Policies and procedures
The following safeguarding policies have been revised and updated to keep people informed of what they are expected to do.
- North West Association of Directors of Adult Social Services, Young People and Adults Complex Safeguarding Strategy
- Contest Strategy for Counter Terrorism
- Home Office Serious Violence Duty
Safeguarding Adult Review (SAR)
Safeguarding Adult Reviews are a multi-agency process that considers whether serious harm experienced by an adult at risk of abuse or neglect could have been predicted or prevented. The purpose of Safeguarding Adult Reviews is set out in the statutory guidance (Section 44) within the Care Act 2014. The reviews seek to ‘promote effective learning and improvement action to prevent future deaths or serious harm occurring again’. The aim is that lessons can be learned from the case and for those lessons to be applied to future cases to prevent similar harm re-occurring. The purpose of a Safeguarding Adult Review is not to hold any individual or organisation to account as other processes exist for that purpose.
During this period the Safeguarding Adult Review panel received five referrals.
Referral one concerns relate to a lack of collaborative working & escalation of an adults known risks self-neglect/disengagement by involved professionals to evidence/rationalise decisions made in relation to Mental Capacity and care arrangements.
Referral two was around the lack of engagement by professionals with the family prior to the adult’s death, however the referral did not meet the criteria for a review as there was no cause for concern on how partners with safeguarding functions worked together.
Referral three involved the sudden death of an adult who suffered with their mental and physical health and ‘self-neglect lifestyle’, however the referral did not meet the criteria for a review as there was no link to the death and suspected abuse or neglect.
Referral four was around the care of an adult with a learning disability and how the lack of appropriate care and agency involvement led to them being admitted to hospital with a life-threatening injury.
Referral five was a discretionary SAR looking at how well did agencies work together to safeguard the adult and issues around the management of medication in the community and hospital discharge protocols and the impact of any delays on a terminally ill patient.
Safeguarding Adult Review reports on completion are published on our website.
Review one:
Norfolk’s Safeguarding Adults Board Safeguarding Adult Review for Joanna, Jon and Ben who were three young adults who died at Cawston Park Hospital within a 27-month period between April 2018 and July 2020. It raised critical questions and learning – not just for Norfolk but nationally, about the care and protection of a group of our most vulnerable adults with learning disabilities and complex needs, placed in private hospitals.
Review two:
David (pseudonym) was at the time of the incident a 17-year-old autistic young man, who was a looked after child under a section 20 agreement. He had been known to Special Educational Needs Services (SEND) and Neuro Disability Services since he was five years old. David was also known to Mental Health Services and in 2016, was placed under a section two and subsequently a section three of the Mental Health Act. At the time of the incident on 4 August 2019, David was living in a bespoke semi-independent care placement where he received 2:1 care. On the day of the incident, David was allowed independent leave between 12pm and 4pm and he informed the care staff that he was going to a local shopping centre. That afternoon David went to a public building in central London and was involved in a serious incident on a young child. The victim sustained life changing injuries requiring hospital care. The victim was not previously known to David.