direct line of sight of, and physical contact with vulnerable children, young people, and their families. However, some great work had been undertaken by partners following the first wave of the pandemic, identifying lessons learnt and a ‘Safeguarding Resilience Audit’ had taken place in relation to potential periods of further lockdown. Engagement was taking place with families via telephone and virtual technology, however some face to face visits were still taking place utilising the appropriate PPE.

It was noted that lessons were also learnt in term of identifying opportunities to engage potential victims at times, and in places, where they could safely communicate and disclose abuse, such as in pharmacies. As a result, Children’s Social Care and other partners had been early adopters of initiatives to prompt professionals to be professionally curious and provide coded language that would enable a victim to indicate that they required help. It was noted that the recently published Home Office initiative and guidance on ‘Ask for ANI’ had been welcomed.

The Independent Chair – BSCP highlighted that a study published by King’s College on engaging with, and safeguarding, those children who were not in direct line of sight, included a number of issues which were mirrored in the Borough. These included some parents, with children who had a safeguarding need for being in line of sight, being reluctant to engage with their school. It was noted that the relationship between Children’s Social Care and Education partners was strong, and they were able to monitor which children should be in school and follow up as required. This pattern was also seen in regard to routine medical appointments, with some parents reluctant for their children to attend. This had been a national issue throughout the pandemic, with a small, but significant, number of infants sustaining head injuries, household ‘slips and trips’ and non-accidental injuries in non-mobile babies.

Board Members were advised that whilst Child Criminal Exploitation (CCE) and Child Sexual Exploitation (CSE) had not manifested as anticipated, there was an anomaly at the Demark Hill site of King’s College Hospital, which had experienced a surge in cases of young people presenting as victims of CCE and CSE. The police were not picking up these cases as they would outside of the pandemic, which may relate to a lack of opportunities to see or engage with young people who were not on the street or using the transport infrastructure. Whilst children remained inside during lockdown, an online environment had presented opportunities for predators, and messages relating to the Bromley Safer Schools App had been reinforced. The UK’s National Crime Agency estimated that around 300,000 individuals posed a sexual risk to children in the UK at any given time.

With regards to mental health, it was highlighted that referrals were increasing – there were high levels of self-harm and eating disorders reported, and a more detailed analysis was being undertaken. Feedback from the Royal College of Paediatrics and Child Health suggested that the increase in referrals were related to isolation; school closures; exam cancellations; worrying about family, and parents being furloughed.

The Independent Chair – BSCP informed Board Members that during the first period of lockdown, police had not received many reports of domestic abuse, but numbers surged once restrictions were lifted and victims could safely seek help. The measures put in place had helped to flatten this curve, and police were reporting that cases of domestic abuse were still coming through. The Director of Children’s Social Care had undertaken some work with the Department for Education (DfE), and it had been reported in December 2020 that there had been a 29% increase in referrals compared to the previous year. It was anticipated that the level of referrals would again be heightened once the current period of restrictions were eased, and the direct and indirect impact of domestic abuse on children and young people would need to be considered. In terms of substance misuse, there had been an increase in access and requests for support from Change Grow Live (Bromley’s substance misuse service provider), as well as an increase in the number of referrals for ‘Hidden Harm’ support for children and young people. As a result, some young people were reporting an escalation in their recreational drug use as a coping strategy to stressors.

Other emerging issues related to housing, homelessness, and other financial pressures – whilst much of the data related to adults, there was a direct and indirect impact on the health and wellbeing of children. It was noted that the Assistant Director for Housing had raised concerns regarding the temporary removal of stamp duty and the impact this would have on the market, relating to increased rents and increased competition for housing stock. Children’s Social Care had also reported a significant increase in the number of calls to MASH for food parcels, winter clothing and basic necessities, some of which could mask a need for other safeguarding services. Whilst Bromley residents generally had a good digital footprint, there were issues with some families experiencing difficulty accessing technology for home schooling, which were being addressed by Children’s Social Care and other agencies.

The Independent Chair – BSCP highlighted that a line of sight had been maintained on safeguarding child practice reviews and “business as normal” – in difficult circumstances Public Health, Children’s Social Care, the voluntary sector and colleagues in the police and youth services were seeing the benefits of the blended safeguarding provision.

In relation to staff wellbeing, the Director of Children’s Social Care advised that weekly returns had been completed, and over 90% of staff had been working throughout both the first and second waves of the pandemic. Board Members were also informed that a daily return was received from the schools. This flagged if any child subject to a plan or open to Children’s Social Care had not attended and allow the team to check-in with their social worker. It was felt that line of sight was being provided, and ensured that children were safeguarded.

Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites, King’s College Hospital NHS Foundation Trust noted that a strong reflection of the teams agility to respond, even when they had been faced with challenges, had been provided by the Independent Chair of the BSCP. A variety of inputs and outputs were being seen as a result of the pandemic, and the strength of the multi-agency approach and established links were highlighted. More and more cases were being seen, but it was hoped that an agile application of the system would protect vulnerable children, young people and adults.

Matthew Trainer – Chief Executive, Oxleas NHS Foundation Trust advised Board Members that a 10% increase in referrals into higher tiered CAMHS services had been seen across all boroughs, and in November 2020 demand in Bromley had been up by 30% compared to the previous year. The increase in demand highlighted by the Independent Chair of the BSCP was very much recognised by Oxleas services. It was noted that some of the consequences of the pandemic would only be understood in the longer term – the economic impact of the pandemic would start to be felt in the coming months. The integrated work of the system would be critical, and t was acknowledged that primary and secondary mental health services, schools and other partners would work together to protect children and young people during these challenging times.

A Member stated that the Strategic Threat Assessment was a very good report and highlighted that a large proportion of the issues raised affected both children and adults. It was questioned if the Independent Chair of the BCSP considered that honest and open reactions had been received from academies within the Borough. The Independent Chair – BSCP said that throughout their improvement journey, engagement with academies had improved over recent years, particularly through the Education Safeguarding Advisory Forum. They had also been looking to introduce a different type of safeguarding self-assessment audit, which by next year, could provide a statistical evidence-based answer to this question.

The Chairman noted that the snapshots provided were extremely helpful, and on behalf of Board Members thanked the Independent Chairs of the Bromley Safeguarding Adults Board and Bromley Safeguarding Children Partnership for their updates.

RESOLVED that the update on Safeguarding issues be noted.