Adult Support and Protection: Large Scale Investigation guidance

3. Introduction

3.1 What is a Large Scale Investigation?

A Large Scale Investigation , or LSI , is a specific type of Adult Support and Protection investigation. It is a time-bound multi-agency investigation (led by the council, or social work service where relevant to the delegation arrangement). It may be required when there is a belief that a particular service, or an alleged harmer, may be placing more than one adult defined as ‘at risk’ under Section 3(1) of the Adult Support and Protection (Scotland) Act 2007 at risk of harm.

It applies to services provided by public, private and third sector agencies and/or organisations, and can include day services, outreach facilities, NHS facilities, care homes, supported accommodation, or when someone is receiving services in their own home or in community settings. The risk of harm can come from different sources: for instance, a member of the public, including an adult who may be themselves at risk of harm; a member of staff, some failing or deficit in a management regime, or in the environment of the establishment or service. It can also apply when there is an alleged harmer, unconnected with a service, placing more than one adult at risk of harm.

The Adult Support and Protection (Scotland) Act 2007 deals with the protection of adults at risk of harm. The Adult Support and Protection (Scotland) Act 2007 Code of Practice provides information and guidance on the principles of the Act, and about the measures contained within the Act including where and when it would be appropriate to use such powers.

According to the Code of Practice, an LSI should be considered if one or more of the following criteria apply:

• An adult protection referral is received that involves two or more adults living within or cared for by the same service or care provider, or
• A referral is received regarding one adult, but the nature of the referral raises concerns regarding the standard of care provided by a service, or
• Where more than one perpetrator is suspected, or
• Institutional harm is suspected, or
• A whistle-blower has made serious allegations regarding a service, or
• There are significant concerns regarding the quality of care provided and a service’s ability to improve. These concerns could come from a regulatory body such as the Care Inspectorate or Healthcare Improvement Scotland, or
• An adult or adults are living independently within the community but are subject to harm from a perpetrator or group of perpetrators, or it is strongly suspected that more than one adult is subject to such harm, or
• Concerns regarding an adult are raised following their admission to hospital or discharge. This may include concerns about a care service that are evidenced by an admission to hospital, or concerns regarding an NHS service area, or
• Concerns are raised via a complaint to the Care Inspectorate, NHS Board, or the local Council or Health and Social Care Partnership, or
• Concerns are raised by GPs, Primary and Community Nursing, Dentists, Allied Health Professionals, social workers, social care staff, etc. who visit a service.

LSIs should only be considered when the above criteria are met. LSIs should not be used as an ongoing support mechanism for services or organisations who are providing a poor standard of care.

There are many different scenarios when an LSI may apply, and every LSI is unique. The most common LSIs relate to care and health services, but they are not limited to use in these settings. LSIs can occur in settings that are ‘unregistered’ with a public body, such as charities or community groups. They can also be applied when an alleged perpetrator unconnected with an organisation is causing harm to more than one adult (who is defined as ‘at risk’ by Section 3(1) of the Adult Support and Protection (Scotland) Act 2007) in the community. While this guidance cannot account for every situation, it does offer a framework for the vast majority of LSIs.

LSIs are a formal process. However, they also offer opportunities for learning and wider improvements to keeping adults safe from harm. This is also reflected in this guidance.

3.2 The legal context

The principal legislation underpinning Adult Support and Protection in Scotland is the Adult Support and Protection (Scotland) Act 2007. LSIs are outlined in the Adult Support and Protection (Scotland) Act 2007 Code of Practice (as detailed in Section 3.1 of this guidance).

However, not all LSIs culminate solely in the use of the 2007 Act. Where appropriate, powers in the Adults with Incapacity (Scotland) Act 2000, Mental Health (Care and Treatment) (Scotland) Act 2003, and/or the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 may also be used.

3.3 Who this guidance is for

This guidance is intended for all who undertake or contribute to LSIs. This includes Council Officers, their managers, members of Adult Protection Committees (APCs), and senior leaders involved in the delivery and/or operations of Adult Support and Protection services within Health and Social Care Partnerships. It is also of clear relevance to commissioning teams, Chief Officer Groups, the Care Inspectorate, Police Scotland, Health Improvement Scotland, local Health Boards, and a wide range of agencies and their staff. Everyone who is involved in carrying out, or may be subject to, an LSI will find this guidance helpful.

LSIs are complex. Many different organisations and individuals may be involved. This guidance seeks to clearly set out everyone’s roles and responsibilities and promote the joint working that’s not only a duty, but so important in making LSIs effective. When close joint working happens, the outcomes are better for everyone – especially those adults who may be at risk of harm.

3.4 What this guidance seeks to achieve

The guidance aims to provide a framework that can be used across Scotland, with a view to improving the quality and efficacy of LSIs. The guidance also aims to achieve greater consistency across Scotland in how LSIs are commenced, conducted, concluded and reported on. There is benefit to everyone (including services that may be subject to an LSI) in having clear guidance to aid local processes, and to improve outcomes overall. The guidance supports using LSIs as a planned and structured intervention wherever possible, while recognising that LSIs will also need to be flexible and respond to changing circumstances.

There will always be the need for some local differences to reflect Scotland’s geographical and social diversity. Job titles, meeting names, and other specifics related to LSIs may differ across Scotland. This guidance does not suggest making these uniform; many aspects of the guidance explicitly support a locally agreed and context-specific approach to LSIs. What the guidance seeks to achieve is consistent and effective practice, whatever the local context , for all relevant organisations .

A simplified flowchart, illustrating the LSI process outlined in this guidance, can be found at Appendix 1.

This guidance is accompanied by several other appendices. These offer templates and documents that, if required, can be adapted according to local need and circumstance.

3.5 How the guidance was developed

This guidance was developed by a short-life working group. The group was made up of professionals from local Health and Social Care partnerships, Police Scotland, the Care Inspectorate, Scottish Care, Healthcare Improvement Scotland, Iriss, the National Adult Support and Protection Co-Ordinator, and Scottish Government. The guidance has also been informed by conversations with the Mental Welfare Commission, Scottish Care, Office of the Public Guardian, Scottish Fire and Rescue Service and the Scottish Independent Advocacy Alliance.

The guidance also drew from the Adult Support and Protection National Large Scale Investigation Framework, published by Iriss in 2023. This framework was based on good practice, policy, research literature, and feedback from professionals experienced in LSIs throughout Scotland.