Adult Support and Protection: Large Scale Investigation guidance

10. General circumstances when an LSI should end

The criterion for ending an LSI is that the service subject to the LSI, or the actions of an alleged harmer, are no longer placing adults at current risk of harm. (In some circumstances, there may be individual Adult Support and Protection enquiries ongoing even though the risk of harm at scale is no longer present.)

The LSI action plan can be used to help determine how far the service or agency subject to an LSI has improved. But if a plan has been implemented, that plan is being monitored and reviewed, and there are no adults at current risk of harm, then the LSI can be closed. In advance of the decision being taken to end the LSI, a Large Scale Investigation Outcome Report (see Section 10.1) should be produced to inform this decision.

10.1 Large Scale Investigation Outcome Report

The LIO (see Section 8.8) should prepare a Large Scale Investigation Outcome Report when all actions agreed on at the Large Scale Investigation Planning Meeting have been completed and the milestones agreed locally have been achieved. A template can be found at Appendix 10.

The purpose of this report is to gather the evidence collected during the LSI and present it to the Large Scale Investigation Outcome Meeting. It should be circulated to attendees in advance of the meeting.

10.2 Large Scale Investigation Outcome Meeting

The purpose of this meeting (which may be called by different names in different local areas) is to determine, based on the information obtained during the LSI, if the adults within the service subject to an LSI are still ‘adults at risk of harm’ under the terms of the 2007 legislation. If they are not, then the LSI can be closed, with the next actions outlined. If they are, then it will be discussed whether the LSI should continue (or if other actions are more appropriate). The Large Scale Investigation Outcome Meeting allows for discussion and deliberation of the findings of the LSI as set out by the LIO in the Large Scale Investigation Report.

If possible, it is good practice for the Chair of this meeting to be the same person who chaired the multi-agency initial LSI discussion (see Section 7.2), and ideally someone not responsible for the management of the LSI. However, if the Chair is not available, the meeting should not be held up and a suitable replacement should be found.

All those who were invited to the multi-agency initial LSI discussion should also be invited to the LSI Outcome Meeting. In addition, any other relevant parties who may contribute to effective decision-making should also be invited. This includes the representative of the service subject to an LSI (although they may be excluded from certain parts of the meeting). The attendees at this meeting should have the authority to agree to the conclusion, or continuance with defined next steps, of an LSI.

At a minimum, the LSI Outcome Meeting aims to achieve the following, and assign named people to any actions arising:

• To discuss the report from the LIO
• To consider any outstanding concerns and their severity, including whether moratoriums are in place, creating an improvement plan, with measurable targets
• To take a longer-term look, giving consideration to how any improvements can be sustained and any supportive monitoring needed for this. It is important that this is done in collaboration with any other public bodies that require improvements, such as the Care Inspectorate. Streamlined improvement plans will reduce duplication of work and provide clarity for the organisation that has been subject to an LSI. The aim should be for improvement plans to work together for as long as they naturally can.
• To ensure that appropriate risk assessments have been completed, and that protection or care management plans are in place
• To create a communication plan for notifying all interested parties – including adults who have been at risk, and their families – of the conclusion of the LSI
• To decide on a media strategy for communicating the end of the LSI, particularly if there has been media interest during the LSI itself. In some cases, there may be a need to develop and share a statement to the press and/or elected members about the conclusion to an LSI. Just as in the media strategy detailed at Section 9.10, this should be developed in collaboration with the police and must include consultation with the police Senior Investigating Officer.
• To discuss any staff welfare issues that have arisen during the LSI, and any action that needs to be taken arising from them
• To identify any themes that can be used for future learning (see Section 10.5)
• To identify if any individual ASP cases are to continue
• To decide on how progress will be reviewed (see Section 10.4)
• To consider any further actions, including the possibility of a Learning Review

10.3 Notifications of the conclusion to an LSI

As a general principle, everyone who was notified at the commencement of an LSI (see Section 8.1) should now be notified that it has concluded. The Care Inspectorate has a dedicated space on its website for notifications to be sent to them.

The HSCP should clarify and formalise local governance arrangements. These may vary according to local structures and agreements, and may be tiered: for example, a report could be submitted to the Adult Protection Committee for the area, the Public Protection Chief Officers Group, and the HSCP’s Clinical and Care Governance Group.

It will be for each area to decide on the degree of detail to be included in a final report on the LSI for appropriate oversight bodies, but any report will be likely to include a summary of:

• the circumstances of the LSI
• details of the agencies involved and the actions they undertook
• the findings and outcomes of the LSI
• any improvements required and impact of such improvement action
• any good practice or areas for improvement identified in terms of the management of the LSI

It is important to ensure that, in any report for wider sharing outside of the core LSI team and Oversight Group, that confidentiality and data protection is adhered to (see Section 9.7)

10.4 Progress reviews

Once an LSI is concluded, progress reviews help determine whether improvements are sustained, and link back to prevention work for future LSIs. It is expected that risk mitigation is to be sustained, with ongoing monitoring to be decided and evidenced locally. Monitoring is essential for hearing intelligence and future concerns at an early stage, meaning review work also becomes prevention work for future LSIs.

If it seems that progress has not been achieved as expected, and adults are once again at risk of harm, there may need to be another initial multi-agency LSI discussion (see Section 7.2). In this case, the discussion would need to explore the reasons why any or all of the improvement plan, implementation of the plan, monitoring or review were not effective and take action to address these concerns. Repeat LSIs in the same organisation are negative for all concerned, particularly adults who use the service.

It should be decided locally how and when progress reviews will be conducted. There may be one progress review, or several, depending on the nature of the LSI that has concluded. The progress review plan should be recorded.

10.5 Future Learning debrief

Since LSIs are usually resource-intensive, there is value in ensur ing that the LSI has been conducted as effectively and efficiently as possible. Robust evaluation and reflection on a recent LSI can also yield intelligence that will support the prevention of future LSIs.

As the LSI concludes, questions for internal review may include:

• Did we have the right people with the right skills involved? Were there capacity issues?
• What were the views and feedback of the adults and families connected to the LSI? What do we need to learn from them?
• Do we need to think about revisiting and amending local procedures?
• Were staff appropriately briefed and/or trained to participate in the LSI?
• Was staff welfare regularly considered, and were issues related to wellbeing addressed quickly?
• Was the LSI expected or unexpected? If unexpected, do we need to consider our approach to prevention?
• Have we agreed if, and how, we can monitor the longer-term impact of the LSI on the adults concerned?
• Might there be value in sharing any learning outcomes across the sector at local and national levels? This would include where the service under scrutiny is operated by a national provider, who should seek ways of conveying learning across their organisation.

It may also be useful to revisit the LSI Principles (see Section 5.1) and reflect on how far the LSI met each one.

Feedback should also be sought from the agency, service or organisation that was subject to the LSI. Questions will be dependent on the nature of the LSI, but may include the following:

• Was the LSI process explained adequately to you?
• Were you aware of the reasons for the LSI?
• Were updates regularly given?
• Was the impact of the LSI on adults at risk regularly discussed with you?
• What do you think worked well in the LSI?
• What could be improved?

LSIs are an opportunity for all to improve practice in Adult Support and Protection. The Future Learning debrief, which can discuss all of the above questions and feedback, is most helpful when it has a tone of learning, support, professional curiosity and sharing. Even if an LSI seems to have been relatively straightforward, with what may be considered a successful outcome, there is a lot of potential learning. It’s important to learn from when things go well in addition to the learning from difficult or challenging LSIs.

Specific attention may be given to learning from what could have happened at earlier stages, with a view to strengthening local preventative work with providers. All professionals involved in an LSI can be considered for attendance at the Future Learning debrief, regardless of seniority, and multi-agency partners may also be invited. National bodies, including the Care Inspectorate, Healthcare Improvement Scotland and the Mental Welfare Commission, may also be invited, in order to consider the wider learning in Adult Support and Protection across Scotland. Public bodies such as these can also offer a ‘birds eye’ perspective on patterns within (for example) large care providers, or Health Board areas. This Future Learning debrief is most beneficial when it convenes no later than a month after the conclusion of an LSI. This is to ensure learning remains fresh.

There may be benefit in writing up the Future Learning debrief as a report, which can then be shared (with confidential and sensitive elements removed) for wider training and learning. It may also be useful to collate Future Learning debriefs into an annual overview, which allows for more thematic analysis. The Future Learning debrief may also identify themes that may be relevant at national level. In this case, it is good practice for the Chair of the outcome meeting to contact the ASP Policy Team at Scottish Government or the National Adult Support and Protection Coordinator.