Adult Support and Protection: Large Scale Investigation guidance

13. Appendix 2: Frequently asked questions about LSIs

This section is written in plain language and can be freely adapted by local areas to create public- and provider-facing information on LSIs. It may also be useful for professionals who are less familiar with LSIs.

What is a Large Scale Investigation (LSI)?

A Large Scale Investigation or LSI is a specific type of Adult Support and Protection investigation. It applies to services provided by agencies and/or organisations, and can include day services, outreach facilities, NHS or other health facilities, care homes, supported accommodation, or when someone is receiving services in their own home. It can also apply when there is an alleged harmer, unconnected with a service, placing more than one adult at risk of harm.

It may be required when there is a belief that a particular service, or an alleged harmer, may be placing more than one adult at risk of harm.

Who are ‘adults at risk’?

An ‘adult at risk’ is a legal term from the Adult Support and Protection Act 2007 (Scotland). It means someone who is 16 years and over, and who has been assessed as meeting all three of the following criteria:

1. They are unable to safeguard their own well-being, property, rights or other interests;

2. They are at risk of harm; and

3. That because they are affected by disability, mental disorder, illness or physical or mental infirmity they are more vulnerable to being harmed than adults who are not so affected.

The presence of a particular condition does not automatically mean an adult is an ‘adult at risk’. It is important to stress that all three elements of this definition must be met. It is the whole of an adult's particular circumstances which can combine to make them more susceptible to harm than others. In terms of an LSI, it means that if more than one adult is assessed as being ‘at risk’ in relation to a service or organisation, or a common alleged harmer, an LSI may apply.

What causes an LSI?

This can vary. In some cases, it may be that a perpetrator, or several perpetrators, are purposefully causing harm to people. In other cases, there may be a poor standard of care in a service that has caused adults to be risk of harm. Part of the reason for an LSI is to understand, and take action to address, the reasons why people are at risk of harm.

What does an LSI aim to achieve?

An LSI is an Adult Support and Protection intervention and it aims to keep adults at risk of harm safe. Many professionals from different agencies and disciplines work together to investigate the reasons for the risk of harm. Then, collaboratively and in a coordinated way, the LSI then takes action to stop it. It’s important to understand that an LSI is about Adult Support and Protection and is time-limited. It is not an ongoing process for addressing poor standards of care in a service.

How long does an LSI take?

It varies. Each LSI is unique and may involve many adults at risk of harm, or only a few. The circumstances involved in an LSI may be particularly complicated and this may mean an LSI takes a longer time. On average, LSIs take between two and four months to complete, but it is not unusual for LSIs to take longer than this.

It is important for everyone involved, especially the adults at risk, that LSIs are time-bound. This means that the team leading the LSI agree milestones and targets with their partners, and clearly communicate these to all involved in an LSI. Sometimes these may change during the course of an LSI, but clear timescales will help prevent drift and delay during an LSI.

Do LSIs only take place in care homes?

No. While care homes are common places for LSIs to take place – because they usually have many residents who may meet all three of the criteria for an ‘adult at risk’ – they are not the only settings. For instance, a hospital ward is also likely to have many adults who could meet all three criteria for an ‘adult at risk’. LSIs can also take place in the community. There may be, for example, a service that provides care in people’s own homes that is subject to an LSI.

Can an LSI take place in NHS services?

Yes. For instance, an LSI may take place on a hospital ward, or in NHS services being provided in the community. Private health services, including private hospitals, could also be involved in an LSI.

Can an LSI take place in a service that’s ‘unregistered’, as in not registered with a regulatory body such as the Care Inspectorate, or in services unconnected with the NHS or Councils?

Yes. For instance, organisations such as charities and community groups, which are not registered with regulation bodies, may be subject to an LSI. Organisations do not have to provide health and social care services to be subject to an LSI. In these cases, awareness of the LSI process is likely to be lower than in health and social care settings. This usually means the team conducting the LSI may need to spend more time explaining the purpose and process of an LSI.

Do LSIs take place in children’s services?

No. LSIs are Adult Support and Protection interventions and do not apply to services or circumstances related to children under the age of 16. It does however apply to those aged 16 and over who may be supported by a children’s service. It is unlikely - but not impossible.

Do LSIs take place outside of Scotland?

No. They are an approach to Adult Support and Protection in Scotland. This is underpinned by Scottish Adult Support and Protection legislation. In some cases, a service or organisation subject to an LSI may have a head office outside of Scotland. But as long as the service itself is provided in Scotland, the Scottish Adult Support and Protection legislation applies.

Should the service or organisation also operate outside Scotland, and there are similar concerns outside Scotland to those which gave rise to the LSI, then the relevant legislation in that jurisdiction applies. However, it will obviously be important for co-ordination and information sharing between any investigations into the same organisation, regardless of where they take place.

Does an LSI mean that a service will close?

Not necessarily. In fact, it is rare that when a service undergoes an LSI it means a service will shut completely, although it can happen. The aim of an LSI is to end the risk of harm and mitigate the risk of future harm. As long as there are other ways to achieve this, the service is unlikely to close completely.

When does an LSI end?

An LSI ends when the adults who were at risk of harm no longer face these risks (although individual Adult Support and Protection investigations may still be ongoing). This is because an LSI is about Adult Support and Protection (and is not about supporting services to improve).

If an LSI ends, it does not mean that a service or organisation has no ongoing issues. (There is likely to be an action plan that addresses these.) But it does mean that adults who were previously at risk of harm when the LSI started are now either not at risk of harm, or any inquiries/investigative activity required is being progressed on an individual – rather than large-scale – basis.

Can LSIs happen to a service more than once?

Yes. After the LSI has finished, there will be reviews of the service to ensure that the improvements needed to keep adults safe have been maintained. If they have not and adults are once again at risk of harm, or if new risks emerge to adults, there may have to be another LSI.

How is an LSI recorded in the Minimum Dataset?

Currently, the ASP minimum dataset collects information, quarterly, on the number of LSIs commenced in that quarter by service type. Other indicators may develop in the future. All ASPCs are required to accurately record the number and service type of LSIs as part of their ASP minimum dataset reporting responsibilities.