Governance: adult safeguarding and homelessness, 23 February 2021

Download presentations from the Rough Sleepers Initiative, Ministry of Housing, Communities and Local Government, Dr Adi Cooper OBE and Professor Michael Preston-Shoot.


Webinar

Transcript

Adi Cooper: Good afternoon, everyone. Can you hear me? Thank you, Michael. I'm Adi Cooper, I'm the Care and Health Improvement Advisor at the care and Health Improvement Programme leading on safeguarding adults and we're here today at sixth of eight virtual seminars, and I'm just going to just do, do a brief introduction. So, this work is based on work previously undertaken regarding adults safeguarding and homelessness a couple of years ago. In 2019/2020, we held four workshops nationally that were organised on the theme of safeguarding adults and homelessness and those were, were, were organised through the Care and health Improvement Programme. Those workshops brought together people from across the country, across organisations, and sectors to listen to speakers and discuss issues regarding safeguarding people who experience homelessness, particularly those who are at risk of abuse or neglect. The outcome of those four workshops was published in a briefing, written by Michael Preston-Shoot, on adult safeguarding and homelessness, which is published by the Local Government Association and the Association of Directors of Adult Social Services. It's available on the LGA website. So, originally, before the COVID pandemic, so over a year ago, we'd planned to disseminate that briefing and use it to support further discussions and debate at regional and local levels, but obviously, COVID changed all of that, and so, in discussion with members of the advisory group, who'd supported this work for the last two years, we talked about what would be most useful at this time. So, a result of those discussions was planning for this series of eight session, based on a range of themes. So, today's theme is on governance, adult safeguarding, and homelessness. We have Jane Cooke here from the Ministry of Housing, the Communities and Local Government, myself and Michael to talk about various aspects of governance and-, in this area, but the objectives of today, really to reiterate, are the same for all the webinars.

 

We're here to share information, particularly regarding positive practice in this area of work and we're very keen for people to share their experiences. We're here to provide an opportunity to understand how safeguarding people who've experienced homelessness has been changing over this last year, in terms of the response to COVID, and the outcome of these eight webinars will be to provide input into a further briefing that will be published later on this year. So, that's the background, that's where we've come from, that's why we're here. Before I ask-, before I hand over to Jane, I'm just going to say that we would like people to submit their questions in the Q&A function, and we have a period of time at the end of this afternoon to address those questions. The slides will be available on the LGA website afterwards and this webinar is being recorded, as are all the other webinars, and they're available in three or four days time, for people to use locally with your teams, with your colleagues, to go back and look at, remind yourself of, of what speakers have said. So, please use-, make use of the resources that are available, coming out of these webinars. So, I'm just going to say that-, just remind, remind you to use the Q&A function at the-, we'll come to the questions at the end of the three speakers. There's a break in the middle, a comfort break in the middle as well, after I've spoken and before Michael will speak. So, Jane, can I hand over to you to introduce yourself and to thank you very much for, for attending today and, and providing a presentation. Thank you.

 

Jane Cook: Thank you, Adi. Yes, as Adi said, my name's Jane Cooke, I'm the Health and Homelessness Advisor with the Rough Sleepers Initiative at the Ministry of Housing, Community, and Local Government and I've been in post for just over two-and-a-half years. So, started just a few months after the initiative started. I'm a nurse and a health visitor by background, and I've worked in inclusion health now, this is my 36th year. So, and I'm obviously looking at safeguarding from a health and homelessness and delivery perspective. So, in this short presentation, I'll be focusing on learning from deaths and incidents and focusing on governance relating to multiple exclusions and complexity, and the two are very much linked. Can I have the next slide, thank you. So, there. Yes, so, the next slide'd be great. That's great, thank you. So, this is the, the Rough Sleepers Initiative originally funded 83 areas which h ad the highest number of, of rough sleepers, and now we're funding 270 areas where there's rough sleepers and the, the Rough Sleepers Initiative, the bids focus on three areas, so, outreach, accommodation, and support, and within the support element, help those (ph 05.44), particularly those relating to mental health and substance misuse are funded, and they have shown where the gaps in services had-, have existed and where there have been problems in accessing both mental health and substance misuse, and also some of the care elements that people require to have their needs met. When the pandemic started, just a year ago, there was recognition that people experiencing homelessness were very vulnerable to the impact of COVID 19 due to underlying health issues that so many people experiencing homelessness presented with, but they were also-, those vulnerabilities were compounded by care and housing issues as well.

 

Within two weeks, there was this massive mobilisation that took place, with 15,500 rough sleepers being moved into safe accommodation, largely in empty hotels, because the tourism industry h ad stopped, and where individuals could self-isolate with the support that was needed. What was also key was an integrated multi-disciplinary in-reach response including substance misuse services, mental health services, and physical health services, which were key to meeting multiple health needs, and those have been really successful in improving access and just show us the model that is-, that works really well, and also, having that multi-disciplinary response to people who are still out on the streets. Also, with everyone in, individuals also h ad comprehensive care and health assessments, whether indoors, in accommodation, or on the street, and where individual were assessed, were identified as clinically or extremely clinically vulnerable, to ensure they were placed in the right accommodation with the right support. So, it was very much around shielding. We also know, from those assessments, we know a lot more about the diversity of people experiencing homelessness, their needs, and especially those who present with very high levels of need and high levels of risk. So, that can help start forming the response that's needed and relates to governance. Next slide, thank you, and so, within the Rough Sleeping Initiative, there was also a strategy that was published, which was very big, but there were some health commitments within that strategy, and this was one of the health commitments, and this was to do with safeguarding adults reviews, and so, there-, it was that every area, there should be a review, when someone sleeps rough, dies, or is seriously harmed.

 

So, if there's a result, if they harm as a result of abuse or neglect, and where there's been incidents as well. So, if we move to the next slide, that's great. So, yesterday, the Museum of Homelessness published their latest funding on, on deaths of people experiencing homelessness, which showed that deaths of people experiencing homelessness spiked by more than a third in 2020. So, in this last year, to 976 people, and at the Rough Sleepers Initiative, we do ask areas to inform us when a death occurs, and we advise them to hold a review into the death and to develop a review process into deaths and incidents, with the learning being able to, to identify gaps in service provision, identify barriers to health and social care, with a view to developing a more integrated whole system approach, that will prevent deaths in the future and also reduce risk. Some of the deaths during the period of everyone in have related to overdoses and to suicides. So, being indoors has also impacted on people's health and this was evidenced yesterday by the Museum of Homelessness. Other common causes, causes have also been due to underlying physical health issues that made a, a person more vulnerable, and that's included when they've moved on, they, they're moved off the street into more long-term housing, that support is absolutely critical, to have that in place, and common institutional issues that have been identified are failure to recognise and respond to cases of multiple exclusion and homelessness, and to recognise the, the care and support needs of a person experiencing homelessness, and those offers need to be bespoke to that person. So, very much person-centred. Thresholds and criteria of services and agencies that have excluded individuals, as well as local bureaucracy and inflexibility of services, we still encounter, and especially for the cohort who are, are quite entrenched and are not always engaging.

 

There's also a lack of inter-agency working and we still see siloed services, a lack of pathways and integrated referral systems, especially at transition points, where there should've been meaningful engagement and referrals onto other agencies. Concerns have not addressed jointly by a range of agency and a lack-, and there's often been a lack of professional concern when referrals have been made and curiosity, and a lack of understanding of health and homelessness, and issues such as self-neglect which need to be addressed with local services. Out of borough placements have also left to individuals being at greater risk as they are unknown in the area, they haven't got those links that are necessary with agencies, and also, where their care packet has not-, care packet has not always followed them into a new area. Next slide, thank you, and we have seen, prior to and since everyone in, some areas have been reporting some high numbers of deaths and have responded accordingly and they've h ad reviews or setting up review processes as well. So, Redbridge, as Michael knows, h ad a high number of deaths and there was a thematic review, and the same with Leeds and Exeter has h ad a high number of deaths, and ten deaths in the last year, and similar to Swindon where we saw a lot of deaths related to overdoses. So, it's about how agencies then respond, what is the learning, which is absolutely key. Bath also responded and have set up a robust review process and, and we've also-, and the findings, learning, and recommendations, the reviews are vital, and how the learnings influence local delivery. So, in Redbridge, the findings were then sent to the Health and Wellbeing Board and then, influences commissioning. So, one of the issues that was highlighted in the review was a problem with accessing primary health care.

 

So, people were going, in crisis, to A&E, and out of that, a GP and a nurse have been commissioned to provide accessible primary care for people experiencing homelessness. So, it's, it's that learning and the governance that's necessary from the reviews that need to be applied. Hull have developed a vulnerable adults meeting and we've seen that happening across the country, where agencies are now coming together in response to a death and looking, what is the learning, what were the gaps, what were the barriers, and so, being open and transparent, and willing to, to learn and, and put into place interventions and that multi-disciplinary working that will reduce risk. Next slide. I have put in this slide around language, because I think it's important that there's a need for agencies and workers to consider how people are experiencing homelessness are seen and spoken about. So, Crisis produced a document a few years ago, but it's very relevant, called re-framing homelessness, and there's a toolkit that goes alongside that document and it highlights the need to address how people experiencing homelessness are seen and how they're spoken about. Very often in, in meetings, I still hear people who are homeless being referred to as the homeless, so, more as an object, and I think we ned to consider that when we're, we're looking at governance as well, and we need to think about the diversity of homelessness, the breadth, the multi-faceted aspects of homelessness, and we need to engage with people who are experiencing homelessness, absolutely crucial, about their experiences, and for them and the-, to be able to co-design and influence local responses as well, and we also need to understand the structural deficiencies, because very often, you can see that there's still this blame culture that it's somebody's life choice to be homeless, and we know that's not so.

 

That living on the streets is not a life choice. So, we need to see what has caused people to become homeless and often, the punitive measures put in place as a way of attempting to control and punish individuals without understanding the causes, identifying transition points, and seeing the impact traumatic events have on people's lives must be understood in the responses. Homelessness must be seen within a much wider context and responsing-, responding to individuals needs must be based in a Human Rights approach with-, which is strength-based and value-based and to ensure that we hear from people experiencing homelessness, and those offers must be bespoke. Next slide, thank you. These some of the-, in recent meetings, so, only in the last couple of weeks, these are some of the cases that workers have shared with me about people who are in accommodation, the front-line workers are going in, the-, they've seen people's mental health deteriorate, and yet, and people's substances misuse issues, and even when they make referrals, there, there's a lack of response and people saying, 'This isn't a mental health issue,' or, 'It's not a substance misuse issue,' or it bouncing between the two. So, these are some of the issues that people are facing on the front-line that ned to be addressed. Next slide, thanks, and there also needs to be-, the learning from SARS needs to be applied to see system change, with a whole system-integrated response at a much earlier time in a person's life, with Care Act Assessments conducted at relevant points, and the Mental Capacity Act, and understanding those issues in particular.

 

So, we need to learn, learn in, in the different areas and there's a need to address thresholds and criteria locally, which often are the barriers to people being able to get the response that's necessary and that multi-disciplinary response, and also, understanding about self-neglect, which has been quite commonplace in the SARS that have been undertaken, where people have got an experience of homelessness. Next slide, thank you. So, these are some of the common challenges which won't be unknown to, I'm sure, all of you who are listening on-, who are attending this event. So, some of the common challenges that I hear from areas are, the lack of response from local generic services, a lack of knowledge from front-line workers, how to escalate their concerns, especially when they don't get a response, or the response is, is not appropriate. This also showed a lack of understanding of homelessness and the impact if homelessness and the impact of exclusion, vulnerability, fragility, and self-neglect. Complex needs and multiple exclusion, another common issue that may not always be met, because of the thresholds and criteria, and also, a lack of understanding about how mental capacity may fluctuate, and this hasn't always been understood by workers or agencies, and the causes for that, and how to respond appropriately, and also, more training's needed to understand about homelessness and, and multiple exclusions, and individuals lack trust, especially in services, and very often have h ad histories of trauma, both as children and as adults, which is not recognised by services that are-, that they are being referred to. So, the response needs to be within a trauma-informed framework and also having workers who, who can work around trauma. So, very important to have-, to see mental health in a much broader context and to involve psychologists is absolutely key. So, the next slide, thank you, and so, these are the principles.

 

When I'm looking, going into areas, these are some of the principles that I'll be looking for in terms of governance. Looking at a response that's presenting health, housing, and care needs in a locality. So, how agencies are working together and are people being empowered, are they listened to? Are they acknowledged? And the approach needs to be strength and rights-based, as I said previously, and there needs to be prevention and an integrated wrap-around support, and have interventions been available at the relevant times and with move on to looking at sustainability for people. So, if people are coming out of prison or leaving care or being discharged from hospital, ensuring that there is a-, there's continuity of care, and also, really, to see, within that prevention, protection for individuals and a reduction in risks from the, the response given, and also, the intervention, there needs to be proportionality to also minimise risk. Governance is absolutely key and holding agencies to account. Learning from SARS. There needs to be local leadership, and are their local forums promoting people's rights? And is there a multi-disciplinary response at every level? So, are we seeing at a strategic level with joint, joint protocols and policies and documents, and then, working it's way down to the front-line service, having multi-disciplinary teams working together and having are assessments being done and staff being properly trained. So, next slide, thank you. So, when we're looking at governance and good practice, when thinking of safeguarding, protecting people, and reducing risk for those who are vulnerable, these interventions must be the focus. So, having a person-centred approach is key. So, responding to need and having those bespoke responses and ensuring interventions and plans are appropriate.

 

Having individual Care Act and Mental Care Act assessments that identify needs are vital, and that individuals are listened to and empowered through that work, and there's a need to also to be careful in removing a coping strategy of an individual, but working with that person around the coping strategies that they've developed and developing their strengths and recognising their strengths as well. Advocacy and ongoing tenancy support are absolutely key to ensure people don't return to the streets and that they are able to access the, the interventions as they need it. Outreach and in-reach and that wrap-around services that are accessible for people who've experiences multiple exclusions, which is increased risks and have caused their health to deteriorate, and that's what we're seeing really works, is having multi-disciplinary teams that go to where people are, rather than saying, 'People have to fit into a system,' where we've seen people then falling out of systems where there's a lot of bureaucracy and barriers. Health needs assessments are, are key and also getting to know what the needs are locally, in a geographical area, and being able to work with public health and social care and housing. Having that integrated response at a-, at a strategic level, and looking at joint commissioning, is absolutely key, and having that whole system trauma-informed integrated approach. So, developing multi-disciplinary responses at all levels that will reduce risk and looking at that joint commissioning is absolutely key in terms of sustainability, and we've seen this in Eastbourne, where they've developed a multi-disciplinary team that works with people n accommodation and on the street, but also they-, at a very strategic level, there's a real buy-in from commissioners at that strategic level and then down to delivery, which is, is quite key.

 

We've also seen where there's homelessness forums and local charters set up. So, we're really getting both statutory services and voluntary services both engaged and looking at joint policies, joint procedures, protocols, pathways, looking at shared record-keeping as well is absolutely key, and the shared agreements. Having local leadership and champions is key to ensuring that there is change, and, and people experiencing homelessness must be included in local plans and be able to be-, have their voice heard, such as we see in Voices of Stoke, and that needs to happen, and we also need to have a skilled and confident workforce. So, having in place the right support for staff, so, the training, as Adi mentioned earlier, the-, that's available through these events, the training on legal literacy, self-neglect, and these are what workers are saying to me that they want to have that, that accessible training, so they know what to do in the different situations. Having supervision, absolutely key. Debriefing, career progression as well, and support for professional curiosity, and in the multi-disciplinary teams, what we've seen is key is not only having substance misuse, seeing mental health in that broader context, but also, having social care involved and in areas where we've seen a social worker employed, it's made a huge difference.

 

So, in Nottingham, they have a social worker who's seconded from adult social care to work as part of the local outreach team. He's-, he as trusted assessor status and does initial assessment and works closely with adult social care, which has been-, made a huge difference in terms of referrals and issues and cases being addressed. He also delivers training to social workers on homelessness, those-, so, there's an increased knowledge about health and homelessness and care that's needed. So, there's a lot more receptiveness there and not-, and Eastbourne also has a social worker in their team. So, these are elements of good practice that we need to see set in place to be able to impact on the responses to people who, who are presenting with multiple and complex needs and to also, ultimately, see improved outcomes and wellbeing for both individuals and services and to reduce the local risks. So, thank you, and I'm going to hand back to Adi.

 

Adi Cooper: Thank you, Jane. So, I'm going to change my hat here and speak as chair of two Safeguarding Adult Boards and a visiting professor from the University of Bedfordshire. So, can someone put my slides up and I'll start the presentation, and my challenge really is so, given the, the, issues that Jane has outlined and the challenges that we've got, what does that mean for Safeguarding Adult Boards? So, Safeguarding Adult Boards have a key role around leadership and governance, and I'm going to talk a bit about how and what that means, and maybe what we can do. So, moving on to the next slide, I thought I'd start off with some basics, because I don't know how much everyone in the audience will know about this. So, apologies to those of you for whom it might be your bread and butter. The Care Act is-, the Safeguarding Adult Boards became statutory under the Care Act. This is the first time they were statutory, although partnerships did pre-exist the Care Act, and research in this field has shown how the government's functions such as strategic leadership and planning, setting standards and issuing guidance, quality assurance, promoting and participation, awareness raising, capacity building, training, relationship management, all of these functions pre-existed the Care Act, but I think the critical step with the Care Act is the Safeguarding Partnerships became statutory boards. So, the slide shows you the statutory requirements for each local authority to have a Safeguarding Adult Board for it's membership. For it's objective to be clearly, to assure itself that local safeguarding adults arrangements are working, but actually, within that, that the SAB can do anything that appears or be necessary or desirable to achieve that objective, and I've included that bullet point because I think it's really important to show that there's-, the, the powers under the act as well as the duties to support that strategic leadership function of the Safeguarding Adult Boards are there and the board is able to do what ever it deems to be necessary to achieve it's objective, and although the SABs main objective is to sure itself of arrangements of those people who are eligible for safeguarding, such as people with care and support needs who are at risk of abuse and neglect and are are unable to protect themselves because of that, it can-, this can include people experiencing homelessness and rough sleeping in their area, and the board has a preventative function as well as a protective function. So, the SAB can do anything that's necessary.

 

So, if we move onto the next slide. Just to continue with the Care Act criteria, the key statutory duties of each board is to provide a strategic plan, to provide an annual report saying, 'Well, this is what we said we would do, this is what we've done, or what we haven't done.' To make sure that it describes what individual members do, but also, what it does as a collective, because the sum is greater than it's parts, and to conduct any safeguarding adult reviews that meet the criteria defined in the act, and these three are the three core statutory duties, but they-, I think it's worth noting that, in the first couple of years after the Care Act was implemented, many boards were focused on ensuring that they were functioning effectively and able to meet these duties in those first couple of years after the boards, but moving on, if we move on to the next slide, what we start to see, and this is revealed in the surveys that came through the national Safeguarding Adult Board chairs network, is that homelessness started emerging as an issue from about 2017, in the Safeguarding Adult Boards, as a strategic issue, and I’ve listed here some of the reasons why that started to happen. So, first of all, people were noticing that there was a broader remit following the focus of implementation of the Care Act, that this had become, maybe, a contemporary safeguarding challenge. That in certain areas there were safeguarding adult reviews that looked at specific deaths, and I won't rehearse what I imagine Michael is going to say in his section, around the learning from safeguarding from adult reviews, but where they have happened and they do happen, there's very specific direction for that local partnership on what needs to be done, what the implications are at a strategic and operational level, and what a safeguarding adult review will do is provide the evidence of what you need to do differently, what needs to be done differently, and a framework for making sure that happens, because that's part of the duties of the board, but in other areas, there was a long-standing priority locally around rough sleeping.

 

So, for example, I chair the board in a city in Hackney-, in the City of London and Hackney, and City of London had a long-standing priority around rough sleeping, quite inevitably, because of the nature of the city, and so, even before, well, even a few years ago, this became a priority for the board and a local task and finish group was safe up-, set up to look at how safeguarding of people who are sleeping in the city, on the city streets were-, how those people were being supported in terms of their safeguarding needs, and similarly, in Westminster, again, where there's a long history of rough sleeping being a local priority, it was on the board's radar prior-, you know, a couple of years ago, because it was a local priority around trying to address the safeguarding needs of that section of the local community. Another driver for thinking about and looking at safeguarding people experiencing homelessness, and I'm using that as short-hand for multiple exclusion, homelessness around how we think about the category of people who are most likely to have safeguarding needs, in some areas, as Jane's talked about, local mortality reviews have shown that there were local drivers. So, thinking about mortality, the deaths of local people who were homeless from a safeguarding lens, and certainly, for people who attended the workshops we did in 2019, you'll remember Gill talking-, Gill Taylor talking about the process in Haringey for reviewing mortality or reviewing the deaths of individual people, and then, maybe linking them through to safeguarding adult reviews where that became necessary, and that was partly in response to the Rough Sleepers Strategy, as Jane describes, and looking more in detail, requiring people to look in more detail at the deaths of people sleeping rough, and I think, finally, Jane's talked about the response to the COVID pandemic and I think that has, sort of, escalated in a lot of places the whole issue of Safeguarding Adult Boards focusing on people experiencing multiple exclusion homelessness as something that is right for boards to look at.

 

So, what I think this slide is trying to show is a, kind of, groundswell of reasons why a particular Safeguarding Adult Board might focus on people experiencing homelessness in their area, bearing in mind the statutory responsibilities that I talked about earlier for looking at what is going on locally and what are the priorities for your strategies and your actions in any given year that you're legally required to report on. So, there has been an increasing focus, I think, for Safeguarding Adult Boards on this area. So, if we move on, I thought it would be useful to think about what's the leadership and partnership requirements of boards. So, if we think about partnership, going back to the six safeguarding principles in the Care Act guidance, partnership is one of those principles. So, working in partnership actually is part of the core responsibilities of people locally in any particular place. It's implicit and explicit in the guidance that the Safeguarding Adult Board evidences that in it's leadership. The board has to demonstrate collaboration and cooperation in delivering it's responsibilities. In other words, achieving that strategic leadership is more than the content of plans and strategies, it's also how it's delivered, it's also how people behave, and in that context, that distributive or dispersed leadership where it's not one leader at the top but a cohort of senior people collectively leading, I think is really important. So, I'm quoting from Michael here. 'Just as safeguarding is everybody's responsibilities, I would argue similarly leadership is everyone's responsibilities, and that at board level, you're looking at that collective and collaborative leadership being demonstrate, and in addition in thinking about leadership style, we know that in order to make change at the kind of level that's required when we're thinking about safeguarding adults and homelessness, it requires a transformative leadership style, because the challenges we're facing are quite considerable and the outcomes that we're trying to achieve for the individuals that we're concerned about are really important.

 

So, that transformative leadership style is also part of the-, I would say the remit of leaders when we're thinking about this area of work. The members of the Safeguarding Adult Board are senior leaders within their organisations. So, their leadership is both within their organisations as-, and as members of the board, and that leadership needs to be evidenced, so that, at the front-line, people feel inspired and supported to work collaboratively, to work in ways that overcome the barriers that Jane's described around the blocks and barriers that actually get in the way of helping the people that we want to help improve their lives and recover from the safeguarding risks and resolve those risks. So, I would also argue that in the nature of-, the nature of the, the leadership style that's needed is partly because the issues that we are trying to resolve or what one would called wicked issues, these are issues that are not easily overcome. Some people don't like that language of wicked issues, but I-, it's a-, it's a short-hand way of describing a complexity of social policy versus economic and structural realities that we're trying to work with, which are, in some respects, across a whole range of different sectors and systems. These aren't simple solutions, they're complex solutions, because we're dealing with very complex systems that are-, and very entrenched behaviours, attitudes, and understandings, and Jane talked about some of those in her presentation, in terms of how those are expressed at the front-line. These aren't easy problems to solve. If they were easy problems to solve, we would've solved them already. I think that's quite trite, but it's true. So, that transformative leadership to resolve these wicked issues is really what's required. Some innovative, challenging, brave, all those sorts of words, to try and confront and deal with issues that aren't straightforward, with people who sometimes don't want us in their lives, and don't want our intervention, don't want our support, for very good reason. Perhaps because they've been let down or disappointed or prevented from accessing support in the past. So, these aren't easy areas. Safeguarding, by definition, isn't an easy area, but I think safeguarding, in this contest, is, is even more, and in terms of that, the engagement and consultation with people who experience homelessness is absolutely key, and Jane, Jane mentioned that when she talked about that.

 

So, what does that mean in terms of a Safeguarding Adult Board? Well, if you go back to the premise that Safeguarding Adult Boards have their key three statutory partners, health, local authority, and the police, but they can invite anybody else to be part of their boards, having representatives of people who use our services, those experts by experience, in the work that we do, not necessarily members of the boards, but maybe participating in training or whatever way in which that's useful is absolutely key to co-producing solutions to some of these problems that we are trying to solve so particularly in this area. So, I would argue for engaging with experts by experiencing as being absolutely key to taking this agenda forward, and I'll just put in a plug, Michael, for the final webinar, where we are going to be bringing people to talk t you, who are experts by experience, because that is so central to the way in which we need to think of working. I wanted to mention here a bit about political leadership and recognition that councils are political bodies, and that Safeguarding Adult Board often have members, lead members, as representatives on their board, but particularly in this area of homelessness and safeguarding adults, there's often a high level of political interest, and it has been shown through research that where there's political leadership around homelessness and issues, that has really supported changed locally. I think, through these webinars, this has also come up when we were talking about people with no recourse to public funds, in a previous webinar, where the local political views, in terms of how to address that particular, kind of, focus in homelessness issues, was a key success factor, in terms of support for staff in driving forward an agenda. So, I wanted to just briefly mention that political leadership, in the context of safeguarding adults and homelessness is quite important, and finally, I just wanted to talk about people like, like myself and other chairs and what's our role as independent chairs, and there's a concept of process catalyst which I find really useful. As process catalysts are people who provide the environment in which change can happen, they support-, they support systems to change and they offer-, people offer constructive challenge, hold partners to account, interface with other partnerships, model a collaborative leadership style, model a transformative leadership style, and I would argue that independent chairs can provide a really critical aspect of that transformal-, transformative leadership that can help take this agenda forward.

 

So, if we move on to the next slide. I just wanted to say a bit about governance here, because we've been using the term through this afternoon, and here are three random definitions. So, what is governance? Governance is quite an amorphous thing but it's also a very practical thing. It's how the organisations direct and control what they do. So, structures, processes, that ensure accountability, transparency, responsiveness, law, stability, inclusiveness and equality empowerment, how we conduct public affairs, how we realise Human Rights. Governance is the way, it's how do we do things? if we move on to the next slide, well, how do Safeguarding Adult Boards demonstrate governance? What are those mechanisms that can deliver leadership, support change in this area? So, a core function of the board is to hold partners to account. To hold them account for delivering the strategic objectives of that board, to provide oversight, the mechanisms include those statutory duties that I've already mentioned, and then, the detail that sits below them that addresses some of the points that Jane, that Jane raised, such as issuing guidance, having protocols, having quality assurance systems, making sure that there are policy and procedures or inter-agency and partnership working. Whether there's any kind of multi-agency review panel. how that works locally is part of the governance responsibility, the mechanism that delivers that governance responsibility for Safeguarding Adult Boards. So, moving on to the next slide. How do we do that when homelessness and safeguarding isn't just within the remit of the Safeguarding Adult Boards? So, what are the partnerships and systems that can help and deliver the leadership and change that we require in this area? And here, this isn't a multiple choice questions, so, I thought, you know, which partnerships lead on homelessness safeguarding?

 

Is it the Health and Wellbeing Board, is it the Community Safety Partnership, is it the Safeguarding Adult Board, is the Homelessness Reduction Board? Now, this isn't a multiple choice question because, in fact, it can be any, all, or some of the above, and I think, Michael, you and I would argue, it doesn't matter, actually. There isn't a right answer. So, as I said, it's not a multiple choice question, there isn't a right answer;. What needs to be established in any particular local area is how is that going to work best for that local area? There isn't-, as I say, there isn't one way of doing this. The most important thing is to achieve the outcome that you want to achieve. So, I think it's worth referencing a couple of examples of where this has been taken forward. So, I would cite Birmingham, where we held out first workshop in the series of four workshops we had, and I would also mention for Birmingham, the absolutely inspirational closing speech from the lead member for homelessness in Birmingham, that really evidences that part-, that leadership role that politicians can have in this agenda, because she was fantastic, but Birmingham has had a-, the Safeguarding Adult Board is working-, has worked with the Homelessness Reduction Board to develop work-streams of safeguarding people who experience homelessness. I'd cite Leeds where the Safeguarding Adult Board and the Community Safety Partnership undertook a joint review looking at street-based-, people living street-based lives and the number of deaths to identify what needs to be done, and I just quote those as two examples of different ways of addressing this agenda in terms of leadership and governance, to show that there isn't a single answer, there is a number of different ways in which the leadership or the governance and leadership in this-, in this area of work can be taken forward. So, if we move on to our-, to my final slide. This is taken from Michael's briefing that was published after the first four workshops.

 

So, I've used these four key questions really for Safeguarding Adult Boards at any stage of work around this area of policy, practice, and delivery. So, wherever you are or whoever you are, to what extent is the safeguarding board holding agencies to account in this area of adult safeguarding and multiple exclusion homelessness? Is it on the agenda, is it not on the agenda? Should it be on the agenda? Is it on someone else's agenda? How is the Safeguarding Adult Board engaged in this? In terms of governance and the mechanisms that I talked about that deliver governance, are there policies and procedures and protocols that need to be developed or reviewed, so that we'll support the front-line staff in working with people who have safeguarding needs and experience multiple exclusion homelessness? Yes, are there safeguarding adult reviews, are there mortality reviews, are there audits that can then inform that practice and service development? And what examples of positive practice can you share? And I think it would be fair to say that in that briefing, Michael has a much longer list which I've drawn these questions for, which any Safeguarding Adult Board can look at and consider, what do they need to do locally, in terms of thinking about this area of work? Regardless of whether they're Westminster or not. You know, regardless of whether they're a, a-, one of the Rough Sleeping Initiative areas or not. These are questions that any board can ask itself, in terms of thinking, what do they-, what does it need to do, what do they need to do, in terms of this area of work. So, I think I'm going to draw it to a close here and hopefully, Michael, your presentation will pick up on some of these things in terms of the governance issues for boards. I'm going to take off my hat and come back to my Health and Care Improvement Advisor hat and say that we've now got a ten-minute break, that we'll be resuming at three o'clock. I can see that some people have put questions in the Q&A, which is really helpful. Please keep putting those questions in and we will come back to them after Michael has spoken and see how we can address them in that session at the end of this afternoon. So, it's three o'clock, don't go away. I mean, don't turn your-, don't turn your, your screens off, but do have a comfort break, and come back again at three o'clock, and we'll resume the session then. Thank you very much and thank you, Jane, for your presentation too.

 

Welcome back, everybody. Hopefully, people are back, having had a cup of tea or a comfort break or whatever. Michael, I'm going to hand over to you for you presentation and then we'll pick up the questions after you've finished, thank you.

 

Michael Preston-Shoot: Okay. Thank you, Adi. I'm going to share the screen. There we go. So, good afternoon, everyone. Thank you very much again to Jane and Adi for the first two presentations. There'll be some overlap with mine, but I don't think that matters, and hopefully, you'll find what I have to say interesting and, and useful. The timetable for the afternoon said I as only going to speak for ten minutes. I think that's a deliberate mistake. It'll probably be around twenty minutes, I suspect, before we get to the Q&A. So, I'm going to talk about governance of adult safeguarding and homelessness, continuing the theme of this afternoon, and I'm going to focus, to some degree, on research relating to the governance of Safeguarding of Adult Boards and the learning that we can extract from the latest of the safeguarding adult reviews that have been conducted, but I'm going to start with voices of experts by experience, and again, as Adi flagged up, I'm going to encourage you to sign up for the final webinar in, in, in March, because we will have a number of presentations who have lived experience of homelessness, and they will be talking about what helped and what did not help from their experience and there will be, I promise you, some synergy with what Jane, for example, was presenting first thing this afternoon, and starting with the voices of, of lived experience is very much inline with a fundamental governance principle, and that is making safeguarding personal. So, in the Worcestershire Safeguarding Adult Board thematic review on homelessness, the review actually starts with a quote from Terrance, which you can see on the slide. Jane mentioned the-, I think it as Jane who mentioned the Leeds thematic review and there are a number of quotations from people with lived experience in that review and I've taken two quotations from, from that particular review, and then, a review which I, I had the privilege of, of, of undertaking, published by Tower Hamlets, this time someone with lived experience talking, not so much about himself, but actually, about his partner who died and talking about her behaviour, including substance misuse, which he attributed in no small way to her attempts to protect herself from loss and trauma, which again, Jane highlighted, and I think what these quotations reveal is, again, something which Jane highlighted in her presentation, and that is the diverse routes into multiple exclusion homelessness.

 

There is no one pathway. Any of us are just one or two clicks away from, from homelessness, and that's been graphically demonstrated by, by the pandemic and the number of people who've been furloughed or lost their jobs with a significant impact on their accommodation situation as well as on their mental health. So, there are diverse routes into homelessness, and therefore, there have to be-, there has to be a range of response to, to homelessness. Changing the focus. Adi talked about the roles and the responsibilities of Safeguarding Adult Boards, and I've put up here a slide which hopefully emphasises why Adi was saying what she was saying. This is drawn from a study which Suzy Braye, David Orr, and I did for the Department of Health, as it then was, in preparation for what became the 2014 Care Act. And drawing on a range of literature, we identified key domains of good governance. So, in the context of Safeguarding Adult Boards, does the Safeguarding Adult Board have a clear purpose and mission that is defined? Does it-, does it identify the scope of its activity and, and as Adi highlighted, does that scope of activity include a focus on individuals experiencing multiple exclusion homelessness? Does it have a clear structure, and a, a, a, a, a clear statement about membership, and is that membership inclusive? In other words, broadly based, exclusive revolving pretty much around the three statutory partners? How does it define its key functions, its key roles and responsibilities? How does it engage, particularly with experts by experience, but also with other partners? And how does it demonstrate accountability, both to citizens, but also to elected members and other partnership bodies? Those are key domains of, of good governance.

 

And drilling down a little further, this also comes from the same research which we did in, in 2012. We began to try to define the key functions of Safeguarding Adult Boards, what they could include within scope. And what we find if we look at Safeguarding Adult Boards in 2021 is that different boards prioritise different initiatives amongst the four quadrants. So, for example, Leeds Safeguarding Adult Board has done a, a considerable amount of work on citizen involvement, and that would be in the top left box of this model. A number of boards, Jane identified a number of them, she used examples from Redbridge, from Eastbourne, from Hull, have undertaken specific initiatives to address identified harm to people experiencing multiple exclusion homelessness. That would be in part the top right box, but it would also be, insofar as fatality reviews, Safeguarding Adult Reviews have been used, it would be the bottom right quadrant. And, and then, bottom left quadrant, included there would be, for example, training programmes, multi-agency, multi-disciplinary, in the way that Jane identified as, as good governance to ensure that across different disciplines, across different professions, people feel that they have the knowledge and the skills with which to engage with people who are homeless and, or, self-neglecting and, or, experiencing challenges with mental health, physical health, or substance misuse. So, pretty much what a board focuses on with other boards in the architecture of governance locally, as Adi identified, what boards focus on should be informed by their analysis of their locality, and needs that are being presented in their specific localities. So, it would not necessarily be expected that a Safeguarding Adult Board with or without other partnership bodies is doing something in each of the four quadrants. It would be expected that there is a clear analysis about where the priorities should be.

 

And if you look in statutory guidance that accompanies the Care Act, one can tease out from that, in a way that Adi in her presentation began to do, to tease out from that, different functions. So, this is just another way of beginning to articulate what might be populated within the four quadrants that were on the previous, previous slide. So, again, where a board chooses to focus should be informed by its analysis of needs within its localities. So, a number of boards, for example, have conducted Thematic Reviews because of the numbers of deaths of people who were homeless in their particular locality. A number of boards have developed policies and protocols around self-neglect, again because of the number of cases of self-neglect coming into adult social care from public (ph 01.00.58) agencies.

 

And as Adi identified, and with which I agree, there is no one right answer to how the architecture of governance is calibrated in each locality. The Safeguarding Adult Board must engage with the Health and Wellbeing Board, Community Safety Partnership, Homelessness Reduction Board, and Safeguarding Children Partnership arrangements, in order to determine how leadership is going to be demonstrated in relation to multiple exclusion homelessness. If it is, for example, decided that a Homelessness Reduction Board is going to take a principle leadership responsibility for developing a multi-agency, multi-disciplinary response to homelessness, then the Safeguarding Adult Board must ensure that, that adult safeguarding is not forgotten in, in that work. And certainly I have experience of undertaking Safeguarding Adult Reviews where the feedback from some agencies has been that policies relating to homelessness are, are all well and good, but where was adult safeguarding within them? So, the Safeguarding Adult Board's responsibility is to make sure that adult safeguarding, both with capital letters, in terms of Care Act responsibilities, and lowercase letters, in terms of adult safeguarding generally being everybody's business, the Safeguarding Adult Board must ensure that in policies, in procedures, in protocols, in training, in service delivery, adult safeguarding is not overlooked.

 

So, moving away from the research that is available on, on governance, and applied to the world of adult safeguarding, and moving into a focus on Safeguarding Adult Reviews, and drawing out data from the National SAR Analysis that I led on with Suzy Braye, and colleagues from Research in Practice. There were 231 SARs in, in the sample of, of reviews completed between April 2017 and March 2019. 57 of which involved alcohol-dependence issues. 25 of which involved people experiencing homelessness. 161 of which involved mental health issues, which simply reinforces and underscores the points that Jane in particular was making about the importance of mental health trusts stepping up to meeting people's needs for mental health assessment. Not just Mental Health Act assessment, but mental health assessment. And then, the provision of mental health support, whether or not somebody is in acute crisis at the time of a referral. And I've used this slide in other presentations in this-, in this webinar sequence, but I've added to it here. There are a range of Safeguarding Adult Reviews over the last few years. You will see that there is mention of Redbridge there, although its review is actually only available in the public domain in a Safeguarding Adult Board annual report. But nonetheless, that, that annual report, that is, is quite comprehensive in terms of what that review found. So, a whole range of reviews illustrating, again, the diversity of routes into homelessness. And some more recent reviews in, in the public domain. I've already mentioned the Worcestershire review, and, and the Leeds Thematic Review. And all of these reviews, at least to some extent, focus on governance in the way that Jane and Adi were referring to, namely, how does the Safeguarding Adult Board participate in ensuring that operational practitioners and managers have a framework within which to, to act?

 

In terms of the national analysis and the cases-, the 25 cases that focused on multiple exclusion homelessness, there were references to good practice. Jane mentioned outreach, and indeed in in-reach, and, and she mentioned the importance of multi-disciplinary team working, and, and all of that found positive references in, in at least some of the reviews that were in the National Analysis, with particularly impressive evidence about the importance of, of co-location. And indeed, in, in the Q and A, someone has asked about hospital discharge, and whether we have any positive examples, and I'm sure Adi and, and Jane and I will address that question further when we get to the Q and A. But there were positive examples of co-location, of housing practitioners co-locating in acute trusts with a clear responsibility to ensure that no one was discharged to no fixed abode. However, as one might expect from Safeguarding Adult Reviews, there were more references to, to practice shortfalls, and, and Jane highlighted a number of areas of good governance, including the importance of robust assessments of risk, and of-, and of mental capacity, ensuring that there is consideration of vulnerability and risk. And reinforcing again the points that both Adi and Jane have made, there were recommendations particularly around multi-agency, multi-disciplinary working, joint commissioning, and wraparound support. And if there's one thing that we can demonstrate as a positive outcome from the pandemic, it is what Jane was presenting, namely, the wraparound support that the-, everybody in initiative enabled people to receive close attention to their physical health issues, their mental health issues, their substance misuse issues, as well as their accommodation needs.

 

In the briefing that Adi mentioned that you can find on the Local Government Association website, published in March 2020, on adult safeguarding and homelessness, we present a model of, of best practice, which, again, reinforces what Jane presented, and what Adi presented. So, there are nine components of best practice in relation to direct work with, with individuals, all of which reinforce what Jane was presenting earlier. And there are nine boxes in relation to best practice in terms of multi-agency working, again, reinforcing the direction of travel that, that Jane was highlighting in her slides on governance. And there are six area components of best practice in relation to the organisational environment, and both Adi and Jane emphasised the importance of supervision and support of staff. This can be a challenging area in which to work. It can be a lonely area in which to work, hence the importance of staff-, of supervision, and support, and manageable workloads. And once again, you see the emphasis on joint commissioning and contract monitoring. And then, six areas of best practice in relation to the role of Safeguarding Adult Boards. Adi's slides included an emphasis on audit and, and quality assurance, an emphasis on how SAB engages with other boards and, and partnership bodies, and a continual review of how the learning from Safeguarding Adult Reviews and from fatality reviews has in fact been learned, and the impact that that learning has had on service enhancement.

 

And turning specifically to this afternoon's focus on, on governance, I thought it was worth highlighting from the national analysis of 25 cases involving homelessness, and indeed, from some of the reviews done subsequently to March 2019, specific recommendations on, on governance. And, and they endorse and reinforce points made by both Adi and Jane. So, the involvement of people with lived experience in the development of policies and procedures, agreeing the main location for strategic leadership and oversight in this area, particularly in relation to two-tier authorities. Adi and I spelled that out in relation to the Oxfordshire Thematic Review which is on the list of reviews earlier in this slide sequence. Making sure that strategies contain-, on homelessness contain over-references to adult safeguarding, and pathways into adult safeguarding with capital letters. Reviewing the range of procedures, not least because of the point that Jane emphasised, that there is no one route into homelessness, and no one type of homelessness. The lead Thematic Review, for example, distinguishes between people living street-based lives, high-risk cases where individuals have capacity, as well as other routes into, into homelessness. The Worcestershire review emphasises what in a children's context, we had-, we might have called contextual safeguarding, extending out the remit of adult safeguarding to other organisations that might encounter people experiencing homelessness, as well as community groups and faith groups. So, reaching out is very much something which is emphasised in the Worcestershire Thematic Reviews.

 

And then there are recommendations from SARs on the enhancement of practice and, and the management of, of, of practice. So, reviewing pathways, particularly into mental health, but pathways also for services for women who are experiencing homelessness, and indeed, pathways for services for people in the LGBTQ communities. Reviewing the use of adult safeguarding decision-making, and challenging how decisions are made by adult social care, in relation to adult safeguarding enquiries. Promoting the recognition of self-neglect. Both Adi and Jane, Jane in particular, emphasising how often we find that self-neglect is not seen as an adult safeguarding issue, is not recognised as such, either for the purposes of an adult safeguarding enquiry, or indeed, for the purposes of a care and support assessment under section 9 of, of the Care Act. And I particularly like the Leeds Thematic Review, when it identified what was necessary in terms of creating an architecture of-, both for governance, and for meeting the needs of, of people experiencing multiple exclusion homelessness. Jane, very early on in her presentation, referred to outreach, accommodation, and support, a three-part model, if you like. Here is Leeds offering another three-part model based around prevention, intervention, and recovery. And if it is a Safeguarding Adult Board, focusing on its leadership and governance responsibilities in relation to homelessness, it could do worse than to focus on prevention, intervention, and recovery, and, and what good may or may not look like in its locality, across those three areas. I, I quite liked that differentiation when I read the Leeds Thematic Review report.

 

And Adi talked about the six principles, and indeed, with Adi, I have discussed how the six principles might apply to the world of adult safeguarding and multiple exclusion homelessness. So, Adi and I jointly own, as it were, this particular slide, and I think that you can see how each of the six principles can be applied to the area of multiple exclusion homelessness, and its interface with adult safeguarding. And as the slides will be available after the conclusion of this webinar, you can return to that slide if you find it useful. Adi talked about independent chairs as, as processed catalysts. I shall have to talk to Adi about that concept afterwards, because I think it's intriguing, but also, potentially useful. So, here is my offer, and that is that a SAB is the guiding presence-, should be the guiding presence in conversations in relation to adult safeguarding, with big and small letters, and multiple exclusion homelessness. And that guiding presence contains a number of statements, and a number of, of questions in which all of us can be engaged, whether or not we are actually formal members of a Safeguarding Adult Board. But in particular, I think we have to become much sharper about what we are hoping to achieve within the context of the rough sleeper initiative which with Jane began her presentation. So, in relation to each locality, what are we seeking to achieve? What inputs are we making in order to try to achieve the desired change? What are the expected outputs? And crucially, what are the expected outcomes? And if I have a concern about Safeguarding Adult Boards, and indeed, other partnership bodies, it is that we are not always clear about what outcomes we are seeking to achieve, and how we are going to know whether we are achieving those outcomes, getting close to those outcomes, or missing the target by quite some distance.

 

And in terms of outcomes, drawing on my background in social work education, there are a range of outcomes that one might be aiming for. We might be aiming to change people's attitudes in the way that both Adi and Jane implicitly, if not explicitly, were saying. Sometimes our attitudes are wrong. We make assumptions about lifestyle choice, for example, or the language that we use, to return to one of Jane's slides, is not helpful when working alongside people experiencing homelessness. We might be seeking to develop the knowledge and the skills within different parts of the practitioner workbase. We might actually be seeking to explicitly change practice, perhaps through co-location. We might be seeking to change organisational behaviour. And the bottom line is that we're trying actually to achieve direct benefits for service users and, and for care givers. So, thinking through what kind of changes we are hoping to see, and intending to see, and then asking ourselves questions about whether the services being provided and the services being developed are likely to achieve the outcomes that we are aiming for. And that brings me to the end of my presentation. I've gone on for longer than ten minutes, and indeed, longer than twenty minutes, so apologies for that. But I'll now pass back to Adi, and Adi and I between us will identify the questions that you-, and observations that you've posted in the Q and A. And I'm sure all three of us will have a go at, at answering what you've put in. So, I'll hand back to Adi, and take a sip of water whilst Adi kicks things off.

 

Adi Cooper: Thank you, Michael. So, thank you for your presentation, and I-, there were a couple more questions in the chat while you were speaking. One was just about whether the slides would be available, so I'm just going to repeat that. The slides will be available, as well as a recording of this webinar, alongside the other ones. The links are on the Local Government Association website. In terms of the questions that have been put in the chat, I wondered whether we should just start with one that's maybe relatively easy to address, which is how the deaths of people who are sleeping rough are reported, and what the sort of guidance is around that? And the interface between mortality deaths and Safeguarding Adult Review deaths? So, I was just going to kick that off, in terms of who's responsible for making the decision about what happens? And from where I'm sitting, what Jane was saying was through the Rough Sleeping Initiative, reporting of deaths of people who are sleeping rough has started to become much more routinised. Locally, within a local authority area, within a Safeguarding Adult Board area, it's a local arrangement as to whether those deaths are reported through to the Safeguarding Adult Board, or how-, when those deaths meet the criteria for a mandatory Safeguarding Adult Review, that decision should be made by whatever the infrastructure of the local Safeguarding Adult Board is for looking at that. And certainly, looking at some of the Thematic Reviews that Michael mentioned, they have included deaths of people who both met that criteria, but also didn't meet that criteria, to look at thematic issue-, themes that arise, rather than focusing on one individual person's death. So, there are-, I think it would be fair to say there are a range of emerging arrangements around how that happens, but there should be clarity locally about the systems and processes for that.

 

There was a specific question about the Charity Commission asking for reporting of deaths, and whether that should be contingent on the Safeguarding Adult Review. My initial response to that is no, because the processes are parallel rather than consecutive. What you won't have necessarily is the outcome of a Safeguarding Adult Review, but you should presumably still report to the Charity Commission if you're aware of a death. But I'm happy for other colleagues to come in. I just thought I'd kick off-, hit the, you know-, kick the-, get the ball rolling on that. Michael or Jane, did you want to add anything on that issue?

 

Jane Cook: No. We are seeing an increase in the number of areas that are doing reviews, and, and they do vary in the, the different models, but a lot of them have actually been based on the Haringey model, which is great. So, and, and are working through the process. So-, and I know Southend, at the moment, are working through the process to include not only deaths, but also incidents, and the-, and the learning from that as well, which is just ongoing. And it's-, actually, that's being led by the local Adult Safeguarding Board, which is great. So, already, there's that link directly into the board, and taking that accountability. So-,

 

Adi Cooper: I think we profiled the Haringey model in a series of workshops, and I know it's been used across parts of London, but I think it, it, it raises the profile of mortality locally, and then that interface with the Safeguarding Adult Review process. Michael, was there anything else you wanted to add?

 

Michael Preston-Shoot: Well, just to agree with you, Adi, that in relation to the Charity Commission comment, not to wait for the conclusion of a SAR. It is a parallel process, so a referral should be made to the Charity Commission as soon as the circumstances justify it, and then clearly, the Charity Commission should engage with the Safeguarding Adult Board, and vice versa, for how the parallel process is, is going to be managed. And that's very much in line with the comments in the statutory guidance on, on, on parallel processes generally. And, and the other observation, and, and this is derived in, in no small measure from the findings in the national SAR analysis, that everybody has got to be very clear about what the mandate in section 44 of the Care Act is, and, and both the mandatory reviews that may result from an accurate understanding of that mandate. But also the possibility for discretionary reviews, where all of the criteria are not met, but where nonetheless some learning might be derived. So, it's important to run that side by side with the development of other means of reviewing the deaths of homeless people. And indeed, the deaths of people from substance misuse, not all of whom of course will be homeless.

 

Adi Cooper: So, hopefully that addresses a cluster of questions around reviews of deaths. I wondered whether we should move on to some of the other questions. Michael, did you want to pull that together, or shall I start?

 

Michael Preston-Shoot: Well, there, there, there's a cluster around who, who might hold Safeguarding Adult Boards accountable, which, which I think is, is, is worth some exploration.

 

Adi Cooper: As well as who holds agencies to account within Safeguarding Adult Boards.

 

Michael Preston-Shoot: Yes.

 

Adi Cooper: So, I was-, on who holds Safeguarding Adult Boards to account, there, kind of-, one way of addressing that is, it's the partners themselves holding each other to account, which is why those two questions are linked. But also, as a Safeguarding Adult Board chair, we're responsible to report to both the chief executive of the council, but other committees in councils and partners. So, for example, a scrutiny committee, as well as a Health and Wellbeing Board, through the reporting of the annual report each year. And to that extent, there are other bodies who can challenge the board in terms of the delivery of its plans and objectives each year, because that should be an annual process. I'm interested that it was a colleague from Healthwatch who raised that question, because I would hope that both within the board, and within those bodies like the Health and Wellbeing Board, Healthwatch is a partner who can help call into-, hold to account the board as a-, as a partnership. In terms of holding agencies to account within the board, again I'd refer to things like annual reports as mechanism to illustrate, because annual reports should show both what individual agencies have achieved in terms of safeguarding work during that year, but as well as what the partnership has achieved during that year, and provide public-, so, again, this is because the annual reports are published and are public documents, provide a public record. But I think there is an expectation, and this is part of the Care Act guidance, that the Safeguarding Adult Board does audit itself, and reviews its own mechanisms. And certainly in London, where Michael and I are both chairs, there are regional mechanisms for self audits that contribute-, they don't-, they're not everything, but they can contribute to evidencing how partners are held to account, but how the board itself is held to account. So, that would-, I would cite as to examples.

 

And certainly, in terms of looking at homelessness, particularly in safeguarding adults, I would be looking to see how that particular priority, if it's chosen as-, in response to a local need, is evidenced through those mechanisms year on year. That there is evidence of improvement, development, responding to a Safeguarding Adult Review, achieving the actions that were needed, showing that those actions have had the impact, the positive impact that they've been expected to have, and these are all mechanisms to evidence what-, that simple statement about holding each other to account, or holding the board to account, should, you know, give, give-, provide evidence of, of that. But please come in, Jane, or-, and, or, Michael.

 

Jane Cook: Yes. No, I was just thinking about a visit I did the other day to an area where the workers were feeling quite desperate, because of the lack of response. And I did suggest they also talked to Healthwatch as a way of, of taking forward some of those issues and, and, and working with the local Safeguarding Adult Boards. So, how do you escalate as well? So, yeah.

 

Michael Preston-Shoot: Yeah. I, I'd add too a, a number of comments to what Adi, you were saying, and Jane, what you were saying. The first is the role of elected members, particularly through the local authority's scrutiny committees. I think that's an important way of, of holding all members of the Safeguarding Adult Board to account, but particularly the independent chair. So, making sure that elected members are clear on their roles and responsibilities, and, and indeed have an understanding of, of adult safeguarding with both capital and lowercase letters. I think it's important to remember to that Safeguarding Adult Boards can be investigated by the local government social care ombudsman, and there are examples of when that has happened, and, and some of the reports from, from the ombudsman have been quite critical of the way in which Safeguarding Adult Boards have performed. And, indeed, ultimately, the High Court through judicial review can hold a Safeguarding Adult Board to account in relation to whether it has acted lawfully, reasonably, and, and, and rationally. So, there are-, there are mechanisms, and, and a really good Safeguarding Adult Board will make sure that those mechanism are publicised on its website, so that citizens, practitioners, managers across statutory and third-sector organisations are aware of, of, of how to hold the Safeguarding Adult Boards to account. And aware of how the Safeguarding Adult Board holds partner agencies to account through the kind of processes that have been described this afternoon. Audit, peer review, and, and, and social.

 

Adi Cooper: I think one of the issues that's quite tricky that was raised by-, which is related to this, is when in a particular case there's a decision that's made that the person referring the concern is unhappy about. So, it's kind of like, how do you escalate-, say, a decision made by social care, or safeguarding team, not to pursue a particular person's circumstances. And I think it's very difficult to have a, sort of, blanket response to that, but certainly, there are mechanisms for escalation and raising complaints with individual organisations. And through the board-, so, as a board chair, taking off my chair hat, and putting on my board chair role, I would say that one would hope that, for example, it-, as a voluntary sector, you would have a representative on the board who would be able to raise if an issue about an individual is, is endemic of a pattern, for example, of perhaps a very narrow interpretation of what a care and support need is.

 

Michael Preston-Shoot: Yes, and that's-,

 

Adi Cooper: Or some of the issues that came up. Sorry, Michael. Some of the issues that came up at our last webinar around the legal literacy of partners not maybe being on the same page as everybody else. So, I would, wouldn't, as a chair, want to see individual cases raised up at the board, because that's inappropriate, but the issues highlighted by individual cases, such as the way in which the decision to pursue a section 42 enquiry, for example, may not have been pursued, would be relevant. And it's quite a nuanced difference, but it's quite significant, because the board is not particularly the place where you have conversations about individual cases, unless, for example, they're subject to a Safeguarding Adult Review. But issues that are about the ways in which agencies work together, so, for example, a partner saying, 'We think that there's a pattern here of a service denying access to a particular group of people, and in this context, people experiencing multiple exclusion homelessness, because of the way in which they're interpreting, for example, self-neglect, or substance misuse, or lifestyle choice,' that issue, I would suggest, potentially is something that can be escalated. Michael, do come in.

 

Michael Preston-Shoot: Well, no. It's-, I'm going to say something pretty similar. I think people, if, if, if people read the statutory guidance, chapter 14, of which is about adult safeguarding, and the role of the Safeguarding Adult Board, it will become clear that independent chairs do not have a mandate to investigate individual cases unless they are SARs. However, if I as an independent chair, receive a complaint, for example, that adult social care did not triage a section 42 concern that had been referred appropriately, or the care and support needs are not being robustly assessed in a particular case, or eligibility criteria are being applied in-, wrongly, the question I ask is, is this evidence of a systemic issue? And if it-, if I think that it is evidence of a systemic issue, then I can trigger audits. I can trigger the request for reports, which then I, I and other parters can scrutinise. The sense I get, from what's in the Q and A, is that a number of people are saying, 'This is not an isolated issue, how eligibility criteria for section 9 of, of the Care Act, for example, are being interpreted. This is a systemic issue.' Well, if something is referred to me, and I conclude that it's a systemic issue, then I can hold partner agencies to account, and that includes adult social care. The other thing I always ask as an independent chair when I receive an individual complaint is, how have you escalated it? And to whom have you escalated it? Because most Safeguarding Adult Boards and partner agencies will have escalation policies and procedures, and I need to know that they've been used, and if they have been used and proved ineffective, then again, a whole process of, of scrutiny can follow from that. So, that's what I wanted to say, Adi. Agreeing with you again.

 

Adi Cooper: No, I think that's really-, of course. I think that's very helpful, and I think what is quite-, sometimes quite hard to get your head around unless you're part of it, is that the board isn't an organisation. There's no managerial responsibilities. We can't tell people what to do unless the guidance tells us we can. And so, the mechanisms and the tools that we have at our disposal within the board are limited, but also, quite flexible. So, it's how that's done. I just wanted to respond, somebody-, because it's an easy answer. Who reports death to the boards? And it's-, the coroner can make referrals to the board for a Safeguarding Adult Review, but actually, most boards will take referrals from anybody. I've had referrals in my boards from relatives who are concerned about the deaths of their loved ones, and have thought that they may be eligible for some kind of review or enquiry. So, there isn't a-, there should be-, each local board should have publicly a process for doing that, but it is-, the answer to that question is, it depends, and it's, it's an, an open question. There are some quite specific questions that I'm not sure we can-, well, I'll, I'll raise them. Someone has asked for an example of good systems for record sharing, and we know that information sharing across systems is always challenging, because often of issues around understandings or misunderstandings around data protection, and how that functions, and how that's changed over the years. But I don't know, Michael or Jane, whether either of you can point the person in the direction of someone who's got a good example of data sharing and record sharing in this area of work

 

Jane Cook: Yeah. I know that Howell (ph 01.39.52) have developed a vulnerability panel, where they, they share data, and, and they discuss cases together. So, yeah. Howell have, have developed-, and they've had some deaths, and they've developed this response to vulnerability, not specifically to deaths, but looking at those, those individuals who do present with quite complex needs. And I've also quite regularly attended the drugs fatality group at Eastbourne, which is really well attended by all the partner agencies, and is very active. And they obviously have a, a sharing of information-, data sharing agreements as well. So, it is developing in, in different areas where we're seeing that multi-disciplinary response. And, and I know in Hackney, I was there this morning, in a meeting, and Mike will know that the-, there's been a Safeguarding Adult Review published last week. Or was it-, or was it this Monday? MS.

 

Michael Preston-Shoot: Yes, last week.

 

Jane Cook: Last week.

 

Adi Cooper: I should-, I should declare an interest, Jane. I chair the board and sit in Hackney.

 

Jane Cook: Oh, okay. Yeah, so-,

 

Adi Cooper: Michael's in charge (ph 01.41.10). We know about it.

 

Jane Cook: Yeah. And they're starting their workshops. The council and the Safeguarding Adult Board are having ongoing workshops, so learning as well. So, yeah. So, it is-, but it's-, it is an issue that people often discuss, and in Leicester-,

 

Adi Cooper: Sorry-,

 

Jane Cook: Yeah. In Leicester, I've been into meetings where, when people come-, when agencies come in, they actually sign a confidentiality agreement as well, so there's different ways agencies are addressing it.

 

Adi Cooper: So, the colleague who raised the question, I think one of the learnings where there are multi-agency panels, where people come together, that the issue of sharing information around safeguarding risks can be articulated because if there are safeguarding risks, there is, in effect, a presumption of being able to share information.

 

Michael Preston-Shoot: Data protection act 2018.

 

Adi Cooper: Thank you, Michael. So, it's not the information sharing agreement. It's the system to support people to work together as an enabler that I think is important. There's a question in the chat about black and minority ethnic people, and the impact of homelessness, which is quite a generic question. And for this session, because it's come up in different ways in previous sessions, as one would expect, I think for this session, what, what I would say is that the issues arising from Safeguarding Adult Reviews, or in a particular local area, will focus the board and partners on any relevant protected characteristics. So, I'll use, because it's now in the public domain, and you've already mentioned it, Jane, the death of-, the death in, in Hackney that has recently been published was a, a man from a minority ethnic community. And certainly, some of the issues about his knowledge and understanding in relationship to language, for example, and his particular cultural needs, as Michael knows very well as the SAR author, were not fully understood. So, I know that wasn't the question, but I suppose my answer is, as with all the work that we do, in terms of personalisation and understanding the impact of policies and socioeconomic impact, and how the profile of local homelessness populations occurs, issues around race and ethnicity are absolutely central. And that was certainly bought out, I think, in the previous webinar we had looking at people with no recourse to public funds, for example. And is brought out in, in the MS SAR, in, in Hackney, as well. Michael, I don't know, or Jane, if you wanted to add anything in terms of that question? I haven't answered it, by the way.

 

Jane Cook: No, no. I think it was-, I think it's a really interesting SAR to read, definitely, and the learning from it. And thinking about issues around training of cultural competency, which often get missed, and are starting to come back because of COVID-19, and highlighting health inequalities. So, people are starting to think about cultural competency, and particularly in relation to mental health issues, and, and also access to trained interpreters is absolutely key, and is, is looking in good governance. So, and looking at local workforce as well.

 

Michael Preston-Shoot: Yeah, I-,

 

Adi Cooper: Michael, did you want to add, 'cause I think we're coming to the end. We need to wind up in a minute.

 

Michael Preston-Shoot: No, I, I, I endorse what you've said, and, and indeed, what Jane has said.

 

Adi Cooper: So, I'm sorry. I don't think we've got time for any more questions, and I apologise if we've missed-, Michael, have we missed anything out that you picked up on earlier, as quickly-,

 

Michael Preston-Shoot: Well, there was a question about have-, any evidence of SABs influencing policy change. And I think we have-, we have some evidence of that, on, on a national stage. But we're perhaps not recording it as well as we might. Jane?

 

Jane Cook: Yeah. No, I was just thinking, there was a question around hospital discharge, and the work of Michelle Corns. And definitely-, and now, we're seeing funding, which is coming out around hospital discharge and homelessness, and there's some really good practice around as well, thinking about intermediate care. So, we are-, there are-, there is change occurring, which is-, which is great.

 

Adi Cooper: Thank you for that. So, Michael, have-, do you want to put up the slides in terms of the final workshops, just to tell people about those? We've got another four minutes

 

Michael Preston-Shoot: Right. No pressure, then, Adi.

 

Adi Cooper: No pressure.

 

Michael Preston-Shoot: What, what's happened to the slides, however?

 

Adi Cooper: Well, so, I don't know. Whilst you're trying to put those up-, so, what-, the slides were just to illustrate that there are two more workshops in this series on the 1st and 8th March. Have you got them?

 

Michael Preston-Shoot: I've got them, but when I click on, 'Share'-, there they go. Right.

 

Adi Cooper: Brilliant. Okay. Do you want to quickly go to that-,

 

Michael Preston-Shoot: Yep. Right. So, just going down. Here are the next two. 1st March in the morning, and then 8th March in the afternoon. So, specific issues being focused on 1st March, and then the contribution from a number of experts by experience on 8th March. So, two more webinars left. Please do send me any examples of positive practice that you might be happy to be included in the second briefing. That will follow the, the eight webinars. And then, there are a number of other resources available on the LGA website around safeguarding adults and reviews, and safeguarding concerns, which picks up some people's concerns this afternoon about the use of section 42 of the Care Act. And also, a, a series of virtual webinars on the EU Settlement Scheme that's being organised by ADASS, and there is a link there if, if you want to register.

 

Adi Cooper: Thanks.

 

Michael Preston-Shoot: So, there you go, Adi.

 

Adi Cooper: Thank you, Michael. So, I'm sorry, colleagues. This is all we've got time for this afternoon. Thank you for your questions and your input. Thank you, Jane and Michael, for your contributions. Thank you everyone for joining us. I hope you've found it useful. So, just to reiterate, the presentations should be available on the LGA webpage within two days, and the recording within three days. There'll be a short survey that we'll send you that we would be very happy for you to fill in and return so that we can learn from your feedback in terms of organising any future events. And thank you, finally, for the support from the events team who support this series of webinars, really, really helpfully. Stay safe, and hopefully see you at the other webinars later on in March. Goodbye, and thanks, Michael, for all your work on this.

 

Jane Cook: Thank you.

 

Adi Cooper: Thanks, Jane. Bye bye.

 

Jane Cook: Bye. Bye.

 

Michael Preston-Shoot: Thank you. And thank you, Jane.

 

Jane Cook: Thank you. My pleasure.

Solution focused responses to complex needs 
Jane Cook, Health and Homelessness Adviser, Rough Sleepers Initiative, Ministry of Housing, Communities and Local Government

Safeguarding Adults Boards and multiple exclusion homelessness 
Dr Adi Cooper OBE, Visiting Professor, University of Bedfordshire

More lessons from Safeguarding Adult Reviews on multiple exclusion homelessness
Professor Michael Preston-Shoot, Emeritus Professor of Social Work, University of Bedfordshire and Chair of the London Region Network of Safeguarding Adults Board Independent Chairs