Adult Support and Protection: Large Scale Investigation guidance

4. Preventing the need for a Large Scale Investigation

While preventing the need for an LSI is not a specified statutory requirement, proportionate and proactive work early on is widely regarded as best practice. Early intervention when issues first emerge can not only reduce the likelihood of an LSI; it can also foster collaboration and partnership working with services, helping to embed support. This, in turn, can further enable potential concerns to be identified and addressed at an early stage.

Should preventative work be unsuccessful, and the service becomes subject to an LSI, earlier work can still have value. It can provide important evidence to aid the LSI process; it can also help minimise the element of surprise when an LSI begins. Additionally, preventative work can inform future learning, since it supports all (including an organisation subject to an LSI) to better understand why the LSI commenced.

Good preventative practice, particularly in terms of health and social care providers, may include the following:

• Considering having a team, or worker(s), holding a specific responsibility for prevention of LSIs and leading on the practice detailed below. This may include collaboration with local independent advocacy services, in order to ensure adult and family views are represented.
• Regular analysis of the patterns of Adult Support and Protection referrals from local health and social care providers (an organisational chronology – see Appendix 5 – can help with this). Do referrals seem disproportionately high or low? If so, proactive working with the service in question to query the reasons for the excess or lack of ASP referrals, involving contracts and commissioning colleagues in these discussions, and providing any support identified, can help prevent an LSI in the future.
• Being transparent and proactive with local health and social care services about local ASP procedures (including what might trigger an LSI) and encouraging services and care providers to reach out at an early stage if they identify any patterns or issues of concern. Appendix 2: Frequently Asked Questions about LSIs may be helpful to share.
• Strengths-based and relationship-based work with local services and care providers, sustained over time, in order to build trust. This can help with developing the soft intelligence needed for supportive work in the event of future ASP involvement.
• Proactive work when a new service or care provider sets up in the local area, building up relationships from the beginning.
• Using the Early Indicators of Concern in Care Services, which are specifically designed to help health and social care practitioners in Scotland intervene at an earlier stage to prevent the significant deterioration in service quality associated with abuse and neglect. They are particularly useful in services for people with learning disabilities, and care homes for older people. Sharing these with local services and care providers can also help establish a common language about standards in care.
• Ensuring a robust mechanism for addressing care that does not meet required standards is embedded in the contracts and commissioning processes.
• Consider how you can build up a picture of the service at times outside of regular office hours. This could include visits in the evenings or weekends, and/or sharing or receiving intelligence with the Care Inspectorate or others who know the adult(s) or the service which may include family and carers.

Not all preventative work will prevent an LSI from occurring. It is important that Section 5 of this guidance – instigating a Large Scale investigation – is adhered to, with an LSI being triggered when the criteria are met.