Hi, I'm Siobhan Fletcher, and welcome along to this latest edition of our newscast. Now, as you've been hearing all this week, the island's support services are currently marking safeguarding week. And here at Manx Radio, we're hearing from the professionals who work to keep the most vulnerable people here on the Isle of Man safe. We've heard from the Isle of Man's safeguarding board and the police, but what about those on the frontlines in our island's health and social care spaces? Today, we're going to be speaking to Manx Care's named professional for contextual safeguarding, Samantha Holmes, and the head of safeguarding for children and adults, Terry Banks, who covers the acute and community health services here on the island. They told me safeguarding is everybody's business. So we're talking this week, it's safeguarding week. The theme this year's exploitation, which suppose we'll get to more specifically in just a second, but first of all, I suppose, what is safeguarding on the Isle of Man? What does it look like? Well, safeguarding is everybody's business, that's the first thing that we need to say. I've come over from the UK three years ago, so I was expecting with it being in Ireland not to be real any safeguarding issues here, and I think that's what a lot of people's perceptions are. However, a lot of the safeguarding on the Isle is hidden, and because we're talking about exploitation, I'm going to say that exploitation has been quite hidden. Some of the parades that we use is we uncover things, it's under the rock, it's under a stone, and that's what we've seen in respect of exploitation in the UK, but also in the Isle of Man. What we've also found in respect of safeguarding, it covers the whole age range from the cradle to the grave. And so I suppose your specific agency within MASH, which again we'll get to, what that is in a minute, how do you deal with safeguarding, what's your role in conversation? Right, so we're embedded in safeguarding, so not only are we in the MASH, we're also in the acute hospitals and also in the community, but while we're concentrated on the MASH, we've got specialist nurses in there, which includes Sam, we've got a named nurse, we've got a nurse that specifically concentrates on the health needs and the exploitation needs of children that are in the care system, and we've also got a midwife that looks after vulnerable women, and some of those are also being exploited, and they could be pregnant by a result of exploitation. So we are very visible within the MASH, we have a duty line within the MASH, and we have daily conversations with our police colleagues and our social care colleagues. So we are fundamental for decision-making and information sharing. So we do now have, since Terry came into post, we have a duty team, and as Terry has already shared, we have visible across Mank's care, and that is where any child or even adult comes through our front door, so the emergency department, and we would follow either that child or that adult throughout their journey, throughout the hospital, and then out into the community. We do have the risk-indicated checklist tool, which is embedded again across Mank's care, so where those conversations where somebody might be admitted into our emergency department, where you're just thinking something's not quite right, and you've got that funny feeling in your chest, so you want to capture that adult's voice when they might not have one, and then equally that child's voice when they've not got one, and it's to allow that professional to fully explore what is the reason why this younger person or adult has come into our service for care, and is there anything else that's outside of that? So is it a genuine admission? They are really unwell, and they just need some of our nurses and doctors to support them, or is there a safeguarding concern, and then that's where our team would obviously explore that with the professionals, and then obviously referrals, timely referrals, I would have to say, are made to ensure that we've got a multi-agency response. I suppose this week, the theme, and our safeguarding comes a whole range of things, this week we talk about exploitation, so when you see someone coming into nobles or into that first point of contact, what are the red flags that exploitation could be involved, and I suppose that what's the range then between kids and adults? Yeah, I think we need to be really mindful that a child or an adult is never going to come into any service and say, "I am being exploited," and I think we need to really be clear as well as that, they may not know that they are being exploited, so it could be really subtle things, so it could be some of our children are going missing from home, so why are they going missing from home, what are they frightened of, and it could be that they have come in through our emergency department, having taken an overdose, self-harmed, they might be intoxicated, now you could look at the intoxication and look at the age of the child, is this just normal teenage, you know, risk-taking behaviour, or are they trying to get away from something, are they trying to mask something, are they frightened about something, or is there somebody giving them that alcohol, which obviously then you need to fully explore in terms of are they being exploited, you know, when you look at the age of them, they're not old enough to buy the alcohol, equally if they're not working, then where are they getting the money from to buy that alcohol, so it's just having to be professionally curious and really having that think-family approach around it. What we also were very quite nosy, we asked the right questions to whether that be an adult or a young person, so we've got, if we've got a teenage pregnancy, for example, and they say, you know, we ask who the boyfriend is, how they've met them, is that for the internet, is it Snapchat, we explore it, just in case there's an exploitation going on, because some of these, specifically the young girls, are in that it's my boyfriend type model, they're not aware that they're being groomed, for example, so we're very, very professionally curious in respect to pregnancies, and also as well, the more subtle signs is who are they with, so if you've got a person 15 or 16 and they've got an adult with them, we need to know, has that person got PR for them, or is that somebody that's brought them in because they're being exploited, so we have to be really professional and curious, and we use what we call a reachable moment, so this is a terminology that was embedded in the UK really after the merger of a young boy that was, he was involved in the gang, he was being exploited, and basically when this police spoke to him, they missed some opportunities to safeguard him prior to his death, and that's called a reachable moment, so what we do, we know that if someone comes in, they've got that nurturing response from one of our staff, are you okay, that's your reachable moment to try and get them to disclose what might be happening to them, and if they don't disclose, we use something called assertive outreach, so we leave the hospital for example, and we don't leave that, we go out again, that would be sound to see them one, two, three or four times, you definitely get that reachable moment, mainly within the ED departments, I have to say, or on the wards, but you can also get a disclosure after keep going out, and you know that never stop, we don't give up on them really. I suppose with that then, Sam, if you're going out to their home to speak to them, I mean, you try and just build a rapport, is that, like you say, reachable moment, that can be over a period of time, then rather than just, you know, that one trip to the ED. Yeah, absolutely, so obviously I would go out and offer a contextual health review, which would capture any identified health needs, but then it is really fully exploring, is this child at risk of criminal or sexual exploitation, and offering them, you know, a lot of support. Now, some of these children, you know, they've never met me before, so why would they tell me all of their worries, all of their fears, so sometimes what I'll do is I'll make contact, I'll go out, and sometimes the children are more than happy to engage equally, sometimes they're not, so I'm like, let's go for a drive, we can go for a walk, you know, whether I've taken, you know, them to Starbucks, you know, just, you know, to try and lay any fears that they have, and one of the things that I would say is it's an absolute privilege to wear the uniform that I do, to gain the trust of the children that I do work with, and the adolescents, and hopefully that that is a reassuring that I'm seeing as a caring and nurturing person, and that I want what's best for them, and it is a real privilege to be able to work with some of the children that I do as well. I suppose in terms of exploitation, you mentioned there's criminal and there's sexual, we touched on this with some kindle as well, I spoke to him from the police, it's not kind of, you know, if there's a parent or a careless today, I'm not trying to scare them in any way, but I mean, in terms of red flags, there's a whole range of exploitation that maybe we see on the island and stuff that maybe people don't realize is exploitation. Here when we threw some of the things that you see as well as in your jobs. So it can be subtle changes, so it could be a child that is more than happy to go to school, has got good, you know, educational attainment, is doing really well, and then all of a sudden, they don't want to go to school, all the parents or the teachers might see that the grades are slightly changing, equally it could be that they are missing from home, they can have a completely different change in friendship group, technology, you know, they're constantly on the phone, more than what they've normally been, they're becoming very secretive, coming to police attention, frequent attendances, upper, you know, the emergency department, I mean, and this is not just ones that are set in stone, but these are some of the things that as a parent or carer, you could be mindful of, like I say, it's very, very hard that some of this is, you know, that adolescent, normal, you know, behavior where they do change, you know, the friendship groups, but again, it from a, certainly from a health perspective, it is about being professionally curious, why has that young person, you know, decided not to go to school, why, you know, have they changed the friendship groups, and why have they got all of these attendances up to the hospital or even the GP? What we can also see in young person is a change of appearance, so you could have a young, I'll use a female, a young female that's never worn makeup, and all of a sudden she's got this boyfriend that happens to be much older than her, but she's not telling anybody, and they start to dye the hair, wear makeup, and dress a lot older than years, and conversely, if you've an adult that's been exploited, for example, being cuckooed, where somebody takes over the family home, and is taking money off them, you could have somebody that's all, you know, once been really smart, have the hair done, etc, and because they've got no finances, because they've been exploited, we'll start to look disheveled, so there's these two strands, so that's the way they look as well. So suppose you've both mentioned the sort of the different agencies that you all feed into, one of them that we've talked about this week is MASH, so you tell me then once you've raised, you've sort of had this red flag raised really on a case, you've had, you know, you try and those reachable moments, what do the conversations look like then across the multi-agent, how do you all work together? Okay, so if we recognise any immediate risk, we can respond collectively within a few minutes, which is beneficial for MASH, so prior to the MASH, we people at the hospital, the police, a bit the police station, the social workers are somewhere being here, we're all together now, so we will come into this room, and we have what we call a strategy meeting, and a strategy meeting is convened under the Children Young Persons Act, and we will all bring our information to the table, so to speak, so we'll look at the health system, we'll say that the child's been an ED, what the health needs are, the police will bring their police intelligence and what they know, and the social workers, and we then make a decision, does this meet a threshold, are we that concerned that we're saying this child, is it significant risk of harm, and if that's the case, then we'll do a visit more or less straight away, so that immediately, it has been amazing since we got the MASH together, and that response to risk, etc, yeah. Have you seen a difference then in your roles, then, since that's the form? Absolutely, yeah, I mean, so we now have the duty role, so we have a person from the Safe Garden Children's Health Team that is available on Day to Friday, who can respond to any of those concerns, particularly as well, if there is a child, obviously if they're on Children's Ward, then we can visit them on Children's Ward, but for those that are over 16, we can actually go out and visit those children on the wards as well to get that timely information and then feed that back very, very quickly here into MASH, and it's just that safe garden is now more visible, which is really, really good in terms of keeping children safe and capturing their voices and making those timely multi-agency decisions, so yeah, absolutely. Also, in the respect of the missing from homes, because we are now doing, we've got Sam doing in the main, most of the return home interviews, they're done within 72 hours, so for example, if somebody goes missing on Friday, when Sam comes in to work on Monday morning, she will be out, where have you been, who are you with, and some of those hot, what we call hot spots, we can then bring that information back to the police and we start seeing frequent addresses, frequent names of males or females of concern coming up and also with victims. Yeah, but as for working together like that, so, you know, we had an example, like I said, when I spoke to the police, of if it was raised to sort of you guys within the health team, this person's at risk, and then we'll go and they'll deal with the criminality involved, and so once you've been all doing your all separate parts, you can come back together and keep yourself updated, how does that work as well going forward? So the strategy meeting that we talked about, where we go out straight away, such is a risk, we'll reconvene that, so that might be in 24 hours, it might be a little bit later, and we'll walk with the same people, we'll come back to the table and we'll say what we've done and what we've identified, and that then will form whether the risk is still as high as it was, or maybe not as bad as we thought it was, because we've now got the information and the decisions were made then on how to proceed in with respect of that young person or adult. Do you see a lot of positive outcomes for young people, because you're getting to sort of almost step in earlier and have all the different agencies working together there? Absolutely, and obviously I'm sure the police have spoke to you about the child exploitation notices, which is obviously stopping those children going to those places of concern surrounding the adults, and definitely from a health perspective, we're getting out there, we're capitalising on those reachable moments, which could be a disclosure of what is actually happening to the child, but actually equally it could be something in relation to do with the health, that they might want an appointment up at the sexual health clinic, so I'm able to get timely early appointments for these children to go up and be seen, so it's definitely having a positive impact on their physical and their emotional health. We've now got our forensic nurse on the island, so she's come from the UK, home officer credited, she's absolutely amazing, we've got that service, so in the past if there was only concerns about sexual assault and you probably know yourself, they used to have to go over, get a plane or a boat and go over to the UK, we've now got that service, that service is on call, so for example if we had somebody that was the victim of a sexual assault, we could ring one of our colleagues from the SARC and what they will do, we'll get that person seen sometimes, even if it's one or two o'clock in the morning, we can get them seen and we can get that DNA and those swabs done more or less immediately, so that's an excellent resource for the island. I've obviously seen them building a permanent base for that as well at the minute, so once that's up and running that's even more, you know, to connect. Yeah, absolutely, we've got a fantastic relationship with them, very well with our SARC colleagues and they are involved in some of the strategy meetings that we have as well, and we invite them on board, yeah. Thank you for making it to the end of the Manx Radio newscast, you are obviously someone with exquisite taste. May I politely suggest you might want to subscribe to this and a wide range of Manx Radio podcasts at your favourite podcast provider, so our best bits will magically appear on your smartphone. Thank you. (gentle music) [BLANK_AUDIO]
