The Director of Safeguarding for the Somerset Partnership NHS Foundation Trust and Taunton and Somerset NHS Foundation Trust developed an integrated safeguarding service across the two organisations. The implementation of this programme is showing demonstrable signs of improved experiences, outcomes and use of resources across the area.
Where to look
The “Think child, think parent, think family” (Social Care Institute for Excellence, SCIE, 2012) report identifies that parents with mental health issues and their families are one of the four groups most likely to not have appropriate access to health and social care provision. The report advocates a new way of working: collaboratively across adult mental health and children’s services.
As part of the merger between Somerset Partnership NHS Foundation Trust (SPFT) and Taunton and Somerset NHS Foundation Trust (TSFT), a review of safeguarding service provision highlighted disparity across the two areas, with unwarranted variation in the signposting and streamlining of services, as well as differing training and development for staff within the services.
Having supported the development of an integrated safeguarding team within another locality, the Director saw an opportunity to address the unwarranted variation and to replicate this model across SPFT and TSFT. The previous integrated model saw an increase in referral acceptance from child protection to social care from 43% to 85% after 6 months, as well as increasing staff satisfaction and capacity.
What to change
During 2017 there was a reconfiguration of Safeguarding Services as the two provider organisations merged. The Director of Safeguarding led a scoping exercise across the two Trusts to identify areas of good practice as well as areas for improvement. The evidence from this review and from previous experience suggested that integrating the safeguarding services could be of significant benefit, notably in streamlining the pathways of care.
How to change
A comprehensive staff engagement process (including a facilitated away day with key stakeholders such as the CCG and Social Care Partners) was completed over a 10-month period leading to a formal consultation process of the draft model.
The Director of Safeguarding supported by Senior Leads at the Trusts established a monthly task and finish group to co-produce the new model of service for delivery and care. Staff engagement was sought and encouraged throughout the process.
On production of the final structure, a business case was agreed by the Executive team before consultation and agreement with key stakeholders including professional bodies/trade unions.
Safeguarding Team members at all levels were involved in the review of job descriptions, roles and structures which resulted in new posts being developed and funded to ensure comprehensive service provision across localities and statutory requirements. This has included extending domestic abuse service provision and supportive safeguarding service for Child and Adolescent Mental Health Services (CAMHS).
Staff training and development has been standardised and enhanced with all members of staff provided with bespoke SCIE enhanced Level 4 training for safeguarding adults and children, in addition to previously provided safeguarding training. This was further enhanced by the introduction of a new duty service which provides a single point of contact and safeguarding supervision.
The model has also introduced a Named Midwife for Safeguarding Children, which has historically sat outside of the main safeguarding structure. This supports a seamless approach through the life-course for safeguarding.
The new model now has a ‘Think Family’ focus to care creating a more robust and holistic response, supporting staff to support their patients and families.
Better outcomes – The development of a ‘Think Family’ approach has supported the delivery of an integrated safeguarding service for the local communities. Working as part of an integrated team means that pathways have been streamlined and care is more cohesive. Staff are learning from each other every day and enhancing their skills. The new service structure also means there is parity of service provision across the Trusts.
Better experience – Having a single point of contact and a dedicated duty team to answer their queries has been very well received by staff a key strength of the programme. Staff have also identified that the new model has broadened and enhanced the knowledge of staff which has given them more confidence in practice and enabled specialist areas to have a clearer focus. Assessment of the impact for patients hasn’t yet been undertaken but is scheduled in the 12 months post-implementation review.
Better use of resources – The reconfiguration of the safeguarding services across the two Trusts has provided a 25% increase in capacity and created a saving for both Trusts too. The new integrated model has improved efficiency and removed duplication. This integration is already showing signs of enhanced skillsets for staff in safeguarding competence, confidence and resilience as well as opportunities for development.
Challenges and lessons learnt for implementation
A significant challenge was to bring together two very different service models. This was achieved through comprehensive staff engagement and a formal consultation process. Bringing the services together was only the first stage with the alignment of processes, policies and procedures following.
Staff reviewing job descriptions and helping to write the new ones for the new structure proved to be a powerful tool to engage them in the changes.
The structure must be based on the service to be provided and the desired outcomes.
Due to the success of the model, a new contract has been awarded to provide safeguarding supervision, advice, support and training to Health Visitors and School Nurses that are employed by Public Health in Somerset County Council. This will further develop integration across boundaries and improve services provided locally.
Patient and carer participation groups will be invited to review current practice and inform future developments.
For more information contact
Director of Safeguarding
Somerset Partnership & Taunton and Somerset NHS Foundation Trusts