Sunderland City Council: local authority assessment

There were effective systems, processes, and practices to make sure people were protected from abuse and neglect. The team were supported by strong business support and data management teams which operated a data-driven approach to identify trends and target interventions. The safeguarding systems were reinforced by effective collaboration with partners, including police, health, and other agencies. However, leaders identified there was further work to be done through training and looking at the alternatives for signposting.

The local authority worked with the Safeguarding Adults Board and partners to deliver a co-ordinated approach to safeguarding adults in the area. The Safeguarding Adult Board undertook an independent review which resulted in condensing to 1 board and 3 sub-groups and a more streamlined system change to.

The out of hours service was supported by the Customer Enabling Service, who managed all contacts into the local authority. There was always a manager, social worker and an Approved Mental Health Professional (AMHP) on duty. A handover occurred every day with teams to alert the out of hours service to any cases that could require their support. All out of hour’s support was case recorded, and the allocated worker and team were sent a notification. Where required, a more formal handover of the out of hours intervention was provided. For example, if there was urgent follow up action needed during office hours. 

There were regular reviews of governance and processes to ensure effectiveness of out of hours and safeguarding. For example, efficient referral and triage processes fed into clear risk assessment and categorisation of cases. These were further supported by a threshold tool which professionals completed. Staff had strong relationships with providers and open communication channels with clear processes for managing concerns. A wider focus on learning and improvement was gained through feedback and audits. Audits were reviewed and fed into the safeguarding board as evidence of how the local authority were meeting its duties under the Care Act 2014.

There was a strong multi-agency safeguarding partnership, and the roles and responsibilities for identifying and responding to concerns were clear. Information sharing arrangements were in place so that concerns were raised quickly and investigated without delay. There was an embedded person-centered approach to safeguarding investigations. This was supported by effective collaboration with mental health professionals, the wider frontline teams and other stakeholders. We heard about a proactive approach to modern slavery and effective advocacy services for individuals. There was a focus on making safeguarding personal and involving service users but also on prevention and early intervention. The culture in the local authority fostered an approach of continuous learning and improvement based on feedback and national best practice. This was supported by data in the national adult social care survey 2023-24, which showed that in Sunderland 81% of people who use services feel safe which was higher than the England average. Additionally, 89.8% of people who used services said that those services have made them feel safe, also higher than the England average.

A similar picture was presented in Sunderland’s data from the Survey of Adult Carers in England. It showed that 85.5% of carers felt safe which was higher than the England average of 80.93%.The local authority training data showed that all staff involved in safeguarding work were suitably skilled and supported to undertake safeguarding duties effectively which was corroborated by their provider survey.

There was a clear understanding of the safeguarding risks and issues in the area. The local authority worked with safeguarding partners to reduce risks and to prevent abuse and neglect from occurring. The safeguarding board aligned its work with national policies on serious violence, domestic abuse, and child protection. There was a focus on prevention and the safeguarding board recognised the importance of prevention, with a focus on early intervention and addressing root causes of concerns. This was followed up by effective collaboration, for instance the involvement of various stakeholders, including Ageing Well Ambassadors, ensured a holistic approach to safeguarding.

There was a commitment to data-driven decision making, such as the use of data and feedback from Domestic Homicide Review (DHR)s and Safeguarding Adults Review (SAR)s enabling and encouraging informed decision-making and continuous improvement. For example, following SARs the local authority had carried out outcome-based work through a SAR group who looked at outcomes from DHR's as well. The safeguarding board regularly reviewed governance which had led to the creation of the SAR group whose focus was on SARs learning and thresholds. Where there was cross over learning with DHRs and SARs this was identified by an overseeing manager and used to inform analysis, learning and system improvements.

Lessons were learned when people had experienced serious abuse or neglect, and action was taken to reduce future risks and drive best practice. A SAR follow-up assurance exercise report considered work undertaken by partners to embed their actions approximately 18 months following the publication of the SAR in 2021. The review was carried out by the Quality Assurance (QA) sub-committee. Though the SAR was published in August 2021, the action plan was monitored and updated on a regular basis until its completion in June 2023, when it was shared with the QA sub-committee to consider assurance and progress. The local authority demonstrated ongoing review of the implementation of recommendations and learning in an overview report, with multi-agency contributions, to demonstrate continued improvement and developments. All actions were in place across the partnership, the report reviewed the continued developments since that point. These included further delivery of training packages, the setting of further objectives, and review of evidence of continued improvement. Staff told us they had received 7-minute briefing information on the learning from Safeguarding adult’s reviews.

Following a SAR, the safeguarding adult board had established the Complex Adults Risk Management Process (CARM). There was a recognition of the risk to adults who had capacity to make decisions for themselves but were at risk of serious harm or death from self-neglect, lifestyles or refusal of services. The process did not replace existing legislation but was an additional tool to support joint working between professionals, establishing actions and clarifying roles and responsibilities. Staff told us CARM was particularly important in supporting engagement with partners, such as health professionals when joint working with people with complex needs.

Sunderland Safeguarding Adults Board (SSAB) Strategic Delivery Plan recognised that strong governance arrangements, quality assurance data from statutory partners, and well-planned and robust assurance mechanisms such as audits were the foundation for a successful Safeguarding Adults Board which achieved consistent positive progress. Links to information were provided on the SSAB homepage to various information tabs, such as 'training'. This included information and guidance about courses from many areas such as Sunderland City Council’s Learning & Skills Service. Further links to information were provided on the SSAB homepage, to various information tabs such as learning resources which included a series of 7 minute safeguarding adult reviews, a series of 7 minute briefings on subjects such as, domestic abuse, female genital mutilation, Prevent (Radicalisation), various forms of self-neglect, sexual abuse, and trafficking and modern day slavery to name a few with some briefings on good practice.

The ICB also attended regional chairs groups to get a regional picture. The ICB had appointed executive nurse for safeguarding which strengthened links and improved efficiency across the partnership. The chair also worked for North East ADASS, and supported commissioning arrangements. These arrangements enabled more information sharing and alongside good relationships with providers enabled successful regional work around modern-day slavery. Leaders recognised that further links were needed with the aging well ambassadors, and there were more opportunities around prevention agenda.

Commissioners were made aware of any emerging safeguarding themes, for example increases in the number or pressure sore related concerns. Providers also submitted information about the number and type of safeguarding incidents as part of quality monitoring which also fed into monitoring around organisational concerns and abuse.

Staff working told us about a new project in safeguarding called Safe Sunderland - Safe Place. It built upon contextual safeguarding but was based on risks posed to a whole community by a place, rather than to/from a named individual. If an area or place was recognised as risky for a community, such as a park, street, or shopping centre, a plan would be developed with partners, including adult social care, to make the whole area safe.

Staff and leaders had clarity on what constitutes a Section 42 safeguarding concern and when section 42 safeguarding enquiries were required, and this was applied consistently. There was a clear rationale and outcome from initial enquiries, including those which did not progress to a Section 42 enquiry.

Data for Sunderland from national Safeguarding Adults Collection (SAC) showed there were 805 Enquiries meeting section 42 threshold in the past year. The data showed the conversion rate from safeguarding concerns to section 42 enquiries had significantly reduced from 2021 (49%) to 15.6% in 2023. Leaders told us their analysis of data over the past few years of the annual report data had shown a low conversion rate, some high referrals and some which should not have been referrals and should have led to signposting. In response to this the local authority examined the thresholds and threshold referral tool. In co-production with partners, they worked to roll out training which leaders advised influenced and resulted in more appropriate referrals which enabled staff to focus on more complex work.

Staff were positive about the improvements and told us leaders had listened to the need to provide a better tool. Outcomes for people were improving as a result and the system was able to keep people safe more effectively. Staff told us an artificial intelligence application they had started to use was having a positive impact on the administration of safeguarding concerns.

Data provided by the local authority showed there were no safeguarding concerns awaiting an initial review and no section 42 enquiries awaiting allocation for enquiries to be made. There were clear standards and quality assurance arrangements in place for conducting section 42 enquiries. When safeguarding enquiries were conducted by another agency, for example a care or health provider, the local authority retained responsibility for the enquiries and the outcome for the person(s) concerned. Providers told us they were involved in strategy meetings relating to their service and that the local authority’s safeguarding lead explained what actions were required, which was supportive.

The safeguarding culture was a learning, non-blaming culture. Several providers said how much they valued feedback from the local authority that enabled lessons to be learned. Providers also talked about how they were kept updated about matters relating to safeguarding, including the commissioning team providing briefings with updates on things like modern slavery, and the Safeguarding Adults Board (SAB) sharing information and videos regularly. The Operational Safeguarding Team also attended the provider network meeting, for example to talk about how to use the threshold tool.

Safeguarding plans and actions to reduce future risks for individual people were in place and they were acted on. Relevant agencies were informed of the outcomes of safeguarding enquiries when it was necessary to the ongoing safety of the person concerned. Providers told us the local authority safeguarding system worked well. Response times following a concern being raised were good, even for low-level concerns.

The local authority had completed significant work around their Deprivation of Liberty Safeguards (DoLS) processes and systems following the 2014 supreme court ruling. The local authority had invested resources in the DoL’s team following the ruling and had prepared for the Liberty Protection Safeguards (LPS). This was evident as the local authority had nine best interest assessors (BIA’s) in the DoL’s team and had 35 BIA’s trained in the community teams. This investment had led to sufficient resources which resulted in there being no waiting lists for new DoL’s applications or renewals. Staff told us they had been provided with dedicated resources to clear the community DoL’s. For example, in 2023 they had cleared the backlog of over 200 community DoL’s, as the local authority offered overtime to Best Interest Assessors who were working in the locality teams. Staff told us their workloads were manageable, and they had very good management oversight and support through monthly supervision sessions. Data for Sunderland corroborated that there were no waiting lists for DoLs applications or reviews.

Hospital Deprivation of Liberty Safeguards (DoLS) referrals had increased in the past year, but the DoLS team had been able to support people without any additional waiting lists. There was a dedicated email for all DoLS referrals, which was triaged daily by a manager and was assigned to a social worker without delay, for a Mental Health Assessment or a Best Interest Assessment. Staff told us they were able to plan the renewals of community DoL’s. They provided us with an example of picking up all the Learning Disabilities renewals 3 months in advance to avoid people waiting for a DoL’s assessment. Staff told us they had formed positive working relationships with care home providers. This was corroborated by providers and unpaid carers. An example provided was when a person's needs had changed or whether a person still required a DoL’s application, the Care Home Providers updated the DoL’s team. The DoLs process ensured people received support.

Safeguarding enquiries were carried out sensitively and without delay, keeping the wishes and best interests of the person concerned at the centre. Staff worked with people for enough time to build trust and ensure their safety, but also to build understanding of best communication and what was important to them. 

People had the information they needed to understand safeguarding, what being safe meant to them, and how to raise concerns when they did not feel safe, or they had concerns about the safety of other people. People could participate in the safeguarding process as much as they wanted to, and people could get support from an advocate if they wished to do so. People were supported to understand their rights, including their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010 and they were supported to make choices that balanced risks with positive choice and control in their lives.

 Data for Sunderland from the national safeguarding adults collection showed that 100% of individuals lacking capacity were supported by an advocate, family, or friend during safeguarding processes. This was significantly higher than the England average and showed Sunderland’s commitment to making safeguarding personal and the value the teams place on ensuring people’s voice was prioritised in safeguarding proceedings. Making safeguarding personal was part of Sunderland’s strategy and data was obtained from statutory processes from the front door to evidence progress in relation to this.

The local authority commissioned a service to undertake a survey with people who experienced the safeguarding process. The aim was to obtain feedback on work with the public on messaging, for example around their understanding of self-neglect. Some examples of the positive findings included the majority of people surveyed understood the safeguarding process and information they had been provided and were encouraged to express their views throughout the safeguarding process. There were also areas for improvement identified, such as ensuring that each individual’s expressed outcomes were recorded, even if they may not be achievable. The survey also identified that half the people surveyed did not know who to contact and how to make contact with someone to get help. In response to this the local authority introduced a programme of work around prevention which included making procedures more accessible and user friendly, resources had been added to the Sunderland safeguarding adults board website to support this.

The local authority took steps to ensure information was available and accessible to all. For example, there was a guide for people using the service which included an explanation of what Safeguarding is, who is responsible for reporting it and where to report. Additionally, the Safeguarding Adults Board commissioned a service to create an easy read version of their annual report each year which aimed to make the report accessible to all residents.

Sunderland Safeguarding Adults Board (SSAB) Strategic Delivery Plan aimed to improve safeguarding by establishing an effective Board to drive change, using data and research to influence service design and delivery, clarifying leadership roles, challenging partners, and implementing an outcomes-focused, person-centered safeguarding model. This included providing resources, briefings, and case studies, and delivering mental capacity training and professional curiosity guidance to promote diversity and equality.